Saturday, March 14, 2009

Tiller trial: Will Dr. McHugh testify?

Late-Term Abortion Provider on Trial for Allegedly Aborting Fetuses Illegally

First of all, I'd like to know how the "Fox news as right-wing mouthpiece" theory jibes with the fact that the article lamented every time Tiller faced opposition, while ignoring the lawsuits against him, the death of Christin Gilbert, and the utterly nonsensical idea that any woman could face a life-threatening or health-threatening pregnancy complication for which the safest course of action is to strenuously avoid all inpatient care at fully-equipped hospitals and to instead spend three days at the La Qunita attended by your mom or boyfriend.

That said, let's look at exactly what justification there was for these abortions.

Kansas law only allows third-trimester abortions (post-viability abortions done on fetuses who could have been delivered alive) for two reason:

“(1) The abortion is necessary to preserve the life of the pregnant woman; or (2) a continuation of the pregnancy will cause a substantial and irreversible impairment of a major bodily function of the pregnant woman.”

Now, these reasons are clearly bogus in the first place, since a pregnant woman whose life or health is in danger in the third trimester would need care in a fully-equipped hospital, not in the La Quinta. There's no medical reason not to do an emergency c-section or delivery in a hospital, where the mother will be attended by medical professionals. There can be no medical reason to have her spend three days in a motel attended by her husband, partner, sister, parents, or friends. But the Supreme Court, in Doe v. Bolton created a "health" need for post-viability abortions. The "need" is a judicial one, not a medical one, invented by men in black robes, not doctors in white coats.

Dr. Paul R. McHugh, who reviewed the redacted medical records on George Tiller's post-viability abortions, explores the reasons given as justification:

Highlights: Interviewer reviews Dr. McHugh's impressive qualifications. Dr. McHugh explains that Attorney General Kline asked him to review the records to "confirm or reject the idea" that the women were "in danger of suffering a substantial and irreversible impairment if the pregnancies continued -- impairment of a psychiatric kind." He did not think those records supported the claim that the women would suffer any substantial and irreversible impairment, as spelled out in Kansas law. The question he was asked was did he, an independent psychiatrist, concur with the idea that an abortion was necessary to prevent substantial and irreversible psychiatric damage.

Dr. McHugh indicated that he looked for evidence of the following: Where the records adequate to develop a diagnosis? Did the diagnoses represent a substantial and irreversible impairment? Would an abortion resolve the problem? Were these adequate psychiatric justifications?

He pointed out that the records were redacted, since names and identifying information were removed. He was to look at the quality and adequacy of the examinations done to determine a psychiatric justification for abortion. The interview establishes that Dr. McHugh was the state's expert witness, and that he wrote an affidavit of his findings.

Paul Morrison, who replaced Phil Kline, never contacted Dr. McHugh to follow through on the case.

What were some of the reasons given by the mothers for these late-term abortions? These abortions were done at 26 to 30 weeks. I address the issue of accuracy in estimating gestational age, and the potential these babies had for survival, here. In a nutshell, assuming that Tiller's estimates of these babies' ages were 100% accurate (odds are against that but we'll assume), they had at least an 80% chance of survival if delivered live via emergency c-section or labor induction, as is the standard of care for treating women with third-trimester pregnancy complications.

So what did Dr. McHugh find were the reasons for these compelling, health-preserving late term abortions?

"The mothers were expressing ... great senses of distress and worry about their future. They were tearful, and preoccupied that only an abortion would help them. They said that they were sad and frightened, and they spoke about fears that their future life would be changed. They expressed ideas that they were not being given adequate support, and that they felt that the abortion would help them."

