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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington.

The murder of Dr. George Tiller leaves many physicians who perform abortions feeling threatened, while many doctors who identify themselves as pro-life feel their cause has been betrayed and fear they will be publicly associated with a vile crime. Today, the family of George Tiller announced that his Wichita clinic will be closed for good. Today, we hope to find out more about doctors and abortion, what it's like for those who perform the procedure, including threats, and how doctors who won't perform it talk with their patients, whether for medical professionals the issues are as black and white as some advocates on both sides make them out to be. If you're in the medical profession as a doctor, nurse, administrator or student, tell us about your experience with abortion, 800-989-8255 is our phone number. Our email address is talk@npr.org. You can also join the conversation on our Web site, that's at npr.org, click on TALK OF THE NATION.

Later in the program, NPR health policy correspondent Julie Rovner joins us with an update on the changes the Obama administration has made on the set of issues that revolve around abortion, and your letters. But first, Dr. Suzanne Poppema joins us from member station WFCR in Amherst, Massachusetts. She operated a women's health clinic near Seattle for many years and is now board chair of Physicians for Reproductive Choice and Health, and it's good of you to be with us on the program today.

Dr. SUZANNE POPPEMA (Board Chair, Physicians for Reproductive Choice and Health): I appreciate the opportunity to be with you.

CONAN: And I know you were friend of Dr. Tiller's. I wonder how you react to the news that the clinic that he operated for so many years will be closed.

Dr. POPPEMA: I'm very sad about it. I completely understand the family's decision but it's a very sad day. There just is so much that we can ask a family to give for this effort. And as someone who - as a family physician who operated her own clinic, I understand what it takes to do that. So I'm very sad to hear it, but I understand - and these procedures will still be done. There are physicians, including in several university centers, who do procedures for severe fetal anomalies, as Dr. Tiller did. The procedures will be done. It's going to be harder for the women to get there.

CONAN: Dr. Warren Hern, who's one of the doctors who does perform late abortions told the Associated Press, he also said he also understood the family's position, but he said this is what they want, this is what they've been wanting for 35 years and there are some who will perceive this as a victory.

Dr. POPPEMA: I'm sure that's true. And those of us who do this as a practice of medicine and not a big political issue will say, we will make sure that these medical procedures get done and while - as I say I'm very sad to hear about this, but I can not hold it against the family that they're choosing to do this.

CONAN: And what would tell a medical student who was thinking about going into this field? Would you say that this is a wise course?

Dr. POPPEMA: I have to say that - I began my practice as a family physician and that's how I became an abortion provider as well. It makes sense as a family physician that you see patients of all ages and throughout their reproductive health care continuum. And it was clear to me that I needed to help women who wanted to have babies have healthy babies, and I needed to help women who didn't want to have babies not have those babies. And family medicine is an incredibly rewarding career and the abortion practice, as part of the continuum of reproductive health care, is also incredibly rewarding. We make a real difference in each woman's life who comes to see us, and you really do see each and every patient as a single individual with her own set of values and needs. And nine times - 99 times out of 100 that person leaves your clinic after a life-changing event able to take over her life again. It's a very rewarding practice of medicine.

CONAN: And you've said that, well, obviously politics has played a large role in it for these many years now, but you don't see it as political.

Dr. POPPEMA: I view it as good quality health care. Reproductive health care should be part of the continuum of health care that we offer to our patients and that's how I've viewed it - my whole practice, that's how I've viewed it. I haven't been doing it for some kind of political statement. I've been doing it in response to the incredible need that women have to not be parents when they know it's not right for them to be parents. The most responsible women I've seen in my practice are women who say, I just cannot be a mother right now. This can't happen. And women will essentially walk through, I always say, walk through hot coals if they need to, to get the procedure. Banning abortion procedures doesn't stop abortion. It makes it dangerous.

CONAN: Hmm.

Dr. POPPEMA: That's all it does.

CONAN: And as you, obviously we've been presented - all of us - with the politics of this. Are the issues as black and white as they are made to seen by some?

Dr. POPPEMA: It's interesting. I, of course, I just don't believe the world operates in black and white. And it's been very interesting when I've had the opportunity to actually speak one-on-one to someone who calls himself pro-life, and have a very quiet, reasonable discussion and hear them lay out the situation, which is that for them it's a religious and moral wrong to have an abortion, engage in abortion, take care of abortion patients, for instance. But at the end of the sentence, the ones that I've had the conversation with, who would define themselves as pro-life, said, but I would never harm someone who is providing abortions. I would never harm a patient.

CONAN: Mm-hmm.

