Stories From the Front Lines of Abortion Care (Dr. Warren Hern)
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Look around! You can find cars like these on AutoTrader. Like that car right in your tail. Or if you're tailgating right now, all those cars doubling as kitchens and living rooms are on AutoTrader too.

Are you working out and listening to this ad at the same time? Well, multitasking pro, cars like the ones in the gym parking lot are for sale on AutoTrader. New cars, used cars, electric cars, maybe even flying cars. Okay, no flying cars, but as soon as they get invented, they'll be on AutoTrader. Just you wait. AutoTrader. You're listening to The Michael Shermer Show. Let's go back in time, way back in time. What did women do?

I don't know, a thousand years ago, ancient Greece and Rome or the Middle Ages or whatever, when they didn't have any medical treatment. Well, you have the situation that we know about from the author Francois Marceau, who was a physician in Paris in the 17th century and published the first textbook on obstetrics and gynecology in 1668.

And he was motivated to do this work by watching his sister die in a pool of blood as she was trying to deliver her fifth child. And anyway, so he wrote this textbook, Maladie des femmes accouchées, the diseases of women in pregnancy and childbirth. And he called pregnancy a disease of nine months.

And, you know, I thought that was quite an interesting perspective. And then I looked at my own obstetric textbook, which was full of all the things that could happen to women when they're pregnant and all the ways to keep that from happening. And meanwhile, calling pregnancy normal and saying woman is most normal when she's pregnant. And wait a minute, what does that mean when she's not pregnant? Is she not normal? Is that what she's for, is reproduction? And there's certain people in this country who believe that.

But in any case, I was questioning the premise of modern obstetrics. This is 50 years ago now.

and 60 years ago and looking at it. And one of my conclusions was that pregnancy has all of the characteristics of an illness condition. It fits into the cognitive framework of illness. And that this is regardless whether one woman wants to be pregnant or not, regardless of the circumstances,

under which she became pregnant, whether it was a loving affection with a man or it was rape. And it doesn't matter. She's in danger of her losing her life because of the pregnancy. And that being the case, my conclusion with my writing and in my textbook and everything I've written is that the treatment of choice for pregnancy is abortion unless the woman wants to have a baby.

And that is quite a different perspective than much of the current ideology, which puts the embryo and the fetus first and is willing to sacrifice the life of the woman. Yeah.

Yeah, do you get the sense, I get the sense that we've sort of forgotten how dangerous pregnancy could be because of modern... I can't hear you very well. Oh, sorry. That, you know, I think a lot of people have forgotten, us moderns now, about how dangerous pregnancy could be historically. I mean, before, say, the 20th century, women routinely died in pregnancy, right? Yes, they did. I think the background...

Nobody knows for sure, but I think the background risk of death for pregnancy and childbirth is about 1% or more, depending on the circumstances. At the end of World War I, the maternal mortality ratio was 1,000 maternal deaths per 100,000 live births.

In the early 1920s, it was 680 per 100,000 live births. By 1960, it was 38 per 100,000 live births. And it kept on going down. In the mid-90s, it was down to seven or eight in the United States. And now it's back up over 30 for various reasons. So under the best circumstances, pregnancy can kill you.

And that means that there's no justification whatsoever for forcing a woman to carry the pregnancy to term. And she should only do so if she wants to do that, wants to have a baby. Yeah. Give us a sense, since you were there, of what it was like before Roe, say, I don't know, in the 1960s up to 73, and then the shift afterwards, after Roe, how things changed. Well, I think that before Roe,

There were a lot of illegal abortions being performed.

very frequently by very skilled people, physicians and others who weren't physicians but knew how to do this properly. And then there were quite a few badly performed abortions, some by women on themselves, sometimes using caustic substances such as lye, coat hangers, and other things that resulted in death and grave disability, grave injury. And so that it was a leading cause of death.

for women in the childbearing age range. And there was also a great difference in disparity in the access to safe abortion and by different groups. The situation is that in New York City, for example, the

Among black women, the proportion of maternal mortality due to abortion was about 50%, and among Puerto Rican women it was about 60%, and among white women it was about 20%. So that shows you the difference. At that time, I was beginning to work for a national family planning program in the so-called War on Poverty, the Office of Economic Opportunity, started by Lyndon Johnson.

And at that time, the death rate due to unsafe abortion for black women was nine times higher than it was for white women. Right now in the United States,

The maternal mortality ratio for black women is three times higher than it is for white women. And in Alabama and other places like Texas, it's maybe five times higher. So this depends on access to safe medical services. Right. So I was just looking at some recent numbers here. The CDC has said,

In 2021, 625,978, so 626,000 abortions. The Guttmacher Institute has it higher at 930,000 abortions.

So and they should are not reporting these now. Yeah, that's right. So but then they had it like in 1973, 744,000 as high as 1.6 million in 1990, then back down to 930,000, whatever. It's a lot. But would it be safe to assume that those numbers were probably about the same before Roe, but just no one could collect accurate data?

