After Tiller: on the frontline of the abortion war

Few outside of Texas would have heard of Wendy Davis until she became something of an overnight star last week thanks to her astonishing near 11-hour filibuster to block further abortion restrictions in the state’s senate. Relatively few people outside the US will have heard of the grisly case of Kermit Gosnell, the ‘monster of Philadelphia’, recently found guilty of murder after an investigation into the appalling conditions and practices at his clinic. Meanwhile, in the UK, the case of Sarah Catt – jailed last year for carrying out her own full-term abortion – and the attempts to bring in ‘independent’ counselling among abortion providers have offered two high-profile reminders that abortion rights cannot be taken for granted. It seems likely that the abortion debate is going to become more, rather than less, vicious.

New documentary After Tiller is therefore a timely contribution to the debate, focusing as it does on the ethical area that divides even pro-choice activists: late-term abortions, and those who carry them out. There are currently only four doctors in the US qualified to carry out such procedures beyond 24 weeks; a fifth, George Tiller, was murdered in 2009. Martha Shane and Lana Wilson’s film, an official selection at Sundance this year, follows doctors Warren Hern, Susan Robinson, Shelley Sella and LeRoy Carhart as they fight to keep their clinics open in the face of intense political pressure and as they reflect on the risks involved in such controversial work.

This is an extraordinarily humane film: a portrait of those left operating in a moral no-man’s land as the battleground shifts over where the right to choose supposedly ends and the right to life begins. Statistically the numbers are tiny – third-trimester terminations account for less than one per cent of all procedures in the US – yet the stakes are enormous for all involved.

At its heart, After Tiller is a study in quiet and deeply unglamorous medical bravery; of doctors putting themselves, their families and their staff under enormous personal and professional risk to perform treatments that are judged by society to be just-about lawful. They are a hardy and diverse bunch, to be sure: Carhart is a former fighter pilot married to his childhood sweetheart; Hern is a reserved patrician type; Sella and Robinson could belong on the set of ER or Nurse Jackie. All are over sixty. In one of the more moving personal scenes, we see Hern discuss with his 90-year-old, religious mother what she thinks about his career choice, which has seen her receive death threats and her windows smashed in: her response is principled rather than defiant.

We see less of the patients (whose identities remain hidden) although we do hear plenty of powerful testimonies from them: of expectant parents making impossibly hard decisions over terminating fetuses with a variety of potential viability issues; of miserable circumstances that have led to this unusual procedure. The film asks us to dwell upon the morality of these counselling sessions, which are a legal requirement for women attempting to undergo abortion. As Robinson emphasises, these sessions regularly result in the clinics refusing treatment if the patients do not meet the specific criteria for late-term abortion: ‘Women come here having decided that this is not a pregnancy that they can or want to sustain. And where does it come from that I get to say, “Oh yeah, well, why? Why? Why do you want an abortion? You explain to me, justify it to me.” Why is that fair? What if you’re just not a good storyteller?’

The film is naturally limited, of course, in how much it can tell you about the rights and wrongs of abortion. That these doctors are personally charming does not prove that late-term terminations are right any more than the isolated wickedness of Gosnell proves the reverse. Sella’s own, somewhat shocking, admission that she considers a stillbirth she induces as a baby, rather than a fetus, certainly proves that when life begins is not a settled debate even among health professionals. Pro-life activists do not appear, except in passing, although filmmakers Shane and Wilson are actually pretty fair in how they choose to depict them: a young mother whose child survived from 20 weeks sitting alongside those cheering on Tiller’s murder; those expressing a sincere concern over the trauma of patients mixing with the NIMBYs worried about what the presence of such clinics does to their town’s reputation.

What After Tiller does offer, however, are probing and challenging questions about the importance of being genuinely pro-choice at a time when, as the British Pregnancy Advisory Service’s Ann Furedi recently argued on spiked, the term is becoming increasingly undermined. What this debate hinges on is not a medical question of when a fetus becomes viable but, as Robinson maintains, at what point a woman can no longer be regarded as being able to make decisions over her own body: ‘What I believe is that women are able to struggle with complex ethical issues and arrive at the right decision for themselves and their families. They are the world’s expert on their own lives. So if somebody comes in and she says, “I want an abortion”, whether or not she is articulate about it – let alone whether she has a great story to tell – isn’t the point. The point is that she has made this decision.’

This is a powerful and sensitive film about choice: about the women who make that decision, about the bravery of those who enable that, and about the broader political issue society needs to grapple with in supporting choice.

This week, Channel 4’s head of factual, Ralph Lee, justified the decision to screen the Islamic call to prayer during Ramadan not out of a principled and reasonable commitment to religious plurality, but instead as a ‘deliberate provocation’. Yet After Tiller, a genuinely provocative film, seemingly cannot currently find a home on British TV, presumably because the schedules are rammed with such delights as Inside Claridges and The Human Swarm, which are humane only in the most banal sense. We hear a lot of back-slapping from our broadcasters about their ‘brave’ content: if they watched After Tiller they would realise they don’t even know the meaning of the word.

David Bowden is a columnist for spiked.

After Tiller is being screened as part of the East End Film Festival at London’s Barbican Centre tomorrow, Saturday 6 July.