Editing Intact dilation and extraction (section)

==Society and culture==
{{Unbalanced section|Anglo-American=This section has an Anglo-American bias contrary to Wikipedia's neutrality core value. Help improve this article.|date=December 2019}}

=== United States politics ===
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] {{Webarchive|url=https://web.archive.org/web/20060421234056/http://www.religioustolerance.org/abo_pba1.htm |date=2006-04-21 }}. religioustolerance.org. Accessed April 14, 2006.</ref> The term is not recognized as a medical term by the [[American Medical Association]]<ref name="ama-assn.org">[http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf Health and Ethics Policies of the AMA] {{Webarchive|url=https://web.archive.org/web/20150320143132/http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf |date=2015-03-20 }} ''American Medical Association''. H-5.982 Retrieved April 24, 2007.</ref> nor the [[American College of Obstetricians and Gynecologists]].<ref>[https://web.archive.org/web/20080531043420/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 [[Congressperson|Congressman]] [[Charles T. Canady]], while developing the original proposed [[Partial-Birth Abortion Ban Act of 1995|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] {{Webarchive|url=https://web.archive.org/web/20081112030956/http://thomas.loc.gov/cgi-bin/bdquery/z?d104:HR01833: |date=2008-11-12 }}.</ref> According to Keri Folmar, the lawyer responsible for the bill's language, the term was developed in early 1995 in a meeting among herself, 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] {{webarchive|url=https://web.archive.org/web/20070614123429/http://mpsa.indiana.edu/conf2003papers/1032123442.pdf |date=2007-06-14 }}” (March 2003).</ref> "Partial-birth abortion" was first used in the media on June 4, 1995, in a ''[[The Washington Times|Washington Times]]'' article covering the bill.<!--
 -->{{Citation needed|date=July 2010}}

In the U.S., a [[Partial-Birth Abortion Ban Act#"Partial-birth abortion" defined by lw|federal statute defines]] "partial-birth abortion" as any abortion in which the life of the fetus is terminated after having been extracted from the mother's body to a point "past the navel [of the fetus]" or "in the case of head-first presentation, the entire fetal head is outside the body of the mother" at the time the life is terminated. The U.S. Supreme Court has held that the terms "partial-birth abortion" and "intact dilation and extraction" are basically synonymous.<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> However, there are cases where these overlapping terms do not coincide. For example, the intact D&E 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">''[[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> 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>[https://www.law.cornell.edu/uscode/text/18/1531- U.S. Code, Title 18, Part I, Chapter 74, Section 1531], "Partial-birth abortions prohibited."</ref>

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>{{cite web|url=https://www.aclu.org/reproductiverights/abortionbans/12669res20040326.html|archive-url=https://web.archive.org/web/20051128182129/http://www.aclu.org/reproductiverights/abortionbans/12669res20040326.html|url-status=dead|archive-date=28 November 2005|title=American Civil Liberties Union :Abortion Bans: Myths and Facts|date=28 November 2005|access-date=4 April 2018}}</ref> Non-intact D&E, though performed at similar gestational ages, is a fundamentally different procedure.