That's correct. It was estimated that there were at least a million abortions being performed per year in the United States before Roe versus Wade. And even during the Depression, it might have been higher. One of the salient facts about this, if you look at the issues of behavior and aspects of medicine, and the...

The medical sociologists call this illness behavior. That is to say that the woman who is pregnant defines the current pregnancy as an illness condition for which she regards the appropriate treatment to be abortion.

And that is independent of background, philosophy, geography, culture, or anything else. And this has been going on for thousands of years. And anthropologist George Devereaux studied 450 tribal societies. He found that women did abortions in all these societies. These are pre-industrial societies. So this is a common experience for women. Yeah.

Yeah, I wrote about infanticide in my book, The Moral Arc. I'll just read you this. Anthropologists, historians tell us that infanticide has been practiced by all cultures everywhere in the world throughout history, including and notably by adherents of all the world's major religions. Historical rates of infanticide have ranged from 10 to 15 percent in some societies to 50 percent in others, but none lack it entirely.

Like all human behavior, infanticide has non-trivial causes. Martin Daly and Margot Wilson unearthed some of those in a study of 60 societies using an ethnographic database. In 112 cases of infanticide in which the anthropologists recorded a motive, 87% supported the triage theory of infanticide, which posits that mothers must make hard choices when times are hard.

a concept well captured in Edward Tyler's 19th century anthropological observation that, quote, infanticide arises from the hardness of life rather than the hardness of heart. Would you say that's true for abortion now as well? Yes. I think that the women coming to my office do not take this casually. This is a very serious decision.

and virtually all of them have some ambivalence about it, but they decided that for various reasons this is what they need to do with this particular pregnancy. This is especially painful for women who have a desired pregnancy. They want very much to be pregnant and have a baby, but they have a fetus that has catastrophic complications.

that may prevent it from living, much less even having a life. And they don't want their baby to suffer.

The other thing is that you have people who are in incredibly difficult, complicated situations such as various kinds of substance abuse, an intimate partner violence, domestic violence and abuse, rape, incest. And we had kids in here 10 or 11, 12 years old. They're children. They have no business having a baby and their risk of death in the pregnancy is extremely high.

And so these are complex problems. And in my office, it's sort of an abortion intensive care unit. We take care of people who have the most difficult problem for this long. Yeah. Yeah, it's amazing. Some of these numbers. Do we have accurate data? I didn't find too much on the reasons for abortion. But you mentioned rape and incest, risk to the mother's life.

abnormality in the unborn baby, other physical health concerns, and then elective or unspecified reasons, which was the vast majority, like 90%. Do you have a sense of what the right numbers are? Is that sound about right? I don't know if it's possible to put a number on that. I mean, every woman has a reason for coming in.

And the reasons can range from some of these very easily identifiable situations, such as a fetal abnormality

or something like that. But many women have medical complications. But frankly, I would say that most women find that the pregnancy, if continued, would disrupt their lives in ways that were really unnecessary and unfortunate and very defeating for them. And their attempt to have an independent life and get an education is

have possibilities of a good job and be able to support themselves and to be able to participate in society. And so that...

This is a situation where the pregnancy is simply a big obstacle for the woman living her life the way she wants to live it and to accomplish her goals, her personal goals that include education, economic independence and other things like that. Yeah.

Can you walk us through, since you're so graphic in your book of what this is like, a woman comes to see you. You have this conversation with her, a consult. You go back and forth. You give her the pluses and minuses. And she says, okay, I want to do it. And you say, okay, you're qualified to get an abortion. Here we go. You come in tomorrow or next week or whatever. She comes in. What happens? Well,

Let's take a situation. Many of the patients that I see at this point are in the middle or late second trimester, early third trimester. The ones in the third trimester are almost always people who have these catastrophic problems with fetal abnormality or some other serious issue. Some don't. The Dobbs decision and the Texas SB-8 law

It's a national catastrophe for women, especially those who want to have an abortion and want to end the pregnancy because they've shut down the services in at least a third of the states. And I mean, it's illegal in America.

probably 40% of the states in this country at this point. And this means that women can't get access to an early abortion at six or seven or eight weeks when it's much less difficult, much less risk, much less expense, much less stress. And it's a very, very safe procedure that can be done by family practitioners, for example, nurses, physician assistants.

But the opposite decision in these political situations have forced women to wait to get actually an abortion. And it means that they're turned down by two or three clinics before they finally get to someone like me who can help them with the later pregnancy. And their choice is to end the pregnancy early.

And this is a very special problem with the medication abortion, so-called, because women will take the medication and it doesn't work. And then by the time they find out they're pregnant, they're too far along or they're continuing to be pregnant. They're too far along to be seen by a clinic that does only early abortions. But in my case, let's take the patient that I see.

let's say somebody who's 25 or 26 weeks pregnant, they come in and before they come in, we make an appointment and we go through an entire medical history with them and we find out whether they're allergic to anything, whether they've had surgery, other kind of medications, what kind of complications they have in their life, substance abuse, and whether they have

any contraindications to doing an outpatient abortion procedure. And then we go through a list of things that they need to know about and precautions.

