Intact dilation and extraction 24560 220088077 2008-06-18T06:06:55Z Jclemens 200029 Reverted edits by [[Special:Contributions/70.161.38.133|70.161.38.133]] to last version by Jclemens (using [[WP:HG|Huggle]]) {{world}} {{Infobox abortion method | | name = Intact dilation and extraction | AKA/Abbreviation= IDX, intact D&X, ''et al.'' | Abortion_type = Surgical | Date_first_use = 1983 | Date_last_use = | Gestational_age = >16 weeks | Usage_notes = | Use_AU% = <!-- Australia --> | Use_AU_date = | Use_CA% = <!-- Canada--> | Use_CA_date = | Use_NZ% = | Use_NZ_date = | Use_SE% = | Use_SE_date = | Use_UK% = | Use_UK_date = | Use_US% = 0.17 | Use_US_date = 2000 | Use_ZA% = <!-- South Africa --> | Use_ZA_date = | Medical_notes = }} '''Intact dilation and extraction''' ('''IDX''' or '''intact D&X'''), also known as '''intact dilation and evacuation''' ('''intact D&E'''), '''dilation and extraction''' ('''D&X'''), '''intrauterine cranial decompression''' and controversially in the [[United States of America|United States]] as '''partial birth abortion''', is a surgical [[abortion]] wherein an intact [[fetus]] is removed from the [[uterus]] via the [[cervix]]. The procedure may also be used to remove a deceased fetus that is developed enough to require dilation of the cervix for its extraction.<ref name="extract">''[[Gonzales v. Carhart]]'', [http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=000&invol=05-380 550 U.S. ____ (2007)]. Findlaw.com. Retrieved [[2007-04-30]]. ("If the intact D&E procedure is truly necessary in some circumstances, it appears likely an injection that kills the fetus is an alternative under the Act that allows the doctor to perform the procedure.")</ref> Though the procedure has had a low rate of usage, representing 0.17% (2,232 of 1,313,000) of all abortions in the United States in 2000 according to voluntary responses to an [[Alan Guttmacher Institute]] survey,<ref>Guttmacher.org [http://www.guttmacher.org/pubs/journals/3500603.html Abortion Incidence and Services in the United States in 2000]</ref> it has developed into a focal point of the [[abortion debate]]. In the United States, intact dilation and extraction was made illegal under some circumstances by the [[Partial-Birth Abortion Ban Act]], which the U.S Supreme Court upheld in the case of ''[[Gonzales v. Carhart]]''. == Etymology == The term ''dilation and extraction'', or ''D&amp;X'', was coined by Cincinnati physician [[Dr. Martin Haskell|W. Martin Haskell, MD]] in a monograph that was distributed by the [[National Abortion Federation]] in September of 1992.<ref name="presentation">Haskell, Martin. [http://www.vanderbilt.edu/SFL/partial-birth_abortion.htm Dilation and Extraction for Late Second Trimester Abortion]. Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992.</ref> Haskell's term was a variation on ''intact dilation and evacuation'' (shortened to ''intact D&amp;E''), the term preferred by Dr. James McMahon, who developed the procedure in 1983 as an alternative to ''[[dilation and evacuation]]'' or ''D&amp;E''.<ref>[http://www.feminist.org/news/newsbyte/uswirestory.asp?id=5169 Owner of Bombed Atlanta Nightclub is Sister of Abortion Doctor]. Feminist Daily News Wire, [[February 26]], [[1997]].</ref> The [[American College of Obstetricians and Gynecologists]] (ACOG) has settled on the term ''intact dilation and evacuation'' (''intact D&E'') for this procedure.<ref> [http://www.acog.org/from_home/publications/press_releases/nr04-18-07.cfm ACOG Statement on the US Supreme Court Decision Upholding the Partial-Birth Abortion Ban Act of 2003] (April 18, 2007). Retrieved [[2007-04-22]].</ref> The much smaller [[American Association of Pro-Life Obstetricians & Gynecologists|American Association of Pro-Life Obstetricians and Gynecologists]] (AAPLOG) contends that this was a contrived attempt by ACOG to legitimize the abortion technique in question, by wedding it to "[[Dilation and evacuation|D&E]]" (a long-recognized procedure) using a sort of legitimacy by association.<ref>American Association of Pro Life Obstetricians and Gynecologists, [http://www.aaplog.org/newspba.htm Partial Birth Abortion]. Retrieved [[2007-04-22]].</ref> The [[American Medical Association]] (AMA) has settled on the term ''intact dilation and extraction'' (''intact D&X'') for this procedure.