Saturday, July 22, 2017

Willie Parker's 'Life's Work' is informative as a physician's perspective on abortion

Dr. Willie Parker has released a great new book in 2017, Life's Work, that describes his experiences as an abortion provider, his formative years, and the evolution of his personal beliefs as a Christian. He grew up in poverty not knowing who his father was, and his sister became pregnant as a teenager. Initially a hardliner on the subject of sexuality, he negatively judged girls and women who had sex outside of marriage and he refused to perform abortions. But as he continued his medical studies, he came to realize the value of personal autonomy to make this decision. This was so important to him that he gave up a penthouse apartment in Hawaii whose wide windows looked out over the Pacific and he moved back to the South so he could help communities who needed a competent, dedicated abortion provider. In Life's Work, he eloquently describes a wide range of issues related to working in an abortion clinic without shying away from the challenging parts.

He shares a compelling picture of what women go through:

"Every woman sitting in one of the high-backed chairs in the Montgomery clinic has missed a menstrual period. She has peed on a stick at home or in a public restroom or at a friend's house or in a dorm and seen the result; in a flash she has had to digest how a new child will alter the future she imagines for herself. She has had to decide who she can confide in and who will judge her or disapprove and thus needs to be lied to or kept in the dark. She has confronted whatever private thoughts and yearnings she may have about her vision for her life, including deeply held and possibly heretofore unexamined ideas about professional fulfillment, love, parenthood, and God. She has had to consider the sometimes viselike practicalities that circumscribe her days: school schedules, work demands, the responsibility of caring for other children or ailing relatives, the reliable and supportive presence — or not — of the person whose sperm entered her body more than six weeks ago, her financial circumstances, her age, the limits of her own health. By the time a woman is sitting in a clinic awaiting my attention, her intention has been focused and clarified. She has figured out how to scrape together $550 if she's six weeks pregnant, or as much as $1,400 if she's further along. She has had to be true to herself, despite the fact that her decision process has been disrupted and corrupted by these new state laws requiring her to be 'counseled' — by me, a credentialed doctor, or a psychotherapist — in a ginned-up 'protective' encounter that often passes along to these women false or biased information about abortion disguised as scientific truth.

* * *

To the point: A woman who wants to terminate her pregnancy has to make her decision in the context of a culture that shames her and, increasingly, within the constraints of laws that dramatically inconvenience her. They demean her humanity by presuming to know better than she does what her best interests are. They limit her access to clinics and doctors and they convey to her false information. The underlying assumption of all the new laws is that women can't be trusted to make their own health decisions; their doctors can't be trusted to tell them the truth; and scientific knowledge must be subverted in the name of religious truth. I strictly abide by these laws, which I believe violate human freedom, because my first priority is to continue to be able to provide abortions. If I break the law out of frustration or fury and get put out of business, the antis win." (pp. 8-9)

Later in the book, he does complicate this picture by mentioning that some women who enter his office do not yet know what they want, often because they are being pressured by someone, and some women are mistaken about how advanced their pregnancy is.

He also talks about what he goes through as a provider:

"But at that early hour, sitting in my car, sometimes around dawn, I am infuriated that I, who am in my fifties, gray-bearded and entirely bald, a physician with a medical degree from the University of Iowa and a master's in public health from Harvard University, have to do a version of a perp walk in order to enter my own place of work. And I am aware that, even though the intention of these protesters is to throw sticks, not stones — the truth is, you never know. One of them might come unhinged at any moment; any one of them might be carrying a gun. (p. 6)

How his understanding of race informs his understanding of abortion

Women's autonomy is important to Dr. Parker in part because of his awareness of the collective trauma of African-Americans not being allowed to make their own decisions about their bodies since the days of slavery. As he describes it:

"'William James, I'm sure glad you came to see me,' Miss Lula said to me as I sat by her bedside. 'Lord, Lord, Lord, I wish people could see you now. So many people said you were never going to be nothing.' And I realized then that, even though I was considered smart and even though I was 'a good boy,' the people who loved me were betting against me because of the circumstances in which I was raised. Now that I have brought all that I was and all that I've learned back to the communities of my youth, I can truly relate to my patients: I understand how being poor and coming from a racially stigmatized group can threaten your sense of self-determination and agency. The women who come to me for abortions are choosing a path different from what others would script for them." (p. 73)

"I am not the first person to say or think this, but having returned in my adulthood to make my home in the South, it is impossible not to think constantly about the analogy of the limits on women's reproductive rights to slavery. As an African American man descended from slaves and raised in the South, it is too easy for me to imagine what it's like to have no control over your body, your destiny, your life. Less than two hundred years ago, white men owned black people's bodies, and the southern legislatures that represented those white men's interests protected their right not just to buy and sell humans as they passed but also to own the babies the black women carried, even before those babies were born. White men maintained jurisdiction over black women's bodies, in that they owned them and took possession of their babies. Insofar as abortion access is limited, this abuse of power extends to all women. I believe that the men who are passing the laws that limit medication abortion want to control women's bodies, which is not so far from wanting to own them outright." (pp. 107-108)

"But no matter what brought them here, they do not deserve to bear the brunt of a culture's historic and dysfunctional shame." (p. 14)

What is sacred and miraculous?

He identifies as a Christian, but his value system around abortion is based in science and liberalism. As a physician, he maintains that the fertilization of sperm and egg is a natural process. It's not a miracle; a miracle would be an event that intervened in this natural process. As someone who grew up in a neighborhood where parenthood was something that just happened, he sees parenthood as a fact of life. What is sacred to him is an individual woman's freedom of choice, the way in which she consents to become a parent (or not), and the medical skills he has cultivated to support women in their choices. His approach is humanistic: People decide what is sacred. The implication is that we have to listen to each other and respect each other's choices to a large extent. When he calls his clinic a "judgment-free zone," he means he sets aside his judgment and defers to the woman's judgment. He feels that women should focus on their own choices and not be holier-than-thou about their parenting choices or their abortion choices when they look at other women. He understands that these are life decisions and behaviors to which women give careful thought and place a lot of stake on a good outcome, and he would like his patients to understand that people may have different psychological experiences of their abortion and may express their feelings differently and that they should all be taken seriously and should not be invalidated.

"I do not engage in or perpetuate any of the culture's sentimental notions about the primacy of motherhood in women's lives; I regard the meeting of sperm and egg as a biological event, no less miraculous but morally and qualitatively different from a living, breathing human life, imbued with sacredness only when the mother, or the parents, deem it so." (p. 13)

"Who enables the desperate isolation of the women of Mississippi? In part, it's liberal women with children who themselves became enraptured with the sonogram images they saw at the obstetrician's office and who wept when they heard the fetal heartbeat. Especially when I travel in upscale, liberal circles I see a fetishization of motherhood and children that I don't quite understand, a universe away from the hardscrabble world in which I grew up. This sacralization of motherhood in every sector of the privileged classes enables a widespread social conservatism that, at base, diminishes women's liberty: a consensus that motherhood is a woman's most important role. When a society tacitly agrees that a morally neutral, biological process — procreation — is 'miraculous,' then any intervention in that process can be seen as desecrating, and any choice against motherhood will be met with widespread disapproval. (In the churches I come from, a 'miracle' is God's intervention in the natural order of things — an ability, say, to turn a flask of water into wine or one loaf of bread into many. The way I see it, through a doctor's eyes, there is perhaps nothing on earth less miraculous or more ordinary than the animal process of human procreation, which was happening long before the Bible was written and will continue long after today's newborns are dead.) But among the elites, the same people who write checks to Planned Parenthood, the whole enterprise of parenthood has taken on a hothouse aspect, which allows a blurry consensus about the 'sanctity of life' to flourish — instead of a clear-eyed definition of what 'life' really is. Mommy blogs, conversations about 'having it all' and 'helicopter parenting' — all contribute to a cultural neurosis around motherhood that obscures what ought to be a value-free choice. A cultish preference for motherhood is so embedded in culture that even well-meaning women reflexively judge one another for their reproductive choices. Now a 'broad-minded' woman may be heard to disapprove out loud of her sister-in-law's abortion ('She could afford another baby!'), or to privately judge her friend's decision not to have children as 'selfish.' The truth is that there is no intrinsic moral value to becoming a mother or not becoming one. A woman who pursues a pregnancy is merely prioritizing her life around motherhood. And a woman who has an abortion is prioritizing her life around not wanting to become a mother or around devoting herself and her resources to the children she already has. Homo sapiens will continue to reproduce and evolve, with or without any individual woman's participation in that process. (p. 178)