And then when they come into the appointment, the first thing we do is a physical exam with a physical exam and an ultrasound to determine the length of the pregnancy. In the early part of the pregnancy, which is, is the woman pregnant? Is she pregnant? If she's pregnant, is she pregnant in the uterus and not an ectopic pregnancy? For example, those kinds of things. The diagnosis is the first thing.

Then the patient fills out her form, her medical history form, and those sorts of things, and talks about her social history, what are her social and economic circumstances and other conditions, does she have someone supporting her or not.

And then she pays her fee. We have the lab work. And then she's with a counselor for some time, depends on how long it takes, what half hour and an hour to help the patient make sure that she understands what procedures we're going to use and that she can give her informed consent to those things.

Then I meet with the patient or one of my other doctors that helped me. And then we talk with the patient about the issues and find out if she has any questions and answer all of her questions and make sure that she understands the consent form and is agreed with that. And she signs that. And at that point, we take the patient into the operating room. She changes into a gown. The doctor does a physical exam, looks at the heart and lungs and blood pressure and all those things. And

And then at that point, with that particular patient, the first thing I do then is to do an injection of medication into the fetus that stops the fetal heart.

And this is done for a variety of reasons, but most of them are a safety reason that the fetus that is no longer alive stops producing urine, which means that the amount of amniotic fluid is diminished, it's absorbed, and that reduces the risk of amniotic fluid embolism. The uterus becomes more irritated and starts to contract better, and the tissues of the fetus begin to soften. And so these are elements that make it more safe for the woman.

And then we will give the patient some of the mifepristone, the abortion drug that's being used for early medication abortion, and come back. And at that point, we also put a laminaria in the cervix.

which is the laminaria seaweed stalk, laminaria japonica, that's grown in the state of Japan. The Japanese discovered, you know, 150 years ago that they could put this into the cervix of a woman, it would expand and cause a woman to go into labor. Now, the European equivalent of that is the slippery elm. I mean, women have been doing this sort of thing for thousands of years.

In any case, so then this starts the process of opening the cervix. And that's placed on the first or second day, depending on how far along the patient is. She comes back the next day. We take that out. We change the laminaria, put in new laminaria that are sterile. And then she gives her antibiotics and

And then she comes back for the third or fourth day, take out the laminar air for the last time. And at that point, she has an IV started. We give her a dose of the misoprostol by mouth, buccally. And then we rupture the membranes under the ultrasound vision, a real-time ultrasound, so I can see what's going on.

And all these procedures are done in the urethra to enhance the safety of this. Rupture the membranes that allows all the amniotic fluid to come out, which diminishes, if not eliminates, the risk of amniotic fluid embolism, which can be immediately fatal, and which happens to women who are carrying the pregnancy to term. And in fact, this can happen in labor, when the woman is in labor. And so it's one of the catastrophes that can happen in pregnancy that is fatal.

So after the amniotic fluid is out, then I put more misoprostol into the uterus and that allows the uterus to continue contracting. If the patient has not had a cesarean delivery before, we start at oxytocin, which is a drug that makes the uterus contract. And then we wait until things are improved and it's possible to deliver the fetus or remove it with instruments, whichever is the best option.

And then the uterus is emptied of the fetus and placenta. I do a force of exploration to make sure that under ultrasound, to make sure that the uterus is really empty and a sharp cure time, which completes that. And then the final step is a vacuum aspiration to make sure any fragments of tissue are removed from the uterus.

And then I teach the patient how to rub her uterus herself so that she can make her uterus contract by that means. We watch the patient operating and they recover him for a couple of hours. And we do a final check before she leaves to look at the uterus and the ultrasound, see if there's an endometrial stripe that shows that the uterus is empty. And then we give the patient discharge instructions, the antibiotics and other medications, and make sure she has a safe way to get home.

and give her ways of getting in touch with us if anything goes wrong. If she doesn't have her own physician to go to for a follow-up exam, we find someone she can see for a follow-up exam in her community. That is becoming extremely difficult with the Texas laws, which allow anybody to sue anybody who helps having an abortion.

And it's a police state kind of tactic, which is very dangerous and very frightening for women. So that is sort of how we would take care of one patient. And the post-op recovery period is about six weeks.

Amazing. Thank you for that. That's incredible. All this is done is something of an outpatient, right? On that second day, it's an outpatient. On that second day, they're home by the end of the day. Well, in the first trimester, that is a much simpler operation. And those patients are able to leave at the end of the second day, depending where they live. They may have to travel back to some distant place in Montana or Idaho, someplace from here. So they...

advise them to wait until the next morning to leave. But the first time is for patients to get through this quite quickly and quite comfortably. And go ahead.

The procedure sounds reasonably complicated, though, to me. Does anything go wrong? Have you ever had patients that died or had serious? I've never had a fatality. I've never had a patient die. But their pregnancy is a dangerous condition. A lot of things can go wrong, even if you're not touching the patient. The uterus can rupture. The woman can have an amniotic fluid embolism. So you have a placental abruption.

and many, many things. You can have a rupture of membranes at 16 or 18 weeks, and then she has to have the uterus emptied right then, which can be done in a few minutes. But in Texas, for example, they say, you have to sit in your car in the parking lot until you're about to die before we take care of you. And we have many cases of women who actually die under those circumstances. It's not necessary. It's barbaric, medieval.