<ref>[http://www.ama-assn.org/apps/pf_new/pf_online?f_n=resultLink&doc=policyfiles/HnE/H-5.982.HTM&s_t=abortion&catg=AMA/HnE&&nth=1&&st_p=0&nth=2& Health and Ethics Policies of the AMA] ''American Medical Association''. H-5.982 Retrieved April 24, 2007.</ref> == Intact D&X surgery == {{AbortionMethods}} According to the [[American Medical Association]], this procedure has four main elements.<ref name="AMA">[http://www.ama-assn.org/apps/pf_new/pf_online?f_n=resultLink&doc=policyfiles/HnE/H-5.982.HTM&s_t=abortion&catg=AMA/HnE&&nth=1&&st_p=0&nth=2& Late-Term Pregnancy Termination Techniques] ''American Medical Association''. H-5.982 Retrieved April 24, 2007.</ref> First, the [[cervix]] is [[Cervical dilation|dilated]]. Second, the [[fetus]] is positioned for a [[Breech birth#Categories of breech presentation|footling breech]]. Third, the fetus is extracted except for the head. Fourth, the [[brain]] of the fetus is evacuated so that a dead but otherwise intact fetus is delivered via the [[vagina]]. Usually, preliminary procedures are performed over a period of two to three days, to gradually dilate the cervix using [[laminaria]] tents (sticks of seaweed which absorb fluid and swell). Sometimes drugs such as synthetic [[pitocin]] are used to induce labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and [[forceps]] to grasp the [[fetus]]' leg. The fetus is turned to a [[Breech birth|breech position]], if necessary, and the doctor pulls one or both legs out of the birth canal, causing what is referred to by some people as the 'partial birth' of the fetus. The doctor subsequently extracts the rest of the fetus, usually without the aid of forceps, leaving only the [[head (anatomy)|head]] still inside the [[birth canal]]. An incision is made at the base of the skull, scissors are inserted into the incision and opened to widen the opening<ref name="SCOTUS">''Gonzales v. Carhart'', [http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=000&invol=05-380 550 U.S. ____ (2007)]. Findlaw.com. Retrieved [[2007-04-19]].</ref>, and then a suction [[catheter]] is inserted into the opening. The [[brain]] is suctioned out, which causes the [[skull]] to collapse and allows the fetus to pass more easily through the birth canal. The [[placenta]] is removed and the [[uterus|uterine]] wall is [[Suction-aspiration abortion|vacuum aspirated]] using a [[cannula]].<ref>[http://americanpregnancy.org/unplannedpregnancy/surgicalabortions.html "Surgical Abortion Procedures"] American Pregnancy Association. Accessed April 14, 2006.<br />Haskell, Martin. "[http://eileen.250x.com/Main/7_R_Eile/Haskell_Desc.html Dilation and Extraction for Late Second Trimester Abortion.]" Presented at the National Abortion Federation Risk Management Seminar, [[September 13]], [[1992]]</ref> ==Circumstances and reasons for this procedure== {{seealso|Late-term abortion}} IDX, along with [[dilation and evacuation]] (D&E), early [[Induction (birth)|induction]] of labor, and rare procedures such as [[Instillation abortion|saline abortion]], are only used in the late stages of [[pregnancy]]. [[Late-term abortion]]s at 21 weeks or later account for 1.4% of all abortions in the USA.<ref>[http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5407a1.htm Abortion Surveillance &mdash; United States, 2002] CDC's National Center for Chronic Disease Prevention and Health Promotion, Division of Reproductive Health. Accessed April 14, 2006.</ref> Intact D&amp;X procedures are used in approximately 15% of those late-term abortion cases. This is the equivalent of between 2,500 and 3,000 per year, using data from the [[Alan Guttmacher Institute]] for the year 2000. They are typically performed between the twentieth and twenty-fourth week of pregnancy.<ref>[http://www.guttmacher.org/pubs/journals/3026398.html Abortion Incidence and Services in the United States, 1995-1996]. Accessed April 17, 2006.</ref> Women choose to have late-term abortions for a [[Abortion in the United States#Reasons for abortions|variety of reasons]]. Once a pregnant woman has made the decision to have a late-term abortion, she or a doctor may choose IDX over other available late-term abortion procedures because: *Although a woman may experience [[contraction (childbirth)|contractions]], she does not have to experience labor.<!