The Least Bad Option

Dr. Walter Hern, one of the four remaining doctors in the country who will terminate a pregnancy after the 24th week of pregnancy.

Americans will declare war on almost anything. Like most nations in history, we declare war on other governments. But we have also made a habit of declaring war on ideologies (Communism, Islamic extremism), on broadly defined patterns of violence (terrorism, piracy), and even on abstract social ills (poverty, drugs). And then there are the “culture wars,” a lazy phrase that at one point served as a shorthand for the political agenda of the Christian right, but which has recently expanded to refer to any controversial topic that doesn’t involve tax brackets or firing cruise missiles into foreign countries. Guns, medical marijuana, zoning regulations, soda bans, physician-assisted suicide, rent-controlled apartments, Citibikes, and the Pledge of Allegiance all are part of the culture wars according to one respected commentator or another.

But there is one front in the culture war where the word “war” doesn’t seem like overheated rhetoric, where real bullets are fired and where real bombs are thrown: the struggle over the availability and scope of abortion. It's the hot-button social issue that stubbornly continues to divide Americans even as other bones of contention like recreational drug use and gay rights inch reliably towards liberalization. And the white-hot beating heart of the abortion debate—its bloodiest battlefield—is the question of late-term (i.e., third-trimester) abortions.

Late-term abortions and the forces arrayed for and against them are the subject of a wrenching new documentary, After Tiller, which opens in New York later this month. The film profiles the four remaining doctors in the United States who perform late-term abortions, all of whose lives were touched in one way or another by George Tiller, the Kansas-based, late-term abortion provider gunned-down by an anti-abortion extremist while attending Sunday church services three years ago. In the aftermath of Tiller’s slaying, Randall Terry, founder of the antiabortion group Operation Rescue, called Tiller a “mass murderer” who “reaped what he sowed.” Despite widespread condemnation, the killer got what he wanted: late-term abortions are no longer available in Kansas. Residents now must travel 500 miles to Denver for the procedure.

After Tiller isn’t formally inventive, and its directors, Martha Shane and Lane Wilson, don’t appear to have been tempted by the many gimmicks in the documentarian’s toolkit. The film is better for it. What the viewer gets instead is a sequence of raw and intimate portraits—filmed dead-on and without intrusive narration—of women struggling to make what will in all likelihood be the hardest decision of their lives. As with many great documentaries, After Tiller can make for excruciating viewing at times, but you’ll be glad you saw it, not least because it takes you to a place that the camera seldom visits.

In the 40 years since Roe v. Wade was decided, tens of millions of women have had some form of legal abortion, and it is a rare few months that pass without some controversy over access to abortion creating national news. Yet most films and novels and nearly all television programs depict abortion-free worlds, where unwanted pregnancies almost never occur, and if they do they are carried to term with little acknowledgement of a legal and safe alternative. Nor do our public figures seem eager to discuss the abortions in their lives, or the lives of their loved ones. After Tiller shines a gentle light onto this much-discussed but still unmentionable topic, taking us inside the consultation room, where we are given searing glimpses of the fear, anger, sadness, and self-doubt, but also relief and hope, felt by women who seek abortions after the 24th week of pregnancy.

Dr. Susan Robinson. Photos courtesy of Oscilliscope Laboratories.

What After Tiller makes beyond clear is that a late-term abortion is never a happy event or an easy decision. Although the camera doesn’t reveal the faces of the patients, we hear their anguished voices and see their trembling hands, which hover anxiously over swollen bellies. Each story is an intensely private tragedy, of a kind that often unfolds secretly, hidden even from friends and family. It’s hard to say which patient’s situation is most harrowing, but they will all break your heart. In one consultation, we hear a couple inform the doctor that their baby has been diagnosed with a lethal condition which will doom him to a very short and very painful life, full of shunts and seizures. “This was not an unwanted pregnancy,” the mother says, muffling sobs, “it’s guilt no matter which way you go.” In another, a woman whose fetus has been determined to be severely retarded tells the doctor she wants to be able to spend time with the body of her stillborn baby after the procedure. In a third consultation, a woman makes an unconvincing promise to her doctor to report her rapist to the police.

The gravity of the decision to abort is not lost on the doctors profiled in the movie. If there is a second lesson in After Tiller, it is that being a late-term abortion specialist carries extraordinary risks and emotional burdens that far exceed the material rewards of the profession. All of the doctors in After Tiller are animated in one way or another by a powerful belief that the work they do is vitally necessary, and that many women would come to great harm were they to give in to intimidation. The four physicians—two men, two women—continue their work despite being at or near retirement age, and despite knowing that there is little that can stop an extremist with murderous intent. Linking them all is a deep grief for Dr. Tiller, whom they all knew both as colleague and friend.

Beyond those commonalities, the four physicians profiled in the film offer a study in contrasts. At one side is LeRoy Carhart, a gruff and defiant Air Force veteran who for many years operated an abortion clinic in Nebraska despite death threats and physical attacks on his property. At the other is Shelley Sella, a soft-spoken gay woman who openly agonizes about the difficulty of her work, observing at one point that “unless people understand what’s going on for the women, it’s impossible to support” late-term abortions. Somewhere between them is Susan Robinson, Dr. Sella’s colleague (the two run a clinic in Albuquerque), whose buoyant disposition is often weighted down by the heavy decision of whether or not to accept a patient. Finally, there is Walter Hern, a former obstetrician and Peace Corps volunteer whose path to providing late-term abortions began during a stint in a Brazilian hospital, where he saw that the number of women hospitalized as a result of self-performed abortions outnumbered those in the maternity ward two-to-one. Each of these four individuals approaches his or her practice with a different mixture of resolve, resignation and fear.

After Tiller

is openly sympathetic to its subjects, and makes no pretense of engaging with abortion opponents, whose presence in the film is limited to shots of praying protesters and clips of scary speeches in churches and halls of government. In that sense, the film can’t be called balanced. But

After Tiller

provides something more important than balance, which usually serves to placate audiences more than move them. That something is intimacy—three-dimensional portraits of individuals struggling to select the least awful choice from among a set of terrible choices. In this respect, Shane and Wilson are more peacemakers than culture warriors, and one can hope that their film will help prevent another murder like the one that took Dr. Tiller.

Related:

Talking About My Abortion

The Abortion Freedom Riders

Why Telemedical Abortions Are the Wave of the Future