Yesterday, the Susan G. Komen Foundation  – the “pink ribbon” breast-cancer research and treatment organization – announced it was ending its long-standing annual grants to Planned Parenthood clinics to perform breast-cancer screenings and referrals for low-income women. The given reasons are as disingenuous as they are shameful: in short, SGK hired a new Vice President who, in a recent losing bid for the governorship of Georgia, had explicitly pledged to defund healthcare services at Planned Parenthood in that state. Within months of her hiring at SGK, SGK just happened to create an internal rule declaring that it would not fund any programs at organizations that were under Congressional investigation; that policy just happened to apply only to Planned Parenthood, which just happens to be the target of a fishing-expedition investigation by a virulently anti-choice member of Congress. So: the right wing has been demonizing and targeting PP for years; one jackass Congressmember creates an investigation simply to grandstand; SGK hires an avowed anti-choice opponent of PP; SGK then creates a new rule about “investigations” that applies only to PP; SGK then abandons its own PP-mediated cancer screening programs and claims it had no choice because of the bogus investigation. Well played, but hardly subtle.

This is as sickening as it is tragic. The results will be, literally, death for a predictable number of women who would have been referred for mammography and received a positive cancer diagnosis, and appropriate treatment, following examination at Planned Parenthood, but who will now go undiagnosed after those screening programs are shut down (assuming adequate replacement funding is not obtained).

I’d like to encourage SGK to reverse their decision – to consider all the benefits that come from these screening programs, and the need there is in the community for the irreplaceable medical resources they provide. I’d like to remind them that Komen Affiliates have funded breast health services through Planned Parenthood programs that have provided breast health education and breast screenings for hundreds of thousands of low-income, uninsured or medically under-served women, and that, in some areas, Planned Parenthood may be the only local source of breast health care. I’d like to point out that women served at Planned Parenthood may receive a clinical breast exam, and when further screening is needed, a referral to either a state program or a private mammogram provider. It would be useful to consider that because SGK only works with non-profit organizations, these women’s  mammograms may be paid for by the Komen-Planned Parenthood grant, since many mammography providers are for-profit but Planned Parenthood works on an entirely non-profit basis for all its services.  Surely they recall that during the past five years up to 2011, Komen Affiliate grants to Planned Parenthood paid for:

• Breast cancer and breast health education for nearly 160,000 women
• 139,000 clinical breast exams
• 4,866 mammograms
• Detection of 177 breast cancers

But I may not need to tell them all that. They already know it. I’m sure of that because every bit of the above information comes from a letter SGK itself posted, on their pink-ribboned letterhead, on their own website, back when the religious right was pressuring them to cut off cancer screening to low-income women as part of their misogynist anti-sex witch hunt.

In that letter – aimed at deflecting criticism from anti-Planned-Parenthood crusaders, and written before SGK hired its own anti-choice crusader as VP – SGK extols its work with Planned Parenthood, and rightly notes not only that the screening programs it funds serve hundreds of thousands of women, and identify thousands of previously undetected potential cancers, but that these programs are carried out in many cases by the only provider willing or available to do them, and thus are literally irreplaceable. In publishing that letter, SGK took a strong stand in defense of women, and of those who provide the vital – in the most literal sense – services that no one else will or can do. It openly and forthrightly documented the need women – almost exclusively low-income women, and disproportionately women of color – have for Planned Parenthood, and the great benefits they got from the Planned Parenthood programs made possible by SGK’s funding. The letter expresses a clear and unambiguous commitment to serving women (even while mush-mouthing on the issue of abortion), and takes a bold stance in the face of harassment and misogynist bullying.

That letter is no longer available on the Susan G. Komen website.

In fact, as of this writing there is no news whatsoever on SGK’s on website regarding its abandonment of the cancer screening programs it once supported Planned Parenthood in providing, and a search for “Planned Parenthood” on that site returns only a single, obscure, broken link. That link turns out to be the page that once held the letter mentioned above. It’s not accessible or advertised. Some careful Googling, however, locates the letter in an unlinked section of SGK’s site. The letter defending Planned Parenthood, its patients, and SGK’s support for them, still exists – but they won’t let you see it.

Here it is, in its original full-color form: Susan G. Komen letter describing benefits from Planned Parenthood cancer screenings.

I’d like to think that “as long as there is a need for health care for vulnerable populations, Komen Affiliates will continue to fund the facilities that meet that need.” After all, they said so – barely 8 months ago. But obviously they’re no longer willing to stand by their word. In fact, they’re no long willing to admit they ever gave their word. They’ve shown us what courage and fidelity to women truly amount to – for them.

I would not have written about it all, since the things that have been written in so many places, by people with much more authentic activist credentials than mine, and more skin in the game (i.e., feminist women), have covered so much of the territory and with such great insight, passion, and theoretical power.  But one thing kept coming back to me as I watched the situation unfold. It was this: my first, surface-level reaction to the situation was to feel that it had been somewhat overblown, that people were using it as an opportunity to grind axes or work out resentments, and that Schwyzer was so evidently a decent and well-intentioned guy that, whatever his past, the current outrage roiling around him was not only counterproductive but indicative of emotions or resentments for which the facts of the situation were only a convenient release.

I didn’t know that much about that Schwyzer, but had read some of his writing, including some of his confessions of his wilder, younger days. My impressions were that he was a skilled writer with a tendency toward romantic over-dramatization, he had a somewhat off-putting tendency to dwell on himself and his own experiences, he had a kind of clammy bourgeois perspective that he seemed ready to acknowledge but not to rise above, and that he was an insightful, well-intentioned, sincere feminist with a lot of good things to say. The slight bragging I heard in his confessions of past misbehavior was not attractive, but I also believed that he had come to terms with his past and put it behind him. It was unsettling that such confessions seemed to surface so often, and their impact never seemed to reach a final cumulative value. The “sinner’s testimony” so beloved of born-again Christians and recovering addicts (of which he is both) never seemed to end, in Schwyzer’s case, and that raised questions, but by and large he seemed to me as he seemed to many others, then and now: someone who was both knowledgeable about and deeply committed to feminism, and was also honestly grappling with its implications for himself as a man of privilege. As a feminist man with much less history of either writing or activism (or sleeping with my students, or murder), I thought of Schwyzer as being in (only) some ways what I felt I should be.

The revelation that finally touched off the current controversy – that, acting on a drug-addled emotional impulse, he had once actually made a considered effort to kill himself and his ex-girlfriend that was in fact the equivalent of an attempted murder – broke his previous record for confessions of irresponsibility, but, in light of his self-advertised past, in some way seemed just more of the same. The outrage it provoked, quickly rising to the level of personal vendetta, seemed unnecessary in response to an event thirteen years in the past, committed by someone whose current bona fides seemed believable and even admirable. I found myself taking Schweitzer’s part in some of these arguments, either in thought or even to a small degree online.