-- --><ref name="continuing need">{{cite journal |author=Grimes D |title=The continuing need for late abortions |journal=JAMA |volume=280 |issue=8 |pages=747–50 |year=1998 |pmid=9728652 |url=http://jama.ama-assn.org/cgi/content/full/280/8/747?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22podalic+version%22&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT |accessdate=2007-04-29 | doi = 10.1001/jama.280.8.747 <!--Retrieved from CrossRef by DOI bot-->}} {Full text of online article requires free registration.)</ref> *IDX is an outpatient procedure; the woman does not have to be hospitalized.<ref name="continuing need" /> *The woman does not have to undergo [[abdominal surgery]].<!-- --><ref>{{cite encyclopedia | title = Abortion | encyclopedia = Microsoft Encarta Online Encyclopedia | publisher = MSN | date = 2007 | url = http://encarta.msn.com/encnet/refpages/refarticle.aspx?refid=761553899 | accessdate = 2007-04-29 }}</ref> *The procedure results in a largely intact body over which the parents may grieve.<ref name="harpers" /> *Instruments are inserted into the [[uterus]] fewer times than in a D&amp;E abortion, potentially reducing the risk of uterine tearing.<!-- --><ref name="salon">{{cite journal | last = Woodbury | first = Margaret A. | title = A doctor's right to choose | journal = Salon.com | date = [[2002-07-24]] | url = http://archive.salon.com/mwt/feature/2002/07/24/late_term/index.html | accessdate = 2007-04-29 }}</ref> *The fetus may have [[hydrocephalus]], where the head may expand to a radius of up to 250% of a normal [[skull]] at birth, making it impossible for it to pass through the [[cervix]]. If [[live birth]] is desired, the [[physician]] may drain the excess fluid ''in utero'' using a syringe,<!-- --><ref name="rationale">{{cite journal |author=Sprang M, Neerhof M |title=Rationale for banning abortions late in pregnancy |journal=JAMA |volume=280 |issue=8 |pages=744–7 |year=1998 |pmid=9728651 |url=http://jama.ama-assn.org/cgi/content/full/280/8/744?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=%22podalic+version%22&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT |accessdate=2007-04-29 | doi = 10.1001/jama.280.8.744 <!--Retrieved from CrossRef by DOI bot-->}} (Full text of online article requires free registration.)</ref> or a [[caesarian section]] may be done as soon as amniocentesis indicates lung maturity.<!-- --><ref>{{cite web | title = What do we expect during the delivery? | work = Fetal Hydrocephalus | date = 2006 | url = http://www.fetalhydrocephalus.com/hydro/info.asp#Delivery | accessdate = 2007-04-29 }}</ref> If abortion is desired, D&amp;X may be the simplest procedure.<ref name="continuing need" /> Reasons a woman or physician may not choose IDX, opting instead for another abortion procedure, include: *IDX requires a larger dilation of the cervix than D&amp;E.<ref name="salon" /> *Podalic version (turning the fetus into a breech position) can be dangerous to the woman.<ref name="rationale" /> *The incision in the fetal skull is made blind; the physician may miss and injure the woman's cervix.<ref name="rationale" /> =="Partial-birth abortion"== {{seealso|Partial-Birth Abortion Ban Act}} The term "partial-birth abortion" is primarily used in political discourse — chiefly regarding the legality of [[abortion in the United States]].<!-- --><ref>[http://www.religioustolerance.org/abo_pba1.htm D & X/PBA Procedures: Introduction]. religioustolerance.org. Accessed April 14, 2006.</ref> The term is not recognized as a medical term by the [[American Medical Association]]<ref>[http://www.ama-assn.org/apps/pf_new/pf_online?f_n=resultLink&doc=policyfiles/HnE/H-5.982.HTM&s_t=abortion&catg=AMA/HnE&&nth=1&&st_p=0&nth=2& Health and Ethics Policies of the AMA] ''American Medical Association''. H-5.982 Retrieved April 24, 2007.</ref> nor the [[American College of Obstetricians and Gynecologists]].<ref>[http://www.acog.org/from_home/publications/press_releases/nr09-22-06.cfm ACOG Files Amicus Brief in Gonzales v. Carhart and Gonzales v. PPFA] September 22, 2006 ''The American College of Obstetricians and Gynecologists''. Retrieved April 25, 2007.</ref> This term was first suggested in 1995 by pro-life [[Congressperson|congressman]] [[Charles T. Canady]], while developing the original proposed [[Partial-Birth Abortion Ban Act|Partial-Birth Abortion Ban]].<!