Doctors in Poland Do About-Face

KATOWICE, Poland â€”  The doctors of the Silesian Medical Academy in a well-to-do suburb of this dreary mining town say they have experienced a remarkable epiphany--one that seems to be sweeping the Polish medical community with a missionary’s zeal.

Just five years ago, a woman could enter the modern, white-tile obstetrics ward here and receive an abortion, with few questions asked. Today all doors are closed to abortion patients; the staff of the prominent state-run hospital has declared it unethical to terminate a pregnancy.

“Our hospital has been unable to put together a medical team--a doctor, anesthesiologist, nurse and midwife--that is willing to perform abortions,� said Jerzy Sikora, 40, a senior gynecologist and one of many staff members who performed abortions in the past.

It’s not that abortion is illegal in Poland. A new law passed in October--amid widespread public protests--relaxes a 1993 statute that ended the longtime Communist-era practice of abortion on demand and was among the most restrictive in Europe.

Last month, it once again became legal for women to get an abortion for so-called social reasons, including situations in which the mother-to-be is unable to emotionally or financially cope with her pregnancy.

But what abortion rights advocates won in a tough parliamentary struggle they are now losing in the hearts and minds of doctors across Poland. Since the new law was proposed, medical associations in every region of the country have pronounced abortion unethical and “against the very essence of the profession of a doctor,� in the words of one such declaration.

Skeptics find the sudden pangs of medical conscience difficult to fathom, and suggest that some doctors are moved more by politics and economics than by the innermost voices of their souls.

Polish health employees are notoriously underpaid, and the underground abortion industry has been a lucrative source of extra cash for them. Abortion has also been a major flash point between the ruling coalition of former Communists and a resurgent opposition led by the staunchly Roman Catholic Solidarity trade union. Parliamentary elections are scheduled for next fall, and abortion is shaping up as a central theme.

“A lot of what the doctors are doing stems from the mind-set that ‘The Commies are in charge, and we have to get them any way we can,’ � said Zbigniew Bomba, a member of Parliament from the ruling coalition who voted for the new law.

But Sikora and other doctors far removed from the din of politics say four years of rigid antiabortion restrictions triggered a profound personal awakening that has little to do with current events. For the first time, they say, physicians were compelled to face the moral implications of abortion, which they had previously accepted as a routine surgical procedure and a common form of birth control.

Now, the doctors insist, there is no going back--new law or not.

“At the moment when women stopped coming to us, I realized I didn’t have this sad obligation anymore,� said Andrzej Witek, 39, a top gynecologist at the Silesian Medical Academy. “Now when the situation of abortion arises again, something inside of me says: ‘Stop. This is wrong.’

“When I really start thinking about what I did in the past, a lot of thoughts come into my mind that I would rather not deal with.�

Raising Objections

Hospital after hospital has turned away women seeking abortions, invoking a clause in the amended statute that allows medical workers to refuse to participate in the procedure for reasons of conscience. In the western town of Zielona Gora, where there is only one hospital, it is impossible to have an abortion because all doctors have raised personal objections.

The Catholic Church, which fiercely opposes abortion, has embraced the extraordinary development and is actively encouraging doctors to stand their ground. In a far-reaching appeal signed by Archbishop Damian Zimon, public health service employees were urged “not to annihilate conceived life� just because legislators made that legally possible.

“The right to life is a natural law present in the conscience of each human being,� said the letter, endorsed by a Catholic doctors association. “Today when [there is] conflict between the natural law and man-made law, it is our duty to stand on the side of life.�

Here in Silesia, a grimy 19th century industrial center, opposition to the abortion statute runs as deep as the coal mines that sustain most of the region’s 3 million residents. All 42 state-run hospitals in the Katowice area, the regional capital, have refused to perform abortions, and it is still unclear whether private clinics will break the widening boycott, except under secretive and costly circumstances.

“We have to find a way for this new law to be observed, but to be honest, it is not going to be easy,� said Bomba, a blunt-speaking, bearded Silesian surgeon. “The resistance is quite significant. Everyone knew there would be problems, but nothing like this.�

Bomba said he has helped five “desperate� women terminate their pregnancies in the past few weeks, by making clandestine arrangements through friends at local hospitals. The women were admitted after hours or under the pretense of a medical emergency, such as a miscarriage or hemorrhaging.