That reaction, one of sympathy and even protectiveness toward Schwyzer – was what began nagging at me in regard to this situation.  I had to ask myself why I felt so sympathetic to someone so clearly open to well-deserved criticism.  You can argue that Schwyzer had rehabilitated himself, that he had done extensive work on his own behavior and beliefs, that his current professed attitudes and his history of teaching and activism were authentic and creditable. He has many supporters who do make such arguments, and they are not unreasonable on their face. You could also argue that he still bears responsibility for his many transgressions, and some of them are of such magnitude that it will be impossible for anyone to have done sufficient penance whether or not he had truly changed the attitudes that had prompted that behavior in the past. There are also questions of the role of individuals of such great privilege in movements targeting the oppression of underprivileged groups; in that light, Schwyzer’s reprehensible past makes him particularly suspect as a figure of respect or prominence even, again, if it were acknowledged that he had rehabilitated himself. These arguments are also reasonable. It is partly a question of values or priorities which perspective – condemning acknowledged transgressions, or praising apparent enlightenment – one takes on the situation.

So I don’t think it’s impossible to believe in Schwyzer’s redemption, or to support him as a prominent or influential figure in the feminist movement. But why would anyone choose to take that perspective on the issue, in distinction to the opposite one? What should determine the degree of one’s willingness to accept professed penance as authentic or sufficient?

I began thinking about other transgressors, ones I would be much slower to forgive or to accept as peers, let alone role models. I began thinking about the terrible crimes of so many right-wing figures: their embrace of death squads, torture, and concentration camps; their economic rapaciousness, and the vast suffering it causes; their unremitting assault on personal autonomy, most especially of women and their reproductive autonomy; and on and on. I think of the names of figures associated with these campaigns of oppression and terror: Falwell, Robertson, Reagan, Bush, Cheney, Gingrich, Santorum, Perry, so many criminal lackeys of the Reagan and Bush administrations, and so many more. I would find it impossible to credit the redemption of any of these figures, even were they to espouse more reasonable attitudes and policies today. I would find it impossible to overcome the revulsion they generate in me. Even though they all are guilty of far more destruction and misery, fully reckoned, than Schwyzer, none of them to my knowledge has made a direct and deliberate attempt to kill another person by their own hand. Yet it seems natural to me to accept Schwyzer on his own terms, when I find it unimaginable to believe in the (hypothetical) redemption of any of these other figures.

Partly, I think it’s because Schwyzer was first established in my mind as a positive figure.  I first knew about his feminist work, and read some of his writings on the issues, before I learned of his shady past, and long before the most recent revelations.  The newest controversies work against an established impression that I had already developed which perhaps makes it harder to weigh the two sides of the issue in a perfectly even balance.  In contrast, the murderers, torturers, and perverts of the right wing have always been perfectly visible to me in their true colors.

However, I think there may be a more personal process at work here. Although Schwyzer and I are not very much alike in personality, history, or career trajectory, there’s an obvious basis of fellow-feeling toward him. We’re both educated white men from at least moderately affluent backgrounds, with connections to academia. We both self-identify as feminists and sympathizers with the oppressed, but both obviously came to that perspective from positions of considerable privilege which we cannot renounce. We both – like almost all male feminists – had to work our way toward feminism from anti-feminist backgrounds which we had to acknowledge and overcome.  Like all feminists, we have particular perspectives on the various internal divisions and conflicts of the feminist movement, and like all male feminists must defend the particular positions we take against other (mostly female) feminists who may see our stances as not merely collegial disagreement but another form of privilege.

And so, when I see Schwyzer attacked for aspects of his pre-feminist or proto-feminist life, I can’t help feeling that those attacks are to some degree aimed at me, or could be. I wonder how other feminists would view me if I confessed all the (far less lurid) details of my past, or the things I’ve done wrong, particularly involving or against women. I want to think that the feminist movement can be not merely welcoming but in some ways forgiving of men and their imperfect pasts. And, in a way that surprises even me, when I regard Schwyzer and his difficulties, I feel a bit of the same defensiveness that I feel when my own shortcomings are called to account: I want to put it behind me; I want to say “yes, yes, I’ll do better” and let the matter drop; I hope my accusers will let me slide as long as I promise to do better, and not keep probing and publicizing my faults.

Schwyzer, whatever his guilt for his past behavior, has been admirably open in the face of the current controversy, and has indicated he will consider and likely accept the many calls for his retreat to a less prominent position within the feminist movement. I don’t know how I would behave in a similar situation (I take comfort in thinking that I will never have to explain away the kinds of behavior that Schwyzer does). And I think some of the sympathy that the situation evokes in me is in part an unexplored sense of a need to atone for myself – the fabled “liberal guilt” – and the hope that my own failures could if necessary be absolved and overlooked. I want this cup to pass away from Schwyzer because I hope that, if such a fateful day were to come, it would pass away from me as well.

It is easy for me to consign right-wing criminals to permanent condemnation. I feel nothing in common with them, and can’t imagine I would even if they repented. Hugo Schwyzer, in his best parts, is the kind of person I want to be, inescapably privileged but using the tools of privilege – intellect and learning – for good. I know that I, in my worst parts, fall short of that. If he – who has done more overt work for feminism than I have – has no place in the movement, perhaps I have none, too.

But Schwyzer’s place in the movement ought to be determined on the basis of the needs and dynamics of that movement, and his own nature and history (hopefully, if not probably, considered objectively). My reflexive willingness to absolve him is more about my needs than his, and thus less about the needs of the movement than either of those. Which is another form of distraction for male feminists (or, at least, for me), and another stumbling block to seeing clearly and acting forthrightly and effectively.

That’s the lesson I take for myself from this, and, like so many lessons learned in growth as a feminist and humanist, particularly as a man of privilege, it is not an easy one to recognize, still less absorb.

This video is great in so many ways: Taylor’s discussion of the ways society makes her life with an impairment harder or easier; her description of the psychological burden in going into a coffee shop and ordering coffee, and then having to deal with the difficulties of either trying to carry it herself or asking for help – “it’s a political protest for me to go in”; the simple and lovely depiction of two affectionate people being out together, while not pretending the issue of disability doesn’t affect them; the segment in which they go into a used-clothing store (which charges by the pound! – I love San Francisco!) and buy Taylor a warm sweater, which is both a perfectly simple and normal act, and complicated by the ways impairment affects her ability to try it on and the process of payment – ending with the store clerk’s matter-of-factly accommodating reaction. Taylor works in a useful bit of disability-theory: the distinction between “impairment” (physical limitations) and “disability” (difficulties in living caused by social context or discrimination), and the video underscores that point again and again as Taylor goes about her day and talks about how disability affects her. (I’m not sure I’d go so far as to say that she has “what the medical world has labeled as arthrogryphosis”. I’m very much sympathetic to the notion of individualized definitions of disease and health, but I don’t think that means there’s no such thing as a diagnosible condition. I see no reason to say that she doesn’t really have arthrogryphosis if she meets the diagnostic criteria for it – as, by her own description, she seems to do. Pointedly repudiating her own use of that name, as she does in the video, doesn’t seem to me to gain anything; whether she wants to call it a “disease” is another matter.) There are also brilliant moments of reflection on the nature of embodiment and what it means to live an embodied life in a social context.

Just a beautiful, sweet film with surprisingly profound content, visually and verbally. I can’t wait to see the rest of this series.

Taylor:     When do you still count as a human?

Butler:     My sense is that what’s at stake here is really rethinking the human as a site of interdependency.

. . .

Butler:     [When] you ask for the coffee, or indeed even ask for some assistance with the coffee, you’re basically posing the question “Do we or do we not help each other with basic needs?”