-- --><ref>Alex Gordon. [http://www.law.harvard.edu/students/orgs/jol/vol41_2/gordon.php "The Partial-Birth Abortion Ban Act of 2003"]. ''Harvard Journal on Legislation''. Volume 41, Number 2, Summer 2004. (see footnote 15)</ref><!-- --><ref>H.R.1833. [http://thomas.loc.gov/cgi-bin/bdquery/z?d104:HR01833: To amend title 18, United States Code, to ban partial-birth abortions].</ref> Keri Folmar, the lawyer responsible for the bill's language, says the term developed in early 1995 in a meeting between her, Charles T. Canady, and [[National Right to Life Committee]] lobbyist Douglas Johnson.<!-- --><ref name="harpers">Gorney, Cynthia. [http://www.harpers.org/GamblingWithAbortion.html Gambling With Abortion]. Harper's Magazine, November 2004.</ref> Canady could not find this particular abortion practice named in any medical textbook, and therefore he and his aides named it.<ref>Adam Simon, “[http://mpsa.indiana.edu/conf2003papers/1032123442.pdf Elite Discourse, Programming and Survey Response in the Partial Birth Abortion Debate]” (March 2003).</ref> "Partial-birth abortion" was first used in the media on [[4 June]] [[1995]] in a [[Washington Times]] article covering the bill.<!-- --><ref>[http://mediamatters.org/items/200412130002 FOX News toes GOP line, using the term "partial birth abortion".] Media Matters For America, Mon [[December 13]], [[2004]].</ref> [[Image:Signing the Partial-Birth Abortion ban.jpg|thumb|254px|right|The signing of the ''[[Partial-Birth Abortion Ban Act]]'' was seen as a political victory for the pro-life movement, though the law was soon declared unconstitutional by some federal courts. It was eventually upheld by the Supreme Court in a 5-4 decision.]] In the U.S., a [[Partial-Birth Abortion Ban Act#Partial-birth abortion defined by law|federal statute defines]] "partial-birth abortion" as any abortion in which the fetus is extracted "past the navel [of the fetus] . . . outside the body of the mother," or "in the case of head-first presentation, the entire fetal head is outside the body of the mother," in order to cause death of the fetus. The U.S. Supreme Court has held that the terms "partial-birth abortion" and "intact dilation and extraction" are basically synonymous.<ref>''Gonzales v. Carhart'', [http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=000&invol=05-380 550 U.S. ____ (2007)]. Findlaw.com. Retrieved [[2007-04-19]].</ref> However, there are cases where these overlapping terms do not coincide. For example, the IDX procedure may be used to remove a deceased fetus (e.g. due to a [[miscarriage]] or [[feticide]]) that is developed enough to require dilation of the cervix for its extraction.<ref name="extract" /> Removing a dead fetus does not meet the federal legal definition of "partial-birth abortion," which specifies that partial live delivery must precede "the overt act, other than completion of delivery, that kills the partially delivered living fetus."<ref>[http://www.law.cornell.edu/uscode/html/uscode18/usc_sec_18_00001531----000-.html U.S. Code, Title 18, Part I, Chapter 74, Section 1531], "Partial-birth abortions prohibited."</ref> Additionally, a doctor may extract a fetus past the navel and then cut through the neck. This could fall within the terms of the statute, even though it would not result in an intact body and therefore would not be an intact dilation and extraction.<ref name="harpers" /> In addition to the federal ban, there have also been a number of [[#State law|state partial-birth abortion bans]]. There, courts have found that state legislation (rather than federal legislation) intended to ban "partial-birth abortions" could be interpreted to apply to some non-intact [[dilation and evacuation]] (D&E) procedures.<ref>[http://www.aclu.org/reproductiverights/abortionbans/12669res20040326.html Abortion Bans: Myths and Facts]. American Civil Liberties Union. Accessed [[April 14]], [[2006]]. <br />[http://www.law.cornell.edu/supct-cgi/get-us-cite?530+914 Stenberg v. Carhart, 530 U.S. 914 (2000)]</ref> Though sometimes performed during the same developmental stage wherein most IDX procedures are done, non-intact D&E is a separate procedure. There is debate over use of the term "partial-birth abortion". Those who oppose the term consider it a political term used to [[framing (social sciences)|frame]] the argument in a way which is favorable to those who seek greater legal restrictions, or a total ban, on this or all abortion procedures, and have called the alleged political framing "partial truth abortion".