Blog Post

Response to Merrily’s Choice - Denver Post January 5, 2021

Merrily’s Choice is a compelling story published in the Denver Post on Sunday, January 5 ( Under the Colorado End-of-Life Options Act, Merrily got to choose the day she'd die (denverpost.com) ) highlighting the perceived benefits of physician assisted suicide (PAS), commonly referred to by the euphemism, medical aid-in-dying (MAID). Merrily clearly had a loving family. It is easy to empathize with her family who thought that PAS was a good choice. However, the positive picture of PAS portrayed by Merrily’s granddaughter is both incomplete and misleading. It can have unintended consequences for those hearing her story.

Social libertarianism is highly regarded by many Coloradans. We dearly value personal liberty and frown on any attempts to limit those liberties. However, Coloradans have become so enthralled with the pursuit of personal liberty and independence that it seems we have forgotten our interdependence and the common good. Our laws are increasingly predicated on this notion of “rugged individualism”. They ignore the totality of our human nature which encompasses not only our individual self-expression but also our mutual dependence and vulnerability. They minimize the importance of human relationships and love. They reinforce the false notion that people with disabilities or sickness are less human and less valuable.

As Coloradans increasingly prioritize personal autonomy over other human values, we are turning our backs on the principle of solidarity. This has been highlighted recently by the refusal of some Coloradans to wear masks or follow social distancing guidelines in the face of the deadly coronavirus pandemic. PAS is another example. In the name of personal autonomy, PAS has become the ultimate abandonment of sick/elderly Coloradans by the physicians who have pledged to care for them and by the families who are called on to love and support them at the end of life. Beneath the veneer of “choice”, PAS often is the outcome of systematic dehumanization of the sick/disabled and inadvertent coercion.

Merrily was 98 years old and slowly losing her ability to perform activities of daily living. She had lost much of her independence and required assistance from home health aides to remain in her home. There is no mention of a terminal illness other than her advanced age. A Covid infection posed an immediate threat to her life and she was enrolled in a hospice program rather than pursue more aggressive medical interventions in a hospital or skilled nursing setting. None of this is controversial. Like most people her age, she was not afraid of the prospect of dying and, indeed, would welcome death. But Merrily did not die from Covid as she and her family expected. The family was “flummoxed” and Merrily “embarrassed”.

As a physician who has attended to hundreds of dying patients over the years, this is not an uncommon scenario. Families can be more disturbed that a loved one survives an anticipated lethal illness than dies during the illness. This is not lost on their sick family members. People who survive a lethal illness often feel embarrassed and believe that their survival poses an undue burden on their families. (They often don’t vocalize this fear.) Because dependency already carries such a stigma in Colorado, the sense of burden is further exacerbated. Studies in other states have demonstrated that the fear of being a burden on family is a primary reason for pursuing PAS. It appeared to be a significant factor in Merrily’s “choice”. Merrily did not have a typical terminal illness and her physicians likely felt that her “failure to thrive” was enough of an indication for PAS. Her children “had found a way” for her to die quickly. Advanced age was never cited as a reason for PAS during the Colorado debate over the End-of-Life Options Act and Merrily’s PAS illustrates how insidiously the “indications” for PAS evolve.

Caring for a family member who requires significant assistance certainly can be a burden, especially for those without time or financial resources. Thankfully, Colorado’s new family leave bill may reduce this burden. However, it is not enough. Colorado needs robust, free, out-patient/in-patient hospice programs. It needs to explore other models to care for the elderly and disabled. Paying family members to care for their loved ones in lieu of nursing home placement or “adult foster home care” are just two option being explored in other states. No Coloradan should be forced to make a “choice” for PAS because they feel a burden on their family or their community. How we take care of these most vulnerable members of our state will be how we are judged as a society – not how assiduously we can enshrine personal autonomy in our culture.

Merrily’s family had “quality” conversations in the two weeks between the prescription of the lethal cocktail and its ingestion. This is wonderful, but nothing unique to the PAS experience. I have attended to patients in hospice at the time of their deaths and personally witnessed incredibly moving conversations, reconciliations, and acts of love between my patients, their families, and friends. In fact, PAS may curtail this important time families have to spend with their love ones at the end of life.

