What the Planned Parenthood Case Isn't About
Last week, a pro-life group called the Center for Medical Progress released a video—in a short, edited form as well as a full-length version—of a conversation between Deborah Nucatola, an executive with the nation's largest abortion provider, Planned Parenthood, and investigators who claimed to be setting themselves up as middlemen distributing organs and tissue from aborted fetuses to medical researchers.
It sounds shocking and disturbing, and the video set off a scramble as the pro-life side of the abortion debate sought to gain political advantage and the pro-choice side scrambled to control the damage.
In this confused noise, both sides have thrown up misconceptions that need to be cleared away before we can understand what the case is actually, fundamentally about.
1) It's not about "deceptive editing."
This was the first line of defense for the pro-choice side: that the short, seven-minute version of the video was "deceptively edited." Well, certainly it was edited to make Planned Parenthood look bad. Every investigative report, every sting, every "must-see" video exposé shared around on the Internet to awaken us to a pet social cause is edited to make a point, and usually to make somebody look bad or somebody else look good. Recall that catcalling video whose producers claimed a handful of black and Hispanic street hustlers were just a sampling of hours worth of men of all races and backgrounds harassing women on the street—yet somehow they never agreed to share the raw footage that would back up this claim.
In this case, the Center for Medical Progress (CMP) released the entire raw video of the conversation at the same time they released the shorter, edited version, and they have also released a transcript. Anyone willing to put in two and a half hours—a little less if you go straight to the transcript—can go over it and very quickly get their own idea of what it is all about. The average person won't do that, but it's certainly possible for anyone in the media who actually does this for a living. Anyone on the abortion beat should have done it the first day.
So enough whining about how the video was deceptive and unfair. People are not simply reacting to the style or manner of the Planned Parenthood official, nor to a few carefully selected quotations. They're reacting to the actual substance of the abortion practices discussed in the video.
Except that some of the substance of the video is not being discussed accurately, this time by the right.
2) It's not about money.
The video claims to present evidence of illegal trafficking in the sale of fetal organs and tissue. But in this video, Nucatola appears to be complying with the current laws. As she describes it, Planned Parenthood clinics ask the woman's consent to donate the fetal organs and other tissues, and seek to recoup only the costs of packaging and transportation.
The one basis in the video for the claim that Planned Parenthood is doing this for profit is a single line in which Nucatola says Planned Parenthood "affiliates"—the individual clinics—want to "better than break even" on each transaction. Yes, despite claims to the contrary, that's not what the quote means in context.
Here is the immediate context:
I think for affiliates, at the end of the day, they’re a non-profit, they just don’t want to—they want to break even. And if they can do a little better than break even, and do so in a way that seems reasonable, they’re happy to do that. Really their bottom line is, they want to break even.
"The bottom line is, we want to break even," is a line never spoken by anyone who was in a profit-seeking enterprise. So it's clear that "a little better than break even" was meant to refer to a small cushion to avoid taking a loss, not to the idea that the sale of organs would be a profit stream. And Nucatola repeatedly emphasizes this. Here is a sampling:
Nucatola: [T]hey want to do this, but they want to do it in a way that’s not going to impact them, and it’s much, much less about money. You could call them up and say, “I’ll pay you double the money,” and they’re almost more inclined to say no, because it’s going to look bad. To them, this is not a service they should be making money from, it’s something—they should be able to offer this to their patients, in a way that doesn’t impact them.
Buyer: Offsetting their costs.
Nucatola: Right. No one’s going to see this as a money-making thing.
[A]gain, affiliates don’t—affiliates are not looking to make money by doing this. They’re looking to serve their patients and just make it not impact their bottom line.
We’re the target. And because we’re the target, we’re not looking to make money from this.... This is not a new revenue stream the affiliates are looking at.
Buyer: [A]re there affiliates, who would just donate the tissue for free?
Nucatola: Probably. I mean really, the guidance is, this is not something you should be making an exorbitant amount of money on.
Buyer: Is that the [Planned Parenthood] guidance, or—
Nucatola: Yes. Our goal, like I said, is to give patients the option without impacting our bottom line. The messaging is this should not be seen as a new revenue stream, because that’s not what it is.
But maybe they are just nominally "donating" the organs but manipulating the handling costs to hide their actual profit, right?
Buyer: That seems like it would be, and correct me if I’m wrong. Seems like it would be such an easy thing to not show a profit. No matter how much we compensate, it—
Nucatola: Yeah. Well, but at the end of the day, you still need to have the paperwork to back it up, because we are under a microscope.
Moreover, at one point in the video, the actors specifically push Nucatola to embrace the idea of selling the organs for profit, offering her the rationalization that this would just be offsetting losses elsewhere in the operation. And she rejects it.
Buyer: OK. I’m just trying to brainstorm. Because, I think offering some people, not only, just offsetting their cost in other areas, seeing the potential for that, besides the potential for the patient. I’m still going down that road, even though I know, I understand what you’re saying. This cannot be seen as, “We’re doing this for profit.”