And so there are many things go wrong. So my procedure is set up to minimize the risk and make this as safe as possible. And in fact, we have the lowest major complication rate in the published medical literature. Not an accident. Are people coming to you from other states now? You're in Colorado. Yeah. I've had patients coming to me from all over the country. Look around. You can find cars like these on AutoTrader. Like that car right in your tail.

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Since I opened my practice. And that's been especially true since I developed the techniques and instruments and procedures for doing the later abortions, which are much more difficult and take a lot more expertise and experience. But I've always had patients from other states. And for a long time, I was having many patients from other parts of the world, from Europe and Canada and Australia, where they couldn't get this kind of care there.

The COVID epidemic changed that, but we still get patients from other places. And has that changed since Roe was overturned? Do you get more patients from other states now, like, say, Texas? Well, yes, it has. I think that, for example, 30% of my patients come from Texas. Another 30% come from all the red states where women simply can't get this kind of medical care and who they're being punished for being pregnant and for having any problems.

So we do see patients from Colorado, but I'd say most of our patients come from out of state at this point. Do you ever get any women in their second half of the second trimester or in the third trimester that say they have no medical problems, they just don't want the baby, they change their mind? Would you do it? Well, of course. If the woman doesn't want to be pregnant, there's no justification for forcing her to continue the pregnancy.

Okay. Has that happened? It happens all the time. Of course. I mean, she has potentially fatal illness condition that can kill her. No, no. I mean, if she has no medical problems. The medical problems is she's pregnant. That's a medical problem. I see. Okay. That's a fundamental medical problem. Okay. But what I'm asking is if she just changed her mind.

She could deliver fine. She's healthy, but she just said, I don't know that. Okay. You don't know. Any woman who's pregnant is at risk of dying at any time from that point on until six weeks after she is not pregnant. I see. And so that, that, that is a well-known risk. And there's a, if the woman, if the principal decision point on the treatment of the pregnancy is,

Whether it's medical management and obstetrical care and term delivery or abortion depends on the woman's desire or lack of desire to be pregnant. And if she doesn't want to be pregnant, then the treatment of choice is abortion for her.

I see. Okay. And so I guess the question is, is how often does that happen versus where there's medical complications in the second or third trimester? The pregnancy is a medical complication. The pregnancy may become more complicated later.

But it is many changes in the woman's physiology and anatomy that can be life-threatening. And so that the medical condition baseline is pregnancy itself. And that can change in a few minutes to something that is deadly. And so that's important to keep that in mind. It's hard to say a proportion of how many patients have a relatively uncomplicated pregnancy and those who don't. But they all pregnancies,

require some form of medical management to assure the survival of the patient, of the woman, and if she wants to carry the pregnancy, to have a healthy baby. I see. I got you. Just to reiterate this, even if you're healthy and there's no problems in, say, the second half of your second trimester, it could go south at any time. That's your point.

Correct. There's no time during the pregnancy when the woman's not at risk. Okay, gotcha. Now, after Dobbs and all these states like Texas, we could use that as an example, surely there are many cases, in fact, I've heard some in the news, where the woman is just, she's practically dying, and they're turning her away. Well, you just gave an example. You're sitting out in the parking lot. Are there not medical practitioners in the state department there of Texas going, hang on,

The Attorney General of Texas, Ken Paxton, intervened in the case of Kate Cox, who followed the law and got a court order that she could have an abortion. And Ken Paxton not only ended that and interfered with that, but threatened the hospital with lawsuits and the doctors with prison time if they violated this law and took care of her.

So she had to leave the state of Texas to get her treatment. The Texans had descended to a pre-medieval situation. To call it the Dark Ages would be way too complimentary.

Wow. Right. Yes, it's astonishing that this is happening. I didn't hear it at all. Oh, yeah. Sorry. So it's roughly 40% of the states, you said now, have essentially made abortion illegal after six weeks when most women don't even know they're pregnant. Correct. Many of the others have very serious restrictions that impede women from getting a safe abortion early in pregnancy. Yeah.

And so what is your response to their argument? Well, it's a states' rights issue, not a federal issue.

Well, that was the argument of the slaveholders, okay? Women are not slaves and they're not stockholders. They're not stock-hard animals. They're not livestock. And it is a violation of human rights not to permit a woman to have a safe horse, apart from basic medical care to have availability of safe abortion. That's modern medicine. And anything less is medieval. Right.