My own father died at age 96 in 2018. He had a slow mental and physical functional decline over a period of years. Like Merrily, he was fiercely independent. He learned to accept help at home after a life-threatening fall and grew to love his home health aide. He did not dwell on his disability and the family did everything we could to make him feel honored and valued despite his limitations. My siblings and I rotated visits with him and relished “field trips”, remembering family events and reviewing old photographs. We will always cherish this time together. Also like Merrily, my father developed an acute respiratory illness superimposed on his advanced age. Per his wishes, he was enrolled in hospice rather than pursue aggressive in-patient care. My father remained comfortable and was able to say good-bye virtually to those who could not travel to be with him. He died painlessly and peacefully with his family at his side as a harpist (provided by the hospice program) played a beautiful musical piece. PAS was not wanted or necessary. He had a “good death”. You rarely hear these stories.

Because Merrily chose suicide rather than a natural death, others may be impacted. It is no secret that Colorado is plagued by teen suicide. Embracing PAS sends the message to vulnerable teens (and others) that suicide is a rational, sometimes preferable, way to address physical or emotional pain. Autonomy is all that is important, even if that autonomy is the instrument of your death. Glorifying suicide is known to increase suicide in a community. This is commonly referred to as the Werther effect. Merrily and others who pursue PAS have no desire to impact vulnerable teens, but, sadly, this may be part of their legacy.

People of Colorado have voted to have access to PAS. This right needs to be accompanied by responsibilities. Coloradans need to hear more stories about “good deaths” made possible by quality hospice programs and not just rosy PAS stories like Merrily’s in the Post. We need to know that disability or even dependence does not detract from a person’s inherent dignity and value. We need to hear that we are not burdens on family or communities, no matter our physical/mental disabilities. Our families need to know that the state of Colorado will be there to assist them with private/public programs at the end of life so that we can nurture our relationships and not focus on the burdens. Finally, we need to know that suicide is not the only answer to difficult or challenging physical, existential or emotional pain.


October 29, 2024
It is becoming more common for ideologues to gaslight the American public to promote their agenda. The latest example is the abortion industry’s attempt to have Coloradoans suspend their common sense, human decency and compassion to place Amendment 79 into the Colorado constitution. State law already protects access to abortion, but they would have us believe it is “progressive” to endorse this constitutional amendment. Amendment would enshrine unrestricted, taxpayer funded abortion into the state constitution. It would prohibit the government from “denying, impeding or discriminating” against the right to abortion. This goes far beyond Roe which was overturned by the Dobbs decision. Roe permitted regulation of abortion in the second trimester to ensure the health and safety of women and allowed states to recognize their compelling interest in protecting the life of a viable baby in the third trimester. Amendment has neither of these important features. If abortion is considered a fundamental constitutional right (unlike any other medical procedure), then a fetus, wanted or unwanted, has no constitutional rights under Amendment 79. Nobody could infringe on the exercise of abortion – no matter the circumstances. Late abortions are common in Colorado. While abortions after the limit of fetal viability only represent 3.2-3.4% of abortions each year, they account for hundreds of abortions. And we know that approximately 70% of these late abortions are performed on healthy women with healthy babies. Amendment 79 would prevent legislators from ever curtailing abortion late in pregnancy for social and economic reasons. The amendment does nothing to address the real needs of women facing financial challenges that forces them to consider late abortion. It leaves them only one regrettable choice. Is it progressive to focus solely on abortion access and forego the hard work necessary to make pregnancy more equitable for low-income women? The Colorado Department of Public Health and Environment licenses, regulates, and inspects thousands of health care facilities in the state to ensure public health and safety. The striking exception is second and third trimester abortion clinics. Abortion extremists pejoratively refer to any laws that regulate abortion clinics as TRAP laws. In their worldview the only motivation for such laws is to impede abortion access. They ignore the fact that second trimester abortions have a 10% complication rate and pose a 1.7% risk of life-threatening complications. While first trimester abortions are relatively safe procedures, the risk of dying from abortion increases by 38% for every additional week of gestation beyond 8 weeks. You would think we would have learned the danger of unregulated/uninspected abortion clinics from the Gosnell tragedy. Dr. Kermit Gosnell was responsible for the injury and death of countless women spanning decades because of the lack of governmental oversight at his Philadelphia abortion clinic. If Amendment 79 passes, legislators will be precluded from instituting prudent health/safety regulations for abortion clinics in Colorado. There