I had dinner tonight with two Canadian colleagues, and near the end of dinner (after regaling each other with the usual gynecologic surgery “war stories”), somehow the topic of abortion came up. For starters, unlike some experiences I’ve had with gynecologists in my own country, I was not shunned nor was the conversation suddenly uncomfortable for the other physicians. Even better, I was told that in Canada, there are simply no laws regulating abortion; none whatsoever. Instead, it is considered something outside of the legal and legislative domains; it is a matter between a woman and her physician. 

Amazing. This was literally one of the few times I didn’t feel slightly ill at ease when talking about one of the most common gynecologic procedures with my fellow gynecologists. Usually someone looks at me when the subject comes up and says something to the effect of “Oh David, do we have to talk about that?” or “Mind you, I’m ‘pro-choice.’ Really. But I don’t do voluntary interruptions of pregnancy; they’re kind of associated with a certain reputation.“ Or else they just stop talking and politely find an excuse to walk away. These folks never mention the ”a-word.“ Every medical euphemism gets used instead: ”voluntary interruption of pregnancy,“ ”VIP,“ ”elective terminations.“ But never the word ”abortion.“ I think I have a scarlet ”a“ on my forehead, even a decade after stopping clinical practice altogether.

So it was refreshing that up here they wouldn’t interfere with the most private decisions, indeed some of the most difficult decisions, a woman makes in conjunction with her physician. They don’t determine, for example, when a fetus becomes a person. They also don’t legislate moral and religious questions such as when does life begin, questions that lack sufficient medical or scientific answers.

In a week when the Republican candidate can’t recall his previous vote against requiring insurers to pay for birth control (when they already cover Viagra) and then claims to not have thought about the issue at all, and a week when my candidate inexplicably claims that second-trimester abortion can be restricted by states when the indication is ”mental distress,“ it’s refreshing to be in a country, albeit temporarily, that at least recognizes that women have brains and should have control over their bodies.

Barack, just between you and me: my family and I are volunteers for your campaign in the Philadelphia suburbs. I am about as strong an Obama supporter as you’ll ever see. But with all due respect, what were you thinking? States should be able to prohibit second-trimester abortion unless there is a physical disorder that would result from the pregnancy?  I get it…you’re trying to pick up some right-wing voters. But good luck with that; they don’t trust you on abortion and probably never will. Worse: some of us progressives are now questioning your commitment to our issues in light of your FISA vote, your comments on abortion, and your sudden support for faith-based initiatives. Going to the center during the general election is one thing, but going into Rush Limbaugh-ville is scary. 

For starters, please stop using the phrase ”late-term abortion.“ There is no such medical term. A term pregnancy is 37-42 weeks in gestation. So isn’t late-term what we would usually call ”post-term pregnancy,“ namely 42 weeks and above? We don’t do abortions at that point. I don’t think I’ve done one above 20 weeks personally, and know of very few folks who do them even at 28 weeks (and those few generally do them in cases of severe fetal defects incompatible with normal life). Also, for anyone to suggest that a woman wakes up one morning at 24 weeks of pregnancy and decides then that ”What the hell, let’s go have an abortion” is both insulting and ridiculous at the same time. When we use the term “acute situational anxiety of pregnancy” as an indication for abortion, we’re talking about women who, after a complicated and very difficult decision process, clearly indicate that their lives would be abnormally and unduly burdensome due to a pregnancy. We’re not talking about a temporary inconvenience that some women are callously avoiding, much like the way that Corporal Klinger tried to avoid being in the military on M*A*S*H by faking a gender disorder. We’re talking about much more than that. To say that “mental distress” should not justify a second-trimester abortion is not within your purview as a presidential candidate, as an attorney and legislator, and most importantly, as a non-clinician.

I expect McCain to say something ridiculous vis a vis women’s rights, like trying to duck the fact that he voted down legislation to compel insurers to fund contraception. I expected Barack Obama to be much more sensitive to the rights of women when they are faced with an unexpected and undesired pregnancy, much like how I expected Obama to stand up for privacy rights and against the telecommunications companies that colluded with the Bush administration to spy on private communications. I’ll still vote for you and will of course continue to vigorously volunteer for your campaign as much as I can with limited free time. But please don’t disappoint me again. Do I have to visit Canada to encounter a more advanced attitude towards women? Can’t I at least expect this attitude in my own country as part of the change I can believe in? Right now I’m tired, and am not sure what to believe anymore.