Muzzling abortion providers sets a troubling precedent

Diane Horvath-Cosper is an abortion provider. She’s also an unapologetic health care provider focused on offering the best care to her patients, using the latest evidence-based medicine, compassion, and sound medical practice. She’s the kind of doctor I’d want for myself, because she’s a good doctor. She’s also a very outspoken public advocate who talks frankly about her work and the importance of abortion access, which makes her even better, in my book — the stigma surrounding abortion is enabled in part by the silence when it comes to the subject, which serves to create a structure of shame about it. People who are providing abortions should be talking about their experiences (while retaining patient privacy) and stressing that it’s a routine medical procedure with minimal risks that greatly improves quality of life.

Obstetricians celebrate their successes, plastic surgeons advertise their cosmetic work on billboards, orthopedic surgeons develop innovative new producers for people with significant injuries that previously led to lifelong impairment. Medical advances are something to talk about, and the practice of medicine is also something worthy of discussion. Abortion care is medicine. Talking about it should not be a problem. Educating people about what abortion is and how it is performed should be akin to any other medical education — just as we encourage people to get STI screening and explain what to expect, or communicate information about cancer screening, we should be able to talk about abortion.

The thing is that abortion is a third rail, and talking openly about abortion can be extremely dangerous. Providers, support staff, and clinic personnel — along with patients and escorts — take risks whenever they show up at abortion clinics, and the appalling amount of anti-abortion violence in this country is escalating. We can thank a lot of things for that, including the Center for Medical Progress, the growing number of restrictions on abortion, and conservative rhetoric. People pushing back on that violence are important, and some of the people best primed to do that are physicians.

Which is why some abortion doctors talk about what they do and will not apologise for it. That includes people who perform complex abortions and those later in pregnancy, usually for patients who have experienced foetal death or medical complications so severe that a wanted pregnancy needs to be terminated in the best interests of one or both parties. Talking about something breaks down the unknown, challenges fear and shame and stigma. But it can also be dangerous, for providers who speak up are often subjected to threats not just to themselves but to their families and employers.

Which is why, MedStar claims, it was necessary to order Horvath-Cosper to stop talking about abortion, effectively putting a gag order in place if she wanted to continue providing services at the company’s Washington, DC facility. So she turned around and filed a civil rights complaint, arguing that the order breached her first amendment rights to freely express herself as a civilian — she’s not speaking on behalf of the hospital, she clearly separates her views and advocacy work from the hospital, and she has a right to talk about abortion, just as people who don’t want to hear about abortion have a right to not listen.

The hospital argues that this is for the safety of the facility and for the physician herself, but it seems like a convenient way to dodge controversy and a high public profile. Even when people make it clear that they are speaking only for themselves, and not their employers, there’s a tendency to assign associations to the people they work for. Many hospitals and medical clinics don’t want to be linked with abortion unless they’re in the reproductive health care field specifically and it’s central to the services they offer or provide referrals for if it’s not available at their facilities. Planned Parenthood physicians can talk about abortion and how it intersects with their work, but evidently employees of major hospitals are not supposed to.

Horvath-Cosper is a grown woman who knows the risks of being an abortion provider and the added risks that come with talking openly about it. She, like a growing number of abortion providers, has weighed these risks and believes that the benefits outweigh the dangers — that by speaking out, she is participating in a national conversation that needs to happen. That she is empowering patients by arguing for bodily autonomy and freedom of choice, for the right to terminate unwanted pregnancies and the right to access excellent abortion care when it becomes necessary to terminate a wanted pregnancy or deal with the aftermath of a miscarriage.

She is doing a bold but important thing by raising her voice, as are her fellow advocates from the medical field. The attempt to muzzle her is disturbing on its face, but also because it sets a dangerous precedent. It creates a dangerous precedent for other abortion providers who may find themselves faced with similar mandates from their employers, for example, and it raises the potential of a social and clinical framework where it is considered acceptable to tell care providers to refrain from talking about their work, which hinders medicine, science, and society. It’s the same framework that says we shouldn’t perform or talk about stem cell research, for example, despite the tremendous opportunities it offers. It’s the same logic that silences disability advocates in the medical field. It’s the same framework that unbalances bioethics committees, and it’s not acceptable.

Image: Your body is a battleground, Quinn Dombrowski, Flickr