would be nothing preventing a Gosnell-like horror in our state. Is it progressive to prioritize abortion access over the lives of women? A 22-week baby born prematurely enjoys all the rights and benefits of other Colorado citizens. Yet, a 22-week, pain-capable fetus in utero can be literally torn apart limb by limb during the D&E procedure favored by most abortionists in Colorado. Later in the second trimester and during the third trimester that fetus can be killed by poisoning before it is extracted during a D&X procedure. Digoxin is commonly utilized. Digoxin can cause hours of agonizing nausea, vomiting, and delirium before eliciting death. Is it progressive to define a human’s value and dignity based solely on their location or to sanction such excruciating deaths? Parental notification prior to a minor’s abortion is current law in Colorado. Guttmacher and other abortion advocacy organizations consider parental notification laws as impediments to abortion access. Amendment would eliminate this. The adolescent brain is still developing prefrontal connections that help modulate their subcortical emotional and impulsive responses to stressful situations, such as unplanned pregnancies. Without parental notification, our teen daughters may face these challenges with more input from their peers, teachers, or counselors than from the parents who love and know them best. And if parental notification is eliminated, sex traffickers will have an easier time eluding law enforcement as they coerce their young victims to have abortions. Is it progressive to remove parents from the most consequential decisions in their daughter’s lives or enable human traffickers? With Amendment 79 in the state constitution, abortions for any reason would be legal. Studies from the US and other countries document the extent that sex selection abortions occur, A Colorado late abortionist recently admitted that he has performed sex selection abortions. Is it progressive to allow abortion for blatantly sexist reasons? We know the answer. No, it is not progressive to promote unrestricted, unregulated abortion in Colorado. Abortion access is already ensured in Colorado. Amendment 79 is unnecessary, inhumane and potentially dangerous. Frances Rossi and Tom Perille MD - Founding members of Democrats for Life of Colorado
October 22, 2024
This piece was originally published in the Colorado Springs and Denver Gazette Perspective Column September 22, 2024 by Tom Perille MD (DFLCO President) and Wendy Smith What would it mean if the only medical intervention that is recognized in the Colorado Constitution’s Bill of Rights was abortion? And what would it mean if abortion was the only medical intervention that couldn’t be constitutionally excluded in private and public health insurance? Not access to basic medical care. Not pregnancy care. Not life-saving cancer treatments. Not mental health treatment. Not care for those addicted. Not affordable pharmaceuticals. Only abortion. That is what those who are pushing Amendment 79 (“Right to Abortion”) hope to accomplish. Not only would abortion at any time in pregnancy for any reason using any method become a fundamental right, but anything that “impeded” or “discriminated” against access to abortion would be prohibited. The people of Colorado have a right to know the profound and dangerous implications of such a measure which won’t be reflected in the Blue Book language. In a poll conducted in July by the Strategy Group, 71% of Colorado voters were unaware that abortion is currently legal under all circumstances in our state. Abortion access is guaranteed in Colorado law. Amendment 79 would do nothing to change that reality. Coloradoans have the right to know that with the amendment in the constitution, the people of Colorado and those working for them in the legislature could do nothing to regulate or restrict abortion in the future– even if those changes represented the overwhelming consensus of Coloradoans and protected the health and safety of women. There were between 468-486 late abortions after the limit of fetal viability (21 weeks) reported to the CDPHE in 2022 and 2023. Guttmacher estimates that there were 71% more abortions in 2023 than CDPHE reported making 500 a conservative estimate of the total number of post-viability abortions each year in Colorado. These babies can “kick” their mother, respond to her voice/touch, acquire her taste preferences, and feel pain while in the uterus. They can survive if born prematurely. Babies born at 22-weeks and later can be found lovingly cared for in neonatal intensive care units and nurseries across the state. Based on research from Boulder abortionist, Dr. Warren Hern, 70% of his late abortions are performed on healthy women with healthy babies. That translates into an estimated 350 healthy babies aborted late in pregnancy each year in Colorado for financial and social reasons. Coloradoans have the right to know that Amendment 79 does nothing to address the real needs of these women and simply streamlines access to one, tragic and regrettable choice. With Amendment 79 in place, legislators would be unable to restrict even the most extreme abortions on healthy women with healthy babies in the third trimester. Colorado parents are currently notified at least 48 hours in advance of their minor teen’s pending abortion. The abortion industry, their research allies (Guttmacher), and aligned medical professional organizations (ACOG) all consider parental notification before a minor teen’s abortion to be an impediment to abortion access. Coloradoans have the right to know that banning parental notification would be one of the most immediate consequences of