Via a link on Scalpel or Sword, I read a post by Catholic blogger Dawn Eden which summarized a post by a medical student blogging under the name Pudu Overload who felt unnerved after observing abortions at a Planned Parenthood clinic. Pudu Overload apparently identifies herself as a supporter of abortion rights, yet felt "incredibly freaked out about the whole thing and [I] don't know how to think about it. It simultaneously seems like a small and an enormous thing."
I must qualify the statement about Pudu Overload's political leanings because, according to Dawn Eden, Pudu took her entire blog down after receiving hostile comments on the abortion post. Ms. Eden then proceeds to quote the post in its entirety, along with screenshots of the blog before it was removed, presumably to verify that Pudu actually wrote it. (You can read the post cached here.)
Ms. Eden's comments upon Pudu conflict reveal an underlying opposition to abortion rights. (I encourage you to read Ms. Eden's post yourself to see if you agree with this assessment.) She then goes on to elicit support for Pudu Overload from her readers: "Please pray that this young medical student and others like her who witness legalized slaughter will receive the grace to see the truth of what is going on— and flee from it." She also expresses regret that Pudu Overload should have received such hostile commentary from other abortion opponents and--rightly--encourages her readers to demonstrate more charity to those with whom they disagree.
I am troubled by the sequence of events described above for a number of reasons, the most trivial of which is my own support of abortion rights. Even though my views are strong, I respect people who hold an opposing view, because I can sympathize with basis of these beliefs, and because I really do believe a civilized exchange of views is the foundation of a true democracy.
I am more troubled by the the hateful commentary Pudu Overload allegedly received in response to her post, and even more so that Ms. Eden has chosen to re-post Pudu's original writing to support her own anti-abortion stance. This is misappropriation malappropriation* of Pudu's words and views, and it seems especially egregious to me in this instance because it occurred when Pudu Overload presumably feels vulnerable and under threat.
The real issue here is easily lost in the anti-abortion jargon Ms. Eden uses to describe and sympathize with Pudu Overload's situation. Yes, I agree abortion is an emotionally charged issue and witnessing the act itself is inevitably going to compel a young doctor to reassess her previously-held beliefs. However, abortion is not the only such act to challenge doctors in training. When I was a medical student I struggled with my beliefs and ethics when confronted with the following clinical situations:
1. Performing a pelvic exam on an anesthetized woman patient, without clearly obtaining consent from her beforehand.
2. Being offered an attempt at inserting a central line into a terminally-ill ICU patient because, I was told, "At this point, the only thing we can do for him is learn how to do procedures so we're ready for the next sick guy."
3. Witnessing the care of a micro-preemie infant who had been resuscitated just prior to the generally-agreed limit of viability (24 weeks gestation), and contemplating the great cost of his care against the likelihood he would only survive to live with significant chronic respiratory/neurological illness.
4. Contributing to the continuation of critical care (mechanical ventilation, pressors, artificial feedings) in a 80+ year-old patient beyond all reasonable expectation of meaningful recovery, because the patient's family could not agree to withdraw care and the medical team did not take on the difficult task of advising the family to do so.
Now, none of these clinical scenarios carries the social, religious or political weight of the decision to participate in abortion care, but each shares with abortion the problems of ethical ambiguity and physical invasion of the human body. Numbers 2, 3, and 4 also deal specifically with the question of who decides when life should begin and when it should end, and what value we place upon humanity at different stages of the life cycle. From my personal experience, they are as painful and agonizing to deal with as it is to counsel a woman with an unwanted pregnancy, and--for most doctors--far more common in practice. All young doctors must confront these difficult clinical scenarios and decide for themselves which boundaries they will not cross and which beliefs will inform their care. This process is intensely personal but benefits from open discussion with friends and peers, and an environment which acknowledges the possibility of ambiguity or conflict between belief and duty.
Pudu Overload's mistake might have been in sharing her experiences on a public forum such as a blog, but I don't blame her for that. Instead, I applaud her for being so honest and exposing feelings which a lot of people share. We need more personal, honest discussion such as Pudu's on difficult subjects such as abortion, and young doctors need a safe forum in which to express themselves. They do not, however, need to become the victims of Internet abuse or have their words misappropriated malappropriated* by others who want to promote an agenda. Instead of passing her post around as an example of how poisonous the act of abortion is--and it so easily could have been the decision not to intubate a 23 4/7 week preemie, or to withdraw care from an 88 year-old grandmother--we should be encouraging her efforts to become a conscientious physician, no matter what procedures she ultimately chooses to include within her scope of practice.
Elizabeth the First of England is credited with saying, "I have no desire to open windows into men's souls" and I agree completely. Let everyone examine their motives and fears and come to their own conclusions. Doctors especially need to confront their feelings about difficult clinical scenarios, and they don't need the additional burden of having their words manipulated for the benefit of political agendas. One lesson I've already learned in my career is the need to let go of partisanship and support people of conscience, no matter what their beliefs may be.
Pudu Overload, if you're reading this--I'm sorry for what happened, and I hope you put your blog back up. Close your posts to comments if you must, but don't stop asking yourself how you feel.
*Addendum: My friend and fellow blogger, Symtym, has drawn my attention to the improper use of the word "misappropriation" in the original version of this post. After some discussion, I have changed this to the neologism "mal-appropriation" to express my intended meaning: the deliberate use of an author's words to support ideas in opposition to her own. Symtym suggested a more common term, "contrarian use," but I prefer my neologism for the purposes of the discussion above.