Doctors who perform abortions are stalked, harassed, and sometimes killed. One doctor talks about his work and why he does it.
By Jesse Fox Mayshark
NOVEMBER 30, 1998: The cards and letters come, not every day, but often enough. Some of them are mass mailings, slickly produced fliers sporting the finest in desk-top fonts and graphics. Some are scrawled in barely legible handwriting, with misspelled words and random capital letters. Some come to his office, some to his unpublished home address. But all of them have more or less the same message, a message he's gotten used to hearing.
"I have as recently as last week been called a baby killer, a murderer, had the work that I do very crudely depicted over a megaphone that the whole community could hear," he says, in a mild voice that still bears the courtly stamp of his Virginia roots.
He's a middle-aged, middle-sized man with a neatly trimmed beard and thinning hair parted to the side. The waiting room in his gynecology practice at a local hospital is plush and friendlyleather sofas, Victorian still lifes, recent issues of People magazine. His own office is small, with a modest desk and the usual assortment of medical certificates on the walls. Here, he is just one doctor among hundreds, his presence announced only by a nameplate in the hallway outside. But this isn't the work that brings the letters, the shouts on the street, the anonymous phone calls to his unlisted number.
His name isn't Dr. Smith, but it will have to do. He doesn't want publicity, both as a general rule and especially right now. It's not a good time to be an abortion doctor. Just weeks ago, an assassin tracked Dr. Barnett Slepian to his home outside Buffalo, N.Y. and killed him with a rifleshot through a kitchen window. Shortly after that, the Knoxville Center for Reproductive Health received a hoax letter purporting to contain the deadly bacteria anthrax. Investigations in both cases continue, although New York police have a suspect in Slepian's murder.
"Things are always kind of tense," says Dr. Smith, who two days a week leaves his quiet office to work at Knoxville's two abortion clinics. "But right now's a little different than usual."
Still, for the same reasons he doesn't want his name used, he does want to talk. He knows the fearof speaking up and ultimately of doing the work at allis what people who kill doctors want. And he also knows it's working. Fewer young doctors are willing to provide abortions. Older doctors are retiring, some of them to escape the harassment and threats, both implied and direct, that have become part of the strange abortion demimonde. In Knoxville, three physicians staff the city's clinicsdown from six in 1990.
Violence against abortion providers is on the rise, although much of the escalation has happened outside the view of the general public. Bombings and shootings make headlines for a few days and then fade. But for the people who every day turn the abstract "right to choose" into clinical reality, the knowledge that something could happen, the sense of vulnerability, is a constant. No one is more aware of it than the doctors themselves.
The anti-abortion movement in the United States has evolved," says Vicki Saporta, speaking by phone from her office in Washington, D.C. Saporta is executive director of the National Abortion Federation, which represents abortion providers in the U.S. and Canada. Among other things, the group tracks anti-abortion violence. The statistics show a clear trend.
"Initially, we had people peacefully protesting outside clinics, and they became frustrated abortions were still being provided," Saporta says. "And they accelerated their actions into blockades and butyric acid attacks, and then accelerated to arsons and bombings. And then when they saw abortion clinics were still keeping their doors open, they accelerated to shootings and murder.
"They have tried to achieve with violence what they haven't been able to achieve in the legislatures and courts of this country."
Before 1993, there had been no murders of clinic workers, although there had been two attempted murders and 27 clinic bombings. Since 1993, there have been seven murders, another 14 attempted murders, and 12 more bombings. The dead include three doctors, two clinic secretaries, one volunteer escort, and one security guard.
While almost all anti-abortion groups are at great pains to distance themselves from the violence, the past decade has seen heightened rhetoric across the board. Nowhere is this more evident than on the Internetmost notoriously in the form of "The Nuremberg Files," a site based in Carrollton, Ga., that has made national news in the wake of Slepian's murder.
Logging on, the first thing you see is an animated banner, a photo collage of fetal limbs that drips blood toward the text below. The site is a collection of names (and in some cases addresses) of people who work in abortion clinics across the country. Ostensibly, it is collecting data for future hypothetical trials of abortion providers for "crimes against humanity." But to a lot of pro-choice supporters, it looks like a hit list. At the top, a legend explains the typeface used for each name: "Black font (working); Greyed-out name (wounded); Strikethrough (fatality)." Dr. Barnett Slepian's name is there, with a line all the way through it.
"I had someone look at it for me," says one Knoxville doctor, explaining why he doesn't want to be interviewed for this story. "My name wasn't on it. I'd like to keep it that way."
Another local doctor's name just appeared on the list recently, apparently for work he does at another clinic out of state.
Doctors are at the top of the fileunder the heading, "Abortionists: the baby butchers"but they're not the only ones there. Other sections list "Clinic owners and workers," "Judges," "Politicians," "Law Enforcement," and "Miscellaneous spouses and other blood junkies" (pro-choice actress Whoopi Goldberg makes the latter list, as do Dr. C. Everett Koop and Mary Tyler Moore).