HT: sexgenderbody

Jill righteously calls him out for it (as did many others):

The deflecting from legitimate concerns, and the fact that the OWS “public” includes a lot of men who think it’s ok to treat women at a protest like we’re there for their visual fulfillment, troubles me. No one is saying, “Don’t find women attractive.” . . . No one is objecting to the fact that straight men are attracted to some women (fun fact: straight women are also attracted to some men! So really, no one is pissed about attraction, I promise). What people are pissed about is what Rebecca Traister says:

“The larger, simpler argument, outside of consent or permission, is: This video is sexist. It’s an example of women participating in public life — political, professional, social — and having their participation reduced to sexual objectification. That’s what happened here, nothing more, nothing less.” . . .

Emphasis mine. . . . [C]reating a blog and a video dedicated to showing women at a protest with the sole purpose of reminding dudes that women at the protest are hot? That does reduce women to objects of male attention. It’s another reminder, for women, that how seriously we’re taken and how valuable we are depends on how sexually attractive we’re deemed.

Read the whole thing; she’s got good things to say. But the part that really triggered something for me was this:

Frankly, the kinds of dudes who would come to the OWS protests because they heard there are hot chicks there? Are not the kinds of dudes I want to be protesting with. I would hope they’re not the kinds of dudes that most progressives would want to be protesting with — but judging by the lefty-dude reaction to Steven Greenstreet (hi Matt Zoller Seitz, looking at you!), that’s not the case. It’s disappointing.

To say the least. And far too common, from way back. It’s no secret that supposedly “progressive” groups have always been rife with sexism and sexual pressuring, and it doesn’t seem to be getting better. Progressives have never been immune to human failings, including stereotyping and bigotry of the kind that they supposedly abhor but sometimes don’t recognize in themselves; the long fight for acceptance in progressive movements of gays and transexuals is one case in point, and the difficulty many white (and especially male heterosexual) liberals have in recognizing and acknowledging their own privilege is another. But the LGBTQ community, people of color, and other marginalized groups, though still embattled, have by now to a considerable degree been granted by progressives the one thing many persist in denying to women: recognition of the fact that they have real interests, problems, and worth that must be taken seriously. The situation is far from perfect, and not everybody agrees on how the tensions between different progressive constituencies should be resolved, but in most cases they are acknowledged, and the human pain and human interests that lie at their heart are given due deference. Except in the case of women.

To be sure, progressives are not right-wingers. They don’t overtly hate women. They don’t gleefully consign them to death by deliberate neglect at the hands of sniffy sex-negative religious bigots. They don’t dishonestly and cynically strain moral concepts – often ones introduced and championed by progressives – such as “informed consent” to create barriers to the very autonomy they are intended to protect. They don’t penalize the fact of women’s having sexual natures – just the opposite! But in too many cases they don’t grant them the respect and freedom needed to act on their own natures and seek their own good. Just as with conservatives, women exist for far too many progressive men for the purpose of their gratification – an impersonal usage that erases those women as persons themselves.

Which leads me, finally, to the question that came up for me on surveying this latest stupid and distasteful incident: how, exactly, are these dipshit “progressive” men progressives? What goes through their heads, what process takes place in their heads, such that they wind up thinking things like “let’s go to the OWS protest and photograph women’s breasts!”? How, when they are called out for that, do they expend so much energy defending their childishness and sexism? Why do they not care about offending or humiliating their supposed fellow activists – about derailing or undermining the movement they claim to support – about embarrassing that movement by acting in a regressive manner and then elevating their own bad behavior into the limelight? More particularly, what is it that allows progressives to empathize with everyone but women, even women in their own movement? What allows them to hear everyone else’s protests at mistreatment, and dismiss those of women out of hand?

In a way, I suppose it has something in common with the denial and self-absorption that allowed Southern slave-holders to rationalize their own crimes. Patriarchy is its own form of slavery, more complex and less overt, but very real, and it is very hard to acknowledge you are doing wrong when your entire lifestyle, all its comforts and conveniences and pleasures, derives so much from others’ service to your needs. It is easy to protest obvious wrongs that don’t require you to change your own life to amend. But progressive men, in many cases, are no better than the privileged classes of the Confederacy, of apartheid South Africa, of Wall Street itself, at admitting that their own satisfaction depends on bending others to their desires, against their will and at the denial of their basic human personhood.

You can’t be progressive just for causes you aren’t invested in, at the expense of people you don’t like. Being progressive means wanting to live in a better world – not just wanting to take down the most guilty in this one and then carry on regardless. Being progressive means checking your privilege, living the dream you envision, being part of the solution – all slogans that have at their heart the basic truth that you have to be as critical of yourself as you are of others, or more so, since you can only really change yourself.

You aren’t a progressive if you mistreat women. You aren’t a progressive if you think progressivism is defined as rallies, protests, and events, rather than a mindset that is grounded on a world in which people are treated with respect, by everyone, starting with yourself. You aren’t a progressive if you go to events but don’t treat the people there with regard. You aren’t a progressive if you revel in your own privileges at the expense of the pain and diminishment of others, then feel hurt because you’ve decided that whatever superficial support you feel for “the cause” entitles you to use others for your pleasure and then resent it when they object.

If you’re not a progressive for any of these reasons, you’re little better than a reactionary even if you vote the right way. You’re pro-choice? Great. You don’t think being pro-choice encompasses the choice to control, and present, your own sexuality on your own terms? You’re not a progressive, and you’re a pain and an embarrassment to those who sincerely try to be.

What got me onto this is that there’s just so much cool stuff in this post and the comments thread. I don’t have anything to say about the basic question of natural transitioning, but I want to point out several things that come up in the discussion.

First, it’s interesting that this post arose on a skeptic (i.e., atheist, anti-paranormal) site in the first place. Transexuality isn’t inherently an issue for skeptics, but the questioner identified as a skeptic and was apparently feeling vulnerable as both a transexual and a skeptic, so sought out a welcoming community. He found the right place: DebGod happens to be gender-queer, and is knowledgeable about transexuality and a former bodybuilder, and the community of readers was supportive. From some of the comments, it appears that many perceive the skeptical community as not uniformly welcoming for LGBTQ people – something I hadn’t known or expected. This post included some interesting discussion of LGBTQ issues among skeptics, and raises questions that – especially in light of the recent conflict over misogyny among skeptics (notably involving another prominent Skepchick poster) – I hope the skeptical community will take the opportunity to address.

More importantly, DebGod’s response is a model of careful and helpful analysis. She gives her own background, with appropriate disclaimers, then lays out the issues clearly and concisely. She notes red flags with the claims being made (no professional credentials, buzzwords, trademarked terminology, skeptical responses from people directly affected). She then reviews the suggested procedure, notes that it relies heavily on biochemical supplements, comments intelligently on their purity and efficacy, and discusses the vague distinction between “natural” and “non-natural” that the promoters take advantage of. She seeks information from a more knowledgeable source. Shen then concludes by running down all the issues this analysis raises, categorically, giving pros and cons for each and pointing out dangers. This is a really well-done, intelligent, well-argued analysis, at least as good as that commonly seen from Quackwatch or prominent skeptics like PZ Myers.

