A Korean gynaecologist explains why he abandoned a lucrative procedure and is campaigning to reduce abortions.

South Korea has one of the highest rates of abortion in the world, even though abortion is technically illegal there except in a few rare circumstances. According to official government figures, there are 340,000 abortions each year, although one parliamentarian has estimated that there may be as many as 1.5 million. At the same time, Korea’s birth rate is the second-lowest in the world – 1.19 births per woman — and some Koreans fear that their very survival as a nation is in doubt.

That is the background for a courageous decision by a 50-year-old Seoul obstetrician and gynaecologist, Dr Sang-duk Shim, to stop doing abortions and to lobby the government for a dramatic reduction. He has even received death threats for his stand. MercatorNet conducted this email interview with him:

Could you explain the goal of your activist group of doctors? What is its name? How many members do you have?

Dr Shim: This movement is the Korean Gynecological Physicians’ Association, or “Gynob”, and is an organization consisting of obstetricians and gynaecologists. Currently we have about 680 listed members. Of course, Gynob is not an organization designed only to resolve the problem of abortion, but is intended to improve the distorted medical enviroment in which OB/GYNs work. It does not mean that all of the members of Gynob actively participate in Gynob activities. Our movement is led by a group of about 30 activists.

The goal of our movement is a Korea without abortions. To be more specific, our immediate goal is to reduce the number of abortions to 100,000 cases within ten years — one-third of what it is today — and to eliminate all forms of abortion except when necessary to save the life of an expectant mother.

How long did you do abortions? How many did you do?

Dr Shim: It has been about 20 years since I obtained my qualification as an obstetrician. I have been involved in abortion for almost 20 years until I discontinued it in October, as part of my commitment to the anti-abortion movement. I do not have any written record of the abortions I did. However, I had about 20 cases a month, which means a total of 4,000 cases over the period of 20 years.

Why did you stop? Has it been a big sacrifice for you?

Dr Shim: Practicing abortion violates fundamental ethical values for medical doctors and I have suffered pangs of conscience for a long while. Over time, I have noticed that society as a whole and the medical services sector in particular did not try hard to reduce the number of abortions. Rather abortion was encouraged and the basic issues have been left untreated. Simply because of financial pressures on obstetricians, it became clear that abortion has been encouraged and generally accepted.

We feel that this problem cannot be left as is, and it must be rectified by the self-purification of medical doctors. Based on these convictions, we decided to launch this movement. However, the doctors who join the movement suffer from financial pressures and, at the same time, experience serious mental pains because they are treated as traitors by the medical doctors who do not support this movement.

In addition, anti-abortion doctors also suffer abuse from feminist activists who criticize us. They allege that we ignore their right to self-determination and their right to pursue happiness.

How has the public responded?

Dr Shim: Abortion has become a national issue. The government, as well as society in general, has begun to seek better ways to resolve this problem. However, because it has become so established and because there are so many different viewpoints in society, no one is taking drastic measures such as filing complaints with the police.

However, national recognition of the right-to-life issue has changed dramatically compared to several decades ago. Our movement has attracted the support of more than half of the population and we are expecting favorable results soon or later.

How have your doctor colleagues reacted?

Dr Shim: It is true that most OB/GYN doctors do not participate in this movement. Non-members even complain about us for two reasons. One is possible loss of income that abortions have provided for them in the past. Strictly speaking, abortion is illegal and so physicians used to charge handsomely for it. If they give up abortion, they are fearful of the sacrifice that they would have to endure. They are also afraid of tarnishing their image and being regarded as doctors who engage in unethical operations.

Your new philosophy is “Abortions, which abandon the valuable life of a fetus, create misery for the nation and society as well as pregnant women, families and OB/GYN doctors.” But why is abortion a misery for the nation? Why for OB/GYN doctors?

Dr Shim: The practice of abortion undermines the government’s effort to improve facilities for deliveries and thus discourages the efforts of healthcare personnel to improve the environment for expecting mothers. As well, systemic support for unmarried or disabled mothers is disregarded. Accordingly, the human rights of pregnant mothers are infringed. This negative atmosphere is an important factor in Korea’s low fertility rate and thus it endangers the existence of the nation itself in the long run.

In addition, if there is little respect for life, social ethics will be endangered, and therefore, society will be weakened.

From the point of view of an OB/GYN, abortion makes life difficult, too. Because most abortions are technically illegal, doctors charge a premium for their services but hospitals receive a very low medical service charge which covers less than half the cost. Many clinics are suffering serious financial problems as a result. If the number of abortions decreased, the service rates could be normalised and the clinics would benefit. Furthermore, the present climate of illegality forces medical doctors to keep quiet on issues even when they have good reason to complain.