===Controversy===
Some people believe the D&E procedure illustrates that abortion, and especially [[Late termination of pregnancy|late-term abortion]], is the taking of a human life and therefore ought to be illegal. People who believe this consider the procedure to be [[infanticide]],<ref>Koukl, Gregory. [http://www.str.org/site/News2?page=NewsArticle&id=5477 Partial-Birth Abortion Is Not About Abortion] {{webarchive|url=https://web.archive.org/web/20070927190336/http://www.str.org/site/News2?page=NewsArticle&id=5477 |date=2007-09-27 }}. ''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] {{Webarchive|url=https://web.archive.org/web/20070430093743/http://usliberals.about.com/od/healthcare/i/PBAbortion_2.htm |date=2007-04-30 }} ''About.com''. Accessed April 25, 2006.</ref> a position that many in the anti-abortion 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 (summary)] {{webarchive|url=https://web.archive.org/web/20060513233915/http://www.patriarhia.ro/eng/bioetics.php |date=2006-05-13 }}. ''The Romanian Patriarchate''. Accessed April 25, 2006.<br />Achacoso, Jaime B. [http://www.catholic.com/thisrock/1996/9606ltrs.asp A Sin and a Crime] {{webarchive|url=https://web.archive.org/web/20061019020143/http://www.catholic.com/thisrock/1996/9606ltrs.asp |date=2006-10-19 }} ''Catholic.com''. Accessed April 25, 2006.<br />Gonzalez, Ramon. [http://www.wcr.ab.ca/news/2000/1023/prolifeteens102300.shtml Pro-life teens challenged] {{webarchive|url=https://web.archive.org/web/20061004185228/http://www.wcr.ab.ca/news/2000/1023/prolifeteens102300.shtml |date=2006-10-04 }} ''Western Catholic Reporter''. October 23, 2000. Accessed April 25, 2006.</ref> Some advocates, both for and against abortion rights, see the intact D&E issue as a central battleground in the wider [[abortion]] debate, attempting to set a legal precedent so as to either gradually reduce or gradually increase access to all abortion methods.<ref>[http://www.perrspectives.com/articles/art_slope01.htm Slippery Slope: Democratic Wavering in the Battle for Reproductive Rights] {{Webarchive|url=https://web.archive.org/web/20060426103413/http://www.perrspectives.com/articles/art_slope01.htm |date=2006-04-26 }}. ''PERRspectives.com''. February 25, 2004. Accessed April 25, 2006.<br />[http://www.rockridgeinstitute.org/research/rockridge/stratinit?b_start:int=1 Strategic Initiatives] {{Webarchive|url=https://web.archive.org/web/20061013195330/http://www.rockridgeinstitute.org/research/rockridge/stratinit?b_start:int=1 |date=2006-10-13 }} '' The Rockridge Institute''. Accessed April 25, 2006.</ref>

Dr. [[Martin Haskell]] has called the intact D&E procedure "a quick, surgical outpatient method" for late second-trimester and early third-trimester abortions.<!--
 --><ref name="presentation">Haskell, Martin. [http://www.sharonvilleclinic.com/uploads/6/2/0/0/6200039/idx.pdf Dilation and Extraction for Late Second Trimester Abortion] {{Webarchive|url=https://web.archive.org/web/20130228101313/http://www.sharonvilleclinic.com/uploads/6/2/0/0/6200039/idx.pdf |date=2013-02-28 }}. Presented at the National Abortion Federation Risk Management Seminar, September 13, 1992.</ref> 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 fetus 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 | access-date = 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" /> Alternately, opponents of abortion rights frame the issue as one in which a partially-born infant's life is disposable, whereas pulling the infant only a few more inches down the birth canal automatically transforms it into "a living person, possessing rights and deserving of protection."<ref>{{cite web|url=http://www.abortionfacts.com/facts/2|title=Fact #2: Every human being is a person. – AbortionFacts.com|website=www.abortionfacts.com|access-date=4 April 2018|archive-date=26 December 2017|archive-url=https://web.archive.org/web/20171226103542/http://www.abortionfacts.com/facts/2|url-status=dead}}</ref> The U.S. Supreme Court has stated that intact D&E remains legal as long as there is first a feticidal injection while the fetus is still completely inside of the mother's body.<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, lobbyist Ron Fitzsimmons, executive director of the [[National Coalition of Abortion Providers]] (a trade association of abortion providers), told ''[[The New York Times]]'' (February 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>{{cite news|url=https://www.nytimes.com/1997/02/26/us/an-abortion-rights-advocate-says-he-lied-about-procedure.html|title=An abortion rights advocate says he lied about procedure|work=[[The New York Times]]|date=1997-02-26|page=A11|access-date=2009-06-08 | first=David | last=Stout}}</ref>
Some prominent opponents of abortion rights quickly defended the accuracy of Fitzsimmons's statements,<ref>Ruth Padawer, [http://www.nrlc.org/abortion/pba/PBA%20activists%20lied.pdf "Pro-choice advocates admit to deception"] {{webarchive|url=https://web.archive.org/web/20070614123430/http://www.nrlc.org/abortion/pba/PBA%20activists%20lied.pdf |date=2007-06-14 }}, ''Bergen Record'', February 27, 1997.</ref> whilst others condemned Fitzsimmons as self-serving.<ref>Melanie Conklin, [https://archive.today/20120708152326/http://findarticles.com/p/articles/mi_m1295/is_n9_v61/ai_19732071/ "Whatever happened to the abortion lobbyist who repented?"], ''The Progressive'', September, 1997.</ref>

