Medical marvels from test-tube babies to viable infants weighing barely more than a pound will take center stage Wednesday when anti-abortion lawyers argue that the U.S. Supreme Court should throw out the 1973 Roe v. Wade decision and replace it with a ruling that would outlaw or limit a woman`s right to terminate a pregnancy.
Since the historic Roe case was decided, medical science has vastly improved the odds that a premature baby weighing less than 2 pounds will survive.
Using ultrasound devices that make fetal television images, physicians can diagnose and sometimes even tral rights.
Reproductive technology has changed so much since Roe that the thinking behind that decision is irrelevant, according to the argument planned by lawyers for the State of Missouri, whose restrictive law is the subject of the current case before the Supreme Court.
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But technology can be a two-edged sword. A new class of abortion pill now being used experimentally outside the U.S. could make much of this week`s debate irrelevant in coming years.
The feeling that technology is changing the face of the abortion debate was given impetus by Justice Sandra Day O`Connor, who wrote in a dissent from an earlier abortion ruling that the Roe decision is ”on a collision course with itself” because science is pushing the point of fetal viability
”further back toward conception.”
But is this really true?
Antiabortion lawyers will focus on medical successes in saving the lives of tiny babies born at 24 weeks, three months before the end of the normal nine-month gestation period. A respected and successful new medical subspecialty to save premature infants, called neonatology, has developed in the last two decades to utilize advancing technology.
Most medical authorities agree that babies who weigh about 1/2 pounds and have been developing in the womb for 24 weeks or more can be saved by intensive modern medical care about 25 percent of the time.
When Roe was decided, such premature infants were very rarely saved, a fact that played a role in the Supreme Court`s concept of trimesters-dividing a pregnancy into three periods of three months.
The high court provided different rules for permitting abortions during each trimester, the requirements becoming more stringent as pregnancy progressed. Jerry Short, a Missouri assistant attorney general, said his office will argue that modern technology can now save babies that would have been hopeless in 1973.
”We`re arguing that the whole concept of trimesters is outdated, and that all of Roe should be reconsidered,” Short said.
However, this part of the technology argument mounted by abortion opponents is focusing on only a tiny minority of the abortions performed in the United States.
Fewer than 1 percent of all abortions in the U.S. occur after 21 weeks of gestation, according to a study for the Alan Guttmacher Institute, said Susan Tew, a spokesman for that private reproductive research organization.
”Virtually all these late abortions are performed to save the mother`s life,” Tew said. ”More than 90 percent of abortions are performed in the first trimester.”
Moreover, whether technological changes since 1973 should make an impact on abortion law seems to be more a matter of philosophy than science. Many more tiny premature babies are being saved now, but there still isn`t much hope for those who have been in the womb less than 24 weeks-nor does hope seem close at hand.
The developing lungs, kidneys and other major organs of a human being are simply too immature before 24 weeks to sustain life outside the womb, these advocates will argue. And so far, at least, scientists would agree with them. Most progress in saving the lives of premature infants stems from improved techniques for feeding and from around-the-clock electronic monitoring that alerts nurses to any problems-such as breathing difficulties, the big killer-as soon as they arise, according to Dr. Craig Anderson, chief of neonatology at Loyola University Medical Center, near Maywood.
Another factor is the array of high-technology medical equipment available to monitor the fetus within the mother`s womb. When doctors see that a fetus is in distress, they will transfer the mother from a community hospital to a major medical center with an advanced neonatology unit, and then induce labor.
At present, Anderson said, an infant delivered earlier than 24 or 23 weeks after conception probably won`t survive. Despite medicine`s success in saving babies born earlier, ”at some point you get down to a point of nonviability.
”If we`re talking about a Brave New World concept, where we`ll take a zygote and put it in a test tube and totally nurture it, right now that doesn`t seem even remotely possible,” Anderson said. ”But who knows what the future will hold?”
Another new technological development, which may radically alter the abortion debate, is an apparently safe and effective abortion pill. The controversial pill, called RU486, is produced by a French firm and already has been approved for use in China.
It works by temporarily blocking the body`s ability to use progestogens, hormones made by a woman`s reproductive system to maintain a normal pregnancy. Taking the pill triggers a woman`s menstrual period, causing any pregnancy to miscarry up to seven weeks after conception.
This is the first of many such pills under development that would make it so simple for a woman to abort a pregnancy that once she misses her period, she merely must swallow a tablet, said Dr. David Grimes, a researcher at the University of Southern California who has used the pill experimentally in about 300 American women.
The World Health Organization estimates that, each year, about 200,000 women die of botched surgical abortions, mostly in developing countries, and that group is counting on widespread use of abortion pills to cut into this problem significantly, Grimes said.
If abortion ever became illegal in the U.S., and if abortion pills were outlawed, it is likely that a black market would spring up. The government probably would be no more effective in blocking the use of such pills than it has been in preventing people from using narcotics.
”That is certainly a concern,” Grimes said, ”and it argues strongly that the drug be made available here under medical supervision to avoid a black market.”
If the Supreme Court declines to overturn Roe and allow states once again to ban abortions outright, it could be swayed by the arguments to rewrite some ground rules set down in the 1973 decision to better reflect current medical capabilities that apply to the relatively rare late abortions that occur.
New life-saving technology, in fact, already has caused many hospitals to adopt rules somewhat stricter than those set down in Roe for elective abortions.
It has happened in some hospitals that doctors caring for a woman six months` pregnant will take her to surgery for an abortion, while colleagues down the hall will be struggling to save the life of an infant delivered after six months in the womb.
Dr. Norbert Gleicher, chief of obstetrics and gynecology at Chicago`s Mt. Sinai Medical Center, said that rules against doing elective abortions after 20 weeks` gestation were enacted at his hospital to avoid such problems. Illinois law requires a physician to do everything possible to help a fetus survive should it show any signs of life after an abortion.
”The situation was absurd,” Gleicher said, ”because the woman who sought an abortion will hate you for the rest of your life if you succeed in saving the fetus, and mostly, you don`t succeed. But it`s still a ridiculous situation. We had a few cases like that before we made our cutoff for elective abortions at 20 weeks.”
The notion that life begins at conception, held by many abortion opponents, is challenged by experience with in-vitro fertilization, said Gleicher, who opened the Midwest`s first test-tube baby clinic several years ago.
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In that procedure, a woman`s eggs are removed from her body, placed in a dish with male sperm, and, if sperm and egg join together to form a zygote, replaced in the woman`s body in hope of commencing a pregnancy.
Gleicher worries that if states are given more leeway in abortion laws, they will adopt a view of the fetus that clearly runs against scientific experience. Nature makes significant distinctions between fertilization, conception, implantation and pregnancy leading to a baby, Gleicher has found. ABORTIONS IN THE U.S.
(color)
By age of patient By marital status
(in percent; projections for 1987) (in percent; projections for 1987)
Under 15 .09% Never married 63.3%
15-17 10.8% Married 18.5%
18-19 13.8% Divorced 11.2%
20-24 33.1% Separated 6.4%
25-29 22.3% Widowed 0.6%
30-34 11.7%
35-39 5.7%
40+ 1.7%
Total abortions, in millions per year, 1973 through 1985.
Note: figures are latest available.
baiduhai Graphic; Source: The Guttmacher Institute.