So do you think there's a chance that the overturning of Roe itself could be overturned and go back to it being a federally protected? We need to have a constitutional amendment that says that a woman's access to safe reproductive health care may not be abridged. Punto. End of sentence. That's it. None of this exceptions going back to Roe versus Wade or any of that stuff because Roe versus Wade was gutted by Sandra Day O'Connor.

and, and, and change and substitute the standard instead of the, the state, instead of the state having to show a compelling interest and keeping the woman from having an abortion. It says now she, she must show, show that the restriction, uh,

is an undue burden, which means the burden of proof is no longer in the state to show why they can limit somebody's freedom, but the burden of proof is on the woman to show why she should have medical care so she can survive. That's barbaric. But that is the result of Sandra Day O'Connor's work in the Supreme Court with the Casey decision, which also substituted the standard of prime minister, which Harry Blackmun put in, to viability. What's viability? How do you define that? Who gets to decide that?

If the woman's life is in danger, the viability of the fetus is irrelevant, period. Right. If the mother's dead, then what's the point? Well, Jewish law and the Jewish tradition means that the woman's life is in danger. Her life is more important. That's the way it should be. Yeah. I'm not Jewish, but I happen to agree with that principle. Yeah. Why is it modern pro-life?

conservative Christians. You mean me because I've said who has saved the lives of thousands of women or the people that want to kill me because I help women?

That is a propaganda term that is unacceptable. Yeah, tell us how that terminology, pro-choice, pro-life, came about. Pro-life, the term pro-life is unacceptable. It is a hateful term of propaganda and is prejudicial. It says that those of us who help women are pro-death and anti-life, which is the opposite of the case. But it is a smear and a scandal. It's an absolute scandal.

an impetus to the anti-abortion assassin who assassinated five of my medical colleagues. Yeah. I understand where you're coming from. You must find a different term. Talk about the people who are opposed to abortion. Yeah, okay. So we call the pro-lifers the anti-abortionists or the anti-choicers. I don't accept the term, and I will not answer any questions about that.

What if the Nazis decided they wanted to be called Bringers of Mother's Milk, Love and Honey?

Does the Reuters headline say the bringers of mother's milk, love and honey murdered 879 Jews and the Germanic thing yesterday? No, it says the Nazis did it. So let's call them what they are. They're anti-abortion fanatics. OK, they are not pro-life. They kill doctors. They prevent people from having birth control. They're against in vitro fertilization, assisted reproduction. And women suffer because of their hideous efforts.

Okay, we'll use your term. According to Gallup 2024 poll just last May, 54% of all Americans are pro-choice, 41% are anti-abortion.

Men, it's 45% pro-choice, 49% anti-abortion. Women, 63% pro-choice, 33% anti-abortion. Republican, it's 23% pro-choice, 69% anti-abortion. Democrats, almost the opposite, 86% pro-choice, 12% anti-abortion. And then independents, it was pretty close to half and half. Yeah.

So this did not used to be a political issue. The Republicans decided to use abortion as a political issue to gain power, and it's worked for them very well. It's allowed them four presidencies. It allows them to completely dominate the U.S. Supreme Court with six people right out of the dark ages. When did this start, in the 80s?

When it became politicized? Yeah, Paul Warrick, Terry Dolan, Howard Phillips, who I knew personally in Washington, started the New Right and a few others.

And they decided to take over the Republican Party. And they got the Christians who were mad about integration. They were racist. So they decided to get the white supremacists away from the Democratic Party into the Republican Party, which they succeeded in doing completely successfully.

And to focus the sense of racism, you know, apartheid was a little bit messy. They decided to use the abortion issue to get the Christians working for them and voting for them. And they did. So Trump got 82% of the vote for the white Christian evangelicals in both 2016 and 2020. The anti-abortion movement is a white supremacist movement. Okay. Of course, they don't say that's why they do it. They say...

They say abortion is murdering human life. They're entitled to their view, but they should stop killing doctors. Well, of course, we agree on that. It's such a massive, obscene hypocrisy. How many doctors have been killed? How many clinics have been? Five physicians have been assassinated, including one of my best friends and a bunch of other people, about half a dozen, have been assassinated also by the anti-abortion fanatics.

That was Tiller, your friend? Dr. George Tiller was my dear friend, and he was assassinated on May 31, 2009, in the lobby of the Lutheran Reformed Church in Wichita, Kansas, where he was having a donut with his fellow ushers, and his wife was singing in the choir. And he said that he didn't need security because the anti-abortion fanatics would not hurt him in church. They did. They killed him. What sort of death threats have you had?

Two weeks after we opened the first nonprofit abortion clinic in Colorado in Boulder in 1973, I started getting obscene death threats at 3 a.m. at my house in the mountains. And this hasn't stopped. My life has been in danger since then. I mean, do you get them like once a month, once a week, every day, twice a year?

It depends. I see. Whenever they feel like it. I see. When they cycle in and out of, I suppose when you get media attention or something. I can't hear you. Yeah. Well, I'm just trying to understand how worried you are about your life. My wife worries me out.

I walk out the door. Your life. Yeah. Do you do you worry about. But I think that the fact is that everybody that I know and everybody who cares about me worry about that also. That's that's the condition we live with. I just had a book event, St. Julian Hotel, about my new book that you showed. We had the Boulder SWAT team at my personal expense.

surround the place with heavily armed police to keep us from becoming tomorrow's mass shooting morning news. And I had to do with the previous book event that I had to do two years ago when the same publisher published my book on global ecology, not a particularly inflammatory subject, one that's controversial, but we had to be protected from the police because I was speaking.

