Doctors are divided on abortion Most in obstetrics will refer patients; moral views vary

Why should doctors be any different? Like the general public, physicians have differing views on the issue of abortion:

An obstetrician of 40 years' standing, who remembers seeing women die after back-alley abortions, says safe abortions are a service he's glad he can provide his patients.


A medical resident assigned to learn how to perform second-trimester abortions says nightmares forced her to tell her supervisors she had to be reassigned.

Dr. Ben Carson, a Johns Hopkins Hospital pediatric neurosurgeon, says that "as an individual who spends a lot of time trying to maintain life, I'm not going to be particularly enthusiastic about destroying life."


Dr. Vanessa Cullins, director of adolescent obstetrics at the Francis Scott Key Medical Center, believes abortion is "a matter of choice that each woman has a right to do with her body as she sees fit, considering psychological and medical conditions, up to viability."

Political leaders can stake out black-or-white positions on whether abortion should remain legal or not. Doctors, who deal with patients and their problems every day, tend to avoid absolutes.

Their personal moral views and their patients' needs shape the doctors' views.

Physicians and national researchers say that despite the loud political debate, abortion remains widely available in Maryland. Most obstetricians and gynecologists will refer a patient for an abortion. Many will perform them. And the state's teaching hospitals include abortion as a routine part of obstetric and gynecological training.

"We've always had an attitude that is open," says Dr. J. Courtland Robinson, a former medical director of Planned Parenthood of Maryland who is now on the Hopkins faculty.

That's in contrast to other parts of the country. In rural parts of the United States, the number of facilities performing abortions decreased by 19 percent between 1985 and 1988, according to researchers at the Alan Guttmacher Institute in New York. And the number of medical programs that routinely train residents in first-trimester abortions dropped from 23 percent to 12 percent between 1985 and 1991, according to Dr. Trenton McKay, an associate professor in obstetrics and gynecology at the University of California at Davis.

In part, Dr. McKay says, that's because more and more abortions are performed in clinics, while doctors foresee themselves in private practice. Also, the doctors who remember when women died of illegal abortions are retiring, leaving fewer mentors who have a sense of urgency about the issue of safe abortions. Over time, Dr. McKay says, fewer doctors will be trained to offer abortion as a standard medical service.

Dr. Timothy Johnson, associate professor of obstetrics and gynecology and director of maternal and fetal medicine at Hopkins, says he doesn't like doing abortions but performs them for a reason. "I've seen women die of septic abortions, and that's the alternative. If they're not legal, women are still going to seek them. And women are going to die."


At the University of Maryland, where abortion training is routine, Dr. Chris Chisholm was assigned to learn how to perform second-trimester abortions when he began his residency two years ago. A Roman Catholic, he quickly decided he could not continue. He was reassigned.

And yet, in some circumstances, he would refer a patient for an abortion. "When there's a documented fetal malformation that's inconsistent with life, there's no sense in carrying that pregnancy to term," Dr. Chisholm says.

A University of Maryland colleague, who would not be quoted by name, says she, too, began her residency doing second-trimester abortions but soon told her supervisor she had to stop.

"It was against what I believed in, and it was causing major emotional stress for me," she says. But like Dr. Chisholm, she says that "if a patient came to me and asked about abortion, I would refer her" to a doctor who performs them. "It's totally her choice."

In a study of Johns Hopkins medical students from 1988 through 1990, Dr. Peter E. Dans found that future doctors' opinions about abortion mirrored those of the general public. They are most comfortable with the idea of abortion for medical problems or in cases of rape, and less comfortable about abortion when the patient doesn't have a medical justification.

As in public opinion surveys, even doctors who believe abortion is taking a human life "still might think there are certain situations in which you can understand why someone would perform an abortion or refer someone to do that," Dr. Dans says.


Dr. Carson, for example, opposes abortion but says he sends patients who are seeking abortions to other doctors.

He is appearing now in a television commercial, whose script he says he modified "substantially," for the Vote kNOw Coalition, which is leading the campaign to defeat a new abortion law at referendum. Because he dislikes high-pitched arguments on the issue, Dr. Carson doesn't argue in the ad against abortion but urges that voters study the law.

The tone, he says, reflects his approach to the debate.

"As a physician who does not believe in abortion, when faced with a patient who has severe medical problems, I would refer someone for an abortion. I believe that person needs to hear both sides."

"I would never advocate it's illegal for a person to get an abortion," Dr. Carson says. "I think in the long run we do a lot of harm when we bludgeon people."

Even doctors who believe in abortion begin to have qualms about doing them after the middle of pregnancy, when the fetus approaches viability. Legally, that's defined at about 23 or 24 weeks, and after viability, courts have said abortion can be severely restricted. But doctors are already more conservative than the law allows them to be.


"We're very uncomfortable doing them after 20 weeks," Dr. Johnson says.

Today, with the recent advances in neonatology, some babies delivered under six months of pregnancy may be kept alive -- at least for a time. As the fetus nears viability, most doctors do not want to risk ending the pregnancy and finding the fetus -- particularly one with severe genetic problems -- is breathing. "Do you resuscitate?" one doctor asks. "Do you not resuscitate?"

One Baltimore obstetrician and gynecologist, who did not want to be quoted by name, says he recently had a patient who was found in her 25th week of pregnancy to be carrying a fetus with a severe genetic problem.

If the child were born alive, it probably would not survive, the doctor says. The patient wanted an abortion. "And I could not find anyone in Maryland to do it," he says. "I had to send her out of state."

But doctors say abortions late in the second trimester or during the third trimester are extremely rare. The Maryland Department of Health and Mental Hygiene has reported no third-trimester abortion in the state since 1982 and only six between 1971 and 1982.

Dr. Carlyle Crenshaw, head of obstetrics and gynecology of the University of Maryland, says abortion "is not a procedure I've ever heard anyone say they like to do. It's not fun. Delivering a baby is fun. But doctors do them because they're in the best interests of their patients."