What I really like about DebGod’s analysis is that she is carefully value-neutral in all of this. Though it’s clear that there is much to be worried about in this suggested regimen, she never takes it on herself to make other people’s decisions for them. Her final statement is a clear and balanced sketch of the relationship between all the competing factors – health, personal goals, available support, and insurance or income – that influence a decision among the many different options for transitioning; she doesn’t declare any of them right or wrong for any individual, but makes it clear that each may be better or worse under different conditions. She includes just a single sentence offering her opinion that the “natural” process is too risky and low-benefit, but clearly identifies it as her own perspective and doesn’t insist that anyone else has to adopt it. She really gets her role as guide and analyst, as opposed to parent, judge, or dictator – something that so many culture-critic blowhards, and even many licensed professionals, can’t accept.

As she notes:

When it comes to gender identity and transsexualism, where you want to go, who you want to be, and how you want to do it is up to you, of course.

- a message that needs to be heard more widely, and not just regarding transexualism.

That leads to another issue that comes up obliquely, but importantly, in the comments. The medical community’s response to transexualism has been mixed, in ways that have generated a lot of resentment in the T/Q community even when the doctors and psychologists thought they were being helpful. For many years, transexuals seeking medical treatment in the US were commonly required to conform to the so-called “Harry Benjamin Standards of Care” (now the “World Professional Association for Transgender Health Standards of Care”), requiring extensive counseling and explicit authorization from multiple psychologists, and a set period of pre-treatment life in the transitioned gender, before professionals would agree to provide the requested treatment. Those standards have been eased but still exist. Many critics have pointed out that this is not only paternalistic but unnecessary – transexual patients have a higher level of success and satisfaction with their treatment than patients of many other conditions, including cosmetic procedures, that do not involve such heavy-handed gatekeeping. The professional societies – starting in the 1950s, when this work was extremely controversial – saw themselves as protecting patients and preventing harmful mistakes, while also going to lengths to provide treatments that more conservative caregivers would have prohibited in the first place. Patients, however, saw it as condescending, offensive, and wasteful of time and money. (Note that in other parts of the world, clinical standards for transexual therapy are much looser or non-existent; there is no known epidemic of regretful genderflippers.)

There are some very interesting comments from “natalie1984″ noting that the sex-reassignment gatekeeping system has been eroded in recent years, and along with it the stereotyped view of what it means to “really” be transexual or gender-dysphoric in the first place. Not only has therapy become more accessible, but what kind of therapy and what therapeutic endpoint the patient seeks have also been thrown open. As she notes: “Now we’re all able to simply work out for ourselves who we are and what we want from transition, and what will make us feel happiest”. She speaks with understanding of why many healthcare professionals are not current on T/Q issues, and simply encourages patients to find caregivers they are comfortable with. There’s also an interesting exchange further down the thread between her and one of the promoters of the natural therapy. She comes across as uncompromising but smart, thoughtful, and understanding.

There’s more, including the politics of gendered pronouns, but even just this adds up to a rich and complex discussion, with intersections between skepticism, healthcare autonomy, gender issues, and, vaguely, perhaps some philosophy-of-science stuff. What this post brings up for me is the deeply connected ways in which such issues always do surface in any similar debates over the proper application of facts to values – that is, the use of science or medicine to achieve chosen goals in human lives, and the conflicts that arise between those who control the science and those whose goals are at stake. It is common in ethics and philosophy of science to emphasize the “fact/value distinction”, but real cases often dredge up facts – and perceived facts – from many aspects of our lives, and competing values that arise from very different lived perspectives.

In this one issue, the skeptical community provides a useful mindset for analyzing clinical claims, but has also been charged with hostility to the LGBTQ community in whose interests those questions are asked. The “natural health” community offers the autonomy and self-direction that many patients want, but also harbors liars and scammers. The doctors who invented the sex-assignment gatekeeping system that so many transexual people hate did so as a way to make it possible for those patients to get care than had never previously been available. It is impossible for anyone to assert an exclusive claim to the moral or epistemological high ground here.

This stuff is hard, and, like so many progressive programs, requires a dedication to working through all the implications of a given position, and to striving to make one’s positions more defensible, more responsive, and more accepting. Every one of these communities – the skeptics, the healthcare professionals, the alternative-health promoters, and to some degree the LGBTQ population as well – have work to do in that way. Some of it has been done, though, and some of it is being done now, over at Skepchick. Good start.

He’s been in the news lately for making bizarre comparisons of gay marriage to beer, a cup of tea, and a paper napkin – all predicated upon the rather obvious but undeniable point that “it is what it is. Right? You can call it whatever you want, but it doesn’t change the character of what it is”. This is a claim on which Santorum congratulates himself by describing it as “sort of metaphysical”, but might otherwise be categorized as “sort of idiotic”. Apparently it means something to him, though, because he keeps saying it – most recently in a just-posted interview on the Iowa Independent Website: “It’s like going out and saying, ‘That tree is a car.’ Well, the tree’s not a car. A tree’s a tree. Marriage is marriage.” He goes on to spew a frothy mixture of crazy in a wide arc: gay marriage “minimizes what that bond means to society” (by letting people . . . form that bond . . .); “you’re gonna undermine religious liberty in this country” (his examples consist exclusively of the liberty to prevent other people from doing things); “we’ve created something that is not what it is” (so much for the tautological metaphysics).

But there’s a particular moment in the interview I want to highlight, because it captures so perfectly the ideological dishonesty, and complete divorce from reality, of the right-wing, and particularly the anti-choice movement.

If your position on abortion prevails and abortion is prohibited, Senator, what should the penalty be for a woman who obtains an abortion or a doctor who performs one?

Santorum: I don’t think there should be criminal penalties for a woman who obtains an abortion. I see women in this case as a victim. I see the person who is performing the abortion as doing the illegal act

This is a common, but relatively recent, dodge for anti-choicers. Throughout history, in the US and many other countries, when abortion was illegal (and it was not always or universally, or even commonly, so), women who sought abortion were held guilty of a crime; a woman who successfully obtained an abortion was often jailed, and women who were injured in illegal abortions were arrested when they sought medical treatment. This was a major contributor to the death rate from illegal abortion: not only could women not find safe providers, but they were fearful of seeking treatment when their unsafe abortions went wrong. This was never, for the anti-choicers, a reason not to make abortion illegal. But it was viciously cruel, and that cruelty became part of the justification for legalizing abortion. The deadly legacy of the lack of choice has likewise been part of the motivation to keep abortion safe and women out of jail, against the misogynistic war to reverse both those developments.

Yet, there is a logic (if not a “metaphysics”) to the war on women who procure abortion: if abortion really is the horrible crime the right wing claims, it’s hard to grant impunity to people who plan, solicit, and participate in that crime. If abortion is murder, surely the one who knowingly seeks, requests, pays for, and submits to an abortion, deliberately, by choice and preference, knowing its meaning and consequences, must be a murderer, at least as much so as the medical professionals who perform the procedure (and surely more so in the case of medical abortion, in which the professional’s only role is to write or fill a prescription, but the woman’s intentional agency is just as extensive as in a surgical procedure). And the idea that someone who solicits, hires out, and participates in a serious crime – let alone “murder” – is not guilty would be a travesty of the law in the case of any real crime.