Dr. POPPEMA: I would not withhold information from the patient. It just is not right for me. And I said well you've just now laid out the exact pro-choice position. So, I don't think it's black and white at all. I think that the key thing would be to be able to allow oneself to spend a few seconds in another person's shoes and be able to say - understand that women who makes this decision are responsible, intelligent, moral agents who have thought a lot about this before they ever come to our clinics, who've really looked at it from all sides. And so, when you allow yourself to see the other as another human being that's similar to you then the black and white disappears.

CONAN: Our guest is Dr. Suzanne Poppema. We're talking today with doctors about abortion. She is board chair of Physicians for Reproductive Choice and Health -for many years ran a women's health clinic near Seattle. 800-989-8255. Email us talk@npr.org. We want to hear today from medical professionals, doctors, nurses, administrators, students. Let's see if we can get Saja(ph) on the line. Saja, calling us from Bolinas, California. Saja, are you there?

SAJA (Caller): Yes, I'm here.

CONAN: Go ahead, you're on air.

SAJA: Thanks. Well, I'm a retired doctor now. I had an abortion myself in 1951 when it was illegal. And I saw the underworld. I saw the uncleaned facilities and the money that was made in it and it was - how dangerous it was. And I vowed, when I became a doctor myself, that I would do my best to help women who were desperate with an unwanted pregnancy to be able to have a clean, safe abortion under emotionally supportive circumstances. And I worked for many years in reproductive health. I did approximately 10,000 abortions in my time, both early and late. I can say that I treated each woman as an individual. And it was - made sure that she was counseled and had made up her mind that this was the best for her.

And I just want to say the desire not to be pregnant is just as strong as the desire to be pregnant. They're both extraordinarily important in women's lives under different circumstances. And I also want to underline what the previous doctor said, that the danger of illegal abortions is real. It is killing women all over the world where abortion is illegal. And it's just so important to keep it safe, legal, medical and supportive.

CONAN: What do you say, Saja, to other medical professionals - say, look my patient is just as much that unborn child as it is the mother?

SAJA: I would say to that person that they should listen to their patient. They should understand that this living, upset and rational human being is going through a very difficult time and that her life is as important as anyone else's and that she should be served in a medically safe way.

CONAN: Saja(ph), thank you very much for the call, appreciate it.

SONJA: You're welcome. Thanks for - bye.

CONAN: Bye bye. And I wonder, Dr. Poppema, if, given her experience, we read so much about the difficulties that, well, that some medical students today prefer not to be trained in abortion procedures and that some medical schools don't provide that information. You can get it outside but not there at the medical school.

Dr. POPPEMA: That's absolutely true. There are very many medical schools, as well as residency programs, who do not provide training, full training, in reproductive health care, who do not provide access to abortion training, and in fact make it quite difficult for you to find that training on your own time.

And in fact back in the late '70s when I was a resident, I got most of my - I got my abortion training outside the university center, in a community clinic. And so I - it's a little discouraging that these things haven't changed, although we are making some progress. And I appreciate what residents have to go through to try to find that kind of training program.

That's one of the things that Physicians for Reproductive Choice and Health is trying to do, is to make sure that we can integrate full reproductive health care training in family practice and OB/GYN residency training programs.

CONAN: Let's go next to Elizabeth(ph), Elizabeth calling us from San Mateo.

ELIZABETH (Caller): Yes. I wanted to say I'm an internist, as well, and my first pregnancy was a trisomy, kind of like poor Mrs. Rick Santorum. The baby wasn't going to live to birth, and I had a late-term abortion. I just really didn't want it, but it made - it helped stop the pain and the loss of my child, and now I have two healthy children, and that's all. Thank you.

CONAN: Elizabeth, thank you. Obviously - you can hear - there is - sometimes it is portrayed that women do these things casually. Obviously that's not the case for Elizabeth. Is that - in your experience, did that ever happen?

Dr. POPPEMA: I've been providing abortions since 1974. I've probably provided over 30,000 abortions in my career. Never, ever once did I meet a woman who sort of trotted into the office, la-la-la-la-la, oh, I saw that there was an abortion clinic while I was grocery shopping, I thought I'd come in and have one. No one takes this decision lightly.

I have - you'd think that in 30,000 women who needed abortions, I would have met one who meets the description that is so, I think, meanly placed on women, that they haven't thought about what they're doing, that it isn't a very moving experience.

This does not mean that women are terminally depressed for the rest of their days because of having an abortion procedure, but everyone is sad about what it means to have an abortion. It's not the way people lay their life plans out. It's a real - it's a real glitch in the road of their life plan.

