There is an off-putting through-the-looking-glass quality to what passes for reasoned discussion on the anti-choice right wing. Their arguments against abortion often read as parodies of rational philosophy; today we get a glimpse of the “medical ethics” found in a “crisis pregnancy center”, and it has a similar clown-college aspect to it. The familiar themes are there: autonomy, patient preferences, informed consent – but as if read backwards.

A particular issue for Scott Klusendorf of the “Life Training Institute” is the use of ultrasound images and graphic pictures of aborted fetuses in “counseling” women at anti-choice centers. He makes it clear that the overriding concern is what is most effective in pressuring women to make the decision he approves of. That these ultrasounds serve no medical purpose is not an issue on his RADAR screen; that the images he shows to patients may be offensive is relevant to him only insofar as it affects their likelihood of doing what he wants.

Although ultrasound is a wonderful tool for reaching abortion-minded women, sometimes it’s not enough. Stronger, more provocative images may be needed (with the client’s consent, of course) if we are to save lives. . . .

Admittedly, the use of abortion pictures by pro-life pregnancy centers is a controversial subject. So, let me be clear about two points: First, I’m not claiming that graphic images work in every case. Sometimes a client is so hardened that we simply cannot reach her. Second, I don’t think for a moment that every woman visiting a CPC needs to view these pictures. However, it doesn’t follow from this that CPCs should never offer them. Sometimes abortion pictures do what ultrasound cannot: reawaken a client’s moral intuitions.

There are medical-ethics buzzwords sprinkled through this: “consent”, “controversy”, “client”, “need”, “moral intuition”. But the discussion makes it clear what these mean to him: the “controversy” is discussed only in terms of practical efficacy in making the women do what he wants; “clients” are women to be manipulated into acceeding to his wishes for them, not persons seeking services from a provider dedicated to serving their needs, and “need” has nothing to do with the women’s health status or goals, but rather with how much coercion they require to comply with his wishes; he does emphasize “consent” in viewing the tapes and images, but, since he would have to commit kidnapping to make a woman view them without consent, this is hardly a concession; and, of course, “moral intuitions” are “awakened” only when the woman agrees with his decision regarding her body – women who leave his center with their own opinions intact do not have “awakened moral intuitions”.

In other words, the entire enterprise is designed for, and exists only for the purpose of, making women agree not to opt for abortion. All the “counseling” that is provided is aimed at this specific goal – that of arriving at one, and only one, choice, which is the same choice for all women and is one chosen for them by the center. The purpose is explicitly stated to be to make sure that women do not make a free choice between options. The tools and techniques used are designed to counter any leanings a woman may have contrary to the path chosen for her. He even breaks it down into numbered categories:

As former CareNet center director Suzanne Genit points out, there are five types of abortion-minded clients:

Type #1: Responds to loving support, chooses life.
Type #2: Responds to information on fetal development—chooses life
Type #3: Responds to descriptions of abortion techniques—chooses life
Type #4: Remains unmoved by love, facts/information, and verbal descriptions of abortion techniques, but responds to graphic abortion videos—chooses life.
Type #5: Hardens her heart to all information—chooses abortion.

Genit’s point is that clients 1 to 3 do not need graphic depictions of abortion. For those women, it’s true: Ultrasound and/or clinical descriptions are suitable alternatives. . . . If client #4 is not more horrified of abortion than she is terrified of her own crisis pregnancy, her baby will die. Given what’s at stake, it’s not enough for her to simply imagine this horror. We must at least offer her the chance to see it.

Here we see the perversion of the “counseling” model. “Clients” are treated with the specific goal of making them accept one and only one choice that has been made for them by others, irrespective of their own circumstances and before they were even encountered for the first time. The “services” provided exist only for the purpose of reaching that goal. Though, again, Klusendorf pays lip service to the client’s consent in watching offensive images, he makes a mockery of the entire concept of “informed consent” that underlies all healthcare services by ranking his so-called “counseling” in terms of the client’s willingness to accept his decision. “Information” and “descriptions of techniques” – standard elements of informed consent for invasive procedures, and available from all real healthcare providers – are not even offered here unless the patient has not yet accepted the decision he approves. If the patient has agreed to do what he wants her to, then the full store of “information” – which supposedly his centers exist to provide – is unnecessary. In other words, actually informing patients (even with the distorted information typical of anti-choice presentations) is used only as necessary to coerce them – letting them make an “informed” decision is unnecesary as long as they’ve agreed to make the decision the “counselor” is pushing them towards. And then, a completely medically unnecessary ultrasound is offered when and only when it will prove useful in pushing a patient into the preferred decision. Presumably, if the ultrasound served any legitimate medical purpose whatsoever, it would be offered to all patients. But providing relevant and useful services has nothing to do with Klusendorf’s (literal, written-out) agenda. Medical procedures, like medical information, are used only to manipulate “clients” into a chosen path, and are provided only to clients who show signs of disagreeing with the path chosen for them.

