Four abortion doctors in a resolute spotlight

From left, filmmaker Lana Wilson, doctors Susan Robinson and LeRoy Carhart, and filmmaker Martha Shane at Sundance Friday. The day after Tiller's murder, Carhart says, "My first thought was to carry on the mission." VICTORIA WILL / Invision / AP
From left, filmmaker Lana Wilson, doctors Susan Robinson and LeRoy Carhart, and filmmaker Martha Shane at Sundance Friday. The day after Tiller's murder, Carhart says, "My first thought was to carry on the mission." VICTORIA WILL / Invision / AP
Posted: January 24, 2013

PARK CITY, Utah - Audiences at the Sundance Film Festival have grown used to security guards scanning the audience with night-vision goggles, on the lookout for anyone who might try to bootleg one of the festival's big-ticket premieres.

But at the first public screening Friday of the documentary After Tiller, the familiar specter in the corner of the theater was a uniformed police officer, and ticketholders were scanned by metal detectors on their way in.

The reason for the extraordinary security was After Tiller's controversial subject matter, and more important, its subjects: the four doctors in the United States who openly perform third-trimester abortions.

With doctors Susan Robinson, Shelley Sella, Warren Hern, and LeRoy Carhart attending the premiere along with the film's directors, Martha Shane and Lana Wilson, Park City's Temple Theater - a pop-up venue in a synagogue - would have been a natural target for anti-abortion zealots. One website posted a photo of the doctors at Sundance with the caption "Murder Incorporated."

The "Tiller" in After Tiller is Dr. George Tiller, whose 2009 murder is proof that the doctors have reason to be cautious. Outspoken, some would say unrepentant, in his determination to perform late-term abortions at his clinic in Wichita, Kan., Tiller had been shot before, and threatened many times, but continued on until he was cut down in the middle of a church service.

Most of the doctors in After Tiller worked alongside him, and all know the risks of following in his footsteps. But they also know that if they stop, either out of fear or because of the constant protests by and legal challenges from pro-life activists, others are unlikely to take their place. In the movie, Robinson calls herself a "court of last resort" for her patients. Carhart, who like Tiller is a military veteran, says that the day after Tiller's murder, "My first thought was to carry on the mission."

For many, of course, that mission is immoral, and for some, evil. Even among those who consider themselves pro-choice, support wanes as a pregnancy comes closer to full term; according to a 2011 Gallup poll, 79 percent of pro-choice Americans support banning third-trimester abortions.

The procedure described in After Tiller, which involves injecting a lethal dose of digoxin into a fetus' heart and delivering it as an intact stillbirth, is rarely performed - abortions performed after 25 weeks make up about 1 percent of the total. "When we started making this movie," says Shane, "it quickly became apparent that even people who are pretty well-versed in reproductive health don't know much about it."

Carhart, who was born in Trenton, graduated from Hahnemann medical school in 1973. (He also served as a resident in 1977-78 at Atlantic City Medical Center.) In the years before Roe v. Wade, he recalls doing rotations at Philadelphia General Hospital and seeing "wards full of women" suffering from attempts to end their own pregnancies. "The back-alley guys in Philadelphia were good," he recalls. "We didn't see a lot of their patients." He also observed the panel of physicians and psychiatrists who determined, in the days before Roe, whether a woman qualified for an abortion.

Although Carhart performed abortions in medical school, it wasn't until much later, after 21 years in the Air Force, that he changed his specialty from general surgery. One of his patients was the director of nursing at a women's health clinic. She spent two years trying to persuade Carhart to work with her. Finally, he came to observe for a day, and became "addicted," not to the procedure, but to the discussions that preceded it. "That's the truly addicting part," he says, "helping [women] get to the point where they can rationally decide."

Carhart, 72, is a registered Republican, although he admits, "I haven't voted for a Republican since Kennedy." He has been married to the same woman for decades, and calls himself a religious, though no longer churchgoing, man. In other words, he's hardly the bomb-throwing atheist baby-killer his most ardent opponents depict.

Like the other doctors in After Tiller, Carhart sometimes turns women down. "I don't believe there's a hard line," he says, "but after 26 weeks, for an elective abortion, there has to be a fairly significant reason." After 28 weeks, 90 percent of the women seeking abortions in Carhart's clinic do so because of fetal abnormalities, he says, which in some cases all but guarantee the child a short and painful life.

Saying no has consequences, of course. One patient Carhart rejected later made national news for stuffing her newborn baby into a pillowcase and leaving him in a trash can. But Carhart says the woman, a drug addict, was "so high she walked out of the clinic twice" and could not have been relied upon to return for a multistage procedure that takes several days. "I didn't think we could safely take care of her," he says.

For years, Carhart has operated out of a clinic in Bellevue, Neb., but when the Nebraska legislature passed a law in 2010 banning abortions after 20 weeks, he opened another facility in Germantown, Md. The move met with fierce opposition from anti-abortion activists, who stood outside the middle school attended by his landlord's daughter with graphic pictures of aborted fetuses. The landlord, whose own father performed abortions out of the same clinic, stood fast, and Carhart continues to commute to Maryland from Nebraska regularly.

Ultimately, After Tiller is less about late-term procedures or even the doctors who perform them than about the decisions that doctors and patients struggle with, together and alone. (The movie, which got two standing ovations at Sundance - one for the doctors - has not yet been acquired for wide distribution.)

Sella insists on using the term baby rather than fetus, since to do otherwise would be to mask the seriousness of the procedure. Robinson wrestles with whether or not to perform an abortion on a young Catholic woman who, while requesting the procedure, still believes it is wrong - and with whether denying her might unjustly take away her right to decide for herself.

"It's like arbitration," Carhart says. "You figure both people are going to leave unhappy, but fairly."

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