The willingness to absolve women of initiating, paying for, and participating in a crime for which the person they paid, who acted on that woman’s own body at her request, will be punished under law reflects no sensible understanding of criminal guilt. It is a purely political move intended to head off a backlash against the anti-choice movement for victimizing women legally as well as medically. It is an attempt to evade the public’s revulsion at the right wing’s treating uppity women as the criminals the wingers say that they are – and to prevent the spectacle of women languishing in jail for simply claiming their own fertility through an act that one out of three women in the US has undertaken in her lifetime. It is a deliberate decision to void their own moral judgments for political expediency – to let a category of so-called “crimes” go unprosecuted to avoid drawing scrutiny to the ways the criminalization of healthcare affects women in general, and thus maintain that oppression in broader effect. It is an all-but-explicit declaration that the ideology that they claim justifies their persecution of women is itself expendable if it would get in the way of persecuting women – that making women suffer is more important than consistently and honestly applying the ideological framework that they use to rationalize that suffering.

But beyond the craven dishonesty and political expedience of the misogynist anti-choice crowd, there is a deep contempt for reality itself. To rationalize their insistence that abortion is a crime, and simultaneous refusal to hold women accountable for their choice to commit that “crime”, they have to characterize the act as criminal but the deliberate commission of it not. Who commits criminal acts but is not a criminal? People who are mentally incompetent, or coerced. Thus: “I see women in this case as a victim”.

This is another popular trope of the misogynist right: women are incapable of agency in their own disapproved choices. The idea that women are commonly “pressured” into abortion is a staple of anti-choice activism, as is the idea that they don’t really know what they are doing. This, of course, makes no sense legally: whether or not you are “pressured”, you can’t plan, schedule, show up for, pay for, and participate in a crime – after extensive discussion, preparation, and informed consent! – and claim you were acting under duress. (It didn’t work for Patty Hearst, and she was truly coerced.) Nor can you claim, after all that, that you didn’t know what you were doing, nor – the legally important part – does that claim matter as a defense to a criminal charge. (“Ignorance of the law is no excuse.”) For women to be exculpable of crime for a crime they planned and participated in, they have to be not just unknowing, or a “victim”, but actually mentally incompetent – a mental child, lacking legal autonomy, unable to give consent for her own choices.

That is the characterization the right wing puts on women – any woman having, or even seeking, an abortion – as their out for criminalizing the act but not the actor. That is how Rick Santorum – and all his Wingnut Woman Hater’s Club fellows – describe every woman who makes a choice they disapprove of: incompetent, non-autonomous, “victimized” by choices they themselves have freely considered, endorsed, and enacted.

But these are not simply more of the crazy opinions and perverse perspectives on women and the world that the right wing wallows in. They are claims of fact – claims about what it is actually like to be a woman who wants an abortion, or simply be a woman who believes abortion is one of the tools she can use to control her own life, take care of her own body, and achieve her own goals. To be a “victim” of one’s own choices and goals, it must be true in fact that you are mentally deficient, not capable of decision-making about yourself as the owner and inhabitant of your own life and body, oppressed by circumstances to the point that you cannot, in literal fact, think straight about yourself. These are claims of psychological fact – claims about the actual mental states of women attempting to assert sexual autonomy – claims about all such women (since the get-out-of-abortion-free card is made available to all women on these grounds).

It is simply impossible that such a claim could be true. It is patently obvious that it is not, in fact, true even about most or very many of the women who choose abortion. (All such women undergo intake counseling and an informed consent discussion. Repeated studies have shown again and again that they are at least as mentally healthy after the fact as are women who have not had an abortion.) The actual facts are clear: women who choose abortion are not mentally deficient, mis-informed, or incapable of making their own decisions. The claim Santorum and his ilk rely on to absolve themselves of the consequences in public opinion of their own misogyny is simply not true. But since it was never intended to be true – only to sound like something that would help them if it were true – that has no effect on their willingness to keep saying it.

What this cashes out as, for me, is the absolute necessity to put women and women’s needs at the center of any discussion about abortion. A third of all women in this country will have an abortion in their lifetime – and that’s with the grinding barriers and hurdles the right wing has put in their way. Tens of millions of them have already had abortions – women from every part of the country, every ethnic and religious group, almost certainly every extended family. In the same way that the “I had an abortion” T-shirt makes that army of normal, everyday, free and independent women visible, and forces the misogynists to question how far they are willing to go in targeting their own friends and family members, we need to make it clear also that those women are not “victims”, nor criminals.

Unless you are willing to call some vast percentage of women in the country – family members, co-workers, the women who raised all those children, taught all those classes, earned all those college degrees, held down all those jobs, accomplished all that they have accomplished and are still doing, and in the course of it knowingly and deliberately and self-affirmingly chose to abort an unwanted pregnancy and were better off for it – mentally ill, mentally incompetent, not in control of their own lives or choices, unable to control their own lives and choices, then you cannot claim their are victims for having made those deliberate and conscious choices. You will have to confront the reality that the women who choose abortion are, in largest part, strong, self-aware, competent, autonomous, and fully responsible for their own lives, values, goals, choices, and actions. And that being anti-choice is an assault on those women and their status as independent and autonomous persons.

Alaska

• Pauline’s Abortion Loan Fund

Arizona

• It’s Your Choice: The Abortion Fund

California

• Reproductive Rights Network of Santa Cruz County
• ACCESS Women’s Health Justice
• Women’s Reproductive Rights Assistance Project (WRRAP)
• Make a Difference Fund

Colorado

• Reproductive Equality Fund of the Boulder Valley Women’s Health Center
• Freedom Fund (Colorado)

District Of Columbia

• DC Abortion Fund
• Justice Fund (DC)

Delaware

• Delaware Pro-Choice Medical Fund

Distrito Federal (Mexico City)

• MARIA Abortion Fund for Social Justice

Florida

• W.O.M.E.N.
• Roe Fund
• North Florida Justice Fund
• Emergency Medical Assistance Inc.
• Women’s Emergency Network
• Broward Women’s Emergency Fund
• Central Florida Women’s Emergency Fund

Georgia

• Women in Need Fund
• Atlanta Pro-Choice Action Committee

Iowa

• deProsse Access Fund of the Emma Goldman Clinic
• Iowa Abortion Access Fund
• Heartland Justice Fund

Illinois

• Illinois Reproductive Justice Fund
• Planned Parenthood of Illinois Reproductive Justice Fund
• Chicago Abortion Fund

Kansas

• Peggy Bowman Second Chance Fund
• Women in Need Fund

Kentucky

• A Fund, Inc.

Massachusetts

• Eastern Massachusetts Abortion Fund
• Abortion Rights Fund of Western Massachusetts
• Jane Fund of Central Massachusetts

Maryland

• June Coleman Reproductive Justice Fund

Maine

• Safe Abortions For Everyone (SAFE)

Michigan

• Fountain Street Church Choice Fund
• Jane Doe Loan Fund
• Jane Doe Fund

Minnesota

• HOTDISH Militia
• Hersey Abortion Assistance Fund

Montana

• Trust Women Fund
• Sarah’s Circle
• Blue Mountain Clinic Access Fund

North Dakota

• North Dakota Women in Need Fund

Nebraska

• Abortion Access Fund

New Hampshire

• New Hampshire Fund for Choice
• Joan Fund

New Jersey

• Justice Fund of Passaic County

New Mexico

• Abortion Assistance Fund of Planned Parenthood New Mexico
• New Mexico Religious Coalition for Reproductive Choice

Nevada

• Justice Fund

New York

• Abortion Fund of Planned Parenthood of NYC
• Joan Bechhofer Fund
• New York Abortion Access Fund
• Access Fund of Aphrodite Medical
• Haven Coalition
• Third Wave Foundation Emergency Abortion Fund

