Gonzales v. Carhart & The Gory Details

Whatever one thinks of Anthony Kennedy's opinion in Gonzales v. Carhart, he has at least done us one service: he has described in clear detail what the phrase "Second Trimester Abortions" means.   

A doctor must first dilate the cervix at least to the extent  needed to insert surgical instruments into the uterus and to maneuver them to evacuate the fetus.  . . . After sufficient dilation the surgical operation can commence. The woman is placed under general anesthesia or conscious sedation. The doctor, often guided by ultrasound, inserts grasping forceps through the woman’s cervix and into the uterus to grab the fetus. The doctor grips a fetal part with the forceps and pulls it back through the cervix and vagina, continuing to pull even after meeting resistance from the cervix. The friction causes the fetus to tear apart. For example, a leg might be ripped off the fetus as it is pulled through the cervix and out of the woman. The process of evacuating the fetus piece by piece continues until it has been completely removed.  A doctor may make 10 to 15 passes with the forceps  to evacuate the fetus in its entirety, though sometimes removal is completed with fewer passes. Once the fetus has been evacuated, the placenta and any remaining fetal material are suctioned or scraped out of the uterus.  The doctor examines the different parts to ensure the entire fetal body has been removed.

That, bear in mind, is not the procedure that is prohibited under the act of Congress at question.  This is how Kennedy describes the latter:

In an intact D&E procedure the doctor extracts the fetus in a way conducive to pulling out its entire body, instead of ripping it apart.  . . . Intact D&E gained public notoriety when, in 1992, Dr. Martin Haskell gave a presentation describing his method of performing the operation. In the usual intact D&E the fetus’ head lodges in the cervix, and dilation is insufficient to allow it to pass. Haskell explained the next step as follows:

“ ‘At this point, the right-handed surgeon slides the fingers of the left [hand] along the back of the fetus and “hooks” the shoulders of the fetus with the index and ring fingers (palm down). 

While maintaining this tension, lifting the cervix and applying traction to the shoulders with the fingers of the left hand, the surgeon takes a pair of blunt curved Metzenbaum scissors in the right hand. He carefully advances the tip, curved down, along the spine and under his middle finger until he feels it contact the base of the skull under the tip of his middle finger.

“ ‘[T]he surgeon then forces the scissors into the base of the skull or into the foramen magnum. Having safely entered the skull, he spreads the scissors to enlarge the opening.  The surgeon removes the scissors and introduces a suction catheter into this hole and evacuates the skull contents. With the catheter still in place, he applies traction to the fetus, removing it completely from the patient.’ ”

The ban on partial birth abortion prohibits only this latter procedure-delivering as much of the fetus as possible, except the head, before killing him or her.  Why is it necessary to crush and "evacuate" the skull of the fetus?  The most obvious reason is that the skull is the hardest part of the fetal body to get out of the woman's body.  But there is another reason. 

Some doctors performing an intact D&E attempt to remove the fetus without collapsing the skull. Yet one doctor would not allow delivery of a live fetus younger than 24 weeks because the objective of [his] procedure is to perform an abortion,” not a birth. The doctor thus answered in the affirmative when asked whether he would “hold the fetus’ head on the internal side of the [cervix] in order to collapse the skull” and kill the fetus before it is born.

Another doctor testified he crushes a fetus’ skull not only to reduce its size but also to ensure the fetus is dead before it is removed. For the staff to have to deal with a fetus that has “some viability to it, some movement of limbs,” according to this doctor, “[is] always a difficult situation.”

A difficult situation.  Delivering a live if dismembered baby where you meant to kill a fetus, well, that would be like discovering that your tie doesn't match your shirt, or that you are wearing the same dress as a rival at a social function. 

Civilization is a precarious business.  It may be that we will be less civilized in the future than we are now.  One hopes for the opposite.  If we do see moral as well as technological progress, we will one day look back upon Justice Kennedy's words with the same horror that we now feel about slavery, or drawing and quartering.  If the procedures he describes are not barbaric, then nothing is.