Do you think that there is any hope of changing Korean attitudes towards abortion?

Dr Shim: I want to emphasize that people’s attitudes toward abortion have already changed significantly. Traditionally Koreans used to treat an infant in pregnancy as an independent being. We considered a fetus to be an individual and when it was born we used to say that it was one year old. With attitudes like these, the population growth rate was around 3.1 percent in 1972.

However, the primary concern of the Korean government at that time was to increase per capita income, which was then only about US$254. Liberalization of abortion was used as a means of achieving a higher rate of growth within a given number of years.

On March 21, 1973 the Mother-Child Health Act was promulgated. Article 14 of the Act established exceptions to Article 269 of the Criminal Code and exempted abortion from criminal sanctions. Until that time the criminal code had punished abortion with a one or two year jail term. The Mother-Child Health Act freed abortions from criminal sanctions. This was the key step in public acceptance of widespread abortion.

As a result, right now the annual growth rate of the population in Korea is 0.4% and it is anticipated that it will drop to 0% by 2014. This implies that Korea will face another stumbling-block on the path to continued economic growth. It is time to change the law and to reactivate Article 269 of the Criminal Code to make abortion a criminal act once again.

I believe that that there is a growing consensus in Korea that human life must be respected. It is our hope that all the efforts made by the activists of the pro-life movement will succeed and that life will return to our nation and to all of our families.

Do you ever regret having stopped doing abortions?

Dr Shim: Although I do not have any religious convictions, I feel that we must restore our own personal legal and ethical validity before we take a stand and ask the government and the society to improve. It seems to us that restoring the integrity of just one medical doctor will be the first step toward the correction of a distorted medical environment.

Frankly speaking, the operation of my hospital has become very difficult since we started our anti-abortion campaign. I have been considering whether I will have to close my office or not. As I already said, income from abortions compensates for the low rates we charge for medical services, which are predetermined by the government.

However, even if these rates are much lower than is reasonable, I have decided to continue because it may compensate for my past wrong-doing. I am very proud of what I am doing right now.

Medical doctors exist for the benefit of our patients. It is not the other way around. This is a fact we cannot deny. While we may be sacrificing money and prestige at this present moment, things will get better in the future for our country. Our actions will certainly contribute to the improvement of medical environments as well as the promotion of women’s health in the days to come.

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We are a newly formed group of Victorian doctors from a range of medical specialities, with diverse backgrounds, representing various faiths and none. We call upon the Victorian government to reject the Abortion Law Reform Bill 2008

We consider the proposed legislation to be poorly framed and unnecessarily coercive. It is based on false premises, incorrect definitions and is not reflective of current clinical realities nor is it supportive of vulnerable pregnant women.

1. The Anti-Conscience Clause.

Clause 8 of the Bill is unconscionable and unprecedented in this country.

We believe it to be an attack on the basic human rights of health professionals which undermines their moral integrity and professional autonomy. The state should not coerce its health professionals to participate in the taking of human life. Many doctors, nurses and pharmacists, with strong ethical, religious and cultural beliefs against abortion will have to consider whether to continue to practice in breach of the law or to discontinue working as healthcare professionals in this state.

We concur with the position put forward by Dr Doug Travis, President of the AMA (Victorian Branch): “The Bill infringes the rights of doctors with a conscientious objection by inserting an active compulsion for a doctor to refer to another doctor who they know does not have a conscientious objection. Respect for a conscientious objection is a fundamental principle in our democratic country, and doctors expect that their rights in this regard will be respected, as for any other citizen.”

We believe the right to conscientiously object to participation in the process of abortion, either directly or through referral, should also be respected for Nurses, Pharmacists and other healthcare workers.

2. The Bill does not reflect current medical knowledge or clinical practice:

a. The definition of abortion used in this Bill incorrectly includes inducing a live birth prematurely for medical reasons and the management of an ectopic pregnancy. A proper definition of abortion should refer to the active, direct and intentional taking of a human foetal life.

b. The premise that an abortion is like any other medical procedure is mistaken. Only euthanasia and medicallyassisted executions share the same objective and intention of abortion: the taking of human life.

c. The concept of an ‘emergency abortion’ is a clinical fiction. Almost always the management of complicated and lifethreatening

pregnancies need not necessitate an abortion.

d. Suicide risk in a pregnant woman is a psychiatric emergency, not an indication for an abortion

e. Lateterm abortions are not medically necessary. Attempting a live birth is a safer option when a mother’s health is at risk.

f. The requirements for permitting a lateterm abortion in section 5 of the Bill are meaningless and in effect endorse all abortions up to birth for any reason. The agreement of just one other “registered medical practitioner” would not be difficult to find and would in practice pose little if any restriction on lateterm abortions.