The anti-abortion fanatics will stop at nothing and they will accept any level of violence to impose their views on the rest of us. Do you think the argument that it's a states' rights issue is just a cover for the longer term motivation of just banning abortion everywhere?

All the time? The slave owners sure like state rights and the segregationists have liked it ever since. The woman's access to a safe abortion should not depend on the results of the last election, her zip code, her skin color, her language, her culture, anything else. She should have access to safe abortion services. The state's rights is a phony argument. And in fact, it was rejected in Colorado by the Colorado Supreme Court. Yeah.

I remember I used to pass by this Planned Parenthood on my weekly bike ride. I would stop and talk to the protesters out there. And this was before Roe was overturned. And I asked them, if Roe was overturned, is your job done? Would you just go home? And they said, no, we're just getting started. This is in California. They will stop at nothing until they have a theocratic fascist government in the United States. And we might get one if Trump is elected in two weeks. Yeah.

Well, I don't know about that. That's the goal. That is their clear objective. Read 2020, the Project 2025. I have. Yes, we just published an article about Project 2025. Yeah. But let's table that for a minute. With these numbers, 625,000, 650,000, 900,000, whatever it is, it's a lot of abortions.

I think sometimes of abortion is the problem is not abortion. It's unwanted pregnancies. Why are women getting pregnant when they don't want to be pregnant? Well, look, we are humans evolved through millions of years to have sex and have babies. That's what we evolved to do. And that's why we're the most successful species on the planet with eight and a half billion and counting and destroying the planet in the process.

But every species is evolved to reproduce. And in fact, the people have sex, not because they want to have babies, but because it feels good. And that has been our history. And so people have intercourse for a wide variety of reasons, ranging from love to rape and an instrument of war.

And so people sometimes do not choose to have sex and get pregnant, but they get pregnant anyway, or their conscious self may fail. But the point is that they have contracted an illness condition which needs treatment, whether it means the woman carries the pregnancy to term or she has an abortion at the end of the pregnancy. Yeah.

I don't think I've ever heard anybody describe pregnancy as an illness. I wrote a paper about that that was published in 1971. I published another paper of the illness parameters for pregnancy in 1975. I've been writing about this, publishing about this for a long time. These are just in the journals. It's not on the front page of the New York Times. Do your colleagues who also do what you do, do they agree with your assessment? I don't know.

I don't know. Okay. I'm just curious. I have no idea. The reason I ask is because, I mean, if it's our goal to reduce the number of unwanted, reduce abortions, this is my argument with conservatives. If you want to reduce abortions, you should want to be in favor of reducing unwanted pregnancies. Why do we oppose contraception?

Well, that's right. It's about power. It has nothing to do with logic or reason, facts, blood loss or sympathy. It has to about power. Yeah. And the Christians are voting against abortion, fertility control because they want power. And the Republicans are using them to get power. And it's a parasitic, symbiotic relationship.

Well, but I did give you some percentages of Democrats who are anti-abortion. Now, I guess we should clarify, you could be anti-abortion personally, just don't have one, but don't tell other people what to do. That's a third point. I don't care what people's attitude about abortion as long as they leave us alone. They should leave other people alone. Right, right. Go butt out. Go find a life. These people out in front of my office don't have a life. They have nothing else to do with their time except harass my patients and make them feel guilty.

Are they out there right now? Are they out there every day? I'm talking to you. I'm not looking. No, I mean, I take care of my patients and my staff takes care of my patients, whether they're out there or not. I mean, I guess I'm asking. And because of the insults and obscenities being shouted at them, these people claim they're Christians. This is the opposite of the Christianity that I supposedly learned about when I was a young person.

This Christianity is fascism. That's what it is. Fascism has two faces in the United States, Republican Party and Christianity. Right. And the voice of fascism is Fox News, phone news. If you are a Christian who claims that you value life, all human life, what do you think is the psychology of killing an abortion doctor or opposing birth control, for example? Ask them.

Ask them. It's twisted logic. It's called killing for life. Yeah. Killing for life. Yeah. Well, that is the argument. It is not about life. It's about power. Look around. You can find cars like these on AutoTrader. Like that car right in your tail. Or if you're tailgating right now, all those cars doubling as kitchens and living rooms are on AutoTrader, too.

Are you working out and listening to this ad at the same time? Well, multitasking pro, cars like the ones in the gym parking lot are for sale on AutoTrader. New cars, used cars, electric cars, maybe even flying cars. Okay, no flying cars, but as soon as they get invented, they'll be on AutoTrader. Just you wait.

Auto trader. Understand that they believe life begins at conception. It did. It began three and a half billion years ago. It doesn't begin anew with each conception. Right. This is a colossal stupidity of the of the anti-abortion people. Where do you how do you answer the question? If somebody asks you, when does life begin?