<ref>{{cite web|author=Miranda Kennedy|title=Partial Truth Abortion Coverage|publisher=Fairness and Accuracy in Reporting|year=March/April 2000|accessdate=2006-09-14|url=http://www.fair.org/index.php?page=1028}}</ref> ==Controversy== IDX is a target of pro-life advocates who believe the procedure illustrates their contention that abortion, and especially [[late-term abortion]], is immoral. Critics consider the procedure tantamount to [[infanticide]],<ref>Koukl, Gregory. [http://www.str.org/site/News2?page=NewsArticle&id=5477 Partial-Birth Abortion Is Not About Abortion]. ''Stand to Reason''. Accessed April 25, 2006.<br />White, Deborah. [http://usliberals.about.com/od/healthcare/i/PBAbortion_2.htm Pros & Cons of Partial Birth Abortions] ''About.com''. Accessed April 25, 2006.</ref> or [[murder]], a position which many in the pro-life movement extend to cover all abortions.<ref>[http://www.patriarhia.ro/eng/bioetics.php The Official Point of View of the Romanian Orthodox Church on Abortion (summery)]. ''The Romanian Patriarchate''. Accessed April 25, 2006.<br />Achacoso, Jaime B. [http://www.catholic.com/thisrock/1996/9606ltrs.asp A Sin and a Crime] ''Catholic.com''. Accessed April 25, 2006.<br />Gonzalez, Ramon. [http://www.wcr.ab.ca/news/2000/1023/prolifeteens102300.shtml Pro-life teens challenged] ''Western Catholic Reporter''. October 23, 2000. Accessed April 25, 2006.</ref> Some advocates, both for and against abortion rights, see the IDX issue as a central battleground in the wider [[abortion]] debate, representing an attempt to set a legal precedent so as to gradually erode access to all abortion methods.<ref>[http://www.perrspectives.com/articles/art_slope01.htm Slippery Slope: Democratic Wavering in the Battle for Reproductive Rights]. ''PERRspectives.com''. February 25, 2004. Accessed April 25, 2006.<br />[http://www.rockridgeinstitute.org/research/rockridge/stratinit?b_start:int=1 Strategic Initiatives] '' The Rockridge Institute''. Accessed April 25, 2006.</ref> Dr. [[Martin Haskell]] has called the IDX procedure "a quick, surgical outpatient method" for late second-trimester and early third-trimester abortions.<!-- --><ref name="presentation" /> The [[Partial-Birth Abortion Ban Act]] of 2003 describes it as "a gruesome and inhumane procedure that is never medically necessary."<!-- --><ref>108th Congress, 1st Session, S.3. [http://news.findlaw.com/usatoday/docs/abortion/2003s3.html Partial Birth Abortion Ban Act of 2003].</ref> According to a [[BBC]] report about the U.S. Supreme Court's decision in ''[[Gonzales v. Carhart]]'', "government lawyers and others who favour the ban, have said there are alternative and more widely used procedures that are still legal - which involves dismembering the foetus in the uterus."<!-- --><ref>{{cite news | title = US top court backs abortion ban | publisher = BBC | date = [[2007-04-18]] | url = http://news.bbc.co.uk/2/hi/americas/6569007.stm | accessdate = 2007-04-18 }}</ref> An article in ''[[Harper's Magazine|Harper's]]'' magazine stated that, "Defending the Partial-Birth Abortion Ban... requires arguing to judges that pulling a fetus from a woman's body in dismembered pieces is legal, medically acceptable, and safe; but that pulling a fetus out intact, so that if the woman wishes the fetus can be wrapped in a blanket and handed to her, is appropriately punishable by a fine, or up to two years' imprisonment, or both."<ref name="harpers" /> The U.S. Supreme Court has stated that intact D&X remains legal as long as there is first an "injection that kills the fetus."<ref name="extract" /> There is also controversy about why this procedure is used. Although prominent defenders of the method asserted during 1995 and 1996 that it was used only or mostly in acute medical circumstances, Ron Fitzsimmons, executive director of the [[National Coalition of Abortion Providers]] (a trade association of abortion providers), told the ''[[New York Times]]'' (Feb. 26, 1997): "In the vast majority of cases, the procedure is performed on a healthy mother with a healthy fetus that is 20 weeks or more along."<ref>[http://www.nrlc.org/abortion/pba/PBA%20NYT%20lied.pdf "An abortion rights advocate says he lied about procedure]," ''New York Times'', February 26, 1997, page A11.