AMA Board Backs Ban on Late-Term Abortion

WASHINGTON — In a decision that could affect the course of the divisive national debate over abortion, the policy-making board of the American Medical Assn. gave its blessing Monday to legislation that would ban a controversial late-term abortion procedure, calling it “bad medicine.”

The AMA’s Board of Trustees, acting the day before a Senate vote on the issue, effectively disassociated itself from an abortion procedure referred to as “intact dilation and extraction” by those who perform it and “partial birth abortion” by those who would make it a criminal offense.

Using language echoing that heard from abortion opponents in recent months, the AMA board called the procedure targeted by the proposed ban “broadly disfavored--both by experts and the public.” In a statement, it noted that the operation “involves the partially delivered body of the fetus which is outside the womb.”

Now having the support of the respected medical professional organization, abortion opponents in the Senate predicted that they are in position not only to pass the ban--which they did last year--but to gather enough votes to override an expected veto by President Clinton. The Senate failed to override a Clinton veto of similar legislation last year, falling nine votes short of the two-thirds majority required.

The House passed the ban in March by enough votes to override.

Sen. Rick Santorum (R-Pa.), one of Congress’ most fervent abortion foes, was among those speculating that the AMA action could make the difference in obtaining a veto-proof majority for the ban in the Senate.

“The nation’s largest organization of medical professionals has joined us in telling the American people that this procedure is never medically necessary to protect the health of the mother and it should be outlawed,” he said.

Kate Michaelman, president of the National Abortion and Reproductive Rights Action League, said that she was outraged by the AMA board’s decision and acknowledged that it could spell a decisive defeat for abortion-rights advocates in the Senate today.

“The AMA has just contributed to the first serious federal legislation aimed at taking away a woman’s right to choose,” said Michaelman. “I know it may sound like a stretch but that’s what this is about.”

In a statement announcing its support for the long-contested legislation, the AMA board argued that a ban on the procedure would not limit doctors’ actions in their patients’ best interests. In doing so, the board undercut one of the most significant arguments made by those opposing the ban--that physicians’ hands should not be tied in the care of their patients.

In an interview, Dr. Nancy Dickey, the AMA president, acknowledged that her organization had intended to fight the legislation. She added: “In an ideal world, there would not be legislation that intruded upon a physician’s decision-making.”

But she said the group agreed to drop its opposition when Senate Republicans consented to narrow the broad language of the bill. Under the compromise, the measure still would make it illegal for a doctor to perform an abortion in which all but the head of a fetus is delivered feet first, after which it is killed by suctioning-out its brain tissue. The procedure is performed on women beyond the 20th week of pregnancy.

But the new language would protect doctors from prosecution in a number of scenarios that might have been covered by the bill. For example, the amended bill would insulate doctors from the need to prove that “no other procedure would suffice” if they had to perform the abortion to save a mother’s life.

The modifications sought by the AMA are expected to pass easily in the Senate today.

The unexpected announcement by the AMA left abortion-rights activists sputtering with rage. “All I can say, is it looks like the doctors took care of themselves and not the women,” said Sen. John H. Chafee (R-R.I.), one of a small group of Republicans who have opposed the ban. “Obviously, it’s a plus for those who are on the [other] side.”

The AMA’s 20-member board of trustees, chaired by Dickey, traditionally makes policy recommendations for the national association and then seeks endorsement for its positions at the full group’s annual meeting, this year set for next month.

Dickey said that in this case, the board decided to forgo seeking the full association’s approval for its new policy because of the timing of the Senate vote.

The board’s decision also came in the midst of complex congressional negotiations over several matters in which doctors have significant interests. One of those concerns the extent to which doctors will be required, under a comprehensive five-year budget package now being negotiated, to limit their fee increases to Medicare patients. With AMA backing, doctors also are seeking to gain the right to form their own health-care networks, patterned after health-maintenance organizations.

Dickey adamantly denied that any deals involving these issues had been made in the brokering of the agreement announced Monday.

“If they’ve been making deals, it’s been without the chair of the board’s knowledge,” said Dickey. “I’ve spent innumerable hours hearing concerns. In no one of those negotiations was there an implicit offer, a subtle offer or even the hint of an offer.”

Despite the board’s action, some doctors continue to hope that Congress is thwarted in its effort to impose the abortion ban.

Dr. David Grimes, chief of obstetrics and gynecology at San Francisco General Hospital, said Monday: “It’s a very slippery slope to get on to have lay people dictating the practice of surgery.”

He said that the proposed ban “is the antithesis of sound public health practice.”

Times staff writers Heather Knight in Washington and Terence Monmaney in Los Angeles contributed to this story.