We don't know exactly the date, but it began about three and a half billion years ago with anaerobic bacteria. I mean human life. In the womb, when does it begin? Human life evolved out of an old set of primate species of

most of which, some of which we have identified in Africa and other places. And it's been a long process with numerous species surviving at the same time. We happen to be the ones that beat out the Neanderthals in Europe. And some people think that the Neanderthals were a little sharper than we were.

Let me ask it a different way. If the moment of conception is not when the human life begins, when does it begin? Where do you draw the line? When the moment of conception occurs. What magical way do you have to find that out? It's absurd. Well, you don't know exactly. Pregnant anyway or aborted without the woman even knowing about it.

I mean, we're talking about, you know, probably 90 or 90% of conceptions do not become a known pregnancy. Nobody knows for sure. My colleagues who study this have some rather precise numbers, but it's still very fuzzy. And the idea of trying to say, well, the life of this particular person began at this time is absurd. You know when they were born. That is a constitutional fact.

A person in the American Constitution is a result of a live birth. A person does not exist before that. We could change the Constitution so it begins at conception, but then birth becomes irrelevant in the law. How do you know when it happened? If somebody had twins, do they get a double representation in the congressional district or what?

What about the old folks living in the seniors? They're not having sex or having babies or anything else. They have less representation than the people who are having lots of kids. How fair is that? Yeah, it's a good point. You know about the problem of the heap that mathematicians talk about? When does the problem of the heap, when does a sandpile become a heap?

a heap of sand rather than a little pile of sand. This is a lot of sophistry. This is, this is believers. This is a way of not talking about the fact that women die from pregnancy and

And they're dying right now because of the Republican rules making abortion illegal and restricting women from having safe abortions when they should be entitled to have it in the 21st century. That is a ridiculous and sophist argument. Well, it is one of the arguments they make. But it's the problem of where do you draw the line? So by that reasoning... You draw the line by helping people have safe abortions. So if a woman came to you and she was due in a week...

and said, I changed my mind. Would you perform an abortion? We talk to every patient. And when she comes in and she requests an abortion, then we will help her. And if she had their, it depends on the medical circumstances, whether I think it's safe to perform the abortion in an outpatient basis in my office.

Just even a week before her birth, her due date? No, no, no, we don't do that. You don't do that. I didn't understand what you were saying. That's not true. The abortions after about the 32nd week are extremely rare, and they're almost always for very, very serious, urgent medical complications. A woman comes in, and her doctor has, she's had a completely uncomplicated pregnancy with a desired pregnancy that she wants to have a baby with,

and she's 37 weeks pregnant, and she goes to the doctor, and the fetus has had a total catastrophic stroke. The brain is gone. The pregnancy is the rest of her life. It is not justified for her to continue the pregnancy, and I will help that woman end her pregnancy with the help of her doctor who would deliver her dead fetus in the hospital. Certainly. Of course, that makes total sense. But what I'm after here is the conservatives say that

that pro-choicers are in favor of allowing women to abort their fetuses even the week before birth. No, absolutely not.

That's not true. Well, this is a reductio ad absurdum argument. That means you carry this to the ridiculous logical conclusion. And it is not true. It is false propaganda. It is meant to inflame the masses, inflame people's opinion, and get them to kill doctors and to shut down safe abortion. It's a propaganda term. Yeah.

I also wrote about abstinence-only education. Does it work? No. Here I'm citing a study that did not reduce the likelihood of engaging in vaginal intercourse, but comprehensive sex education was marginally associated with a lower likelihood of reporting. I saw that in your article. Yes.

Yeah, so that's good. My favorite study there was the women... You can even deal with reality or you can pretend and make things up. You know, if you're going to jump off a 10-story building, you should figure out before you do that whether you really believe in the theory of gravity. You know, if you don't believe in the theory of gravity, you want to jump off the... You're going to have the same experience when you hit the sidewalk as the guy who does believe in it, okay? Yeah.

My favorite paper was the one on where they found that half of 1% or 1 in 200 adolescent girls reported that they'd become pregnant without sex. In other words, these are... That's a nice one-liner joke, but it doesn't have anything to do with their subject.

which is why are women in the United States having such a hard time and almost impossible time of having a safe abortion early in the pregnancy when it's much easier, it's safer, it's less risk, less stress, less expense, and all the rest of it. It's because the Republicans have used this issue to win elections, and that's what they're doing right now as we speak, and it is enabling a fascist theocracy that's coming and has a good chance of getting elected.

What is it you think that the people that are voting for them think? I mean, are they, you know, the tens of millions of Americans who say, well, they say they're pro-life, you would describe them as anti-abortion, whatever. But they seem to believe it. They don't seem like fascists to me. They just vote...

Half the country votes Democrat? They're voting for fascism. You know, most Americans, except for the Jews, don't understand fascism. The Jews have been the target of it for hundreds of years, if not more, thousands of years. But most Americans don't understand fascism, even if they're participating in voting for it. But 70 or 80 or 90 million people are ready to vote for fascism next week. Yeah. In this country. Right. It's easier than thinking.