Also available online is a symposium sponsored by Campus Crusade for Christ in which leading anti-abortion advocates weighed in on whether it's justifiable to kill abortion doctors. Most of the participantswho included Catholic Cardinal John O'Connor and former Christian Coalition head Ralph Reedargued against violence. But that may mean less to clinic workers than the fact that the question's being seriously debated at all.
"These are incredibly courageous health-care providers who really put their lives on the line every day," Saporta says.
Dr. Smith tries not to think about that too much, but the sampling of letters on his desk show that he gets plenty of reminders. One reads, in nearly illegible wavering lines, "You killed a Baby. Your going to Hell." Several others are part of a series of brochures aimed at shaming doctors out of their work. One shows a small girl using a stethoscope on a teddy bear and says, "Ask yourself if the child you were would be proud of the abortionist you became." (Anti-abortion literature always uses the term "abortionist," never "doctor." Clinics are "abortuaries.") One is a flier that was posted at a Wal-Mart near Dr. Smith's house. It gives his name and address and encourages people to "confront" him so he will "quit killing babies." ("I take those down at my local Ingle's all the time," he says.)
And then there was the postcard that arrived at his home shortly after his own child was born. It showed a decapitated fetal head held between two forceps. On the back was the message, "We're glad this didn't happen to your child."
"Of course I was glad too," he says emphatically. "I love my child, I love children in general. And most of those I know of who are pro-choice have children, love children, and want to see them properly cared for and wanted." But the unspoken message behind the mailing didn't escape him"They knew where I lived, they knew even that I had had a child."
Dr. Smith didn't get into medicine to be a martyr. He started practicing in 1973, the year of Roe vs. Wade. Abortion was not a focus of his work, although as an OB/GYNhe estimates he's delivered thousands of babiesit was inevitably an issue. It became more of one in the early 1980s, when he started working a few days a month at Knoxville clinics. After a few years, as other doctors retired or moved away, Dr. Smith found himself having to devote more time to the clinics. Eventually, and reluctantly, he dropped the obstetrics part of his practice so he could staff KCRH and Volunteer Medical Clinic.
"I think it's very important to realize that pregnancy is not a benign process from many standpoints," he says, by way of explaining his dedication to the work. "There are a multitude of diseases and medical conditions that afflict only women who are pregnant or have been pregnant, which can cause severe disability or death. They are not always predictable. And obviously there are major effects, on particularly teenagers, young women who frequently after having a child will not be able to complete their education, will not be able to provide for their child."
The women and girls he sees in the clinics often come in with one or both parentsbut very rarely with the men who got them pregnant. They come from all over East Tennessee and surrounding states"a 200-mile or more radius from Knoxville," Dr. Smith says. There are no clinics south of Knoxville between here and Atlanta, none to the north until Lexington, Ky. (Of the seven clinics listed under "Abortion Services" in the Knoxville Yellow Pages, five are out of state. A new $11 million women's health center just announced by Baptist Hospital bills itself as offering "comprehensive women's care"but it won't offer abortions.) The National Abortion Federation says 84 percent of counties in the U.S.and 94 percent of rural countiesdon't have a local clinic or hospital that provides abortions.
Dr. Smith tends to talk about abortion in precise, somewhat detached medical terms"procedure," "technique." But his thoughts on the issue and the anti-abortion movement are both strong and complex.
"I was raised in a Christian home and still consider myself a Christian," he says. "The [Baptist] denomination of which I was and remain a part, in the years that I was growing up, was supportive of the right of choice and made major public statements to that effectthat abortion was a matter of individual conscience. And my outlook and position on this issue have remained the same through the years, but the position of my church is very much the opposite now."
In the turn toward fundamentalism and increased political activity within the church, Dr. Smith thinks Baptists have lost sight of their long tradition of individualism.
"I think what we have at this point is an unholy alliance of right-wing politics and fundamentalism that is actually destructive to our political processes as well as religion," he says.
He's wrestled with the religious issue and can find nothing in the Bible to support the anti-abortion stancealthough historians say abortion has been widely practiced throughout human history, it merits no mention in either the Old or New Testament. Ironically, Dr. Smith says, much of the current religious opposition is actually based on sciencewhat we now know about genetics and fetal development and "viability."
"I would make a point too of saying that despite all this emphasis on life, the fact is humans do not differ from other animals or even plants in terms of a natural abortion rate," he says. "It's been estimated that only a third to half of all conceptions would progress to an actual human being. And we've known for many years that even 15 percent of known pregnancies will miscarry. I think one thing that might be concluded from this is that God himself does not attach particular significance to a conception. I think it is certainly important to recognize that potential life is important, but I think it does not have the moral standing of actual life. And it's important to make the distinction."
In fact, he says, Roe vs. Wade laid the groundwork for recognizing any fetal "rights" at all. By giving states almost total discretion to regulate or ban third-trimester abortions, Dr. Smith says the court acknowledged that as a fetus gets closer to birth it deserves more and more legal consideration. The result has been a wave of "in utero" crime laws that make it an offense to injure an unborn child, either through violence or neglect. The laws might seem at odds with legalized abortion, but Dr. Smith sees them as signs of the deep complexities of the issue.