People would - I think that kind of moving experience, both about why people have abortions but also why physicians are providing abortions, is available if people are interested in a wonderful piece on our Web site, prch.org, called "Why I Provide" and "Voices of Choice." It's in the voices of physicians themselves talking about why we provide this tremendously necessary and valuable medical care.

CONAN: Dr. Poppema will return. We'll also talk with another doctor who doesn't provide abortions. This is NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. For most doctors, the decision whether or not to perform abortions is deeply personal. As a political issue, we often hear abortion discussed in black-and-white terms. Today, we're talking with two doctors on either side of the debate about their experience with abortion.

If you are in the medical profession, as a doctor, nurse, administrator or student, call and tell us about your experience. Our phone number, 800-989-8255. Email us, talk@npr.org. There's also a conversation on our Web site. Go to npr.org. Click on TALK OF THE NATION.

In a few minutes, we'll hear from a pro-life surgeon. Right now, our guest is Dr. Suzanne Poppema, who ran a clinic that provided abortions and reproductive health care for many years, now serves as board chair of Physicians for Reproductive Choice and Health. And let's get another caller on the line. This is Cynthia(ph), Cynthia with us from Tulsa.

CYNTHIA (Caller): Hi, thanks for taking my call. I just wanted to make a statement that it's fundamental that we provide these services because otherwise, and this might be a slippery-slope kind of argument, people are going to seek this out in back alleys and from non-medically trained people. And no matter what we do, it's still - the procedure is still going to take place. People are going to seek out abortions, whether, you know, you close a clinic or not. There has to be somewhere for people to be able to go to get these by trained professionals.

CONAN: And Cynthia, what's your part in the profession?

CYNTHIA: I'm a student at Oklahoma State University.

CONAN: And I wondered, do you talk about this with other students?

CYNTHIA: Yes, yes. I've taken a couple of biomedical ethics classes, and it's a hot topic. It's a really hot topic, especially late-term abortions, because of - you know, just you know, especially being in the Bible belt and, you know, out here a lot of people don't understand that, you know, the medical risk that can happen, you know, and can impair, like the woman who called earlier. You know, she wasn't able - she had difficulties with that pregnancy, but now she has two children that are healthy because she went ahead and had that late-term abortion.

CONAN: And are the conversations, would you say they're civil?

CYNTHIA: Yeah, they're heated. They're very heated. I wouldn't - yeah, it stays civil in the classroom for the most part. Outside the classroom, you can get some nasty looks, especially for the more liberal students, but it gets pretty heated. And I choose - like, I will practice it, and you know, hopefully just provide. You know, the medical care is there, and it's needed, you know.

CONAN: And are you planning to go into family health care, reproductive care included?

CYNTHIA: Family physician for pediatrics.

CONAN: And just to follow up on the conversation we had earlier with Dr. Poppema, is the training available there in your medical school?

CYNTHIA: No, it's not. I would have to seek outside of Oklahoma to be able to go - to be able to be trained on that procedure.

CONAN: Cynthia, thanks very much for the call, and good luck with your studies.

CYNTHIA: Thanks so much, all right, bye-bye.

CONAN: And Dr. Poppema, as we move ahead, how do you think Dr. Tiller's murder has changed the conversation?

Dr. POPPEMA: I think Dr. Tiller's murder has had a very short - what I would say - a short-term chilling effect. I'm one of the people who has always believed you have to speak out. I spoke out during the spasms of violence in the '90s. In fact, I wrote a book about being an abortion provider in the '90s in the hopes of being able to do what I was saying, to humanize the discussion, and I'm still willing to speak out. But I have some very dear friends who are very articulate speakers who right now have been temporarily silenced, at least. And so it has a very chilling, frightening effect, and we all deal with that fear in different ways, and we might deal with that fear in different ways depending on where we are in our lives.

So I understand their fear, and I also understand that for me, it's vital to always speak my truths and that if I have fear, so be it, but I have to speak the truth.

CONAN: Dr. Poppema, thank you very much for your time today.

Dr. POPPEMA: Again, I was happy to be here. Thank you for having me.

CONAN: Suzanne Poppema, with us from the studios of WFCR in Amherst, Massachusetts. She's board chair of Physicians for Reproductive Choice and Health, and she used to run a reproductive health clinic near Seattle.

And joining us now from Manassas, Virginia, is Dr. John Kelly, a retired surgeon. And Dr. Kelly, it's very good of you to be with us today.

Dr. JOHN KELLY (Retired Surgeon): Yes, glad to hear you.

CONAN: And I just want to start with you at the same point where we left Dr. Poppema. How do you think the murder of Dr. Tiller in Wichita changes things?