Ohio

• Preterm Cleveland
• Women Have Options
• Cleveland Abortion Network
• Agnes Reynolds Jackson Fund

Oklahoma

• Roe Fund

Ontario

• Canadians for Choice Norma Scarborough Emergency Fund

Oregon

• Planned Parenthood Columbia Willamette Abortion Fund
• Network for Reproductive Options

Pennsylvania

• Women’s Medical Fund
• Vivian Campbell Fund
• Margaret C. Rubin Freedom Fund
• Planned Parenthood of Northeast and Mid-Penn Fund for Choice
• Western Pennsylvania Fund for Choice

Rhode Island

• Women’s Health and Education Fund
• Hope Fund

South Carolina

• South Carolina Women’s Choice Fund

South Dakota

• South Dakota Access for Every Woman

Tennessee

• J. Paschall Davis Fund

Texas

• Stigma Relief Fund
• Texas Equal Access Fund
• Lilith Fund
• Jim Wimberly Fund

Virginia

• Richmond Reproductive Freedom Project
• Women in Need Fund
• Blue Ridge Abortion Assistance Fund

Vermont

• Vermont Access to Reproductive Freedom

Washington

• North Idaho Fund
• Women in Need Fund—Renton
• Women in Need Fund—Tacoma
• Abortion Access Network
• Community Abortion Information and Resources Project (CAIR Project)

Wisconsin

• Freedom Fund
• Options Fund
• Women’s Medical Fund

West Virginia

• WV FREE Choice Fund

Wyoming

• Women for Women

I can’t vouch for any of those links or the organizations, but this service is desperately needed. Check them out, make them known, and throw them some bucks. “Because women’s lives matter”, as the NNAF so rightly and tragically puts it.

It’s not an unreasonable law, and I think it’s something that probably ought to be done though I have the impression that the issue is overblown from both sides. It’s also obvious that the law would most directly impact Jews (and adherents of some the other smaller faiths,  including some branches of Islam); the largest number of parents choosing circumcision in American are Christian, but they don’t make a religion out of it. (Ha! Haha!) But the debate over “male genital mutilation” – while pretty crazed at times – has mostly not had a religious focus; there are good non-religious reasons to oppose circumcision, and some non-religious reasons to favor it, and both argunents have been beaten to death by combatants on this subject without making it a religious war (other than to the extent that some people support circumcision for religious reasons).

But the group in San Diego that wrote the bill coming up for vote, and pushed the signature campaign that got it on the ballot, somehow stepped on a banana peel just recently, and threw the whole issue down a steep and bumpy flight of steps to an ugly landing (if you’ll excuse an increasingly awkward metaphor). The group has generally followed the “I mourn my penis” line in its “intactivist” crusade for prepuce justice, but for reasons that are hard to comprehend it recently came out with this:

This is a page from their “Monster Mohel” comic book, issued in support of their ballot initiative. The comic features a blond, muscular superhero – “Foreskinman” – who bursts in on a group of Orthodox Jews conducting a bris on a struggling boy. The villain – “Monster Mohel” – and his evil minyans (Ha! Haha!*) are wild-eyed, scraggly-haired, and grinning psychotically; one of them holds the child’s terrified mother by force while they cut her baby boy. Just to top off the Jews-as-freaks theme, the mohel gibbers about a “sacrifice to God” while brandishing scissors over the boy’s crotch, and also gushes praise for “the metzitzah b’peh for [sic] which I am about to partake” (the latter being a rare version of the circumcision ritual in which the mohel cleans the penis of blood by sucking it).

So: Jews as savages, religious nuts, and perverts, and their religious rites as violent and forcible; the anti-circumcision types as strong, Aryan, saviors rescuing children stolen from their mothers for bloody Jewish religious rituals. Hmmmm . . . never heard of anything like that before.

Not surprisingly, this has gotten a lot of criticism as anti-Semitic, and many commentators, especially on the right wing, have gone on from there to state categorically that the entire anti-circumcision bill is an exercise in anti-Semitism, and the “MGM” activism movement is just anti-Semitism in disguise.

That seems to me no more than another example of right-wing logical failure. (Are anti-Semites really that hung up on Jewish penises? And would they really go to the extent of funding and promoting years of agitation, and multiple state ballot initiatives, on an issue that makes them sound like cranks while affecting over 90% non-Jews? As far as I’m aware, even Nazis didn’t ban circumcision.) Through some bizarre twist of religio-political fate, the political movement that was forever railroading Jews on false charges and banning them from colleges and country clubs has in recent years decided that Jews are their special project (i.e., a convenient hammer in the Middle East to use against Muslims, and tied up in some loony way with Rapture prophecies – which also foretell the murder or forcible religious conversion of those same Jews, but that part doesn’t get mentioned). So finding an initiative they regard as left-wing that also has anti-Semitic elements is a welcome opportunity for them to paint the left wing as anti-Semitic. Between the fact that there’s nothing leftist about the “MGM” movement (except insofar as it’s anti-traditionalist and anti-religious, so clearly not rightist – but most liberals aren’t het up about foreskins and there’s nothing about them that is particularly associated with liberalism) and that tiresomely familiar hasty-generalization thing, the whole argument just makes no sense to begin with. The fact that one argument against circumcision is anti-Semitic, or even that some opponents of circumcision may be anti-Semitic, doesn’t mean that opposing circumcision is in itself anti-Semitic, especially when, again, Jews are only a tiny percentage of the people in the US who practice infant circumcision. Besides,  if we’re going to ban an entire policy because some of its supporters did something stupidly offensive, there would simply be no right-wing policies at all, so this is an argument form they really don’t want to be throwing around lightly.

But the weird thing about this is that the group forwarding the bill is not, seemingly, anti-Semitic. Their Web site is for the most part filled with the standard kinds of information and arguments about circumcision that you find among most supporters of this movement; religious issues are hardly touched upon and not, where I’ve seen, in an offensive way. The comic book is just absurdly divergent – in tone it’s completely incompatible with the rest of their work, and in content it has nothing to do with the actual substance of the group’s issue. It’s hard to believe it comes from the same group as is running the “MGM Bill” Web site. It may have been an attempt to address the strongest source of the religious-tradition argument for circumcision, that simply came out stupid-bad. Even though it’s hard to believe this sort of thing could have been dreamed up, proposed, produced, and approved without someone raising a flag, still, things do fall through the cracks. I can believe that something this messed up could emerge from a group that does not have overt or overriding anti-Jewish sentiments, in the same sense that I can believe Michael Richard didn’t intend to sound like a racist dick in his infamous comedy-club meltdown incident – sometimes you lose sight of what you’re trying to do, and . . . well, shit happens. It’s a very weak argument to claim that “they’re not anti-Semitic except for the unbelievably offensive anti-Semitic stereotypes in the major publication they just issued”, but, even so, for the reasons given above I think it’s believable in this case that this was an aberration more than a real statement of their policy.

