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I provide abortions for my patients and for any other girl or woman who feels this her best option after making what is, for most women and their families, a soul searing self-examination before arriving at the decision to abort a pregnancy.

Why would I or any other reputable physician provide abortions? Good question.

First the long answer.

In 1964, I was admitted to medical school on the day that our second child was born. I sat with my wife through her labor and at the last minute they took her into the delivery room where our son was born. My mother and father, her mother, my sister and about half dozen friends were at the hospital with us. All came into her room a few minutes after delivery. There was such a tremendous feeling of love and goodwill in that room that I decided then and there that if I were granted the opportunity, I was going to become an Obstetrician.

I started medical school at age twenty-nine, the father of two wonderful children, the husband of a wonderful wife, and the happiest man in the world.

But a large part of this answer began years before the night I decided to become an Obstetrician.

I grew up in a small town, the son of small town teachers. We were Methodists but we went to whichever of the two churches (they alternated services) was open on a particular day for worship, Sunday School, MYF, BTU, prayer meeting or revival; the Baptist or the Methodist, it didn’t matter…we were there! My father was the Sunday School superintendent (at the Methodist church) and my mother played the piano at both churches. Obviously we were well churched. We were also poor as church mice since my parents had five children on a very limited income.

I had no concept that I would ever be able to go to medical school when I was young, and when we started in 1964, I had no idea how we were going to be able to finish. But my mother always said to me, “the Lord has a special purpose for your life.” (I suspect that she told all her children that.) The longer I live, even though I am not a particularly superstitious man, the more I have come to believe that to be true for each of us – if we make it happen.

By 1967 I was a third year medical student, still with no visible means of support, and we were pregnant with our third child. It was the spring of that year and I was ending my rotation in the Ob-Gyn Service clinic. I was assigned a 40 plus year old, poverty stricken mother of several children. I think she was unmarried but I am not sure of that now. This care worn mother-of-several had a large abdominal mass that I rapidly determined to be a well advanced pregnancy. I asked my resident to come and break the news to this woman; it was very obvious to me that she was not going to be happy about the news of another pregnancy. When told that she – already unable to adequately feed and clothe her family – was again pregnant, she looked up at me and the resident. There we stood, two white males, well clothed, well feed young men with superior educations. We were, in her eyes, stunningly blessed and obviously going places in the world. She began to weep silently. She must have assumed, for good reason, that there was no way that we would understand her problems; she knew also that there was nothing that we could or would do to relieve her lacerating misery.

“Oh God, doctor,” she said quietly, “I was hoping it was cancer.”

That mother’s anguished whisper eventually became a shriek of despair and hopelessness that has reverberated in my heart and mind and soul for over thirty years. Before that moment, forever seared like a brand on my memory, I would have described myself as “Pro-Life” had I then known this political term .

Over the next few years, I was exposed to real life as it is lived by millions of people who don’t have the sanctification granted in America to those who are white, male, well educated, well gene-ed, well nurtured, well advantaged. I learned that what this woman knew was a personal tragedy for herself and her family, was only one face in a multifaceted problem confronting thousands of girls and women every day.

How did I learn this?

I learned it – really made it a part of my essential being – by seeing the repercussions of desperation walk, and crawl, and be carried through our emergency room door three, four, five times, every night for four years. Each night we would admit to the wards of University Hospital in Little Rock (a fairly small hospital, as metropolitan hospitals go) girls and women with raging fevers, extraordinary uterine and pelvic infections, enormous blood loss, and a multitude of serious injuries of the pelvic and intra-abdominal organs as a result of illegal and self-induced abortions. During the years 1970 through the end of my residency in June, 1972 we did in the same hospital perhaps twenty to thirty safe, legal abortions a month on girls and women of various ages for mostly elective reasons. The contrast between the outcomes for these two sets of women was dramatic, not only for what happened to them immediately – that is, the almost total lack of complications in those undergoing legal abortions and the terrible consequences of some of the illegal abortions that we saw – but also for what happened over the next few years to those who had illegal abortions as they discovered that they were sterile, or faced total hysterectomy for the effects of injuries suffered during their illegal procedures.