The interviewer asks him to summarize his findings. Dr. McHugh says these records were "very inadequate psychiatric records." He described them as being very brief, lacking a patient history, lacking detail. "There was no clear work of -- in those records that would be construed of capable of giving you a full picture of the mental condition of these women. They highlighted certain kinds of things that .... were sometimes of a most trivial sort, from saying that 'I won't be able to go to concerts' or 'I won't be able to take part in sports'" to a reluctance to surrender the child for adoption or concern about the child's future. "At no time could you see and understand the future of these individuals and in what way they could be seen as full people, people capable of being helped in this situation. Rather, they were highlighted for certain kinds of -- well, preoccupations and concerns." Dr. McHugh pointed out, "I could pick out only bits and pieces of this. This is not a -- None of them represented a full psychiatric history."

Highlights: Interviewer asks for Tiller's justifications. "He had mostly social reasons for thinking that the late term abortions were suitable. That the children wouldn't ... that the offspring would not thrive. That the woman would have her future re-directed. That they wouldn't get a good education after they had a child. That they would be always guilty in some way about having that child. That they had been abused already and that this -- to have the baby would be another form of abuse. These ... are not psychiatric ideas... These were social ideas. .... There was nothing to back these things up in a substantial way."

Dr. McHugh also stressed the lack of follow-up planning, no follow-up care of any sort, including a lack of a psychiatric aftercare plan. There were also no explorations of alternative treatments other than abortion. "You couldn't even begin to try to get a true picture of the person." He noted again that some of the justifications included concerns about attending the prom, or concerts, or sporting events. Dr. McHugh also noted that attending concerts and sporting events, or pursuing an education, are things many people pursue after having a baby.

"Occasionally you would hear someone say their suicidal ideation would increase." Dr. McHugh noted that "being pregnant and being the mother of a child up to age one actually reduces the suicide risk to women from three to eight-fold." He also noted that abortion and miscarriage are known to increase suicide risk. There was nothing in the records to indicate why Tiller felt that these women's situations ran so far contrary to the established patterns of suicide risk.

He again noted the paucity of information on these cases, and the lack of proper psychiatric work-ups. "These cases have not been studied thoroughly. And the diagnoses that have been made, such as depression, adjustment disorder and the like -- those are not substantial and permanently impairing conditions. Those are conditions we psychiatrists deal with all the time." He points out that most psychiatric practice involves helping patients to overcome these diagnoses "and restoring people to their mental health. We do that all the time."

Dr. McHugh says, "I think that these young women were all in a demoralized state of mind. You -- These diagnoses become almost interchangeable, at least on the evidence that's produced here. They're all fundamentally demoralized young women and what they needed was support, help, care, and long-term treatment for the situation that they had, in which they felt abandoned, so that they could once again feel, as they should feel, that their future is rich."

The interviewer asked if it wasn't a breach of medical care to lack follow-up plans. Dr. McHugh says, "It relates to my concern about these records as not being adequate, either in what they brought to the case, or what they propose for the case other than the abortion. And I had to ask myself, looking at these records, is any person who comes to this clinic ever found not to be appropriate on psychological or psychiatric grounds for abortion?"

The interviewer asked if Tiller ever rejected a patient. He said he'd seen no such records. "I'm saying that looking at these records, and what they were employed to do, I can't imagine that anyone wouldn't satisfy those criteria." He added, "From these records -- anybody could have gotten an abortion if they wanted one."

"When I look at the records, as far as I can tell, all these young women were very similar in the sense that they were all demoralized. And what other diagnostic term you wanted to give it was almost interchangeable on the basis of these records. They were discouraged -- fearful, worried young women who needed support, and would express a variety of ideas in that context to win what they were looking for. And that's -- that's the way to understand these people in my opinion. And a thorough psychiatric examination, and a thorough and adequate psychiatric plan was needed by them, and was not received -- here, anyway."

Highlights: She asked about Tiller's training in psychiatry and psychology. Dr. McHugh says he doesn't know, though he does understand Tiller worked in pathology for a while and is not a psychiatrist. And he stresses that he wasn't called upon to judge Tiller's qualifications, just to review the records and their adequacy as far as psychiatric evaluations and psychiatric treatment planning.