The travesty this represents should be obvious. Support of the client’s values and goals, provision of necessary and useful medical care, provision of all relevant and useful information about the full range of options – all the principles and practices of patient counseling and informed consent are turned on their heads, while the language of healthcare ethics is employed to describe manipulation, coercion, and the restriction of treatment options.

Even basic compassion gets a nasty twist:

If clients are looking to us for help exploring all of their options, we should honor their wishes and respectfully offer visual evidence, including abortion pictures. That is the compassionate thing to do. After all, what is worse: a client seeing an abortion or actually having one because we prejudged her ability to handle all the relevant facts?

Tim Wiesner, Director of Choices Medical Clinic, . . . explains why gruesome pictures–when used appropriately and with the client’s consent–are not manipulative. Rather, they save lives and impact clients positively:

“We tell each woman what [counseling techniques] we offer. These include items some CPCs may find objectionable, such as the ‘Harder Truth’ video, abortion instruments, and a suction machine. We let the clients choose what items to view. You can’t predict what will strike a chord with them. Sometimes the ultrasound does the trick, sometimes not. Sometimes it’s the abortion instruments. Sometimes it’s the “Harder Truth” or the suction machine. The point being that we need multiple points of influence to grapple for the life of that baby. Clients sign an informed consent prior to viewing the “Harder Truth.” They hold the remote and can stop it at any time. We’ve had only one person who agreed to watch it resent us for it. Meanwhile, there are countless stories of women choosing not to abort because they did watch it. Sometimes, it may not influence the client, but it may influence her friend who accompanied her to our clinic. That friend will then begin trying to influence the client not to abort.”

It’s simply staggering to try and make this all make sense. “If clients are looking to us for help exploring all of their options, we should honor their wishes” – by not mentioning some of those options except in the specific context of something to avoid, and by doing everything possible to ensure the client makes one decision, pre-chosen for her? Information carefully chosen to produce that one, pre-determined decisions, is “not manipulative”? It’s the definition of “manipulative” to use chosen means to influence someone to a particular end they would not have chosen on their own! And the claim that these means are effective motivators is proof that they are manipulative! They “let clients choose” – but only for the purpose of finding the most manipulative means to influence them; as Klusendorf makes clear, those means are categorically organized by their relative effectiveness, not by their relevance to the client’s own situation. And, finally, one goal of the “counseling” is to encourage third parties to continue to pressure the woman to make – as always – the decision the center has chosen for her. But none of this is “manipulative”, none of it is incompatible with “free choice”.

Klusendorf claims that a huge majority of “clients” at these centers report themselves satisfied with their services. He also that the women who chose these centers did so voluntarily. (Here he echoes Sartre, who famously pointed out that we get the advice we ask for.) These are relevant points. I am doubtful, though, both of his survey numbers and of the usefulness of exist surveys taken in the presence of – and with data collected by – the people who run these centers. And, as for voluntariness, that ignores the large number of cases in which clients are deliberately tricked into coming in under false pretenses. Nonetheless, his claims could be true. They do not absolve him of the responsibility to respect the autonomy of the clients he does see . . . but that’s not part of the package at his centers.

Through and through, the “ethics” and practices of the anti-choice “counseling” industry are perverse mutations of real medical ethics and real medical counseling procedures. They employ cynical distortions of ethical concepts to cloak themselves in a pretentious, quasi-professional vocabulary, but work on their “clients” with literally single-minded zeal to ensure that clients do not get information that would allow them to neutrally evaluate all their options and arrive at a personal decision. No one who favors patient autonomy will be surprised at this behavior – it has been obvious from the beginning – but it is startling to hear them say so out loud. I hope no one imagines any longer that these centers are responsible, professional, or “supportive” in any way that makes sense.