But whatever its genesis, there’s no question that the publication, deliberately or not, is unmistakably anti-Semitic, and trades in ugly and ridiculous stereotypes. (I have to say I do like Foreskinman’s superhero logo, though: a round knob with a slit at the tip, flanked by a thin spreading collar coming up around the sides . . . use your imagination.) For an issue that has plenty of reasonable arguments on its side, including counter-arguments to religion-based adherence to tradition, this is stupid, divisive, offensive, and counterproductive. This really isn’t helping their movement – in fact, it may well kill it in California before the vote is taken – and causes real harm to many people, irrespective of their stance on the circumcision issue. Bad move, and their dismissive reaction to the first complaints made it worse. The MGM people need to start taking stock, and taking responsibility, soon.

* Yes, I stole that one.

Note that these abortion laws: forced pregnancy from the time of conception (not the beginning of pregnancy itself); limited or no exceptions for cases of rape or incest; refusal of authorities to assist in obtaining abortion even when it is legal; state coercion and withholding of truthful information to manipulate women and girls out of exercising their legal right of choice; and general hostility to choice in all its forms, and collusion of state officials to impose forced pregnancy outside the bounds of the law, with impunity – are exactly the policies promoted and supported by the religious right in the United States. In Mexico, where the Catholic Church has much greater social and political power, they have been enacted and are in force.

So if you want to know what it looks like to live in the kind of country envisioned by “pro-life” forces in the US (though with a bit less Catholicism), this is exactly what it is: 10-year-old girls raped and subject to incest held in a locked ward by the state to force them to bear the child of their rapist, with virtually no legal rights to make their own choice in the matter, and what little legal rights they do have systematically withheld from them by force and deception, by the state itself. Every aspect of this case has been managed in such a way as to ensure that this girl – note again, 10 years old – is forced to do what the religious right and the culture of patriarchy have chosen for her life and her body: bear children under force and duress, through rape and incest, while held under guard as her rights and her body itself slip away from her control. Once more, these are exactly the laws the US religious right is campaigning for; this is exactly what they want and will get.

Let me make one final point: Recall again that it is the Mexican law that prescribes forced pregnancy for child-rape victims in that country. It is the Mexican Police who are holding this girl to prevent her from exercising the limited rights the law grants her. If she had come to a US Planned Parenthood clinic needing help in this case, she could have gotten an abortion; the US religious right demands that Planned Parenthood turn her over to the police. It is one of their main complaints against PP: that they provide healthcare on demand, rather than violating confidentiality and turning rape victims over to the state – and their families, which may include the rapists themselves. PP trusts women – even girls – to know whether they are willing to be pregnant or not; the religious right demands that they do so.

For Planned Parenthood, what a rape victim deserves is the power and the right to reclaim control of her body. For the religious right, what a rape victim deserves is to bear the rapist’s child. And the younger the better, apparently. They got what they wanted in this case. And they’re coming for more.

The amendment is odd, though, and uglier even than it seems. It is so vaguely written that it is hard to figure out just how it would work if it were enacted, but its most likely interpretation would be literally deadly. It also extends the odious “conscience clause” for neglect of patients to every health plan, contract facility, professional group, doctor, nurse, or other staffmember at every medical school and teaching hospital in the nation, through a single sentence in this seemingly minor funding provision regarding training for one specific type of care.

The text of the amendment is here (scroll down). Recall this is an add-on to a larger bill; the parent bill seeks to defund all residency-level training in hospitals and medical schools nationwide, to force a new budget fight for training subsidies every year thereafter, rather than allowing block funding with less meddling. That bill by itself is part of the Republican assault on mainstream medicine – this proposed amendment is just a little anti-choice icing on the cake:

(d) Prohibition Against Abortion.–Section 340H of the Public Health Service Act (42 U.S.C. 256h) is amended by adding at the end the following new subsection:

“(k) Prohibition Against Abortion.–

“(1) None of the funds made available pursuant to subsection (g) shall be used to provide any abortion or training in the provision of abortions.

“(2) Paragraph (1) shall not apply to an abortion–

“(A) if the pregnancy is the result of an act of rape or incest; or

“(B) in the case where a woman suffers from a physical disorder, physical injury, or physical illness, that would, as certified by a physician, place the woman in danger of death unless an abortion is performed including a life endangering physical condition caused by or arising from the pregnancy itself.

“(3) None of the funds made available pursuant to subsection (g) may be provided to a qualified teaching health center if such center subjects any institutional or individual health care entity to discrimination on the basis that the health care entity does not provide, pay for, provide coverage of, or refer for abortions.

“(4) In this subsection, the term `health care entity’ includes an individual physician or other health care professional, a hospital, a provider-sponsored organization, a health maintenance organization, a health insurance plan, or any other kind of health care facility, organization, or plan.”

The Meaning – Such As It Is – of the Amendment

The amendment is so badly worded that it’s not clear what it actually does. Section (k)(1) – the central defunding provision – prohibits any residency training money from being “used to provide any abortion or training in the provision of abortion”, but this is far from self-explanatory.

The first part is confused: the funding in question (defined by the parent bill, HR1216, which addresses “funding for graduate medical education in qualified teaching health centers”)  is for post-graduate medical education (i.e., medical residency programs or the equivalent), not actual clinical care, and the infamous “Hyde Amendment” prohibits federal money for abortion care in the first place, so the “provide any abortion” provision here would seem to be superfluous at best.

The real issue – and the way the amendment has been packaged – is the denial of funding to train residents in abortion techniques, with an eye toward making abortion unobtainable by flooding the country with surgeons and OB-GYNs who are simply incompetent to provide this standard care. Since almost all residency training takes place in facilities receiving federal subsidies, this provision, if enacted, would mean the coming generations of doctors would receive no training at all in central aspects of women’s healthcare. (It might be possible to obtain such training at the resident’s own expense, but it’s not clear where that would even be possible, since this amendment would restrict almost all centers even capable of providing the training regardless of who paid for it. The only realistic alternative would be to go overseas – again, at the doctor’s own expense – and even that would not necessarily be availing, because it raises licensing questions and is not a practical option for all residents, even the ones who were willing to go to such lengths.) This is not a new tactic on the anti-choice right wing; at one point, Georgetown University’s Medical Center attempted to ban its GYN residents from obtaining abortion training anywhere, even on their own outside the program – and this when such training was still funded. But making it mandatory, inescapable, and nation-wide, is a step never before taken.

But it also seems that much of the intended impact of the amendment could be escapable. Here, the strange wording of the amendment provides a paradoxical loophole. Section (k)(2) allows exceptions for “an abortion . . . ” involving the usual grudging set of special horrors (rape, incest, death*) that some of the right wing are willing to overlook. But, again, notwithstanding the wording of the amendment, there is no funding addressed by this amendment or its parent bill that would “provide an abortion” under such conditions, since it does not provide funding for clinical care in the first place. So these exemptions for “an abortion”, if they do anything at all, must modify the prohibition on “training in the provision of abortions” – that is, Section (k)(2) apparently grants exemptions for federal funding for “training in the provision of an abortion . . .” in pregnancies involving rape, incest, or the threat of death. But of course all techniques used in abortion may be used in cases involving these exempted situations – so presumably federally-funded health centers can provide any kind of appropriate “training in the provision of abortions” for pregnancies involving rape, incest, or the threat of death - after which it’s the doctors’ own concern how they actually put that training to use!

