Doctors are divided on abortion Most in obstetrics will refer patients

moral views vary

September 30, 1992|By Sandy Banisky | Sandy Banisky,Staff Writer

Why should doctors be any different? Like the general public, physicians have differing views on the issue of abortion:

An obstetrician of 40 years' standing, who remembers seeing women die after back-alley abortions, says safe abortions are a service he's glad he can provide his patients.

A medical resident assigned to learn how to perform second-trimester abortions says nightmares forced her to tell her supervisors she had to be reassigned.

Dr. Ben Carson, a Johns Hopkins Hospital pediatric neurosurgeon, says that "as an individual who spends a lot of time trying to maintain life, I'm not going to be particularly enthusiastic about destroying life."

Dr. Vanessa Cullins, director of adolescent obstetrics at the Francis Scott Key Medical Center, believes abortion is "a matter of choice that each woman has a right to do with her body as she sees fit, considering psychological and medical conditions, up to viability."

Political leaders can stake out black-or-white positions on whether abortion should remain legal or not. Doctors, who deal with patients and their problems every day, tend to avoid absolutes.

Their personal moral views and their patients' needs shape the doctors' views.

Physicians and national researchers say that despite the loud political debate, abortion remains widely available in Maryland. Most obstetricians and gynecologists will refer a patient for an abortion. Many will perform them. And the state's teaching hospitals include abortion as a routine part of obstetric and gynecological training.

"We've always had an attitude that is open," says Dr. J. Courtland Robinson, a former medical director of Planned Parenthood of Maryland who is now on the Hopkins faculty.

That's in contrast to other parts of the country. In rural parts of the United States, the number of facilities performing abortions decreased by 19 percent between 1985 and 1988, according to researchers at the Alan Guttmacher Institute in New York. And the number of medical programs that routinely train residents in first-trimester abortions dropped from 23 percent to 12 percent between 1985 and 1991, according to Dr. Trenton McKay, an associate professor in obstetrics and gynecology at the University of California at Davis.

In part, Dr. McKay says, that's because more and more abortions are performed in clinics, while doctors foresee themselves in private practice. Also, the doctors who remember when women died of illegal abortions are retiring, leaving fewer mentors who have a sense of urgency about the issue of safe abortions. Over time, Dr. McKay says, fewer doctors will be trained to offer abortion as a standard medical service.

Dr. Timothy Johnson, associate professor of obstetrics and gynecology and director of maternal and fetal medicine at Hopkins, says he doesn't like doing abortions but performs them for a reason. "I've seen women die of septic abortions, and that's the alternative. If they're not legal, women are still going to seek them. And women are going to die."

At the University of Maryland, where abortion training is routine, Dr. Chris Chisholm was assigned to learn how to perform second-trimester abortions when he began his residency two years ago. A Roman Catholic, he quickly decided he could not continue. He was reassigned.

And yet, in some circumstances, he would refer a patient for an abortion. "When there's a documented fetal malformation that's inconsistent with life, there's no sense in carrying that pregnancy to term," Dr. Chisholm says.

A University of Maryland colleague, who would not be quoted by name, says she, too, began her residency doing second-trimester abortions but soon told her supervisor she had to stop.

"It was against what I believed in, and it was causing major emotional stress for me," she says. But like Dr. Chisholm, she says that "if a patient came to me and asked about abortion, I would refer her" to a doctor who performs them. "It's totally her choice."

In a study of Johns Hopkins medical students from 1988 through 1990, Dr. Peter E. Dans found that future doctors' opinions about abortion mirrored those of the general public. They are most comfortable with the idea of abortion for medical problems or in cases of rape, and less comfortable about abortion when the patient doesn't have a medical justification.

As in public opinion surveys, even doctors who believe abortion is taking a human life "still might think there are certain situations in which you can understand why someone would perform an abortion or refer someone to do that," Dr. Dans says.

Dr. Carson, for example, opposes abortion but says he sends patients who are seeking abortions to other doctors.

He is appearing now in a television commercial, whose script he says he modified "substantially," for the Vote kNOw Coalition, which is leading the campaign to defeat a new abortion law at referendum. Because he dislikes high-pitched arguments on the issue, Dr. Carson doesn't argue in the ad against abortion but urges that voters study the law.

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