Amendment 79. In practical terms, this means that the people that know and love the teen the most may be unaware of their pending abortion and unable to support their daughter. Even worse, teens may be pressured by peers or an abortion clinic counselor to pursue an action that is inconsistent with their wishes and core values. Parents may be blindsided by the potentially severe physical and mental health consequences of their teen’s abortion. And sex traffickers would be able to hide their nefarious trade by pursuing abortions for their teenage victims without the safeguard of parental notification. Trafficking is a multi-million-dollar criminal enterprise in Colorado. Victims rarely self-identify. Anyone who works with domestic minor sex trafficking knows that the very definition of trafficking involves force, fraud and/or coercion. It is also well known that girls who are trafficked often view their trafficker as their “boyfriend”, lacking the maturity and discernment to know they are being trafficked and in danger. If they refuse to do what the trafficker wants, they are often subject to physical and mental abuse until they submit. There is a growing concern over forced abortion, especially with the availability of medication and telehealth abortions. These girls are not free to choose. Without the safeguard of parental notification, minors may be exposed to continued risk. Keep in mind, minors can be brought across state borders by anyone for abortion, just to be released back to the trafficker/perpetrator. For this reason, parents have a right to know when their daughter is considering abortion so that they can seek help and intervene. Most states have regulations that pertain to abortion clinics and promote the health and safety of women. Colorado is not one of them. The abortion industry pejoratively refers to any regulation that specifically applies to abortion providers as TRAP laws. They view them as impediments to abortion access. Even though thousands of medical facilities and agencies are licensed, regulated and inspected by the Colorado Department of Public Health and Environment, second and third trimester abortion clinics are the glaring exception. This omission is especially perplexing since second trimester abortions have a 10% overall complication rate and 1.7% life-threatening complication rate. The risk of having a complication increases for each additional week of gestation. Furthermore, the risk of dying from an abortion increases 38% for each week of gestation beyond 8 weeks. We should heed the lesson from other states that have tragically witnessed the maiming and death of women when government oversight is lax or non-existent – such as Pennsylvania and Dr. Gosnell. Coloradoans have a right to know that if Amendment 79 passes, the state will be unable to impose prudent health and safety regulations for abortion clinics which may jeopardize women’s health and lives. Another goal of Amendment 79 is to facilitate publicly funded abortions. Currently, Colorado Medicaid only pays for abortions in circumstances of rape, incest, and threats to the life of the mother. If Amendment 79 passes, the prohibition against public funding in the constitution will be removed and the state will be able to underwrite elective abortions for Medicaid patients. In states where public funding for abortion is already law, they spend millions of dollars subsidizing abortion for in-state and out-of-state women. Coloradoans have the right to know that this may take precious tax dollars away from other medical priorities like pregnancy services and mental health. It may even divert money from non-medical budgets for education, affordable housing, and the environment. There is already inadequate private and public support for pregnant women in our state. One of the few shining exceptions is the 58 pregnancy resource centers. They provide millions of dollars of uncompensated care to women during and after challenging pregnancies. However, because they typically don’t offer abortion services or refer for abortions, the abortion industry has been targeting these charitable organizations. Coloradoans have the right to know that the ability of pregnancy resource centers to assist pregnant women in need may be jeopardized by the passage of Amendment 79. Under Amendment 79, the right to abortion would become absolute. Coloradoans have the right to know the implications of such an extreme position. It would strip all rights and protections from the developing fetus, even those that are wanted. The legislature couldn’t proscribe abortion methods that are especially cruel such as second trimester D&E (dismemberment) abortions on pain capable fetuses. It would jeopardize the conscious rights of medical professionals across the state who maintain medical/scientific, moral or religious objections to elective induced abortions. Since the amendment forbids “discriminating” against a woman’s desire for an abortion, even physicians and nurse practitioners who perform abortions would be unable to refuse abortions for reasons they may view as morally repugnant – such as aborting a fetus solely because of their sex (which is already occurring) or because of the ethnicity/race of their father. Abortion access is already guaranteed in Colorado law. Making the right to abortion the only medical procedure recognized in our constitution is extreme and ties the hands of Colorado citizens and legislators. It goes far beyond the abortion rights promulgated in the Roe decision. Coloradoans have the right to know that Amendment 79 would have these many unintended consequences. Given the facts, we hope that Coloradoans reject Amendment 79.