The psychiatric assessments justifying the abortions evidently were being done by Tiller, and each file included a letter from a second doctor who expressed "her" opinion -- indicating that it was always the same doctor (Likely Dr. Kristen Nuehaus) -- seconding Tiller's opinion that the woman would indeed suffer a substantial and irreversible impairment of a bodily function, psychiatrically, should they not have abortions. Dr. McHugh noted, "that letter did not come with the kind of pages of psychiatric study, evaluation, biographical details, understanding of the person on which -- from that record you could confirm that opinion." He noted, "At least from the record,that second opinion ... rested upon an encounter with the young woman and a statement of her present state of mind. So it was an opinion derived in much the same way, from the statements of the patients themselves of how distressed they were." He noted that the letters were not highly detailed, but a letter was "brief, symptom-only based, and unsubstantiated in its prognosis on the basis of a rich detailed study of the young woman and her potentials."

He looks at the lack of any review of the woman's situation, or her resources. "One wonders looking at this why some consideration isn't being made to employ them for the benefit of these patients." He notes that the impression one gets from reviewing the cases is, "These young women came here for an abortion, and the effort on the part of the psychiatric assessment was to support that -- that idea that an abortion is appropriate rather considering the alternatives, the risks and benefits of this to this person in a life."

The interviewer asked if any of the files showed sufficient psychiatric evidence to justify an abortion. Dr. McHugh saw none. They were all based on the "present state of mind of being distressed" and the social idea that the patient's opportunities might be lessened if they bore their children.

Dr. McHugh felt that the records were inadequate to perform a diagnosis, and very inadequate to understand the women in question. He picked up that they were "discouraged" and "demoralized" and "disheartened" and a psychiatric diagnosis of depression seemed very inadequate to him. The records were so inadequate that they did not, in his opinion, support the diagnoses given, nor of any other diagnosis. He felt that no psychiatrist would consider them adequate records to make a diagnoses or make a psychiatric plan. And, he noted, despite the paucity of information on which to base a psychiatric plan, these files were in fact being used to make a psychiatric plan -- to perform an abortion as a treatment for the diagnoses in question.

The interviewer went through the diagnoses given and asked did they constitute permanent and irreversible impairments, and Dr. McHugh indicated no, and that furthermore these conditions, if the diagnoses were correct, are treatable in pregnancy.

Highlights: "How would you summarize ... Tiller's findings that justify these late term abortions?" McHugh noted, "All I can carry away from this is that by these criteria, is that no person that would want an abortion -- a late-term abortion --would be turned away from that. So I presume that the idea here is to justify that surgical procedure. That -- And these records on a psychiatric basis do not justify that."

The interviewer asked about the social reasons Tiller used. Dr. McHugh referred to his notes. Tiller claimed that a patient would end up uneducated -- which is a social prediction, not a medical prognosis. That the patient feared occupational setbacks or family disapproval.

Dr. McHugh said, "I don't mean to say that if you do lose out in your education that that's not harm, but it's a social harm, and those kinds of things should be treated in a social fashion. And by supporting the individual, re-moralizing her, giving her her strengths ... she then, as we know, independently can demand the kinds of support ... that she would be entitled to!"

Dr. MrHugh quoted one of Tiller's notes justifying one of these third-trimester abortions: "If she was forced to carry to term, she would end up as an uneducated person without occupational skills and have multiple other pregnancies. ... All of those things are social predictions! .... I'm saying, and we psychiatrists would say, will be avoided if you can get this person once again to feel what she's entitled to feel, that she is an independent individual with rights.... If you teach her that the only thing that can be done here is that this viable human being has to be killed in order for her to have anything in her future, that's a lesson, that's a social lesson, that may well... take from her the sort of sense that she can overcome hurdles that life brings her."

He points out that this sort of defeatist attitude toward women in any other context would be treated with the appropriate scorn.