Dr. KELLY: Well, that is a singly bad and terrible thing. Nobody advocates killing innocent people, whether they're in the womb or out of the womb.

CONAN: And that, though, you disagreed with his position on abortion.

Dr. KELLY: Pardon?

CONAN: And that, though, you disagreed with Dr. …

Dr. KELLY: Oh, I disagreed totally with his position. I mean, the only danger to the women with those late-term abortions is the infection that's possible through the procedure itself.

CONAN: Do you think, Dr. Kelly, there's something unique about what doctors do, their reason to be, that lends itself to a pro-life position?

Dr. KELLY: Oh, I would think that anybody who's in medicine should understand that life begins at conception, and there's no other point, until death, when life leaves that person. There's something going on while the patient, while the person is alive. There's some animus, some soul if you call it that, some spirit of living that keeps the organism growing. It can't be defined rightly because it is a supernatural type of a force.

CONAN: And someone as experienced with death as a doctor, do you feel that gives you special reverence for life?

Dr. KELLY: Yes. Well, I know that seeing a person five minutes before they die and seeing them five minutes after is very obviously a change in the body. Something is taken out of there, which directed the ability to manipulate, live and repair yourself or do whatever you do.

CONAN: Surgeons in particular can sometimes face dilemmas where a woman's health can be in conflict with the health of the fetus, the case sometimes if a woman requires surgery and chemotherapy for cancer. I wonder, have you ever faced a situation like that?

Dr. KELLY: Yeah, no. I've experienced patients who had that dilemma, but the advice is you take care of the sickness, whatever it is. If she has a cancer, your advice to her is you want to get rid of the cancer as soon as you can. If a baby happens to be in there, in the first month or two, then I don't pass judgment on whether the woman is making a bad choice. That is a choice that is up to an individual person.

CONAN: So you, too, would not see the situation necessarily as black and white.

Dr. KELLY: Yeah, but that's a rare situation.

CONAN: No, I understand. I understand that. Let's see if we can get some more callers on the line. Our guest is Dr. John Kelly, a retired surgeon, with us from Manassas, Virginia. Let's go to Colby(ph), Colby with us from Boston.

COLBY (Caller): Hi. I used to a unit secretary in a hospital, and they wanted me to process the paperwork for a woman having an abortion. And I didn't want to do it, but I had to face the worry about repercussions for my job.

CONAN: And in fact, later in the program, we're going to be talking with Julie Rovner about the conscience, so-called conscience provision, which would have protected you if you'd declined to do that. What did you do, Colby?

COLBY: I said no, not knowing what would happen, not knowing if I had a conscience protection. And in fact I didn't get fired or get, you know, seemed to feel repercussions, although you never really know if somebody takes it wrongly. But I did do it. I think a conscience provision is important.

Also, the risk that they're talking about with a late-term abortion, the supposed risk of having the child, is exactly the risk of a cesarean section or less. At worst, supposing you have this baby, and it's - you know, you're in your eighth month, and you realize you have some kind of problem. Have a cesarean section if you have to, if you can't give birth normally, or induce labor early and give birth vaginally, naturally. That's the risk, just the risk of birth and cesarean.

CONAN: And I'll take that advice. But the situation you found yourself in, you - it's possible you could have had repercussions to your job. People who feel strongly the other way and work in clinics that do provide abortions, sometimes their lives are threatened.

COLBY: Mm-hmm. Yes, they are. It's a violent situation to be in. It's dangerous all around.

CONAN: Colby, did you have any thoughts about that?

COLBY: Yeah. The - out of all the women and their unborn babies that go into the clinic, half of them die. And some of the workers die also. And all of that is an infinite loss to lose a human being.

CONAN: Colby, thanks very much for the call. Appreciate it.

COLBY: You're welcome. Bye.

CONAN: Bye-bye. Let's see if we can go - I just wanted to ask you, Dr. Kelly, it is obviously just - the physician is the primary person but there are many other individuals involved in these kinds of decisions, nurses and administrator secretaries like Colby.

Dr. KELLY: Yeah. Well, the physician is 100 percent involved.

CONAN: Yes. Let's see if we can go to Damian(ph). Damian with us from Honolulu.

DAMIAN (Caller): Hi.

CONAN: Go ahead, please.

DAMIAN: Well, I'm finishing - I have one more year left of surgical residency, but I have a personal experience with this situation. My wife and I worked - we were - we became pregnant and we found that our child had a severe heart defect, ectopia cordis, which had a very slim chance of survival. But, you know, we believe in, you know, we're pro-life and we went through with the pregnancy and the baby lived 11 days.