By Thomas Perille March 1, 2024
By Tom Perille January 31, 2024
We should recognize ideological conflicts of interest in clinical research just as we recognize financial conflicts of interest in clinical research. It doesn't negate the studies, but tells us about potential biases and requires us to look more closely at the methodology and reporting.
By Tom Perille MD January 23, 2024
Cobalt and other proabortion organizations are currently circulating petitions to have Initiative 89 appear on Colorado 2024 ballot. They have the money to pay circulators to get the necessary signatures so there is little doubt it will be on the ballot in November. The ballot initiative is deceptively drafted to make it appear that the primary issue is correcting an “unintended consequence” of Amendment 3. Colorado constitutional Amendment 3 narrowly passed in 1984. It prohibited the use of state public funds for induced abortions unless the life of the mother was in jeopardy. Initiative 89 backers are highlighting the lack of funding for state employees for abortions in cases of rape, incest, issues that “gravely endangers the patient’s health” or when there is a “fatal fetal condition”. They also point out the lack of an exception for state Medicaid funding for issues that “gravely endangers a patient’s health” or for a “fatal fetal condition”. What are they not saying? There already is an exception for the pregnant woman’s life which would encompass anything that “gravely endangers the patient’s health”. They are trying to blur the line between an exception for a condition that jeopardizes a woman’s life and any complication that requires treatment during pregnancy but does not threaten her life. Similarly, Medicaid already offers reimbursement for abortions related to rape or to save the mother’s life. It does not have an exception for the nebulously defined “health” of the mother, which can be treated in the normal course of obstetric practice, or for fetal conditions. A “fatal fetal condition” is a pejorative phrase with little resemblance to reality. For instance, Trisomy 18 is often referred to in this manner. The problem arises because the condition may be as much as 90% survivable if treated with standard interventions (employed on infants without Trisomy 18 diagnoses). It doesn’t mean that there aren’t life threatening fetal conditions or that some infants will have significant disabilities but describing these fetuses as “fatal” is a way to dehumanize them and justify the abortion decision. If they were really motivated to remove the barriers to the < 4% of abortions that occur for reasons of rape, incest, life of the mother, and life-limiting fetal conditions, why doesn’t Initiative 89 simply ask Coloradans add these exceptions to Amendment 3s language? The answer is clear. They want to evoke an emotional response which will override Coloradans’ qualms about unrestricted abortion. Their arguments gloss over the main purpose of Initiative 89 – to make abortion access a constitutional right without any gestational limits for any reason and to use public funding to subsidize it. They would like the public to be unaware of the fact that hundreds of healthy viable (>21 weeks) fetuses gestating in healthy women are currently aborted in Colorado. And that at least one late term abortionist (Warren Hern) has publicly acknowledged that he does abortions for absolutely any reason – including for sex selection. If the public had an inkling of the magnitude of the slaughter of prenatal humans purely for social and economic reasons, they would be appalled. There are so many other legislative initiatives that could be undertaken to provide support for pregnant women and their families so that they don’t feel compelled to consider abortion. Why don’t we focus our efforts on these life-affirming alternatives to the violence of abortion? DFLCO will be participating with Pro-Life Colorado, the state-wide umbrella organization uniting prolife groups, to defeat Initiative 89. DFLCO members should begin talking to their prochoice friends and writing letters to the editor of local media shedding light on the deceptive nature of Initiative 89 and the Trojan horse it represents for constitutionally protected unrestricted abortion. If your contacts don’t recoil at the reality that hundreds of healthy viable fetuses are being aborted for reasons as abhorrent as sex selection, then Colorado is in worse shape than any of us recognize. Initiative 89 should have no place in Colorado.
