Ten years ago, on 31 May 2009, George Tiller, an abortion provider in Kansas, was assassinated in his church by an anti-abortion zealot. Given today’s turbulent environment, with Alabama legislators seeking to ban nearly all abortions and with Donald Trump likely to make attacks on rare third-trimester abortions – “infanticide”, as he misleadingly calls them – a centerpiece of his re-election campaign, Dr Tiller’s legacy in American abortion history is ever more important.
That’s because Tiller, during his lifetime, became the public face of late abortion provision. Reviled by the anti-abortion movement but cherished by his supporters, especially among the close-knit abortion-providing community, he came to symbolize the great abortion divide in American society, one that continues at full throttle today. But a lesser-known aspect of Tiller’s work consists of the unique practices he developed to care for women and their family members at the saddest time of their lives.
Dr Tiller provided third-trimester abortions in cases where wanted pregnancies had gone horribly wrong, due to severe or lethal fetal anomalies that had been discovered only late in pregnancy. (These post-24-week abortions constitute about 1% of abortions taking place in the United States each year.) In his Wichita clinic, he developed protocols to make the heartbreaking experience for these patients, which could stretch over four or five days, as humane as possible.
He spent considerable time with the patients, both alone and in groups. Tiller encouraged these patients to bond with the others who were there for the same procedure, and he counseled them on how to respond to queries about why they were no longer visibly pregnant when they returned home. A rabbi who had accompanied his wife to the Wichita clinic wrote in a eulogy after the doctor’s death: “Dr Tiller had an understanding of (our) pain, perhaps better than anyone who has never gone through it personally.”
The induction method of abortion that Tiller employed for third-trimester patients meant that women would eventually deliver a stillbirth. Before this occurred, Tiller and his staff would hold highly sensitive discussions with them about what the clinic called “baby plans”. (Notably, for these patients with wanted pregnancies, the term used by staff was “baby”, not “fetus”). Did they wish to see and hold their baby after delivery, which could involve upsetting sights, such as misshapen heads and organs outside the body? Did they want keepsakes such as footprints? Or to have their babies’ ashes shipped to them after cremation?
Tiller and his staff were attentive to the spiritual needs of those patients who expressed such interest. The clinic employed a chaplain who conducted various rituals according to patient requests. A local imam was brought in to instruct staff on how to deal in the most culturally and religiously appropriate ways with Muslim patients after an abortion and to conduct funeral services, if the parents wished. Tiller himself reached out to local rabbis on behalf of Jewish patients, for example arranging a seder invitation for the above-mentioned rabbi and his wife, whose stay in Wichita coincided with Passover.
Dr Tiller was a man of remarkable equanimity in the midst of the constant chaos outside his clinic, with protesters screaming at entering patients. He withstood repeated denunciations of him as “Tiller the Killer” on Fox News, a firebombing of his clinic and an earlier shooting, before the fatal one. Protesters would periodically show up at his house and the homes of his devoted staff. The state of Kansas made numerous attempts to shut him down.
When asked by friends how he could endure all this, his answer revealed not only his selfless nature, but also the state of abortion access in this country: “Where else will these women go?”
As we mark the 10th anniversary of his death, his legacy should not only be that he was the most polarizing figure in America’s abortion wars. George Tiller should also be remembered for his pioneering efforts to bring compassion and comfort at such a tragic time for the women who came to him. Today some of the doctors who worked with Tiller continue to provide later abortions in other facilities, incorporating the practices they learned in Wichita and some new providers of these services have stepped up as well. Tiller’s successors, too, are vilified and doubtless will become even more so, as the election season heats up. But they will hopefully stay the course, as their mentor modeled for them.
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Carole Joffe is a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. She is the author, with David S Cohen, of the forthcoming book Obstacle Course: Everyday Struggles to Get an Abortion in America