I could and sometimes do go on for hours about what I saw during those years of training and in early private practice, before abortion became universally legal and affordable in the first few months of pregnancy for any woman who determined, for a myriad of reasons, that carrying a pregnancy to term and delivering a baby was not in her best interest. Or perhaps not in the best interests of her family. (The very poor in those early days of legal abortion were covered by Medicaid.)

But what of the concern for, as a ninth grader expressed it, “someone who is often forgotten, the little life who doesn’t even have a chance to live.”

No one, neither the patient receiving an abortion, nor the person doing the abortion, is ever, at anytime, unaware that they are ending a life. We just don’t believe that a developing embryo or fetus, whose mother cannot or will not accept it, has the same moral claims on us, claims to autonomy and justice, that an adolescent or adult woman has. I have never seen an abortion decision entered into lightly by anyone involved. The decision to have an abortion is most often made in the time of the first great personal moral crisis that ever faces a girl, a woman, her family and the people who love them. It is only those who stand outside and condemn the women and families who are faced with these dilemmas who take lightly the decisions made in these straits and trivialize the circumstances in which they are made.

Moral dilemmas are always about difficult problems. Decisions between right and wrong are not moral dilemmas; decisions between right and wrong should be no-brainers and should never be difficult.

It is in deciding between what we consider morally near-equal alternatives that we are forced to make agonizing appraisals. The decision between competing evils or competing goods – these are the judgments that may burn in your mind and live forever in your memory, that fry your soul. And it matters not whether one believes elective abortion a good or an evil, for every abortion decision is made between self-perceived competing goods or competing evils, not between obvious good and self-evident evil.

Is legal abortion dangerous? I personally have not seen an abortion injury to a woman since 1974, with three exceptions: One was a young women who became sterile after a post legal-abortion infection in 1974 in my practice; another was a woman from my practice who had a ruptured uterus in about 1975 as the result of an abortion done in Little Rock at about twenty-four weeks by a resident using a no-longer-used method of abortion.

There are risks to any medical procedure; however, legal abortion, done by competent medical personnel is among the safest operative procedures performed today in the United States.

I mentioned earlier that my mother always said to me, “the Lord has a special purpose for your life,” and that the older I get, the more I think she may have been right; not just for my life, but for all of us. (But we have to find that purpose ourselves.) We each have unique skills, talents and abilities to be used in the service of our fellow human beings. What I mean by this is, that I was led into OB-Gyn by my love for delivering babies. Gynecology was really to be only an appendage to my obstetrical practice and I am sure that providing abortions, even thinking about abortions, would never have been a major part of my life had other physicians in my area continued to provide them as was being done prior to 1984.

However, I soon found my practice inundated with abortion patients because other physicians who had also been providing abortions stopped doing so. In late 1983 it suddenly became uncomfortable, and very soon dangerous, to provide abortions. I literally had no option but to make a “Sophie’s choice” between delivering babies, which I loved, or making what for me would be an immoral and unethical decision, that is, to choose to abandon those girls, women and families who started coming to my office by the dozens. How could I look my children, my wife, my mother and my friends – myself – in the face and say, “I believe that abortion should be legal, safe, and available. But now some people disapprove and it’s become very uncomfortable, perhaps even dangerous, to provide them. And so I am going to stop doing what I know to be absolutely right. When it gets uncomfortable or dangerous, it’s OK to say, `not me, coach.’”

Was that the morality that I wanted to demonstrate to my children? To parade in front of my wife, my family and friends?

Not me, coach!

Why do I provide abortions?

Here is the short answer.

Like multitudes before me and, I trust, multitudes to come, I eventually heard (Try as I might to avoid hearing it!) in that mother’s grief-filled declaration, “Oh God, Doctor, I was hoping it was cancer”, a still, small voice asking, “Whom shall I send, and who will go for us?” to which I was at last compelled to reply, “here am I, send me.”

I am Dr. Tiller.