Yeah. OK, I guess what I'm asking, you know, what are they thinking? I mean, they're most people. They don't want to kill you. They don't want to blow up your clinic. They're not out there. Every single abortion doctor and colleague of mine who've been assassinated have been assassinated by someone who says they are Christians. They're peaceful, unquote, and pro-life, unquote, which is absolute B.S.,

The philosophy is killing for life. And if somebody says they're pro-life, that means that they are ready to kill me and I will make that assumption. And they will support people to kill doctors. That's the only conclusion I can from the last 50 years. I understand. Given your position and the threats you've had on your life, I can see why you see that. I'm buying four layers of bolt-proof windows. That's not because I just like bolt-proof windows. They're expensive. You have to walk or drive around in a Popemobile? No.

The bulletproof glass, it's no good. But back to the question of... I mean, it seems like the solution to the unwanted pregnancy problem is birth control and education. You know, if birth control is so readily available since, I don't know, say the last 25 years, why are women still getting pregnant when they don't want to? Why don't you figure out how many tonsils are done, tonsil exosomes are done each year instead of abortions? So what? These are private decisions for women.

who make these decisions by themselves or with their families or partners. Why is that anybody else's business? Why are you spending any time on it? This is ridiculous. This is absurd. And it's an invasion of their privacy. This is a medical condition that requires very specialized treatment and nobody should stand in the way of that. This is about power.

And if the anti-abortion people want to prevent abortion, they should support birth control programs. And they don't. They oppose them. I know. But half the country is Democrat, and they do support birth control and education for girls. So why is this still happening? How much legislation has this Congress passed? Zero. Well, we have a current Democratic administration for the last four years. The Republicans are running the House of Representatives.

Well, I'm asking Warren, our society is awash in birth control. Why is it not being utilized more? It's being used. Birth control is not 100% effective. I see. Okay. So do we know the numbers on that? Yeah. I don't have the handle at my fingertips right now. But, you know, the various methods of birth control are quite effective, but they're mostly not 100%.

Even tubal sterilization has failures. Vansectomy has failures. Right. Yes. Do we know what those failure rates are? 1%, 10%? Yeah, we do. Some people do. My point is that every person who wants it should have access both to effective, safe and effective contraception, sex education, and safe abortion services. Punto. That's it.

There's nothing else to argue about. And the fact that the Republicans have used this issue to get power very effectively for the last 50 years means that we're now living under a medieval Supreme Court that's eliminating voting rights, civil rights, human rights, and the restrictions on campaign spending and all kinds of things that are very destructive. And they're even making decisions about the environment that are absolutely hideous and destructive because they have no education in the sciences.

All I know is medieval legal literature, period. Okay, if Kamala Harris wins the 2024 election, what do you think will happen in the next four years regarding your profession? I think the first thing that will happen is Donald Trump will challenge the election and try to ruin it. I don't mean that. January 6th, that will be the first six months after the Harris administration. Trump will not stop. That will be the first thing that will be happening. We have to deal with Trump trying to overthrow the government again.

But that's not going to happen. So Harris is almost certainly will. But Kamala Harris will support reasonable, logical and humane policies and support safe abortion services for women. OK. And how will she do that with the current laws?

I don't know the answer to that question, but I think that one of the things that there are many proposals for laws to pass in the Congress that she would sign immediately. And there have been some attempts in the past, the Women's Health Protection Act, some other thing. The problem with that is that it includes the same provision, Roe versus Wade, which is not acceptable. That's a step backwards.

We have legislation that assures a woman's right to have a safe abortion or a passage of the Equal Rights Amendment to the Constitution, which would solve this problem. And it's been approved by all states. We have to have a president and a Congress that will let it go forward. Well, a constitutional amendment requires two-thirds of the states. That's hard to get. So in the event that that doesn't happen— My information is they haven't. My information is they haven't.

I was talking to people in the Feminist Majority Foundation last week, and they tell me they have the votes and they can do it. Wow. Okay. They need cooperation at the top. You mean for the ERA in general or for abortion rights in particular? No, ERA in general. But that just should apply to workplace situations, health care, and a variety of other things. Yeah. Okay. All right, Warren. I know you're busy. The proportion of the pay, the men.

Yeah. I don't want to take up too much more of your time. You're 86 years old. You've watched this unfold for a long time. Yeah, no, don't go dying on us. It was like putting water on a plant. I'm refreshed. Keep going. I support what you're doing. I think it's important.

Thank you. But are you optimistic? You sound you're pretty, you know, what happens next Tuesday? OK, so you really think it all turns on that? You're going to have democracy or dictatorship. And I mean, it's under those circumstances, the fact that tens of millions of people are going to vote for fascism next week is very unnerving to me.

You're not going to leave the United States, are you? No, I'm here. If Trump comes after me, he's got no problem with me. Okay. Yeah. I have a feeling you could defend yourself. Yeah.

Okay. All right, Warren. Well, thank you again for your time. Thank you for your passionate arguments. Let me show the book again. Here it is. Thank you. Abortion and an Age of Unreason. Okay. A Doctor's Account of Caring for Women Before and After Roe v. Wade. Thank you very much. I appreciate your help and helping me on your program. Thank you.