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No Choice for Doctors

By Sarah Jacoby

Abortion doesn't come up in daily conversation very often. Every once in a while there is a flurry of abortion debates in the media. After the murder of yet another abortion doctor everyone pipes up with opinions, whether it be dismay or glee. When University Health Services' rather innocuous policies were revealed, a handful of students expressed different sentiments.

But in general the topic goes untouched. And why not? It is not a particularly pleasant subject to discuss. Nobody is a fan of abortion; it is only that some, myself included, believe in the necessity of choice. But who wants to talk about abortion and open a moral can of worms? So it is rarely mentioned; and until someone is shot through their window, I am complacent about my freedom of choice.

An article published last January in The New York Times Magazine raised an often overlooked question about abortion: Though abortion is technically legal, are there enough doctors who can perform abortions?

According to the article, 59 percent of all abortion doctors are at least 65 years old. Two-thirds of the doctors who perform abortion are beyond legal retirement age. Where is the new generation of doctors? Why are there so few younger doctors performing abortions?

There are some easy answers. As the death rate of abortion doctors sky-rockets, young doctors may be thinking of self-preservation. Others may have religious or ethical issues with abortion and thus choose not to perform them.

But regardless of whether doctors prefer to perform abortions, a procedural knowledge should be part of any doctor's repertoire. After all, as older doctors explain in the article, safe abortions can prevent women from taking desperate measures, such as illegal and dangerous abortions. Knowledge of life-saving techniques is a doctor's job. Though each doctor will personally decide what to specialize in and whether to perform abortions, it should be expected that in a pinch they can perform most common surgical procedures.

So do these younger doctors know how to do abortions, even if they don't like to? Standard medical procedures are taught in medical school, and then skills are put into practice during a residency period at a hospital. Even if a doctor chooses to specialize in brain surgery, he or she should have learned about abortion techniques in medical school.

However, states the article, in some schools abortion is taught only as an elective. At others, it is not even taught. Medical school students are often not required to learn how to do abortions, and must take on an additional workload if they want to learn. Your neighborhood practitioner, who should have a knowledge of most basic surgical procedures, could easily not know how to do an abortion.

What is the policy on teaching abortion at Harvard Medical School? Undergraduates who are applying to medical school may not be concerned whether they will earn how to perform abortions. But for those of us who are interested in upholding the law, this is a crucial issue Bill Schaller, a public information officer at the Medical School, explains that the required Obstetrics-Gynecology rotation includes training in abortion, which is a "legal and necessary" technique.

However, according to Schaller, "any student who for whatever reason has a concern, be it moral, ethical or religious concern about an academic program, is encouraged to talk to an advisor." Though each student's objections are considered on a case-by-case basis, students who have "concerns" can technically opt out of any course. Schaller had no information as to whether other students opt out of procedures other than abortions.

In theory, abortion is not given special treatment. If a young medical student feels a little squeamish learning about open heart surgery, he or she can speak to an advisor and be excused from class. It seems implausible that someone can graduate from Harvard Medical School skipping a variety of classes based on different moral, ethical, religious objections.

But this is the problem. Students would not opt out of open heart surgery. They are, after all, at medical school because they want to be doctors. There seems to be no procedure comparable to abortion, a technique students are strongly morally averse to. Setting broken bones, hysterectomies, removing malignant moles--on what grounds would anyone be interested in avoiding learning these topics? Regardless of medical students' personal beliefs, a medical school is obligated to teach medical procedures. Even if the medical school's official policy legitimizes all concerns about any courses, it is hard to think of anything besides abortion that a student could be exempted from out of respect for their beliefs.

Though Harvard does include abortion as part of the regular required courses, the loophole of "concerns" makes me concerned. Whether doctors feel uncomfortable performing abortions, and whatever they may choose to specialize in, it should be expected that someone who has attended medical school will know how to perform common and relatively simple surgical procedures.

In order to protect a right to choice, doctors must know abortion techniques. If nobody knows how to perform safe abortions, what the law says is irrelevant, and my complacency is certainly ill-advised.

Sarah B. Jacoby '99 is a history and science concentrator in Mather House. Her column appears on alternate Mondays.

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