Nucatola: No. Nothing, no affiliate should be doing anything that’s not, like, reasonable and customary. This is not—nobody should be selling tissue. That’s just not the goal here.
I would note that the CMP transcript renders this line as "Nobody should 'selling' tissue." But the quotation marks are their addition, meant to soften what is actually a flat denial.
So this is not really about selling organs. Money changes hands, but as described by Nucatola here, it is only to offset specific preparation expenses so that clinics don't take a loss. If you're looking for a smoking gun that proves otherwise, you won't find it in this video.
This is a big point. If you're going to put together a video that claims to show Planned Parenthood "selling organs," it had better actually show that, rather than containing repeated protestations to the contrary.
But I don't think settling this issue one way or another will really change anything about the debate. For all the headlines about "selling organs," nobody really cares about the money. Pro-lifers would not be mollified if an independent auditor confirmed that Planned Parenthood isn't making a profit, or if all the costs were covered by private donations. The issue is the abortions that are being performed in the first place. The harvesting of the organs is secondary, and the prospect that someone might be profiting from it is even less important.
The other side also keeps raising an issue that is very much secondary.
3) It's not about cures, either.
In the long version of the video, there is an extended exchange about the role of the harvested organs in medical research and the benefits it might bring. Nucatola suggests that it would be a good "talking point" to argue that "everybody knows somebody who can benefit from stem cell research." The CMP investigators, settling into their role as advocates for organ harvesting, hold forth about its research benefits for so long that Nucatola even suggests that they give a presentation about it at conferences and clinics. I'm guessing that isn't going to happen now. And no doubt we will see some on the pro-life side argue that research with fetal organs and tissue hasn't produced any big cures.
But this is also an irrelevant issue that won't change anyone's mind on either side. So what if the use of fetal tissue or fetal stem cells produced some kind of miracle cure? Would that in and of itself make it acceptable? If you could develop a cure for some disease by killing hobos, would that be ethical? (Someone actually made a movie based on this premise, and it was pretty clear who was the good guy and who was the bad guy.) It's the ethics of the underlying process of abortion that is the real issue, not whether some countervailing practical benefit comes out of it.
4) It's not about encouraging abortions.
The disturbing aspect about citing the benefits that come from harvesting organs is that it seems to create a perverse incentive, to encourage women to perform abortions.
On the one hand, it's doubtful that anyone making such a momentous decision would be swayed specifically by the idea of making a contribution to medical science. On the other hand, it does seem realistic that a young woman looking to feel better about her decision might grasp for the reassurance that some good would come of it.
What's important from the video, though, is that Nucatola tells her interviewers that Planned Parenthood does not bring up organ donation until after the decision to abort.
I think that a lot of people feel strongly that the conversation shouldn’t be had until after they’ve made their decision to terminate, they know how far along they are, and they know what’s going to happen, and when all that is said and done, and they’ve had time for all of that to sink in, then it’s time to basically say, this is how we normally handle the tissue, but if you would be interested here’s another opportunity to contribute to research, contribute to science, donate your tissue....
[T]here’s always concerns, too, about kind of coercion. So you always have to make sure they’ve made their decision, to actually have the procedure, and then before you start adding on other things.... [T]here’s still certain principles we still think it’s most ethical to follow. And that is just to make sure they’ve made their decision and they’re comfortable with the decision, then to say, OK, now that you’re past that point in the process, now there’s one other opportunity we wanted to let you know about.
So as described here, Nucatola is saying that Planned Parenthood deliberately separates the decision to donate organs from the decision to terminate the pregnancy.
And that leads us to another misconception.
5) It's not about callousness or indifference to ethics.
It's easy to assume indifference just from watching the video, from the casual way Nucatola discusses abortion procedures while sipping wine and munching on salad. But if you've ever spent much time with physicians, you know that it's totally normal for them to discuss amongst themselves the most horrible cases with what seems like casual nonchalance. For the patient, going through chemotherapy may be a traumatic life-and-death struggle. For the doctor, no matter how seriously he takes his professional responsibilities, from an emotional perspective it's just another day at the office. This is why it's probably best that you never overhear your doctor discussing your case with his colleagues or assistants.
Of course, there is a danger that over-familiarity can lead to indifference or a disregard for the humanity of the patient. That is why we develop ethical principles and standard protocols, to ensure that physicians don't have to rely on their emotions to prompt them to do the right thing. And if you read the transcripts of the Planned Parenthood video, you will notice that the discussion of ethical standards repeatedly recurs.
Take, for example, the discussion about whether a physician would alter the procedure to make it easier to harvest organs.
[T]hat’s kind of an ethical issue too, ideally you shouldn’t do the procedure in any other way. You should always do the procedure the same, and that’s what the providers try to do. They’re not gonna treat these patients any differently than they would treat any other patients, just the disposition of the tissue at the end of the case is different.
I should also note that while Nucatola frequently talks about "perception" and worries about something "looking bad," rather than just being bad, she never talks only about perception. She repeatedly returns to ethical standards and protocols.