But I think there's something to be said in allowing a child to be born despite defects. I believe that, you know, taking an active part in the ending of a life is wrong and that you should allow nature to take its course.

CONAN: Obviously...

DAMIAN: So the question is, do you think that the babies - a fetus is alive much as the other physician was saying?

CONAN: No, I understand that. And obviously, this is something you've given considerable thought to and...

DAMIAN: Yeah. It was a very sad thing for us, but I think I would be more upset if we have actually terminated the child's life actively.

CONAN: And I understand that, too. Nevertheless, would you question the judgment of somebody who had made the other decision?

DAMIAN: I would. I know it's a very difficult time, but I - you know - and humans sometimes act selfishly. And I think the responsible thing to do if you consider the baby as a living being is to allow that baby's life to take its course.

CONAN: Dr. Kelly, I wonder if you've had situations analogous to what Damian is talking about.

Dr. KELLY: Yeah. I didn't quite understand that.

CONAN: He had a baby with heart defect and decided that it would be born, though it had a very slim chance of life, and it did die after 11 days, though he feels that was very much the right decision to allow the baby to be born.

Dr. KELLY: Yeah. Well, the baby's life must be thought of. If the woman had a cancer of the uterus, all the people would advise her to get her uterus out as soon as possible. It's not a question of doing an abortion. You're removing a uterus that has cancer in it.

CONAN: Damian, thank you very much for the call. We appreciate it.

DAMIAN: You're welcome.

CONAN: Bye-bye. We're talking today with doctors and nurses and secretaries, administrators about abortion, following the murder of Dr. George Tiller.

You're listening to TALK OF THE NATION from NPR News.

Let's get Jim(ph) on the line. Jim with us from Upland, California. Jim, are you there?

JIM: Yes. I am definitely here.

CONAN: Go ahead, please.

JIM: I've been a clinical ultrasonographer for 35 years and I also teach it. And on the other side of the coin, I'm also a scientist, so I look at things rather clinically and very objectively. And my big problem with this, and I've sat down and done thousands and thousands of ultrasounds on the very - you know, on women from all walks of life, from all nationalities, all races, all perspectives and et cetera.

And the thing that I find that's on the other side of the coin is that the disingenuousness of groups like the, you know, women, you know, for a pro-life, or like when there's family planning clinics and et cetera. 'Cause they will go initially - and you have some young women who really doesn't quite know what's happening - they go have an - you know, they go to have ultrasound done, it's six, seven, eight weeks at which time the heart is usually clicked on.

And they're told that it's all just a blob of tissue. So, they go ahead and have the abortion, you know, and for them it's just fine. It's just a decision that they made, which they have every right to do. But what happens is that I will get the same patient back after they decide that they're going to have a baby.

I sit down and I very carefully, because I teach this also, explain it to them what's happening, what they see, here is the heart, here is the neural tube, here is whatever else, and I have had more women say to me, is that the heart beating? And that was at the same period of time that the abortion clinics have said, no, it's just a blob of tissue and become very emotionally upset because they have discovered that they have killed their baby.

I had one woman get off the table saying, those GDSOBs, and went immediately to the abortion clinic which was next door, and subsequently it evolved into a lawsuit. So I think a woman should have pro-choice, but they should also have what I consider an informed pro-choice.

CONAN: And...

JIM: If they know what they're dealing with and they're stopping a beating heart, if they choose to do it, it's their choice. But what...

CONAN: But accurate information, transparent.

JIM: Yes. Accurate information. But what's happening is there's a lot of emotional trauma going around by a disingenuous segment of the medical profession that is not giving them the whole truth. And I find that appalling -just to make money.

CONAN: Now, Dr. Kelly, when you were in practice, was ultrasound relatively new procedure? Was that the in vogue then?

Dr. KELLY: Well, when I started practice or when I started medical school, the - abortions were not allowed. There wasn't any state that didn't have a law against abortion.

CONAN: That was quite some time ago.

Dr. KELLY: Oh, yes.

CONAN: Well…

Dr. KELLY: I'm 88 years old.

JIM: It - I'm 69 and it goes back to the mid-'70s.

CONAN: Jim, thanks very much for the phone call. Appreciate it.

JIM: You're entirely welcome.

CONAN: And Dr. Kelly, thank you so much for your time today.

Dr. KELLY: All right.

CONAN: Dr. John Kelly joined us from his home in Manassas, Virginia. He's a retired surgeon.

Coming up on TALK OF THE NATION, an update on the Obama administration's changes on reproductive health policy, including an abortion conscience clause. Stay with us. Julie Rovner will join us.

I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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