By Tom Perille MD January 10, 2024
Cobalt and other proabortion organizations are currently circulating petitions to have Initiative 89 appear on Colorado 2024 ballot. They have the money to pay circulators to get the necessary signatures so there is little doubt it will be on the ballot in November. The ballot initiative is deceptively drafted to make it appear that the primary issue is correcting an “unintended consequence” of Amendment 3. Colorado constitutional Amendment 3 narrowly passed in 1984. It prohibited the use of state public funds for induced abortions unless the life of the mother was in jeopardy. Initiative 89 backers are highlighting the lack of funding for state employees for abortions in cases of rape, incest, issues that “gravely endangers the patient’s health” or when there is a “fatal fetal condition”. They also point out the lack of an exception for state Medicaid funding for issues that “gravely endangers a patient’s health” or for a “fatal fetal condition”. What are they not saying? There already is an exception for the pregnant woman’s life which would encompass anything that “gravely endangers the patient’s health”. They are trying to blur the line between an exception for a condition that jeopardizes a woman’s life and any complication that requires treatment during pregnancy but does not threaten her life. Similarly, Medicaid already offers reimbursement for abortions related to rape or to save the mother’s life. It does not have an exception for the nebulously defined “health” of the mother, which can be treated in the normal course of obstetric practice, or for fetal conditions. A “fatal fetal condition” is a pejorative phrase with little resemblance to reality. For instance, Trisomy 18 is often referred to in this manner. The problem arises because the condition may be as much as 90% survivable if treated with standard interventions (employed on infants without Trisomy 18 diagnoses). It doesn’t mean that there aren’t life threatening fetal conditions or that some infants will have significant disabilities but describing these fetuses as “fatal” is a way to dehumanize them and justify the abortion decision. If they were really motivated to remove the barriers to the < 4% of abortions that occur for reasons of rape, incest, life of the mother, and life-limiting fetal conditions, why doesn’t Initiative 89 simply ask Coloradans add these exceptions to Amendment 3s language? The answer is clear. They want to evoke an emotional response which will override Coloradans’ qualms about unrestricted abortion. Their arguments gloss over the main purpose of Initiative 89 – to make abortion access a constitutional right without any gestational limits for any reason and to use public funding to subsidize it. They would like the public to be unaware of the fact that hundreds of healthy viable (>21 weeks) fetuses gestating in healthy women are currently aborted in Colorado. And that at least one late term abortionist (Warren Hern) has publicly acknowledged that he does abortions for absolutely any reason – including for sex selection. If the public had an inkling of the magnitude of the slaughter of prenatal humans purely for social and economic reasons, they would be appalled. There are so many other legislative initiatives that could be undertaken to provide support for pregnant women and their families so that they don’t feel compelled to consider abortion. Why don’t we focus our efforts on these life-affirming alternatives to the violence of abortion? DFLCO will be participating with Pro-Life Colorado, the state-wide umbrella organization uniting prolife groups, to defeat Initiative 89. DFLCO members should begin talking to their prochoice friends and writing letters to the editor of local media shedding light on the deceptive nature of Initiative 89 and the Trojan horse it represents for constitutionally protected unrestricted abortion. If your contacts don’t recoil at the reality that hundreds of healthy viable fetuses are being aborted for reasons as abhorrent as sex selection, then Colorado is in worse shape than any of us recognize. Initiative 89 should have no place in Colorado.
By Tom Perille MD December 13, 2023
The pregnancy of Kate Cox, the Dallas-area women who sought an abortion in Texas because her fetus was diagnosed with Trisomy 18, raises numerous emotionally charged issues. She is 31 years old and has had two previous C-section deliveries and two healthy children. Texas has enacted abortion restrictions which prompted her to sue the state to procure an abortion after 20 weeks gestation. This is a tragedy for Ms. Cox and her family. it is incredibly painful when a family first learns that their dreams for a healthy child are dashed. However, it doesn’t mean that their pain is diminished by access to abortion. And it doesn’t mean that their lives won’t be enriched by their child -even if their child’s life is abbreviated. It is worth reviewing some of the more prominent media distortions pertaining to the Cox pregnancy/baby that prejudice the public’s response to this tragedy: 1) Trisomy 18 has a poor prognosis. It is true that there is a high probability for a fetus with Trisomy 18 to be stillborn. However, the prognosis is not as bad as portrayed in the media. According to a recent systematic review, a baby born with Trisomy 18 in 2020 has a 13% 10-year survival rate. 2) A Trisomy 18 baby may face challenges, but their lives can be a source of great strength and inspiration for a family. Senator Risk Santorum’s baby, Bella , is a case in point. 