So this is not about cynical indifference to ethics. What people are really objecting to is that they think Nucatola has the wrong ethics, that she takes for granted the moral permissibility of abortions which the pro-life side of the debate believes to be evil.
Fair enough, so long as we're clear what the real issue is. But there's one final big issue that's muddling the debate from the pro-life side.
6) It's not about late-term abortions.
This is the part that surprised me the most. When the CMP describes the video, it claims that it shows how Planned Parenthood "Uses Partial-Birth Abortions to Sell Baby Parts."
But "partial-birth abortion" refers to a technique mostly used for very late-term, third trimester abortions. So the casual reader or viewer would assume—as I did until I pored over the transcripts—that this conversation was about third trimester abortions.
Yet throughout the video they are mostly talking about 20-week fetuses and earlier: "in general, you’re probably going to be able to get to twenty weeks, it’s going to be very unusual to get a patient that’s above twenty weeks." Nucatola goes on to describe how in some jurisdictions abortions past that point are illegal. There is a brief discussion farther on about late second-trimester abortions, but it is more speculative.
This makes a difference in the politics and ethics of the issue. If the point is about elective late-term abortions—if it's about the termination of a fully formed, viable fetus when there is no threat to the life of the mother—then there are a lot of people (myself included) who will find the whole business morally repugnant and be shocked that anyone would be so ghoulish as to kill a baby for its spare parts. But if we're talking about first-trimester or early second-trimester abortions, far before the point where the fetus is even theoretically viable outside the womb, most people consider it less repugnant. There is a reason why state-level regulations only limit late-term abortions. That reflects the political fault line with the general public between support for abortion and severe moral discomfort with it.
So if this case were about Planned Parenthood asserting the right to perform elective third trimester abortions and dispose of the bodies any way they please, then they would be pushing a position well outside the usual mainstream of the debate. As it is, however, this is about CMP attempting to push people toward repugnance against first-trimester abortions—while making it look as if they're talking about late-term abortions.
I raise these distinctions to clarify the story and define it properly—not to dismiss it. And that leads me to the biggest obfuscation offered by the pro-choice side.
7) It's not an insignificant story.
The defenders of abortion have a bad habit of trying to evade the procedure's ugly aspects. Abortion is not a normal, ordinary thing, it is always some kind of tragedy, and it raises real ethical questions. So to be dismissive of this story is to dismiss the whole argument over abortion. This is the left's usual trick of trying to win the debate by never having one.
As with the Kermit Gosnell case—the specifics of which were much more repugnant than this—they foolishly think that they can make the story disappear. Instead, they somehow manage to seem both secretly guilty and genuinely indifferent to the disturbing aspects of abortion. This is the occupational hazard of the partisan: you can become so dedicated to a certain idea or practice that you defend it reflexively and irrationally, turning yourself into the caricature your opponents have set up for you.
That previous case, in which the abominable Dr. Gosnell went up the to the line between abortion and infanticide and sauntered straight over it, required us all to confront the morality of late-term abortions. This case requires us to confront another issue.
There is a real ethical difference between the donation of fetal organs versus ordinary organ donation, or even the donation of medical leftovers of delivery like the placenta or umbilical cord, which are uncontroversial sources of fetal tissue for medical research. In those cases, the organs are available because of a death that occurred through unrelated causes, or the tissue is the normal waste product of birth that would otherwise be destroyed. But in the case of an abortion, the organs are the product of a death caused by one's own medical intervention. That certainly creates a different moral dimension, one that needs to be discussed seriously.
But if left is trying to evade the issue, the right is also trying to muddy it. They are trying to make it about "selling organs" or violating existing law or discussing abortion in an ordinary tone of voice over salad, when that is not what this is about.
The outrage over this video is largely driven by a single, deeper issue. In Reason, Elizabeth Nolan Brown complains that "as bioethicists noted in an early '90s paper on the issue, for many people 'the transplantation of tissue from an electively aborted fetus is morally inseparable from the morality of elective abortion.' As Arthur Caplan, head of the Division of Medical Ethics at New York University and one of the study's authors, told Vox: 'For critics of abortion, the idea of making something good from something they see as inherently evil is not something they have room for.'" Well, that seems natural enough, though, doesn't it? Should we really adopt more flexibility when it comes to things we regard as "inherently evil"?
But what this implies is that the actual driving issue in this case is the morality and legality of abortions performed in the first 20 weeks of pregnancy. That's a debate worth having, and the pro-life side should not be dismissed—as some of my fellow atheists do—as being driven by mere hatred of sex or by what pro-lifers' "imaginary friend" (a derisive way of referring to God) tells them to do.
Yet it's also going to be a harder case to make, and one with less immediate public appeal than screaming about "selling organs" or making out abortion advocates to be obvious cartoon villains. It's going to require a deeper, longer discussion which depend more on philosophy and basic principles than on emotion—and that's not the conversation either side is trying to have right now.