Dr. McHugh expressed a sense that Tiller was reinforcing the patients' views of themselves as powerless and incapable, with no promise and no strengths, that Tiller was underscoring and reinforcing a sense of hopelessness.

Dr. McHugh says, "Doctors are supposed to give hope to people, and give support to people, and they have to believe that there is such hope to be found in them. And usually ... that kind of hopeful attitude comes out of taking the full history of the person, noticing not simply what life has imposed upon her, but what she has brought to life, what her strengths are. If we approach a psychiatric problem as though there are only deficits rather assets for a person, we will never have an optimistic and future-oriented therapy for people. We've got to see their assets as well as their vulnerabilities.... And those don't come across in these records."

He adds, "By the records, anyway, what is being looked at is the state of mind of the woman right at the time, in which the issues of the stressing aspects of her present context are emphasized, and her strengths, her assets, the things that she brought, and, by the way, our capacity to open up for her and broader her horizons as to what can happen in the future for her is neglected. It's as though, from the records .... one has the idea that the purpose of this visit is to justify an abortion, rather than the purpose of this visit is to have a full psychiatric understanding of this person and see all of the alternative ways that she could approach her life."

The interviewer then reinforced that these are viable fetuses, late in pregnancy. "These are the very kinds of little babies that are being taken care of in ICUs all around our country. .... To eliminate them is a serious business. .... There's no psychiatric reasons for that."

Dr. McHugh notes that "There is no psychological condition for which abortion is the cure."

The interviewer asked why Dr. McHugh chose to speak out. He noted that he was invited to this situation by an attorney general, and that psychiatry was being called in to justify these abortions. "This is not a full psychiatric practice that we are seeing here. Rather, psychiatric terms are being employed to justify doing a procedure." He sees speaking out as "speaking out for my discipline."

Dr. McHugh said, "These records are not adequate records for the support of a serious decision for abortion, and that they do not represent psychiatry at its best, and psychiatry at its best should be employed when serious decisions are being made."

"The people of Kansas have written these laws," Dr. McHugh stressed. "'Viable fetuses should not be aborted unless there is a substantial and irreversible condition that the pregnancy will produce.' Well, when a psychiatric diagnosis is brought forth, I think that the people should understand that that requires a heck of a lot more than I found in these records. That's what I' here and that's what I'm trying to report."

And the narrator recaps.

The things Dr. McHugh brought forth are in keeping with what investigators found when they researched abortion lobby claims that late abortions are done only in desperate situations where either mother or baby had a terrible diagnosis. In fact, what Dr. McHugh describes being done in Kansas to get around laws against post-viability abortions is highly reminiscent of the rubber-stamping psychiatrists used to do to enable women to get around laws banning elective abortions prior to legalization.

As this woman's testimony bears out that these abortions are not being done to address women's critical health issues, and also, Tiller is not reporting statutory rape. She was only 14 years old.

She describes pushing her baby out into a toilet, which was the standard way the abortions were being done.

You can hear Michelle Arnesto's unedited testimony about her illegal late-term abortion at Tiller's mill here. And there are summaries of other cases here. The cases, in a nutshell, are 26 weeks for Anxiety Disorder Not Otherwise Specified or Adjustment Disorder with mixed anxiety and depressed mood; 29 weeks with no reason given for declaring the fetus "non-viable"; 28 weeks for Major Depressive Disorder Single Episode, 28 weeks with no note on the mother's medical condition, 28 weeks for Major Depressive Disorder Single Episode, etc.


XtnYoda said...

I posted the sequel to Crazy Pete's Abortion Barn you linked me to.


God Bless,


G. Casey said...

When I was four my mother was left in a position for risking her life at the age of 42, my dad was going through a timne drinking a lot and was not giving any support. She asked for his strength and support and he kept drinking. She would end up having an abortion somewhere around the third week after conception. This was 1971. I always had mercy for my mom in this decision but it still left me for the longest never could see this issue straight. Thank you for the insight and research you have done. In knowing that the medical industry is complicit in cover up and lies I am thouroughly disgusted.