At least, that’s how it reads, in strict logical terms. That may not be how it would be implemented, however. It’s clear from the legislative history of the amendment – the discussion on the floor before it was voted on – that, regardless of the grammatical deficiencies of its author, it was in fact intended to prohibit all training in abortion techniques.† Probably the courts would interpret it that way, even if that’s not what it says. So in practice the impact of the amendment is (a) to prohibit (with few exceptions) all abortions provided using medical-residency training funds – a category which does not exist, and (b) to prohibit all training in all methods of abortion regardless of likely application.

Scope of Ban

The result of all this, as noted, would be to permanently exclude competency in certain standard professional practices from the skill set of all US-trained physicians in all specialties, even including surgery, obstetrics, and gynecology. The skills in question, it should be noted, would almost certainly include, among others, the following methods most commonly used in pregnancy termination:

• uterine vacuum aspiration
• dilation & evacuation
• dilation & currettage
• intact dilation & evacuation

However, every one of those techniques is used for purposes other than abortion (most commonly, to remove dead tissue left by menstrual troubles, fetal death or an incomplete miscarriage). As noted above, the strict text of the amendment allows training in “abortion” techniques if it is not intended to facilitate abortion, but that’s obviously not what the author hoped for, so presumably it must be interpreted to include any technique that could be used in abortion, regardless of its common application. That would also include:

• cervical dilation (used as part of many gynecological procedures including abortion, but not abortive in itself)
• menstrual extraction (used to evacuate menstrual tissue after heavy menses, and also for early abortion)
• hysterotomy (used to access the uterus through the abdomen, used for late-term abortion but also for in-situ fetal surgery and non-abortion-related surgery)
• induction of labor (used to expel a fetus in late-term abortion, and ubiquitous in normal delivery or the removal of a miscarried fetus)
• hysteroscopy (an examination and treatment technique used in many conditions of the uterus, only sometimes for abortion)
• and more . . .‡

Impact of Ban

What would it mean if doctors were banned from all training in those techniques, for all purposes? Well, among much other harm, it would mean that any woman would face almost certain death from any of the following conditions, for which one the above techniques is the standard treatment:

• infection from retained products of conception
• hemorrhage or infection after incomplete miscarriage
• hemorrhage or maternal exhaustion after failed labor
• virtually any other condition that requires emptying the uterus, at any time just before or after fertilization of an egg or during any actual or failed pregnancy

It would also mean that women would have no access to standard or best practices under any of the following conditions, among others, because those treatments involve techniques that could be used in abortion:

• persistent menses or dysmenorrhea
• uterine fibroids and other endometrial malformations
• removal of retained products of conception
• cervical dilation for any purpose
• uterine aspiration for biopsy
• any other condition requiring dilation of the cervix, aspiration currettage of the uterine contents, or open surgical procedures on the uterus

And of course there’s the whole conspiracy-of-silence-about-birth-control thing (see ‡ below).

In short, this ban – if it were enacted and if it were implemented as intended, and as anticipated by its legislative history – would kill even more women in the US, in coming years, than are currently sacrificed every year from the current lack of abortion providers. We would see a return to death from emergencies in childbirth – even for women not seeking elective abortion – at levels equivalent to that in some Third-World countries (since, given that appropriate care would be banned under this amendment, women facing certain labor-related emergencies would essentially be getting Third-World care even though best-practices-level care could have been provided). Many more would suffer, some greatly, from the lack of access to perfectly ordinary and preferred treatments for conditions having nothing to do with abortion. By making it illegal for physicians in training to obtain the necessary skills to treat a wide range of common gynecological conditions, some of them life-threatening, this amendment simply condemns their future patients to death, permanent disability, and other suffering from conditions for which safe and effective treatments were available, and which are universally practiced in every other advanced nation, but which their US-trained doctors were prohibited from learning.

[NB: I am not a clinician. The information above is common knowledge from widely-available sources. I am confident it is accurate; it is likely incomplete - the full impact of this legislation is likely worse than I have been able to describe. For actual clinical guidance or practical healthcare purposes, be sure to consult a knowledgeable clinician who has a full range of professional skills (i.e., one who was trained at a non-misogynistic healthcare center before this ban was enacted).]

Comments

As with so much of Republican “healthcare”, it’s hard to imagine this policy could ever be taken seriously, or enacted in any nation that makes a claim to basic decency. But as so often has been the case in the past, it’s best to be prepared to be surprised by what levels of indecency Republicans are willing to reach.

As I noted, the amendment contains inherent loopholes that its legislative history makes clear were unintentional. It may be possible to circumvent some of its provisions nonetheless, by sequestering training in the relevant techniques to programs ostensibly aimed at other conditions: that is, teach vacuum aspiration as a treatment for dysmenorrhea, teach dilation and extraction as a procedure for removal of a dead fetus after incomplete miscarriage, etc. This could work, but only if the ban were confined to overt training in abortion as such, and not to training in any procedure that could be used for abortion. There is no question how vicious, and how hostile to the lives of women seeking abortion, the supporters of this bill are; it remains to be seen if they are willing to sacrifice innocent breeders, too, in their pursuit of death for rebellious hussies. Virginia Foxx, the sponsor of this amendment, is known for her bizarre and incoherent beliefs; I think it is really likely she just does not understand the implications of her own amendment, and it would not in the end be taken to the extreme of a complete ban on all gynecological surgical methods. Or would it?

At any rate, the stupid and ugly thing is not going to pass. But it is worth considering just how serious its sponsors were, and how far they were willing to go, to kill and punish women who sought control of their reproductive organs, through the medium of their own doctors – how far they were willing to go to make the ignorance that characterizes Republican health and science policy across the board in fact mandatory for those who refuse to adopt their values voluntarily. As in so many cases, denial of knowledge is both the substance of, and a weapon for imposing, the right wing’s values as punishment upon those whose crimes are knowledge and independence.

* Note that only death – not merely unendurable pain, permanent disability, or traumatic stress – is grounds for exemption. And, too, the section on the woman’s health repeats the phrases “physical disorder . . . physical injury . . . etc.” four times, making it clear that there is to be no sympathy extended to women whose traumas are psychological, whether or not life-threatening, because that’s not part of your “physical” health. Apparently the people who are convinced there is such a thing as a soul are not convinced there is such a thing as a mind.

† This raises another issue: the technique for “provision of abortions” in the case of medical abortions – RU486 or similar medications – is simply to conduct an appropriate examination and write a prescription. The “techniques” for doing so are used in the treatment of every condition, and the specialized knowledge involved in using this particular medication is trivial to acquire independently. So, again by the strict logical meaning of the text, either hospitals are prohibited from teaching residents even to write prescriptions – unless they argue that techniques that merely could be, but are not intended to be, applied to abortions prohibited by this amendment are therefore not prohibited in their non-abortion contexts. And that – again, if logical consistency means anything – would authorize all abortion techniques, medical or surgical, for the reasons I explained in the preceding paragraph. But these are Republicans we’re talking about.

‡ And of course the anti-choice nuts characteristically go so far as to define mere fertilization as a “pregnancy”, and I have no doubt that the supporters of this amendment would argue that its provisions apply not merely to the prescription of abortion by medication, but also to post-coital medical contraception such as Plan B. But . . . Plan B and its like are essentially equivalent to nothing more than high doses of ordinary prescription birth control, and in fact ordinary birth control pills can be used for that purpose without a separate prescription. So presumably this amendment would also prohibit either training in prescription of oral contraceptives, or at least mentioning the fact that they can be used for morning-after contraception. So far does the absurdity extend, if you take this policy seriously.