Bioethics Forum Essay
Ethics, Optics, and Medicine as Work: Backstage at Planned Parenthood
Two days after a hidden camera video of Planned Parenthood’s senior director of medical services was released, the president of Planned Parenthood Federation of America, Cecile Richards, apologized for Dr. Deborah Nucatola’s tone:
“Our top priority is the compassionate care that we provide. In the video one of our staff members speaks in a way that does not reflect that compassion. This is unacceptable, and I personally apologize for the staff member’s tone and statements.”
This was a reasonable corporate response, since Dr. Nucatola’s frank discussion of abortion procedures and medical research shocked even some who support their legality, and ethicists criticized her on this count as well. But I don’t think Dr. Nucatola’s tone and statements fail to reflect compassionate care—what they reflect is a doctor who believed herself to be “backstage.” And contrary to the claims of the video’s originators, what they reveal is not the “selling of baby parts,” but medicine as work.
Dr. Nucatola was videotaped at a lunch meeting with people who she believed provided medical researchers with the tissue they need by collecting it in doctors’ offices. It’s rare for people outside of medicine to hear blunt procedure dialogue from any medical specialty, and seeing that backstage dialogue put in front of an audience and performed while eating in a restaurant is especially jarring. So of course the optics on this are terrible.
But that’s different from the ethics. Discussing work while eating is something overbooked clinicians are forced to do all the time, and sociologists tell us that professionals in many fields use blunt shorthand for efficient conversations when speaking to each other outside of the public eye. Knowing these facts is why I wasn’t shocked by the tone of Dr. Nucatola or that of the second physician secretly taped in a similar situation, Dr. Mary Gatter.
Instead, in reviewing the unedited videotape, I was actually moved by Dr. Nucatola’s compassion. She keeps returning to a focus on patients—how many of them want to donate their fetal tissue to research, how many feel this is a good thing for them to do. She says that the day before this meeting, 100 percent of her eligible patients agreed to donate their tissue. Later she says, “[P]atients are asking more . . . . Patients will call and make an appointment and say ‘I’d like to donate my tissue,’ and then the affiliates really feel like, ‘Oh, wow, I need to find a way to get this done.’” There are many more examples of her focus on patients throughout – and of her insistence that this is patient service, not something Planned Parenthood does for profit. At the end of the lunch, Dr. Nucatola hugs these saboteurs, and thanks them for what they do.
The person who deserves an apology for lack of compassion is the phlebotomist featured in the video released July 28, and if her claims are true, she’s owed it from the (actual) tissue procurement organization she worked for, not Planned Parenthood. On her first day of work, with no warning or preparation for going backstage into this part of medicine, Holly O’Donnell was told to collect fetal tissue. She was shocked to see technicians sorting fetal body parts, and she fainted. In this third video, O’Donnell’s narrative is interspersed with hidden camera footage of the same sorting process happening at a Planned Parenthood clinic.
Guess what: terminating a pregnancy requires destruction of an embryo or fetus. Anti-abortion advocates have had success focusing on this obvious fact, because the graphic specter of it makes many of us turn away in disgust. I’m not sure this completely distinguishes the medical specialty of abortion care; most of us also don’t want to see graphic photos of any other type of surgery either. But our desire to look away isn’t inconsistent with thankfulness for the life-saving and health-preserving results of any type of medical procedure. It just means we don’t want to watch their gory accomplishment.
But physicians don’t have the privilege we have of enjoying medical results without seeing the unpleasant in-between. They see the visceral subject matter of their specialty many times a day, thousands of times in a career. For example, physicians must examine fetal tissue after every abortion. (This has nothing to do with tissue procurement; leaving any tissue in the uterus can cause complications, so this routine tissue-sort confirms whether the procedure is finished or not.) For an ob-gyn’s short description of this procedure, see http://bioethics.northwestern.edu/atrium/articles/issue12/harris.html.
I am respectful of the moral seriousness of abortion. And I’m aware that once a doctor and patient move from the realm of ideas to action, when they decide that this act is morally permissible for the two of them and together they choose to do it, there is a moment behind closed doors when abortion becomes work. So why would we expect more “compassion” from a surgeon sorting dead fetal tissue than a surgeon in the midst of transplant surgery? It would be horrible if a transplant surgeon was disrespectful when interacting with the family of an organ donor who just died.
And it would be bizarre to fault that surgeon for keeping a technical focus on her living patient instead of “expressing compassion” for the dead donor during discussion of the procedure. Some people require abortion patients to show shame and regret in exchange for cultural permission and forgiveness for their act. One strain of the reaction to these videos strikes me as a new version of this—a demand that individual doctors providing abortions constantly embody and perform our larger cultural conflict over abortion, rather than standing as squarely in their conclusion that it is moral as those who oppose abortion stand in their conclusion that it is immoral.
If I were going to post an edited segment of the hidden camera video of Dr. Nucatola on YouTube, I’d pick an exchange that happens toward the end of the nearly three-hour discussion (a portion of the tape few will ever watch) because it “reveals” why people who could choose any lucrative, rewarding medical specialty instead choose to practice under the constant threat of terrorism – assassinations, clinic bombings, and now a new type of media terrorism:
DR. NUCATOLA: So how did you get involved in [tissue procurement]?
FAKE TISSUE PROCUREMENT GUY: [Feigns excitement about long description of current research using fetal organs.] It’s because of that kind of model that we’re on the brink of a cure for HIV. I mean, literally.
DR. NUCATOLA: [Expresses genuine excitement about the hope this research could someday create HIV vaccines and cures.] That’s the thing. I think if people got to hear more about the bigger picture . . .
FAKE TISSUE PROCUREMENT LADY: What about you? How did you come to be . . .
DR. NUCATOLA: . . . I really liked babies, believe it or not. And so I said, okay, I’m going to be a pediatrician. [She described finding out that she would really treating moms more than sick kids in that specialty.] Then I said, okay, I’m going to become an ob-gyn and I’m going to become a maternal-fetal specialist. . . . And I will tell you the date, I was on call. . . . February 28, 1998 was my last day of gyn ever as a resident . . . and on that day there was a patient that was transferred to me from an outside clinic who had had a D&E, dilation and evacuation, a late second trimester abortion [one of the abortion procedures Dr. Nucatola discussed bluntly earlier in the video], and was bleeding. . . . I met her in the emergency room, and she was as white as this napkin. I still remember her name; I remember everything about her. And she looked up at me, and she said, “Don’t let me die.” And she actually bled to death. We did a hysterectomy [uterus removal] in about 12 minutes, and she died. And it was very distressing and very upsetting. And, I probably had a very different reaction than most people would, which was, “Well, I do D&Es all the time, and I don’t ever have complications, and I think I’m pretty good at them. So I need to keep making sure there are lots of people who can do D&Es safely so there’s not another patient like this.” So that was the day I said I’m not doing perinatology, which is high-risk OB. I’m going to do family planning, and I’m going to train other providers to do family planning.
I believe the word for why Dr. Nucatola became an abortion provider is “compassion.”
Katie Watson, JD, is an assistant professor in the Medical Humanities and Bioethics Program at the Feinberg School of Medicine at Northwestern University.