3. This Bill offers no support for women facing difficult or unexpected pregnancies.

The rejection of proposals that would have given support to pregnant women in crisis through proper referral systems, information provision, independent counselling, a cooling off period and effective followup, does not reflect a real concern for the welfare of women.

4. The Bill endorses poor clinical practice and exposes pregnant women to unnecessary health risks.

In terms of complexity and risk, abortions, especially late term abortions, are the equivalent of major medical and surgical procedures. However, unlike any other major procedure, this bill would allow:

- a non GP referral, walk-in, same day service without the requirement of a proper, independent medical assessment or the need for appropriate follow up provisions.

- an abortion to be performed by any “registered medical practitioner” without the need for specialist training or proper accreditation.

- an accredited Nurse or Pharmacist to procure an abortion up to six months without the involvement of a medical doctor and without the need for proper medical assessment or support.

This legislation exhibits a disregard for the health concerns of women with difficult pregnancies.

5. The interests, value and humanity of the unborn child are ignored.

This bill shows a disregard for the humanity and the basic human rights of the embryonic and foetal child. The unborn child should not be treated as though it were of no value at all. We thank you for considering our concerns. A longer and more detailed and referenced document is attached to more fully explain our position against this Bill.

FOR MORE GO TO

http://www.doctorsconscience.org/

ANN ARBOR, Michigan, October 15, 2009  - [An Excerpt]

Lisa Harris concludes that the “visually and viscerally different” component of a second-trimester abortion, as opposed to a first-trimester one, leads to questions such as:

“What kind of dissociative process inside us allows us to do this routinely? What normal person does this kind of work?” To answer the questions, Harris notes that the “violence” of abortion must be acknowledged, and relates a “bizarre” experience she once had of observing a premature baby struggling to survive immediately after dismembering an unborn child the same age:

The last patient I saw one day was 23 weeks pregnant. I performed an uncomplicated D&E procedure. Dutifully, I went through the task of reassembling the fetal parts in the metal tray. It is an odd ritual that abortion providers perform – required as a clinical safety measure to ensure that nothing is left behind in the uterus to cause a complication – but it also permits us in an odd way to pay respect to the fetus (feelings of awe are not uncommon when looking at miniature fingers and fingernails, heart, intestines, kidneys, adrenal glands), even as we simultaneously have complete disregard for it. Then I rushed upstairs to take overnight call on labour and delivery.

The first patient that came in was prematurely delivering at 23-24 weeks. As her exact gestational age was in question, the neonatal intensive care unit (NICU) team resuscitated the premature newborn and brought it to the NICU. Later, along with the distraught parents, I watched the neonate on the ventilator. I thought to myself how bizarre it was that I could have legally dismembered this fetus-now-newborn if it were inside its mother’s uterus – but that the same kind of violence against it now would be illegal, and unspeakable.

Harris then goes on to explain that she rationalizes the bizarreness of the situation by the “location” of the baby, whether it is “inside or outside of the woman’s body,” and “most importantly, her [the mother's] hopes and wishes for that fetus/baby.”

However, she says, “this knowledge does not change the reality that there is always violence involved in a second trimester abortion, which becomes acutely apparent at certain moments, like this one. I must add, however, that I consider declining a woman’s request for abortion also to be an act of unspeakable violence.” Harris points out that the abortion lobby’s discomfort with “the violence and, frankly, the gruesomeness of abortion” has led to a pro-abortion discourse that she says “contradicts an enormous part of” the abortionist’s experience.

While pro-abortion activists may claim abortions “don’t really look like” the graphic images often displayed by pro-life protesters, Harris notes, “to a doctor and clinic team involved in second trimester abortion, they very well may.”

“Of course, acknowledging the violence of abortion risks admitting that the stereotypes that anti-abortion forces hold of us are true – that we are butchers, etc.,” she adds. Harris also touches upon the psychological burdens second trimester abortion care lays upon its providers, including “serious emotional reactions that produced physiological symptoms, sleep disturbances (including disturbing dreams), effects on interpersonal relationships and moral anguish.”

Harris tackles the “ethical and moral positions that allow for grey areas” in abortion provision by advocating the “gradualist perspective” – stating that “the respect owed to a fetus increases as pregnancy advances and the fetus becomes more like a born person.”