Naaman said...

Christina, thank you for your in-depth coverage of this case. We know that Tiller will face justice in eternity (as we all will), but I'm starting to hope that he might face justice in this life as well.

Lilliput said...

"As this woman's testimony bears out that these abortions are not being done to address women's critical health issues, and also, Tiller is not reporting statutory rape. She was only 14 years old."

It doesn't looklike Kelly was raped - she just had sex before turning 16 - there is a huge issue. If you want to bring in the fact that she was a child into it - then you have to respect Kelly's parent's parental rights over their child as they decided that an abortion was the right thing to do.

Her beef should be with her parents who obviously forced her to have the abortion as they felt that ultimately they would have to look after it and didn't want that for themselves or their daughter.

I see Tiller as just filling a need that unfortunately won't go away even if we put him in jail.

I wonder what kind of relationship Kelly had with her Mom, that she successful hid her pregnancy for so long. Its this unhealthy relationship and not her abortion, which led her to continue her sexual, drug and mental ill health.

GrannyGrump said...

Lilliput, nobody had to respect anybody's idea that killing a baby for social reasons is hunky dory. If we thought killing babies was an acceptable way of addressing problems, we'd be "prochoice" in the first place.

Lilliput said...

All I'm saying is Tiller is not the problem and getting rid of him, will not stop the late term abortions. Its like a pimp or a drug dealer. The problem is with the demand. And unfortunately, somehow - countries which have legal abortions and high level of free contraceptives have a higher level of quality of life, living standards, human rights, life expectancy etc etc and these are all "social reasons" as you called it.

I just watched another Brazillian fim last night. I can't believe how Christians can live with themselves when they keep contraceptives and abortion away from this nation allowing huge number of slums to develope where feral kids roam like stray cats and dogs which have to be cleaned up when the Pope wants to come and visit.

Your denial of any of the above makes it impossible for anyone of rational mind to take on this Pro Life stance.

Yes killing babies is horrific - but over population is just as horrific - just look at the thirld world.

Naaman said...

Lilliput wrote:
All I'm saying is Tiller is not the problem and getting rid of him, will not stop the late term abortions. Its like a pimp or a drug dealer. The problem is with the demand.

Yes, there is a big problem with our society in that we encourage killing children as an acceptable solution to many of life's problems. Pro-lifers agree that we need to provide better options for pregnant women, which is why so many of us donate our time and money to crisis pregnancy centers. We also believe that we need to reset our society's moral compass so that abortion is recognized as the appalling crime that it truly is. One excellent way to reset our moral compass is by highlighting the moral failings of abortionists like Tiller and sending them to prison whenever possible. If Tiller goes to prison, it will contribute to society's perception of him as evil.

Furthermore, your argument basically assumes that abortion isn't a serious problem. To clarify that, let me apply your logic to a different offense:
All I'm saying is an individual wife-beater is not the problem and getting rid of him, will not stop domestic abuse. Its like a pimp or a drug dealer. The problem is with the demand.

See the problem? Yes, we recognize that there are problems in our society, and we seek to prevent domestic abuse whenever possible. But we also throw wife-beaters in prison! Because sometimes it doesn't matter how good your excuse might be ... the offense still needs to be punished.

Lilliput also wrote:
I just watched another Brazillian fim last night. I can't believe how Christians can live with themselves when they keep contraceptives and abortion away from this nation allowing huge number of slums to develope where feral kids roam like stray cats and dogs which have to be cleaned up when the Pope wants to come and visit.

So you would advocate mass killing to deal with Brazil's poverty? Those kids would be better off dead then poor?

That's the logic of proposing abortion to as a solution for poverty. You're assuming that death is better than being poor. If you were consistent about it, you'd be encouraging "mercy killings" for all poor children, not just the unborn ones.

Lilliput also wrote:
Your denial of any of the above makes it impossible for anyone of rational mind to take on this Pro Life stance.

