Across the United States, women are traveling great distances—sometimes hundreds or even thousands of miles—to access the health care they need. The reasons for seeking late-term abortions are as varied as the women themselves: some arrive with fetal conditions so severe that their babies will not survive outside the womb; others are too young to have consented to sex, let alone to parenthood. There are those escaping domestic violence, and many who live in states with restrictive laws that prevented them from obtaining care sooner.
By most estimates, a small percentage—approximately 1%—of abortions occur after 20 weeks, often contrary to the sensationalized narratives presented by those who oppose abortion rights. As a physician, when I prepare a syringe with a medication designed to stop a fetus’s heart, I am fulfilling a critical role: helping my patients end suffering, whether that be the suffering of a baby diagnosed with brittle bone disease who will not survive labor and delivery, or the emotional anguish of parents who cannot bear the thought of witnessing such a tragedy.
The polarizing rhetoric surrounding late-term abortions—phrases like “ripping babies out of wombs” or claims that “no one is having an abortion near their due date”—oversimplifies a profoundly complex issue. For the individuals seeking these procedures, politics often feel irrelevant; what matters most is accessing the care they need.
Contrary to popular belief, many of us who provide abortion care later in pregnancy have grappled with the ethical implications of our work. We’ve reached the conclusion that providing this care aligns with our personal values and professional ethics. While the notion of conscientious refusal—where physicians can opt out of providing care that contradicts their beliefs—is frequently discussed, the concept of conscientious provision of care receives far less attention. I perform third-trimester abortions not only because it is my professional duty but because it is morally imperative to protect the life and welfare of individuals who choose to end a pregnancy under harrowing circumstances.
The distinction between moral simplicity and moral clarity is crucial. Ending a third-trimester pregnancy is rarely morally simple; even individuals who support abortion rights may perceive these later procedures differently from earlier ones. However, moral clarity emerges when we acknowledge that few life decisions impact a person’s trajectory more than the choice of whether to give birth and the conditions surrounding that decision. Those seeking abortion care have often already conducted their own moral assessments and determined that ending the pregnancy is the right choice for them.
It is striking how many politicians feel comfortable delegating this deeply personal decision to state legislatures, often without considering the lived realities of those affected. When an individual chooses to spare their child suffering or to prevent it from the outset, I believe I have a moral obligation to assist them in making this difficult choice. To do otherwise would be unconscionable.
In my office, a quote by Atul Gawande serves as a guiding principle: “Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.”
As I administer the injection, I observe the gradual slowing of the fetus’s heartbeat until it stops. I remove the needle and hold my patient’s hand, expressing my sorrow for her situation. Despite the gravity of the moment, they often thank me. Initially perplexed by their gratitude, I learned from one patient that my compassionate care made an unbearable situation “slightly more bearable.”
After this procedure, I induce labor, ending the pregnancy. In the room, amidst profound sadness, I often witness love and comfort intertwined with grief—a sense of relief that accompanies their heartbreaking choice. Providing patients with some agency and choice during this devastating time can offer a small measure of solace. Denying them that agency would be not just a medical failure but a moral one.
In conclusion, third-trimester abortions are not simply a matter of choice; they are a necessary aspect of health care that addresses complex, painful realities faced by many individuals. The decision to seek this care is rarely made lightly; it reflects profound personal struggle and moral conviction. As medical professionals, we must uphold our ethical responsibilities to support those navigating these heart-wrenching circumstances, ensuring that they receive compassionate care tailored to their unique needs.
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