"I think that the decision the court made was right," he says, "and I think that increasingly as maturity is reached, that additional fetal rights is the appropriate approach."
That's why he says he would have a problem performing late-termor "partial-birth"abortions, which have become a hot political issue in the past few years. (He has never performed one and knows of no doctor in Tennessee who has). But he also thinks the rare procedure is being used mostly as a political diversion by anti-abortion groups, who ultimately don't want any distinctions between late-term and early-term.
"We see essentially a fertilized egg being called a person now or a baby," he says. "It certainly conjures up very vivid images to think that we're destroying babies, when the fact is a fertilized egg is a blueprint and it has the requisite number of chromosomes for a potential person. A blueprint is no more a building than a genetic code is a person."
But he thinks the talk has taken a toll, both on doctors and their patients. New doctors, first of all, grew up with legal abortion and therefore don't share their elders' memories of how widespread and dangerous illegal abortion was. And whatever their own views, they might be squeamish about entering a field that promises so much conflict. Dr. Smith is the physician of record for medical residents in area OB/GYN programs who want to learn abortion procedures. In the past several years, he says, he's had only one student.
"I do anticipate that being a continuing problem, a worsening problem," he says. "There are still a few doctors going into the provision of this service, but not very many. I have on occasion worked with another clinic in another state [North Carolina] that's about to close, and one of the reasons it's closing is because it has not had access to a doctor consistently."
The National Abortion Federation says only about 12 percent of OB/GYN residency programs nationwide mandate abortion training (although many others include it as an option). A national survey by the Alan Guttmacher Institute found the number of abortion providers fell 18 percent from 1982 to 1992. New numbers due out next month will show a continuing decline from 1992 to 1996, a spokeswoman says.
As for patients, Dr. Smith thinks anti-abortion groups are convincing many young women not to have an abortionat least, for their first pregnancy. Nationwide, abortion numbers have fallen to about 1.2 million a year from a high of 1.4 million. The ratio of abortions to live births is at its lowest level since 1975. The pattern is the same in Tennesseein 1990, there were 19,641 abortions state-wide, and 1,771 among Knox County residents; in 1997, the numbers were 16,557 statewide and 1,182 locally.
But Dr. Smith sees increasing numbers of patients who have had one or two children and are still in the same position they were originally, on their own with few resources.
"The fact they go ahead and [have a child] imparts a real sense of reality that is different from the commercials that show the healthy little kids running around in their Nikes, who are happy and well-provided for," he says.
Among his patients have been many women who told him they were fervently anti-abortionsome of them even activistsuntil finding themselves in a position they "never thought they'd be in."
He's careful not to draw too close a connection between mainstream anti-abortion protesters and the small number of people who have committed violence. But he also thinks extreme dialogue is an almost inevitable precursor to extreme action.
"Those who have voiced the most heated rhetoric, the person who placed the Nuremberg list on the Internet, may want to deny any responsibility," he says. "But you can't deny responsibility when you inflame the issue to this extent, when you publish a hit list, when you publish wanted posters. There is responsibility there."
Lisa Thomas agrees. "I feel that violence begets violence," says the director of Volunteer Medical Clinic, who often arrives at work to the chants and shouts of protesters outside. "It's one of the reasons we kind of discourage counter-protests. While I think that's important, I don't like it in front of my clinic, because that creates an area of strife. My bottom line is my patients, and if they have to walk through that, that's not helpful to them."
But, she notes, the protests and shouts of "Murderer!" just scare patientsthey don't stop them from coming.
Saporta says the same is true of doctors. After Barnett Slepian's murder, NAF was deluged with phone calls and e-mails from physicians pledging to continue their work. One West Coast doctor wrote, "My kids say they don't need to talk about it. I will put back on my bullet-proof vest and go back to work." One doctor, a single mother who worked with Slepian, initially said she was too scared to continue working. But a week later, Saporta says, she decided she couldn't let herself be intimidated, and she went back to the clinic.
"It is concerning," Dr. Smith acknowledges, "and as a result I have adopted a number of measures for the security of myself and my family. [But] it does not discourage me from doing what I believe to be right."
He doesn't expect any let-up in the anti-abortion barrage, even with the help of the Justice Department, which recently announced the formation of a task force to study anti-abortion violence. But he does find occasional reasons to hope the issue can ultimately move toward reason and productive rather than destructive dialogue.
"I've had personal discussions with some of the protesters," he says. "One who was particularly vehement several years ago, I went to breakfast with and had a very calm discussion. Despite the names he had called me and informing me I was going to hell and so forth as I was entering the clinic, we were able to sit down and actually have a dialogue without getting into name-calling or anger or harsh words. I wish we could do that on a larger scale.
"Many of the anti-abortion people I have talked with," he continues, "if they're actually willing and able to sit down and discuss the issues, realize that we do have some common ground."
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