The Morality of Abortion: The Making of a Pro-Choice Physician

Dr. Curtis Boyd

March 27, 2008

The opportunity to speak to you about the morality of my work as a physician who provides abortion services is dear to me. The central moral question in the public debate that continues to swirl around abortion is whether we as a society ENTRUST women with this decision. In short, do we accept women as moral agents in their own lives? If we do, then every other consideration (save one)—moral, ethical, religious, spiritual, or practical—is the sole purview of the pregnant woman. The one saved is the medical safety of the woman choosing an abortion. With that, she entrusts me, and others who, like me, believe that women are their own moral agents.

So I want to tell you a bit about what it is like to stand in my surgeon’s scrubs in the midst of a holy war in the first nation on earth with a constitutional commitment to the separation of church and state. Obviously, for me, the irony alone is hard to bear. Finding my self at the center of a holy war is difficult—sometimes frightening, sometimes infuriating. But it is also important that you know how deeply rewarding my work is. I spent the first six years of my professional life as a family practitioner in that small town in rural East Texas. I attended my patients in birth and death, illness and injury.I loved my work, and was in turn both loved and respected. But few of those patients, whose entire extended families I knew by name, thanked me with the depth of feeling that women whom I’ve never met before and will probably never see again thank me when I’ve completed their abortions. Whenever the difficulties of my work discourage me (and you can imagine that of late the difficulties have taken center stage), I need only meet my next patient to be reminded why I continue to provide abortions despite the seemingly endless harassment and very real violence against me and those who work with me.

Let me tell you some Christmas stories. On Christmas Eve of 1988, our clinic in Dallas, Texas was doused with gasoline and set ablaze. Fortunately, that blaze was contained within the administrative portion of the building.It did well over $100,000 of damage, but over that holiday period patients continued to call for appointments and former patients called to offer their help with the clean up.We were open for “business as usual” on Jan 2nd 1989.

On Christmas of 1990, I received a Xmas card from a former patient. It read “Peace on Earth” and she wrote, “Dear Dr. Boyd, In 1973 [the 1st year abortion was universally legal in the US] you gave me an abortion. I was 26 years old, new in town, waiting tables. I am now 42 with two boys 4 & 9. Although both of their fathers left when I was pregnant, I was ready to love, nurture, and support them. I often think how different it would have been had my abortion been impossible. I don’t know which would have been worse—being a confused, inadequate, impoverished mother; twisting my soul to give the baby away; or experiencing an illegal abortion. I’m especially grateful to doctors like you. I’m sure you take a lot of flack and see a lot of troubled women.But you make it possible for so many women to have healthy families. Thank you and Merry Christmas.” She enclosed a photo of herself with her two smiling boys.That is why I do abortions.I believe that the availability of abortion allows more women and men to create healthy families.

As all of you know, this past December our office here in ABQ was set ablaze. (And on Xmas Eve 2 PPhd offices were attacked.) This time the fire at my office destroyed our entire unit. Our staff spent the Xmas holidays fielding patient calls and moving between 4 sites—2 generously offered by PPhd (for which I can never express the fullness of my gratitude), the other 2 offered by courageous young doctors who work with me—in order to see as many of the women who needed our services as we could accommodate.The burden of work that our staff undertook, by their own choice, out of their commitment to abortion rights and to the women who need them, is nothing short of inspiring.And again, former patients sent letters, gifts, even money. An older couple, living on Social Security, explained that they wished they could send us more, but with the price of gas, getting by on their SS was tight.They enclosed a check for $100. Another woman sent a check for $30. Recognizing that we might not be able to personally accept her money, she asked that we use it to do something nice for our staff. You brought us food and coffee when we most needed it and escorted our patients to and from the PPhd clinic. The outpouring of support and good will, in the face of violent ill will, helped us keep going.

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One of the things I have learned from patients and especially from Glenna, who is a psychologist and a writer, is that everyone has a story. That’s what makes each patient interesting.In order to understand how I came to do abortions, you need to know some of my story.