Pro-lifers simply don't agree that death is an acceptable solution to poverty. Rather than kill poor people, we'd prefer to help them as much as possible.

Lilliput said...

Pro-lifers simply don't agree that death is an acceptable solution to poverty. Rather than kill poor people, we'd prefer to help them as much as possible.

So Naaman, help them by giving them what will pull them out of their poverty - access to birth control.

Amy said...


You DO know that birth control isn't failsafe, right? That people don't take it properly, don't take it at all, or that it fails for other reasons, correct?

Now, unless you're advocating forced contraception by government mandate and/or forced sterilization, then your argument will not help them.

Also, why is the solution to poverty to always create a culture of death? Why are children always blamed for poverty?

GrannyGrump said...

Lilliput, the doctors are indeed a problem. If they were providing real counsel and help the women wouldn't be so demoralized. It takes TWO doctors in Kansas to do a post-viability abortion -- something that didn't even EXIST until the Supreme Court (judges, not doctors) invented it in 1973.

And do you really think that pimps and drug dealers aren't helping to create the demand for their "services"?

And the developing world isn't poor because it's overpopulated. It's poor because of politics. Look at Singapore. Look at Hong Kong. Wealth and dense population going hand in hand.

Abortion is like the wolf in Aesop's fable. He could always find a reason to eat the lamb. People who fall into abortion's thrall will always find SOMETHING it's a panacea for.

GrannyGrump said...

Lilliput, you guys have been banging the contraception drum for decades. Has the rate of unintended pregnancy fallen where contraception is readily available and socially sanctioned? HELL NO! It's gone UP. Why? The law of unintended consequences.

Say you are alarmed by construction workers falling and being injured or killed. You want to prevent this. So you invent the Bounce Safe -- a device that, if properly maintained and consistently worn, will allow you to escape unscathed from 99% of falls.

You release Bounce Safe amid much fanfare. And Bounce Save becomes the norm at many construction sites.

But funny thing -- the sites with Bounce Save have MORE injuries and deaths from falls than the sites without Bounce Safe. It turns out that people don't maintain the Bounce Safe properly. They don't get it fitted properly. They don't wear it properly or consistently. And they take far more risks than the workers at sites without Bounce Safe. They neglect to put up safety rails. They show up for work drunk. They leap from beam to beam, confident that Bounce Safe will catch them.

This is what happens with contraception. People have 100% faith that it will prevent unintended pregnancy -- even though they don't use it consistently or properly. With more people taking more risks, you get more of the ill effect you were trying to prevent in the first place.

Kathy said...


My memory of history may be a little fuzzy, but from the best of my recollection, hormonal birth control has only been around for the past say 50-60 years, whereas the quality of life in the world progressed by leaps and bounds from the end of the Dark Ages through the early 20th century. If fewer children is the only way to get out of poverty, then how did our forefathers do that without modern birth control and modern abortion methods? And if they could do it, what is preventing Brazilians and others from doing what Americans and Europeans of the 1600-1900s did? Yeah, I know, there were still slums... but there still *are* slums, despite 50-60 years of birth control and 30+ years of legal abortion.

I would also point out that China has very high abortion rates, even forced and unwanted abortion, as well as high birth-control rates, and there are still many, many people living in poverty there. And the same could be said for other locales, such as New York City and Washington, D.C., which have high rates both of poverty and of abortion.

Kathy said...


I also read somewhere that on a "scale of happiness" the people of Nigeria rated themselves as being happier than the people of the United States. Money doesn't solve every problem (which you can see by looking at how many celebrities end up hooked on drugs, committing suicide, or accidentally overdosing on drugs, or otherwise harming or killing themselves or others -- if they were happy, they wouldn't be searching for happiness in a snort of cocaine or a line of speed). There can be happiness found in adverse circumstances; I'm afraid that we in the West are just too sheltered and selfish to believe that anyone can be happy living in conditions beneath or own standard of living.