How medical residents wrested their consciences into submission

By Dave Andrusko

Sarah Terzo’s except from an academic study posted elsewhere today inspired me to revisit the personal stories from young residents that appeared in the Journal of Obstetrics and Gynecology, under the headline “Four Residents’ Narratives on Abortion Training: A Residency Climate of Reflection, Support, and Mutual Respect.”

I first learned of the original study several years ago when I ran across a piece that appeared at WBUR, Boston’s National Public Radio station: “Medical Professionals Voice Their Feelings In The Abortion Discussion”. It provided invaluable background to the essays and excerpts from the residents.

We glean fascinating insights from young doctors, and especially how they wrestled their consciences into submission. But to fully understand the responses, you have to understand the background.

The ringleader was Janet Singer, a nurse midwife on the faculty of Brown University’s obstetrics-gynecology residency program. According to the NPR story, Singer “found herself acting as a confidant in many discussions with residents about abortion.”

“Over the years, when a resident felt confused, overwhelmed or thrilled about something to do with abortion care, they often came to me to discuss it,” she says. So in order to enlighten the “general public,” she “asked four residents to write about their feelings about abortion training and services, or as one resident characterized it: ‘one of the most life-changing interventions we can offer.’”

Singer told the Lisa Mullins, the NPR reporter, about the “grey areas,” including when one colleague (she doesn’t specify if it was a doctor or resident)

came to me overwhelmed on a day when she had done a late-term abortion and then been called to an emergency C-section for a fetus/baby just a week further along.

She needed to talk about how overwhelming it felt to try to decide where the cusp of life was, why it was OK to take one fetus/baby out of the womb so it wouldn’t live and one out so it might.

Ah, yes, that would be overwhelming!

What do we come away from these essays? First and foremost, the still small voice that we all possess screamed out as they sliced and diced huge babies.

So how did they still that voice? Here are some examples of refusing to heed what you know is right (and wrong).

The first excerpt is from someone who was “open” to doing abortions. “Over the course of internship, I came to understand embryonal development as a fluid yet constant march toward being human in which an embryo at 6 weeks is an entirely distinct entity from an anatomically formed fetus 2 months later. Unfortunately, this acquired knowledge has failed to help me fully define my position.”

If the “acquired knowledge” didn’t to the trick, what did help him or her “fully define” their position?

“Discussions with co-residents have helped me consider the individual woman who has the courage to request an abortion. Since opting out, I have realized that my line of thinking has been feto-centric at best and over-intellectualized at worst.”

“Feto-centric.” Uh, oh. We know where this is headed.

But, no! The resident concludes, “Nonetheless, in the absence of a clear moral understanding of abortion, I can only do no harm.”

In spite being “taught” his view of the unborn was “feto-centric,” the resident went back to the first principle of medicine: first do no harm.

For many reasons, the excerpt from the second resident’s essay is enough to make you cry. It begins,

“At the start of residency, I was not sure if I was ready to perform elective terminations. I realized that the lion’s share of my reluctance was driven by ‘what would my mom think of me?’ I struggled with my own faith, and with what God would think.”

That’s a lot to struggle with, a lot to “‘overcome.” (Maybe it’s just me, but if I were someone considering whether to obliterate a helpless unborn children for a living, and then I asked myself WWJD?, I think I’d know clearly. But, back to the resident.)

He or she had an experience with a woman with severe preeclampsia at 20 weeks and they had to fly someone in to “perform an abortion at this gestational age.” As they thought about abortion, the resident understandably thought about that woman – but evidently not the baby who by this time was mature enough to be pain-sensitive.

The turning point appears to be when a senior resident told them that abortion is

“not a ‘feel-good’ procedure, but it changes the course of a patient’s life. It was so helpful to know that my apprehension was normal. That affirmation, along with my desire to gain gynecologic experience, gave me the confidence to pursue abortion training.”

So someone tells you the alarm in your soul is a false alarm, plus you do want to gain gynecological experience…

Bingo. They’ll do abortions.

But the most revealing remark comes next. The resident is at a Planned Parenthood and after a morning of first-trimester abortions,

“we performed an 18-week termination. Seeing the fetus on an ultrasound scan and then watching it as we did the procedure really shook me to the core.”

Now, all the alarms have gone off and the warning is clear. But he or she gets by that, nonetheless.

How?

Partly by hearing that other residents also have serious qualms. Oddly, rather than reinforcing their own doubts, this makes it easier for the resident to go forward.

After all, “our patients are the mothers” and “After listening to the struggles of fellow residents, I convinced myself to return to the clinic.”

The final step is when the individual is at the clinic and “I soon realized how powerful it was to be able to comfort and assure such vulnerable patients. I began to frame my interventions at the clinic as life-changing for women.” (Emphasis added).

By excluding any consideration that there might be a second patient; by limiting vulnerability to the mother, to the exclusion of the unborn baby about to be torn to pieces; and by [re]framing the moral equation to turn a death experience into a “life-changing” experience for women, the resident has “convinced” himself or herself that what they know is wrong is right.

I will refrain from talking about any of a dozen parallels and resist the temptation to apply that logic to any other category of dependent people.

It is enough to say that if someone feels in the pit of their stomach that what they are doing is violating a moral imperative, they ought not draw the bizarre conclusion that this is “normal” – and thus to be ignored – particularly if many people have exactly the same sense of deep revulsion.