I was raised on a farm ten miles down a dirt road from the town where I later had my family practice. By the time I had completed medical training and returned, the roads were paved and REA had completed electrification. I grew up drawing water from a well and studying by a kerosene lamp.My grandfather was an elder in the Foot Washing Baptist Church.I went to church with him every service—which was once a month. The preacher rode a four-church circuit. I studied the Bible (one of only 2 books in my home—the other was the Farmer’s Almanac). And in high school I was “called” to preach. Throughout high school I rode the circuit with Elder Will Fugate and Elder P.E. Weissinger. In college, my doubts about the inerrancy of the Holy Scripture became so great that I left the ministry. When I was admitted to medical school, my family and my “brothers and sisters” in the church were disappointed. I was choosing a lesser calling. I had been chosen by God to preach; instead I was going to be a doctor.

During medical school, I joined the Unitarian Church, and in 1968, when I was serving as President of the Tyler Unitarian Fellowship, I became involved with the Clergy Consultation on Problem Pregnancy.At that point, abortion was a human rights issue for me. I was also serving on the Athens School Board, where I pushed for racial integration.I wanted to do my part to create a fairer world for all people, regardless of race or sex.I knew that the segregated schools of Athens, Texas did not offer blacks an equal education. I believed that women would never really have equal opportunities if their lives could be “ruined” by an unintended pregnancy.I grew up in a world where at best pregnancy established a woman and her child as the property of a man; at worst, it meant her ruin. Of the early experiences that stirred my compassion and shaped my commitment to women’s rights one in particular stands out. My high school burned down between my sophomore and junior years.I was bussed into a big (to me) high school in the nearest town. Going from a class of 12, all of whom I’d known since first grade, to a class of several hundred was a shock. In the new big-city school there was a girl. Only years later would I recognize that I had a crush on her. She was smart, pretty, vivacious, and she had a beautiful singing voice. I didn’t know why she was absent from all extracurricular activities until I suggested that she be the singer for an FFA event. (I was President of the Future Farmers of America.) My great suggestion was met with silence. Later that day a new friend took me aside. “Didn’t I know that she’d got knocked up?She had a baby at home. Someone like that couldn’t be our singer!” I began to get the picture. But I got a larger jumbled picture. I could never date her. That I knew with the certainty of any unexamined assumption. She was the American equivalent of an untouchable.But our caste system penalized only the girls who got caught. Sexually active girls who didn’t get pregnant (or managed to hide the pregnancy) did just fine, and the boys actually moved up a notch or two when they were known to have been the father. I didn’t have words for all of this then, but in my silence and my compliance with the rules, I was also outraged. And that sense of outrage at the unfairness of it all later found an expression in my work. This story has a sad post-script. Years later, when I was practicing medicine in my high-school town, her parents were my patients, and one summer so was her lovely little girl.The child was a delightful version of who I imagine she had once been. When her father was dying, she made an appointment to see me to discuss her father’s deteriorating health. I looked forward to meeting her again, but the woman who came to see me was a cold and bitter stranger. Life had not been kind to her, and it showed.That early pregnancy has been her “ruin.”

I had come to believe in a God of kindness and compassion—for women and men, black and white. As a physician it never occurred to me to do an abortion. I didn’t know how. But as I continued to work with the church groups and to refer women out of the US for abortions, those desperate women kept pleading, “Doctor, can’t you do something?” At first, the answer was obvious: “Of course not.” In their desperation, I’m sure those women had no idea what they were asking of me. I would risk my medical license, my entire career, my young family’s well-being, and my own freedom, if I performed an illegal abortion. Ultimately, I risked all those things which I held dear because I could no longer live with the knowledge that I could do something and I was choosing not to. That choice ultimately cost me my 1st marriage, and that has turned out to be a very good thing—for both me and my 1st wife.

I performed my 1st illegal abortion in 1968 or 69.I’m not sure exactly when.The shift from religious belief to social action was so gradual, and I was in a daze of fear and excitement. I was finally doing what I believed in, but at great personal risk. When the clergy network began to refer women to me, they came in droves.There was no way that I could see that many women. The need was so great, and the personal story of each woman was so compelling.The realities of the risk I was taking also became very real. Each patient could be the one who put me in jail. A serious medical complication would expose me to criminal prosecution. A patient death would result in murder charges. At the same time, each woman had to trust me—trust that she would return home unharmed. Although most patients were cooperative and grateful, several women threatened to report me when I was unable to do their abortions. They were simply too far along in their pregnancies, and I was afraid that I would harm them if I attempted an abortion. A young man threatened blackmail after I performed an abortion for his girlfriend. He had wanted the pregnancy aborted, but he also wanted money.Once a desperate husband tried to rob me at gunpoint. My office was under police surveillance, yet I could no longer turn to the police when I needed protection. I lived in constant fear.