This, she says, serves to “close the gap between pro-choice rhetoric and the reality of doing a second trimester abortion,” and “allows us to simultaneously acknowledge the value of early human life and be woman-centred, an ideal position for a second trimester provider.”

While the “gradualist” approach raises the spectre of later abortions being “more serious” than early abortions, says Harris, the concern is allayed by the fact that “women have all sorts of compelling and legitimate reasons for choosing abortion” – particularly, she says, in second trimester abortions. Still, for Harris, there remains the problem of abortionists “caught between pro-choice discourse that, while it reflects our values, does not accurately reflect the full extent of our experience of abortion and in fact contradicts an enormous part of it, and the anti-abortion discourse and imagery that may actually be more closely aligned to our experience but is based in values we do not share.” Harris conjectures that the needs of abortionists in this regard are not met because “frank talk like this is threatening to abortion rights.”

“While some of us involved in teaching abortion routinely speak to our trainees about the aspects of care I’ve described, we don’t make a habit of speaking about it publicly. Essays like this bring the inevitable risk that comments will be misinterpreted, taken out of context and used as evidence for further abortion practice restrictions,” she writes. “We might conclude at this point that a provider who feels that abortion is violent is simply ambivalent, conflicted, is not really committed to women’s abortion rights, and just shouldn’t be doing this work,” Harris writes.

“‘Pro-life’ supporters may argue that the kind of stories and sentiments I’ve relayed spell the end of abortion – that honest speech acts regarding the reality of abortion will weaken the pro-choice movement to the point where it cannot sustain itself any longer. However, she contests the point, arguing that, rather than weakening the argument for abortion, facing abortion with “honesty” can “be the basis for a stronger movement – one that makes it easier for providers and the teams they work with to do all abortions, especially second trimester abortions.”

______

[The excerpt that came before the above text]

“There was a leg and foot in my forceps, and a ‘thump, thump’ in my abdomen. Instantly, tears were streaming from my eyes.” So writes abortionist Lisa Harris in a disturbing article relating her experiences as an abortionist, particularly her anguished and “brutally visceral” experience of dismembering an 18 week gestation unborn child, while 18 weeks pregnant herself. In the article, entitled “Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse,” Harris, an abortionist and assistant professor at the University of Michigan, explains the ethical position that she says helps her and other abortionists continue practicing despite the moral and psychological hurdles involved in what she describes as an undoubtedly “violent” procedure. The article was originally published in “Reproductive Health Matters” in May 2008.

“Abortion is different from other surgical procedures,” Harris writes in her candid article. “Even when the fetus has no legal status, its moral status is reasonably the subject of much disagreement. It is disingenuous to argue that removing a fetus from a uterus is no different from removing a fibroid.” Harris says that there is a need to “cross borders and boundaries (including seemingly inflexible ones like ‘pro-choice’ and ‘pro-life’)” in order to “reflect seriously on the question of how providers determine their limit for abortion,” and warned that the issues surrounding the question “may frankly be too dangerous for pro-choice movements to acknowledge.”

Harris then describes how she once performed an abortion on a woman whose fetus was at 18 weeks gestation. Ironically, Harris herself was pregnant at the time, and her baby was also at 18 weeks gestation. Consequently, she explains how she was “more interested than usual in seeing the fetal parts when I was done, since they would so closely resemble those of my own fetus.”

“I went about doing the procedure as usual,” she writes. “I used electrical suction to remove the amniotic fluid, picked up my forceps and began to remove the fetus in parts, as I always did. I felt lucky that this one was already in the breech position – it would make grasping small parts (legs and arms) a little easier.” With my first pass of the forceps, I grasped an extremity and began to pull it down. I could see a small foot hanging from the teeth of my forceps. With a quick tug, I separated the leg. Precisely at that moment, I felt a kick – a fluttery “thump, thump” in my own uterus. It was one of the first times I felt fetal movement.

There was a leg and foot in my forceps, and a “thump, thump” in my abdomen. Instantly, tears were streaming from my eyes – without me – meaning my conscious brain – even being aware of what was going on. I felt as if my response had come entirely from my body, bypassing my usual cognitive processing completely. A message seemed to travel from my hand and my uterus to my tear ducts. It was an overwhelming feeling – a brutally visceral response – heartfelt and unmediated by my training or my feminist pro-choice politics. It was one of the more raw moments in my life.

Doing second trimester abortions did not get easier after my pregnancy; in fact, dealing with little infant parts of my born baby only made dealing with dismembered fetal parts sadder…