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So it should not be surprising that discussion of a federal ban on "intact dilation and extraction" should produce divisions along several lines among physicians at the AMA House of Delegates meeting in Chicago.
Many physicians questioned the use of the procedure known colloquially as "partial birth abortion," but expressed anger about what they perceived as the AMA's acquiescence to the criminalization of a procedure and government intrusion in the physician-patient relationship.
Others, including gynecologists who perform abortions, said the procedure was not defensible. "If we can't say no to partial birth abortion," said one member of the American College of Obstetricians and Gynecologists, "we can't say no to anything."
Still others, distressed about both the procedure and "The Partial-Birth Abortion Ban Act of 1997," argued that to rescind the AMA board's endorsement of the legislation would irrevocably damage the medical association's political credibility.
"The bill is terrible; so is the procedure," said Charles W. Plows, M.D., chair of the AMA's Council on Ethical and Judicial Affairs. "But it would be a disaster" if the house rescinded the endorsement, he added.
APA's delegates to the "house of medicine" wrestled with their own concerns about the issue.
In accordance with APA policy and at the direction of APA President Herbert Sacks, M.D., both delegates_Jerry Wiener, M.D., and Joseph T. English, M.D._cast a voice vote in opposition to the board's endorsement of the Santorum legislation.
But it was Sacks who went to Chicago to speak for APA, in deference to the delegates who had expressed reservations about opposing a ban on "intact D and X."
Sacks told APA's Board of Trustees following the meeting that his decision to speak on behalf of APA and in support of its policies followed extensive consultations with ethicists, obstetrician-gynecologists, and relevant constituencies within APA, including the Committee on Women and individual women leaders in the organization (Psychiatric News, July 4)].
"I made my own judgment to specifically instruct the delegates that they should vote in favor of rescinding the AMA Board of Trustees action on the Santorum bill," Sacks told APA Trustees, and he thanked English and Wiener for their duty to the Association.
English, who has openly declared his opposition to abortion, hailed Sacks for making efforts to ensure that delegates could follow the will of the Association's policies "without conflicting with our own matters of conscience."
English also saluted fellow Board member Diana Dell, M.D., a board-certified obstetrician-gynecologist and a senior resident in psychiatry, who was one of the leaders of the movement to rescind the AMA board's endorsement of the Santorum legislation.
Following the AMA meeting, Sacks told Psychiatric News that he believes the Santorum legislation is a first step in reversing the 1973 Roe v. Wade decision.
"The delay in moving the bill to the White House is seemingly calculated to gain conservative support to make the bill veto-proof," Sacks said. "Importantly, that delay will in all likelihood make the bill a divisive election issue in November."
Wiener, during the APA Trustees meeting, reminded colleagues that the Roe v. Wade decision has established that the state has an interest in the life of the fetus once it is deemed viable.
"There are a number of states that have already enacted legislation much more draconian than what the AMA [endorsed]," Wiener said. "The question becomes: Does medicine maintain a position that any legislation is absolutely unacceptable. . .or will it step in and try to modify that legislation to make it as acceptable as possible?
"This issue is going to continue" to demand a response from physicians, Wiener said. "It is not resolved."
(Psychiatric News, July 18, 1997)