For my own safety, as well as that of my patients and my family, I moved to Dallas and then to New Mexico.I was working in New Mexico when the 1973 Supreme Court decision changed everything. Roe v Wade was more than I had ever expected.When the decision came, I was in the middle of an abortion, and I was overjoyed. I naively believed that the issue had been settled. My fears of losing my medical license, of going to prison, seemed behind me. My marriage was over and I returned to Dallas to establish the 1st legal abortion clinic in the 4 state area of Texas, Louisiana, Arkansas, and Oklahoma.This is when and how I met Glenna who had also been active in the civil rights movement and worked for abortion reform. We did not intend to make abortion our life work. We imagined that the abortion clinic was a temporary measure, a way to meet the need until abortion became a routine part of medical practice.

Obviously, we were wrong. Abortion has remained a subspecialty, most often provided in a clinic setting. And as most of you know all too well, the harassment and violence continue today. I will not bore you with a litany of the terrors that have become a routine part of daily life. The continued violence against abortion providers is, in fact, a large part of why abortion has not been absorbed into the mainstream of US medicine. When I walk through a hostile crowd shouting “Murderer!” at me, I know why other doctors (and nurses and counselors) do not choose to provide abortions.Glenna and I now teach in the Ryan Fellowship program, based at UCSFO Medical School and now in 15 medical schools across the US (including UNM). This program is training young, idealistic ob/gyns to provide abortions– and dealing with the psychological and social ramifications of commitment to this work is part of their training.

In my generation, many of the doctors of conscience who chose to provide abortions were moved by the horrors of botched illegal abortions. I too saw those ill and sometimes dying women in my training. I was moved by their plight. But that was not what drove me to risk my career and sometimes my life. I was moved by the certain knowledge that women’s lives could be ruined when they could not abort a pregnancy.

As I said, I did not intend to make abortion my life work, but as I invested more and more of my time and identity in doing abortions, I made a conscious decision to approach my work as an affirmation of life. The conventional moral reasoning of the clergy was that abortion was the lesser of evils. (Much as conventional wisdom today asserts that legal abortion is the lesser of social ills—better than the horrors of illegal abortion.) Well, I was not about to devote my career to a lesser evil. I believe that abortion is a good and moral choice—for the woman, her family, the larger community and the earth.

Women who come to us for abortion care may not see themselves as engaged in an ethical decision making process, demonstrating a high level of moral development. But they are, and we are aware of it every day. We see a woman who knows she cannot be a good mother at this time—she is too immature (her words, not ours), she lives in poverty, she is drug addicted, she is in an abusive relationship in which she and her children are not safe. These women may have children now and want other children in the future, when they believe they can be good mothers, provide a family and community of support, realize some of their own dreams and aspirations.

Women have abortions because they want to be good mothers. The fetus has value to the pregnant woman, and it has value to me. But the fetus does not have equal value, nor should it have rights that are equal (nor superior) to those of the pregnant woman. The abortion issue must focus on the full personhood of the woman, who considers the potential personhood of the fetus in terms of her psychological state, personal history, social situation, and the meaning and implications of this pregnancy for everyone’s future. The pregnant woman reflects upon what is good for the creation of which she is an agent. Pregnant women are not only capable of moral decision making, fortunately, they do it every day.And for those of us who do this work, we have the honor of bearing witness.

For years we had a regular picketer at the Dallas clinic. He carried a placard that read “What Man Would Allow His Baby To Be Aborted?”That statement encompasses centuries of women’s experience—their PLACE in society. He speaks of the baby as his property and by extension the woman is his property too—the vessel of HIS progeny. In his mind the “decision” is NOT hers to make. She is not even a participant. To the best of our knowledge the young men who torched our clinic this past December acted on that belief. On Friday, Glenna and I saw a patient in Dallas whose boyfriend had threatened to kill her if she aborted his baby.They had known each other less than a year. When she became pregnant 2 months ago, he began to beat her, and he kept a loaded pistol.She decided that she could not have a baby with this man. She was afraid for her life and the safety of her 6 year old son from a previous marriage. As part of her abortion we made an elaborate plan for her safety. This is NOT the Dark Ages. (At least that’s what I like to believe.) It was the day before yesterday!

I grew up in a world in which women and children were the property of men. I have committed my career to changing that world. And I am grateful to be in the company of men and women who share that commitment.