“This is not the way it should be done,� he said. “Neither the women nor the doctors should be put in this situation.�

Opinion polls have consistently shown that a majority of Poles favors broader abortion rights, but most are unwilling to confirm publicly what they tell pollsters privately. Public outrage over the new law’s problems has been muted; the country’s independent ombudsman, who responds to thousands of consumer grievances every year, has called on the government to “prevent further breaches� of the statute, but he did so on his own initiative, without the impetus of a single complaint.

In Silesia, among the country’s most conservative regions, there is no organized effort to oppose the doctors’ stance. The region’s only women’s advocacy group is run from the two-room apartment of a reserved widow and has a membership roster of nine; the group, a branch of a Warsaw-based organization, is painfully aware of its limitations.

Danuta Lis, the group’s leader, says most women will have nothing to do with her organization because “they think we are feminists trying to start World War III.� Lis said women feel pressure from their husbands, parish priests and other women to conform to the traditional role of mother, wife and caregiver.

Even with her husband dead and her daughter grown, Lis says, she cannot escape the guilt of her activism, which is modest by almost any standard. She is convinced, she confesses tearfully, that her involvement drove her husband to suicide. She understands why women prefer to remain silent.

“A man doesn’t like his wife to protest,� she said. “A good marriage has a wife at home, the kids nearby and the husband on the sofa. When I got involved in this group, my husband told me I needed the help of a therapist.�

A small woman with a thick, braided ponytail, Lis gently assailed the doctors of conscience for toying with women’s lives. While she accepts that some health care workers may have undergone a legitimate conversion, she doubts the sincerity of such a far-reaching rebellion.

Charge of Duplicity

“If this was only about ethics, it would be a beautiful thing,� she said. “But what about the doctors who refuse to perform abortions during working hours, and after 5 p.m. suddenly lose their ethical objections? The doctors get rich, and it is the women in Poland who are the losers.�

Though no such cases have been officially reported, Jacek Kozakiewicz, a regional health official responsible for implementing the new law, acknowledged that some doctors may try to exploit the statute. He promised to take duplicitous physicians before a medical ethics board and strip them of their credentials. New legislation may make such actions easier by requiring staff at state-run facilities to submit ethical objections to any abortion in writing.

But Kozakiewicz, a throat specialist who judges the doctors’ stance as genuine, said he expects few such problems. Four years of abortion restrictions transformed not only the medical community, he said, but also many women. More women are using contraceptives, he added, and fewer who become pregnant consider abortion.

During the past few weeks, nine women have come to see him because of problems related to unwanted pregnancies and the new law. But unlike Bomba, Kozakiewicz did not arrange for secret hospital stays.

“After our conversations, I came to the conclusion that if these women were given material assistance, their decisions would be different,� he said. “I am absolutely sure the decision to have an abortion for social reasons is a horrible one for these women. We must now investigate all possibilities for assisting women in need. This should be our emphasis.�

At the towering Catholic cathedral near the center of town, Father Henryk Krzysteczko said family counselors have reached a similar conclusion. Many pregnant women turned to the abortion underground or went abroad during the years of strict regulations, but others sought counseling and opted to have their babies.

The cathedral’s adoption program has quadrupled over the past four years, and Krzysteczko said there has been a similar surge in cases of women he described as “victims of abortion.� The women, he said, undergo a “sudden awakening of their consciences� and regret the procedure.

Overwhelming Burden

In the case of Lidia, a 49-year-old woman who terminated four pregnancies, the burden of those events has become overwhelming. According to a transcript of a recent counseling session, she blames the breakup of her marriage and the cancer death of her 5-year-old son on the abortions.

“I personally treated this as God’s hate for those unborn children,� she said. “When my husband came and said, ‘You killed [our son],’ I didn’t cry but said both of us killed him long before he was born.�

Despite the newfound confluence of church teachings and medical practice, doctors have carefully avoided linking their abortion stance to religion and have instead emphasized the Hippocratic oath’s respect for life. Many support other provisions in the abortion statute--including making contraceptives more readily and cheaply available--that the church strongly opposes.

But some doctors acknowledge that there has been another motivation as well. As the abortion debate becomes more polarized, they see unsettling parallels with the United States, where violence has been known to replace dialogue.

“We are afraid of extremists,� said Witek, a gynecologist for 14 years. “Nobody wants to be an easy target because he is the only one performing abortions.