"In the abortion clinics where I work, I try to cultivate compassion — not just in myself, but among the staff and even among the patients themselves, who meet in my waiting rooms having come from all different walks of life and whose pregnancies and abortion decisions mean something different to each one. I have zero tolerance for women who judge one another or who presume that their abortion, and their circumstances, are somehow more stressful or more extenuating than anyone else's. I remember a lawyer who came to see me in Montgomery. She was well educated and charismatic. But as she lay on the table, she began to complain about the irreverent jokes and wisecracks that the other patients were making as they sat, stressing, in the waiting room, drinking soda and eating chips. She said, 'Don't they know that this is very difficult for some of us? Can't they show some respect?' And though I didn't show it, I got angry, because no one is entitled to sit in judgment of others, no matter their education, their status, their station, the circumstances that led them through our doors. She wanted her abortion to be sacred, and more, she wanted others to express their feelings in a way that was compatible with her sensibility. Well, all of this — the procedure, every woman in the waiting room, the nurses and aids and administrators who provide this excellent care, my own hard-won skill — is sacred to me. When she wrote a letter to complain of the atmosphere in our clinic, I was unmoved." (p. 202)

"If God is wholly Other, then the miracle of life is not some ordinary meeting of sperm and ovum — a morally neutral, purely biological event — but the agency and responsibility that come with being able to participate with God in a creative process. God is not human. God is not on the planet. God does not have babies, or make babies. People do. As part of a greater intelligence, as a lover of beauty and creativity, God made the world. And sexual reproduction is part of a collaborative process — between a male and a female and between God and humans. In that process, all distinctions disappear. God has no hands but your hands. God has no ability but your ability. That is what the Bible means when it says that you are God's child.

And if you look at it that way, if you set aside the idea that God is like Siri, telling you to go left or to go right, then the whole business is sacred. All of it. A pregnancy that intimates a baby is not more sacred than an abortion. You don't become sacred, like Mary, just because you conceived, and the termination of a pregnancy is not the resolution of an error. It is merely one of the reproductive outcomes. So is miscarriage. So, now, is surrogacy and in vitro fertilization — all these are on a continuum and they all hold moral weight. The God part is in your agency. The trust — the divine trust — is that you have an opportunity to participate in the population of the planet. And you have an opportunity not to participate. Is God vested one way or another in whether you, as an individual, become pregnant? No. Is a pregnancy sacred because there will be a baby, ultimately, in a bassinet, beautiful, maybe the next Obama? No. The process is bigger than you are. The part of you that's like God is the part that makes a choice. That says, I choose to. Or, I choose not to. That's what's sacred. That's the part of you that's like God to me.

The procedure room in an abortion clinic is as sacred as any other space to me, because that's where I am privileged to honor your choice. In this moment, where you need something that I am trained to give you, God is meeting both of us where we are. (pp. 211-212)

If you think this is fascinating or challenging, you should buy this book and consider the meaning and implications of this — not only for one's views on abortion, but for one's overall worldview.

Book

Dr. Willie Parker. Life's Work: A Moral Argument for Choice. New York: Atria, 2017.

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