Will Dr. Henry Foster be confirmed as our next surgeon general? Whether or not he is, the controversy surrounding his performance of abortions compromises the quality of comprehensive health care for all citizens -- especially women.
Dr. Foster has the background and training to tackle some of the most pressing public health problems facing our nation. Prevention of infant mortality, teen-age pregnancy and heterosexual transmission of HIV could be brilliantly addressed by a physician committed to care in obstetrics and gynecology. Yet, the professional commitment that brought Dr. Foster to President Clinton's attention now threatens to permanently exclude him or any other OB/GYN from serving as surgeon general.
Until a few years ago -- before doctors who performed abortions were shot at or threatened -- most OB/GYNs were trained to perform the procedure. In fact, unless they had a conscientious objection, it was considered part of the package of medical procedures they learned and were prepared to perform. Quite simply, without abortion services, physicians would not be able to provide comprehensive care to women in need of OB/GYN services.
Ironically, if Dr. Foster had never performed an abortion, many more of us might have wondered whether he was in fact qualified to be surgeon general. Barring a strong religious conviction, not performing an abortion would have meant that he had abandoned (mid-stream) the care of many of his patients who had determined that a safe and legal abortion was the medical procedure of choice. Nobody chooses to get pregnant to have an abortion. So, to abandon women who are in need of care is to ignore the moral and legal obligations of the OB/GYN. Selective care of patients would have raised real doubts as to whether Dr. Foster had the commitment and compassion to be surgeon general. Regardless of whether abortion is unpopular, unpleasant, or a risk to one's livelihood, it is legal and Dr. Foster appropriately made this medical service available to his patients.
Yet, with increasing frequency, abortion services have become marginalized in free-standing abortion clinics, away from the base of care and practice of many OB/GYNs. More and more residency programs (not only the Catholic-based hospitals) stopped requiring or even offering training in abortion, even though the American College of Obstetrics and Gynecology appears to have recently renewed its commitment to this training for residents seeking certification as OB/GYNs. Sadly, the majority of OB/GYNs do not perform abortions. In some states, not a single physician provides these services.
Whether or not surgeon general nominees should have to pass the political litmus test of abortion, an appreciation for historical and social context also is critical when evaluating an individual's deeds over a professional lifetime. Consider, for example, the other major controversy at issue in Dr. Foster's nomination: the sterilization of the mentally retarded. For many of us, at first blush, it would seem distasteful that Dr. Foster sterilized mentally retarded individuals in the 1970s. This clearly is not, and should not be, the standard of care in 1995. Over the past 25 years, significant civil rights protections and procedures for the mentally retarded have been well-established.
Yet it also was true in the 1970s that physicians and parents routinely allowed infants born with Down syndrome who suffered from esophageal atresia to starve to death without corrective surgery. Such inactions in 1995 would clearly be deemed contrary to standard practice and be labeled as medical neglect. Medical, ethical, and legal standards do change. And any physician with a lifetime of professional experience will be caught up in these currents.
Actually, the most damaging criticism of Dr. Foster may hinge on recent accusations concerning his role in the Tuskegee experiment, in which black men with syphilis were used as "guinea pigs" in a U.S. Public Health Service research project. At issue is whether Dr. Foster knew that these men were deliberately denied treatment when he served as vice president of the local medical society in 1969. If he knew, and took no action, his credibility as a surgeon general should be challenged. But if, as Dr. Foster maintains, he immediately called for a halt to the study when he learned of it through news reports in 1972, then his nomination should go forward.
In the often contentious marriage of politics and public health, we must ask ourselves if the issues of sterilizing the mentally retarded or the Tuskegee experiments would ever have been raised had the abortion issue not been raised first. To Dr. Foster's nay-sayers, if abortion is wrong, it is wrong, period, and no other issue really matters. Thus, the number of abortions performed or the reasons should not really matter either. In the end, however, abortion opponents may be satisfied with any reason that derails Dr. Foster's nomination.
In my lifetime, I do not recall a surgeon general who ever was an obstetrician/gynecologist, and maybe now I know why. But Dr. Henry Foster has the creativity and vision to make a difference at a time when our country needs leadership to address so many challenges in public health. Unless we have the capacity to de-politicize abortion, we may never benefit from the training, perspective and compassion an obstetrician/gynecologist could provide as surgeon general. And what a loss that be for all of us.
Karen H. Rothenberg is the director of the Law & Health Care Program at the University of Maryland School of Law.