Dobbs outcry lacks nuance that debate desperately needs

Like many social issues, abortion is one of those topics I usually prefer to avoid like the plague. No matter how carefully considered and thoughtfully formed my opinion is, there’s always someone waiting to tell me how wrong I am.

When I say “wrong,” I don’t mean that in the sense of being incorrect. I mean it in the sense of being evil. To my right are those who say that anyone who doesn’t favor a total ban on abortion supports murder. To my left are purple-haired progressives wailing about a dystopian future where women and their reproductive systems are controlled by the government. (At least the left finally remembered what a woman is for five minutes.)

Neither position is helpful. And what a terrible time it is for both sides of the argument to remain so entrenched—with the Supreme Court (rightfully) holding last Friday that the United States Constitution does not confer the right to an abortion, the authority to regulate abortion has been “returned to the people and their elected representatives,” prompting a watershed moment in abortion policymaking all over the nation. One good way to get that policy very wrong is to deny it the nuance it desperately needs.

Like many Americans, I believe abortion is wrong. I believe it’s wrong for the simple reason that it extinguishes the life of an innocent human being. Society has held since the beginning of time that killing a person is immoral, and an unborn person is indeed a person.

I also understand that enshrining morality in law is easier said than done. Senate File 253 is a perfect example of that. Introduced in the Iowa Senate in 2017 after electoral wins gave Republicans a governing trifecta, it was touted by pro-life advocates as a “personhood” bill. At a single page in length, which I described to other Republicans at the time as “ruinously simple,” the bill declared that life was “protected from the moment of conception.”

Protecting life is good. How the bill was written was bad. By defining the moment of conception as when the sperm meets the egg, the bill left too much room to interpret any interference after that—including measures to prevent implantation of the fertilized egg, which is the function of intrauterine devices (IUDs)—as an abortion. That could have effectively banned those IUDs that are used by 10 percent of childbearing-aged women, as well as emergency contraception, commonly known as by the brand name Plan B®.

Worse, the way that SF253 defined abortifacients left me with doubts about whether or not even drugs used for purposes other than elective abortions would remain accessible. Methotrexate is a 75-year-old medication originally used to treat cancer. In a larger single dose, it can induce an abortion. I took it weekly for years as one of the most common (and effective) treatments for severe rheumatoid arthritis.

Here in Iowa, the potential loss of access to my disease-modifying drug was purely hypothetical. SF253 never had a path out of committee, likely because enough Republican legislators saw it for the poorly-written problem it was. But even before the Dobbs decision, other states that have put strict measures in place are seeing some physicians and pharmacists err on the side of avoiding steep legal liability. After a new law was passed last year in Texas, a pharmacy sent out letters to OB-GYNs in the Austin area alerting them that they would no longer dispense methotrexate to treat ectopic pregnancies.

An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. In no circumstances can the egg survive, but the growth of tissue in the area can cause the tube to burst and can be fatal, especially if left untreated.

Texas law already recognizes that discharging an ectopic pregnancy or other miscarriage is not considered to be an abortion. It also allows for elective abortion in the event that continuing the pregnancy places the mother in danger of losing her life or at “serious risk of substantial impairment of a major bodily function.” Furthermore, last year’s law, which specifically names methotrexate as an “abortion-inducing drug,” does so under the context of intent to cause an abortion, and goes on to state that the term “does not include a drug, medicine, or other substance that may be known to cause an abortion but is prescribed, dispensed, or administered for other medical reasons.”

Yet with all of that language quite apparently confirming that methotrexate is legal to prescribe and dispense for everything from autoimmune disorders to miscarriages, some physicians and pharmacists fear punishment for providing it. It illustrates a crucial point: How a law is written and how it is interpreted are two very separate, very distinct concepts. One speaks to intent, and one speaks to effect.

Disconnect between the two isn’t limited to the anti-abortion end of the ideological spectrum. At the other end, proponents of legal abortion in all cases without exception claim the intent of preserving bodily autonomy for females. With no laws in place to prohibit it, the effect of restriction-free abortion includes countless instances of the killing and dismemberment of a viable human fetus, done out of absolutely no medical necessity in a procedure no less invasive or traumatic than childbirth itself.

I understand abortion to be immoral, something for which I will never apologize. I also understand that policy-making is a complex and complicated process, and if it is to be done well, both sides will need to set aside their rhetoric, focus on reality, and work together to find achievable solutions to promote the health, welfare, and dignity of women and babies.

For those opposed to abortion, one positive step to making sound policy may be to understand and accept that stringent, simplified “life at conception” bills don’t make for prudent or practical legislating, no matter how difficult that is to consider. For those who favor abortion, a positive step may be realizing that any justification for an abortion evaporates as a fetus becomes viable, that late-stage abortion is a gruesome and harrowing procedure, and that law can indeed play a meaningful role in preventing it without derailing the reproductive rights of women.

Will both sides of the argument drop that rhetoric, which at times enters into the realm of absurdity and temper their passions into meaningful reform? I dare not hope too much. Though we may do so for different reasons, the pro-life and pro-choice believers can agree on one thing: Dobbs v Jackson hasn’t ended the fight over abortion. It has only reignited it. And it’s about to get very complicated.

Comments: 319-398-8266; althea.cole@thegazette.com

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