</ref> Some prominent self-described pro-choice advocates quickly defended the accuracy of Fitzsimmons' statements.<ref>Ruth Padawer, [http://www.nrlc.org/abortion/pba/PBA%20activists%20lied.pdf "Pro-choice advocates admit to deception"], ''Bergen Record'', February 27, 1997.</ref> In support of the Partial-Birth Abortion Ban Act, a nurse who witnessed three IDX procedures found them deeply disturbing, and described one performed on a 26½-week [[fetus]] with [[Down Syndrome]] in testimony before a Judiciary subcommittee of the US House of Representatives, where she states "[t]he baby’s little fingers were clasping and unclasping, and his little feet were kicking," right before the procedure.<ref>[http://judiciary.house.gov/legacy/215.htm Testimony of Brenda Pratt Shafer, R.N.] Committee on the Judiciary, Subcommittee On The Constitution, U.S. House Of Representatives, March 21, 1996. Retrieved May 2, 2007.</ref> A journalist observed three IDX and two D&E procedures involving fetuses ranging from 19 to 23 weeks. She "watched for any signs of fetal distress, but ... [she] could see no response, no reflexive spasm, nothing. Whether this was a result of the anesthesia or an undeveloped fetal system for pain sensitivity, one thing was clear: There was no discernible response by the fetus."<ref name="salon" /> Abortion provider [[Warren Hern]] asserted in 2003 that "No peer-reviewed articles or case reports have ever been published describing anything such as 'partial-birth' abortion, 'Intact D&E' (for 'dilation and extraction'), or any of its synonyms."<ref>Hern, Warren. "Did I Violate the Partial-Birth Abortion Ban?" [http://www.slate.com/id/2090215/ (''Slate'', Oct. 22, 2003)].</ref> Therefore, Hern expressed uncertainty about what all of these terms mean. The U.S. Supreme Court held in ''Gonzales v. Carhart'' that these terms of the federal statute are not vague because the statute specfically detailed the procedure being banned: it specified anatomical landmarks past which the fetus must not be delivered, and criminalized such a procedure only if an "overt" fatal act is performed on the fetus after "partial delivery." <ref>''Gonzales v. Carhart'', [http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=000&invol=05-380 550 U.S. ____ (2007)]. Findlaw.com. Retrieved [[2007-04-19]].</ref> ==Legal and political situation in the United States== ===Federal law=== {{main|Partial-Birth Abortion Ban Act}} Since 1995, led by [[Republican Party (United States)|Republicans]] in [[United States Congress|Congress]], the [[United States House of Representatives|U.S. House of Representatives]] and [[United States Senate|U.S. Senate]] have moved several times to pass measures banning the procedure. Congress passed two such measures by wide margins during [[Presidency of Bill Clinton|Bill Clinton's presidency]], but Clinton [[veto]]ed those bills in April 1996 and October 1997 on the grounds that they did not include health exceptions. Subsequent congressional attempts at overriding the veto were unsuccessful. Doctors "have been successfully sued for failure to refer patients for late-term abortions in cases of fetal abnormalities."<ref>Trupin, Suzanne R. [http://www.emedicine.com/MED/topic5.htm Abortion] ''emedicine.com''. Accessed [[April 25]], [[2006]].</ref> A major part of the legal battle over banning the procedure relates to health exceptions, which would permit the procedure in special circumstances. The 1973 Supreme Court decision ''[[Roe v. Wade]]'', which declared many state-level abortion restrictions unconstitutional, allowed states to ban abortions of post-viable fetuses unless an abortion was "necessary to preserve the life or health of the mother." The companion ruling, ''[[Doe v. Bolton]]'', upheld against a vagueness challenge a state law that defined health to include mental as well as physical health. The Court has never explicitly held, as a matter of constitutional law, that states have to allow abortions of post-viable fetuses if doing so is necessary for the mother's mental health, but many read ''Doe'' as implying as much. The concern that the health exception can be read so liberally partly explains why supporters of the Partial-Birth Abortion Ban Act did not want to include one. The Act includes an exception for the life of the woman, but explicitly not for non-life-threatening health issues; opponents believe that this exception is