The Wall Street Journal - February 9, 1996
William Saletan

The controversy that has finally clarified this paradox and forced it onto the national political stage involves a particular category of late-term abortions. Pro-life strategists have dubbed them "partial-birth" abortions. At their most grisly, they involve the extraction of the brains of a fetus so that its head, still joined to its body, can be removed through the birth canal. Congressional Republicans will soon pass and send to President Clinton a simplified version of a bill to ban these abortions. Senate Majority Leader Bob Dole has made it an issue in his campaign against Mr. Clinton.

Two months ago, when Republican Sen. Bob Smith of New Hampshire stood up on the Senate floor to lead the charge for this bill, officially known as the Partial Birth Abortion Ban Act, he described these surgeries as "brutal," "savage" and "barbaric." He implored his colleagues: "How could we possibly stand by in this country and let this happen?" Mr. Smith decried the "irony" of liberal senators refusing to intervene to protect the lives of children. Numerous fellow Republicans rose to concur.

But the irony went both ways. A week later, when it came time to intervene to protect the lives of children in Bosnia, Mr. Smith and his colleagues balked. Opposing the deployment of U.S. troops, Mr. Smith lamented that innocent civilians had been "butchered" in Bosnia but insisted that America should "sit this one out." "It's a terrible tragedy," he conceded, but that alone was not sufficient reason to risk the safety of American soldiers. "Is it something that those men and women should die for?" he asked. "They are the ones who will be in harm's way . . . while we stand here on the floor of the Senate, debating."

The paradox comes down to this: On abortion, Republican lawmakers demanded life-saving intervention at any cost; on Bosnia, they declared that the cost of such intervention was too high to impose, from a comfortable distance, on the men and women directly involved. Liberal critics like to view the GOP's position on Bosnia as a betrayal of its pro-life rhetoric about abortion. But maybe the lesson is just the reverse. Maybe what conservatives need to bring to the abortion debate is the unromantic sobriety, the cold calculus of life and death, that has governed their responses to Bosnia and other quandaries.

One of conservatism's deepest and most enduring themes is a bitter respect for tragedy, for dilemmas in which no course is free of death or great suffering. Often, conservatives have served us well by puncturing illusions about the technical or moral ease with which our problems can be resolved. They remind us that sometimes nature, limited resources, or human weakness or aggression compels us to choose between bad and worse.

During the Cold War, Barry Goldwater and Ronald Reagan admonished us that armaments and even warfare and death were the unfortunate price of defeating totalitarianism. More recently, when AIDS activists have demanded more federal money for AIDS research, conservative critics have pointed out that many of those dollars would be diverted from research on other fatal diseases.

On the major issues that confront Congress today -- welfare, Medicare, Bosnia, tort reform, environmental deregulation -- conservatives have consistently argued that tragedy cannot be abolished. Not every Bosnian child can be saved by American soldiers. Not every toxic substance can be cleansed from our communities. Not every injured party can be fully financially compensated. Republican strategist Bill Bennett concedes that some children may perish under conservative welfare reform but reasons that the "body count" will be lower than under the current welfare system. Conservatives point out that we can't drown our children in debt to guarantee our elderly, through Medicare, an absolute right to life and health.

It's no coincidence that pro-life activists have quarreled with the GOP on many of these issues. These activists spurn the cold logic of the body count. They have repeatedly warned that Republican cuts in welfare will imperil poor children and induce desperate women to abort their pregnancies. Likewise, the National Right to Life Committee has cautioned that Republican schemes to steer Medicare patients into managed health care might precipitate "involuntary euthanasia" of the impoverished. By and large, the antiabortion movement rejects the very concept of tragic choice. It insists on saving life at any cost. In this respect, it belongs more to the left than to the right.

No one can deny the horror of late-term abortion. It kills a fetus that is considerably formed. At its ugliest, in the case of a "partial birth" (known among its practitioners as an intact dilation and evacuation, or IDE), it may involve scissors in the fetus's neck and a catheter to extract its brains. There is only one good excuse for it: The alternatives are even worse.

Pro-life activists and lawmakers insist there is always a better alternative. They argue that "partial birth" abortion is often chosen casually. Their best evidence for this claim comes from statements by Martin Haskell and James McMahon, the two American doctors known to have specialized in the procedure.

Dr. Haskell has classified four of every five abortions he performs between the 20th and 24th weeks of pregnancy as "purely elective." It is possible that some of these abortions involved maternal defects, since Dr. Haskell applied the term "elective" to every abortion that did not involve a genetic fetal anomaly. In any event, none of his abortions occurred in the third trimester. Dr. McMahon, who has since died, listed maternal depression and cleft fetal palate among his reasons for performing IDEs. But, again, it is unclear whether other problematic factors were involved in these pregnancies. Dr. McMahon's widow, who assisted him as a nurse, has denied that he performed any IDEs "on women who just don't want to have the child for one reason or another."

There is no evidence that a "partial birth" abortion has ever been performed on a presumably viable fetus in the U.S. except to protect the woman's life or health. Roe v. Wade allows states to outlaw late-term abortions with those exceptions, and 41 states have done so. In fact, only about 600 third-trimester abortions are done in this country each year, and no one knows what fraction of these are IDEs. Even the National Abortion and Reproductive Rights Action League has explicitly affirmed that "women should have [late-term abortions] only when they are necessary to protect their lives or health or when they face grave fetal abnormalities."

In that spirit, Sen. Barbara Boxer (D., Calif.) tried to amend the Partial Birth Abortion Ban Act to allow abortions that a doctor deems necessary to "avert serious adverse health consequences to the woman." Pro-life lawmakers and activists rejected this compromise. They charged that doctors would interpret the "health" exception to allow abortions for trivial reasons. It is an odd complaint, given Dr. McMahon's outspoken anguish at being forced by complications of pregnancy to destroy what he repeatedly referred to as an unborn "baby."

The Boxer compromise does not address abortions late in the second trimester, about which there are legitimate questions of abuse. Recent articles about the few clinics that specialize in such abortions indicate that many teenagers end up seeking them simply because they have denied or concealed their pregnancies. No one knows whether the "partial birth" procedure is being used in such cases unnecessarily, but if it is, Naral President Kate Michelman agrees that doctors should develop "guidelines" to restrict it. "Let the medical profession deal with this, take it up," she proposes. "Get OB-GYNs, get the medical ethicists to look at the complicated nature of these questions."

With the defeat of the Boxer compromise, the Partial Birth Abortion Ban Act will arrive on the president's desk lacking an allowance for serious health risks. Sen. Smith refuses to worry about this, insisting that Congress found no evidence "that the partial-birth-abortion procedure is ever necessary to save the life of the mother." Such naivete defies the medical record and the conservative tradition. Nature can be cruel. Sometimes a fetus's brain develops outside its skull. Sometimes its head swells from a lethal accident in the womb. The child cannot be saved from imminent death, and compressing its head is, for the woman, the safest way to remove it. As Sen. Smith observed in another context: It's a terrible tragedy, but is our clumsy attempt to abolish it worth risking the safety of American women? They are the ones who will be in harm's way, while he stands there on the floor of the Senate, debating.

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Mr. Saletan, a contributing writer to George magazine, is the author of a forthcoming book on the politics of abortion.

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