In support of the Partial-Birth Abortion Ban Act, a nurse who witnessed three intact D&E 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 [[United States House of Representatives|U.S. House of Representatives]].<ref>[http://judiciary.house.gov/legacy/215.htm Testimony of Brenda Pratt Shafer, R.N.] {{webarchive|url=https://web.archive.org/web/20070501040628/http://judiciary.house.gov/legacy/215.htm |date=2007-05-01 }} 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 intact and two non-intact 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">{{cite journal |last=Woodbury |first=Margaret A. |title=A doctor's right to choose |website=Salon.com |date=2002-07-24 |url=http://archive.salon.com/mwt/feature/2002/07/24/late_term/index.html |access-date=2007-04-29 |url-status=dead |archive-url=https://web.archive.org/web/20070503180410/http://archive.salon.com/mwt/feature/2002/07/24/late_term/index.html |archive-date=2007-05-03 }}</ref>

Abortion provider [[Warren Hern]] asserted in 2003, "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'', October 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 specifically 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 name="SCOTUS"/>

===Legality in the United States===
{{Main|Partial-Birth Abortion Ban Act}}

==== Federal law ====
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.

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 woman'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.

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 |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 |access-date=2007-04-18 |url-status=dead |archive-url=https://web.archive.org/web/20071114231038/http://www.sfgate.com/cgi-bin/article.cgi?f=%2Fn%2Fa%2F2007%2F04%2F18%2Fnational%2Fw070844D25.DTL&type=politics |archive-date=November 14, 2007 }}</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 intact D&E if it is performed after [[Fetus#Viability|fetal viability]].

Many states have also passed bans specifically on intact D&E. 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 in June 2000, thus resolving the legal challenges to similar state bans nationwide.

Since the ''Stenberg v. Carhart'' decision, Virginia, Michigan, and Utah have adopted legislation very similar to the Nebraska law overturned as unconstitutional. The Michigan law was similarly struck down for broadness and failure to provide a health exemption. Utah's law remains on the books, pending trial, but is unenforceable under a court-ordered preliminary injunction. Virginia's Law was initially ruled invalid, but was reversed and remanded to the District Court in the wake of the ''Gonzales v. Carhart'' decision, where it was upheld as constitutional. This is despite the fact the Virginia law criminalizes abortions for accidental or intentional intact D&E.

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, which would have changed the definition of birth and therefore effectively ban intact D&E. The definition of birth as defined in the bill was that once any part of the body had passed beyond the 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]].<ref>{{Cite web |title=Michigan Legislature - Senate Bill 0395 (2003) |url=http://www.legislature.mi.gov/(S(kz3mkcpt1fo2oj3akzcg2bcc))/mileg.aspx?page=GetObject&objectname=2003-SB-0395 |access-date=2023-03-28 |website=www.legislature.mi.gov}}</ref>

====Clinical response to legal bans on the procedure====
Since the passage of the Partial-Birth Abortion Ban Act in the United States and similar state laws, providers of later abortions typically induce and document [[feticide|fetal death]] before beginning any later abortion procedure. Since the bans only apply to abortions of living fetuses, this protects the abortion providers from prosecution. The most common method of inducing fetal demise is to inject digoxin intrafetally or potassium chloride intrathoracically.<ref name=":02"/><ref>{{cite journal |last1=Diedrich |first1=J |last2=Drey |first2=E |last3=Society of Family |first3=Planning. |title=Induction of fetal demise before abortion. |journal=Contraception |date=June 2010 |volume=81 |issue=6 |pages=462–73 |doi=10.1016/j.contraception.2010.01.018 |pmid=20472112 |url=https://www.societyfp.org/_documents/resources/InductionofFetalDemise.pdf |access-date=17 November 2022 |language=en}}</ref>
===In other countries===
Questioned about the policy of the [[United Kingdom|UK]] government on the issue in [[Parliament of the United Kingdom|Parliament]], [[Kay Andrews, Baroness Andrews|Baroness Andrews]] stated that:

<blockquote>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>[https://publications.parliament.uk/pa/ld200203/ldhansrd/vo030512/text/30512w05.htm#30512w05_sbhd0 Text of a written answer to a parliamentary question] {{Webarchive|url=https://web.archive.org/web/20161027025347/http://www.publications.parliament.uk/pa/ld200203/ldhansrd/vo030512/text/30512w05.htm#30512w05_sbhd0 |date=2016-10-27 }} at The House of Lords ''[[Hansard]]''. Accessed 7 September 2006</ref></blockquote>