too narrow and have mounted numerous legal challenges. Congress asserted that the procedure is never necessary for maternal health. In 2003, the [[Partial-Birth Abortion Ban Act]] (H.R. 760, S. 3) was signed into law; the House passed it on [[October 2]] with a vote of 281-142, the Senate passed it on [[October 21]] with a vote of 64-34, and President [[George W. Bush]] signed it into law on [[November 5]]. Beginning in early [[2004]], the [[Planned Parenthood Federation of America]], the [[National Abortion Federation]], and abortion doctors in Nebraska challenged the ban in [[United States district court|federal district courts]] in the [[United States District Court for the Northern District of California|Northern District of California]], [[United States District Court for the Southern District of New York|Southern District of New York]], and [[United States District Court for the District of Nebraska|District of Nebraska]]. All three district courts ruled the ban unconstitutional that same year. Their respective [[United States court of appeals|federal courts of appeals]]&mdash;the [[United States Court of Appeals for the Ninth Circuit|Ninth Circuit]], [[United States Court of Appeals for the Second Circuit|Second Circuit]], and [[United States Court of Appeals for the Eighth Circuit|Eighth Circuit]], respectively&mdash;affirmed these rulings on appeal. The three cases were all appealed to the [[Supreme Court of the United States|U.S. Supreme Court]], and were consolidated into the case ''[[Gonzales v. Carhart]]''. On April 18, 2007, the Supreme Court voted to uphold the [[Partial-Birth Abortion Ban Act]] by a decision of 5-4.<ref>{{cite news | first=Mark | last=Sherman | coauthors= | title=Court Backs ban on abortion procedure |date=[[April 18]], [[2007]] | publisher= SFGate | url= http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2007/04/18/national/w070844D25.DTL&type=politics | accessed = [[2007-04-18]]}}</ref> Justice [[Anthony Kennedy|Kennedy]] wrote for the majority and was joined by Justices [[Clarence Thomas|Thomas]], [[Antonin Scalia|Scalia]], [[Samuel Alito|Alito]], and Chief Justice [[John G. Roberts|Roberts]]. A dissenting opinion was written by Justice [[Ruth Bader Ginsburg|Ginsburg]] and joined by Justices [[John Paul Stevens|Stevens]], [[David Souter|Souter]] and [[Stephen Breyer|Breyer]]. ===State law=== Many states have [[Late-term abortion#Legal restrictions|bans on late-term abortions]] which apply to the IDX procedure if it is performed after [[Fetus#Viability|viability]]. Many states have also passed bans specifically on the IDX procedure. The first was Ohio, which in 1995 enacted a law that referred to the procedure as ''dilation and extraction''. In 1997, the United States Court of Appeals for the Sixth Circuit found the law unconstitutional on the grounds that it placed a substantial and unconstitutional obstacle in the path of women seeking pre-viability abortions in the [[second trimester]]. Between 1995 and 2000, 28 more states passed Partial-Birth Abortion bans, all similar to the proposed federal bans and all lacking an exemption for the health of the woman. Many of these state laws faced legal challenges, with Nebraska's the first to reach decision in ''[[Stenberg v. Carhart]]''. The Federal District Court held Nebraska's statute unconstitutional on two counts. One being the bill's language was too broad, potentially rendering a range of abortion procedures illegal, and thus, creating an undue burden on a woman's ability to choose. The other count was the bill failed to provide a necessary exception for the health of the woman. The decision was appealed to and affirmed by both the Eighth Circuit and the Supreme Court on June 2000, thus resolving the legal challenges to similar state bans nationwide. Since the ''Stenberg v. Carhart'' decision, Virginia, Michigan, and Utah have introduced laws that remain virtually identical to the unconstitutional Nebraska law. The Virginia and Michigan laws were similarly struck down due to broadness and the failure to provide a health exemption, Utah's law remains pending trial, though is unenforceable due to a court-issued preliminary injunction. In 2000 Ohio introduced another "partial-birth abortion" ban. The law differed from previous attempts at the ban in that it specifically excluded D&amp;E procedures, while also