It has been two years since Dr. David Gunn was shot to death outside a Pensacola clinic on March 10, 1993. Michael Griffin was convicted of this murder and sentenced to life in prison. On August 19, 1993, Dr. George Tiller was shot in both arms as he drove out of his Wichita, Kansas clinic's parking lot. Rachelle Shannon was convicted of this crime and sentenced to 11 years in prison. On July 29, 1994 Dr. John Bayard Britton and his escort, James Barrett, were slain outside a Pensacola, Florida abortion clinic. Paul Hill, a defrocked minister, was convicted and sentenced to death. Hill stated he will have no regrets over dying for such a worthwhile cause. On November 8, 1994, Dr. Garson Romalis, who performs abortions in Vancouver, Canada, was shot in the leg while eating breakfast in his own home. On December 30, 1994, clinic receptionists at two different abortion clinics in Boston were shot and killed. John Salvi III was arrested for murder in Virginia. If guilty, he desires to die for the cause. If not, he wants to become a Catholic Priest.

All of us certainly deplore this killing of human beings. The common belief of these murderers is they do not feel they are guilty of murder since they attempt to stop prenatal murder. Statistics suggest that the majority of Americans feel abortion is wrong, but agree that these murderers should receive their punishment. There are estimates that between 3 and 8% of Americans feel that it was not wrong to kill Dr. Gunn or Dr. Britton whom they regard as the real criminals. Given that equation, there may be 8 to 20 million Americans that feel it is appropriate to kill a doctor who performs abortion. No one knows how many could actually do it themselves. Any doctor who performs abortion is not safe from being killed. Dr. Brian Finkel proudly displayed his bullet proof vest and a 9_mm pistol as he enters and leaves his Phoenix clinic in a US NEWS report pictorial. How naive.

The FBI is stepping up surveillance at abortion centers. But will that be effective? There is usually about one correctional officer for each 10 inmates in some penal institutions. If correctional officers, many with guns on gunwalks, can't keep a similar unknown number of inmates from killing each other inside of prison walls, would arming 10% of the entire US population (25,000,000 police or FBI officers) keep those 8_20 million unknown vigilantes in our population from killing doctors and others involved in abortions who are not inside the clinic? In fact, operation "No Place to Hide" has been announce to begin nonviolent protests away from the clinics at such places as the doctors' offices and homes. We know that will facilitate a violent fallout. We may be reading Dr. Finkel's obituary.

There are many articles, editorials, and public debates deploring this assault on women's rights. But do these 8-20 million Americans who feel it is not a crime to kill those that commit abortions see it as a women's issue? It may be that they see it primarily as a moral issue. When Planned Parenthood invited local religious and community leaders to draft a statement condemning violence against abortion clinics, only a handful of religious leaders and no community leaders showed up at the Jan 27 meeting. The BEE stated that BishopWeigand could not have made his position any clearer. He stated, "We opposed the violence of abortion and we oppose the violence of killing abortionists."

On January 10, 1995, Nancy Schneiderman, a San Francisco physician who substitutes for Sacramento host Joan Lunden on Good Morning America, was interviewing a priest and the head of the Catholic Prolife agency. When Nancy asked her guests why they were fighting abortion which is the law of the land, this guest articulated in a very personable way that slavery was also the law of the land at one time, but that didn't make it right. They would continue, just like those that were against slavery in the last century, to correct this great injustice. Nancy, unable to continue, reverted to a commercial break. However, the camera focused on her an additional several seconds as she buried her face in her hands with no response.

It's hard to get a reasoned dialogue on these issues. The following week firing line had an all women's panel debating women's issues on public TV. No one was able to develop a line of reasoning before being interrupted. At the conclusion an elderly lady, who I believe was one of the professors, stated that for women to tie the issue of abortion, which after all is stopping a beating heart, to women's rights, was to doom women's rights.

Are we going to keep on watching physicians being killed? To continue to read medical obituaries? What went wrong?

When I went into practice in 1970, there were frequent D & C's with very thin medical indications, as well as therapeutic abortions (TABs) at American River Hospital. However, every TAB had to meet the requirements of the hospital, be presented to a review board of primary care physicians and psychiatrists, and meet all other surgical standards.

Are these standards being met in today's abortion mills? From the reports in the press, as near as I can calculate from the time these traveling doctors spend in each clinic per day and the number of TAB's they do, the entire history, physical examination, review of laboratory data, obtaining of informed consent including alternatives, anesthesia time, surgery time, post op recovery time, and completion of the medical record would have a lapse time of somewhere between 15 and 20 minutes. It would also appear the doctor never made any clinical decision and his medical license was simply being used for legitimizing the process. This obviously would not meet any hospital standard of care.

Some of the OBG doctors who were doing TABs in the early 1970's, felt that all of their patients who needed D & C's and TABs were getting them before Roe v. Wade. If TABs would then have remained within the practice of medicine, the practice would have then evolved with the highest standards possible. Perhaps refinement of antifertility measures, RU 486, or even other unknown measures would have made TABs as we know them relatively rare. Roe v. Wade took this practice outside of medical decision making into a legal right. Politics or the practice of law trading on our medical licensure resulted in the violence that we are now witnessing.

The US abortion rate has fallen to the lowest level since 1976 according to the Alan Guttmacher Institute. In addition to the 580 Catholic hospitals and about half that many surgicenters, more than 500 US hospitals and clinics have stopped offering abortions. The number of physicians who learn abortion techniques as part of their training has plummeted. Many doctors have discontinued doing abortions saying, "I just don't want to be killed." Many members and former members have told me they are unhappy that the AMA has gone on record to require abortion training in OBG residency programs. Has the AMA taken a "No Win, Lose" position? Could it be that with Roe v Wade, TABs will soon be less available than if they would have been allowed to evolve in the mainstream of medicine and surgery? It may be too late to regroup. We can't even have a learned debate on the issues. (It may have been a mistake for me to even comment on it in the name of our overall topic of "Practice Issues.") But have we learned our lesson to never have a law to determine non-medical indications for a medical/surgical procedure? As Aziza Hussein, leader of Egypt's non-government National Committee for Population and Development, stated, "Start with politics, and you go to War... like the Americans have done."