providing a narrow health exception. This law was upheld on appeal to the Sixth Circuit in 2003 on the grounds that "it permitted the partial birth procedure when necessary to prevent significant health risks." In 2003 the Michigan Senate introduced Senate Bill No. 395. The bill, which would change the legal definition of birth, would in effect ban partial birth abortions. The definition of birth as defined in the bill was that once any part of the body had passed beyond the vaginal plane of introitus it is considered a birth. The bill included an exemption for the mother's health. The bill was passed by both the Senate and House of Representatives but was vetoed by governor [[Jennifer Granholm]]. ==Legal and political situation in the United Kingdom== Questioned about UK government policy on the issue in [[Parliament of the United Kingdom|Parliament]], [[Kay Andrews, Baroness Andrews|Baroness Andrews]] stated that "We are not aware of the procedure referred to as 'partial-birth abortion' being used in Great Britain. It is the [[Royal College of Obstetricians and Gynaecologists]]' (RCOG) belief that this method of abortion is never used as a primary or pro-active technique and is only ever likely to be performed in unforeseen circumstances in order to reduce maternal [[death|mortality]] or severe [[morbidity]]."<ref>[http://www.publications.parliament.uk/pa/ld200203/ldhansrd/vo030512/text/30512w05.htm#30512w05_sbhd0 Text of a written answer to a parliamentary question] at The House of Lords [[Hansard]]. Accessed 7th September 2006 </ref> ==References== {{Reflist|2}} ==External links== ===Legislation, testimony, and court decisions=== * [http://www.ama-assn.org/amednews/2004/01/19/gvsa0119.htm Appeals court upholds Ohio "partial-birth abortion" law (AMANews article)] : [[19 January]] [[2004]]. * [http://pacer.ca6.uscourts.gov/cgi-bin/getopn.pl?OPINION=03a0446p.06 Appeals Court decision in ''Haskell v. Taft'', upholding Ohio PBA Ban] : (decided [[17 December]] [[2003]]) Includes description of the procedure, Decision of the Court, and Dissenting opinion * [http://news.findlaw.com/usatoday/docs/abortion/2003s3.html Partial Birth Abortion Ban Act of 2003, signed by President Bush in March, 2003] * [http://onlinedocs.andersonpublishing.com/oh/lpExt.dll/PORC/13316/13a49/13a6f/13a9a?fn=document-frame.htm&f=templates&2.0# Ohio law banning "partial birth feticide"] : enacted [[18 August]] [[2000]]. * [http://supct.law.cornell.edu/supct/html/99-830.ZS.html ''Stenberg v. Carhart'' Decision voiding Nebraska's PBA ban, circa 2000] * [http://www.jeremiahproject.com/prophecy/clint_banact.html HR 1833, vetoed by President Clinton in 1996] * [http://www.priestsforlife.org/testimony/brendatestimony.html Congressional Testimony of Brenda Pratt Shafer, RN, March 21, 1996] ===Commentary=== * [http://www.reason.com/sullum/102403.shtml Ban Wagons] - ''Reason Magazine'' article about the naming of "partial birth abortion" (supporting legality of the procedure) * [http://usliberals.about.com/od/healthcare/i/PBAbortion.htm About.com's Pros & Cons of Partial Birth Abortion] (neutral about the legality of the procedure) * [http://www.politicalaffairs.net/article/articleview/283/1/32 The Myth of Partial Birth Abortion, by Don Sloan, MD] (supporting the legality of the procedure) * [http://www.cwfa.org/articledisplay.asp?id=3399 Partial-Birth Abortion - A Chink In The Pro-Abortion Armor] (opposing the legality of the procedure) * [http://slate.msn.com/id/2090201/ The "Partial-Birth" Myth - No, it's not a birth] (supporting the legality of the procedure) * Gina Gonzales as told to Barry Yeoman, [http://www.barryyeoman.com/articles/gina.html "I Had An Abortion When I Was Six Months Pregnant,"] Glamour (supporting the legality of the procedure) ===Other=== * [http://www.vanderbilt.edu/SFL/partial-birth_abortion.htm Martin Haskell's 1992 monograph], which called the procedure "Dilation and Extraction" * [http://www.religioustolerance.org/abo_pba.htm ReligiousTolerance.org: D&X Procedure (aka Partial Birth Abortion) - All sides] * [http://www.ppl.org/PJune_PostViability_2001.html Presbyterians pro-life]: A Pediatrician Looks at Babies Late in Pregnancy and Late Term Abortion * [http://dir.salon.com/story/mwt/feature/2002/07/24/late_term/index.html A doctor's right to choose] - [[Salon.com]] article [[Category:Methods of abortion]]