3) For those families who choose comfort care (perinatal palliative care and/or perinatal hospice ) for their baby with Trisomy 18, the experience is described by many families as deeply moving and life-affirming. These families don’t try to extinguish the memory of their child, but instead, celebrate their short life. A team of professionals walks with the family during the pregnancy, at birth, and post-partum. They provide support to the mother and baby and ensure that when the baby dies it is without discomfort and surrounded by loving family. This can contribute tremendously to healing for the grieving family. The healing is impeded for those families that choose abortion since they will never forget their complicity in their child’s violent death. 4) At 21 weeks, the D&E procedure that was recommended to the Cox family is associated with substantial risk to the mother. This is omitted from mainstream media stories. The risk of dying from an abortion increases by 38% for each week of gestation after 8 weeks. Even without factoring in her increased risk for uterine rupture by virtue of her previous C-sections, the risk for an induced abortion is substantially greater than the risk of natural childbirth based on evidence from national record linkage studies. If the Cox baby needs a C-section rather than vaginal delivery, the risks are higher, but C-section is not an inevitability. If Ms. Cox had two previous low-transverse cesarean deliveries, she would be a candidate for a trial of labor after C-section (TOLAC). 5) The recommended D&E abortion procedure is often performed without administering a feticide- a chemical/drug that kills the fetus prior to the surgical abortion. One review reported that only 52% of abortion providers inject a feticide before proceeding with a second trimester D&E abortion. The D&E entails the systematic dismemberment of the living fetus which is pain capable by the gestational age of the Cox baby. Imagine for a moment the excruciating suffering elicited in the living fetus as its limbs are literally torn off. Some abortion advocates mistakenly view this as the “compassionate” choice. 6) Even in those cases where an abortionist chooses to administer a feticide prior to the procedure, the fetus will endure incredible suffering. The most common feticide, digoxin, takes up to 4 hours to kill the fetus if it is injected directly into the fetus and up to 24 hours if it is injected into the amniotic fluid surrounding the fetus. Digoxin overdose is associated with intense nausea, vomiting, abdominal pain, and delirium before it slows the heart and induces death. This can aptly be described as fetal torture. 7) The media suggests that Kate Cox’s life is in jeopardy if she continues the pregnancy. However, there is nothing in the lawsuit that corroborates this assertion. Ms. Cox visited the Emergency Department for cramps and diarrhea, but this is not a concerning symptom for her health or life. During a second Emergency Department visit she was reported to have some unidentified fluid from her vagina – suggesting the possibility of leaking amniotic fluid. This would be a more significant concern, but the Emergency Department commonly visualizes the cervix to make this diagnosis. They can also perform ultrasounds and several forms of tests on the vaginal fluid to establish this diagnosis (including pH-based tests, a fern test, and placenta alpha-1 globulin protein). The fact that none of this was mentioned in the lawsuit leads one to believe that Ms. Cox was not manifesting Premature Rupture of Membranes (PROM) and leaking amniotic fluid. The lawsuit mentions an elevated prenatal blood sugar, but gestational diabetes can be managed with a very low risk of morbidity/mortality. Translation - there was nothing in the lawsuit suggesting her life was at risk. 8) The media uncritically reports that future fertility is at risk if she continues her pregnancy. In the lawsuit, Ms. Cox indicates that she would like to have another child. It is true that if she had a C-section to deliver her child with Trisomy 18, there would be increased risk from a 4th C-section with a future child. The risk of uterine dehiscence (which means the partial opening of the uterus at the previous C-section scar) goes from 6.6% with her third C-section to 10.3% with her fourth C-section. This is a concern, but the absolute risk remains low. Furthermore, she is at increased risk with a future child regardless of her abortion decision by virtue of her C-section history. As indicated previously, it is not certain that a repeat C-section would be required and if she has a vaginal delivery of her Trisomy 18 child, there is little additional risk incurred with her future pregnancy. 9) Surgical abortions in general, and late abortions in particular, are associated with premature birth in subsequent pregnancies. Induced abortions are associated with cervical damage . This means that if Kate Cox obtains a late abortion, she may be putting her own and her future baby’s life at risk. Preterm delivery is associated with long term mortality for the mother and is the biggest driver of infant mortality for the child. 10) If any of the facts reviewed above miss some of the salient clinical features omitted from the lawsuit or if Kate Cox’s condition deteriorates, the Texas Supreme Court has made it clear that abortion is an option if her bodily functions or life are at risk. Furthermore, the court explicitly stated that her life does not need to be in “imminent” danger to pursue abortion in those circumstances. Her attending physicians simply need to make that determination based on reasonable medical judgement and the Texas Supreme court says it does not need to be reviewed by the judiciary. The Cox family have our sympathy and we all wish them well. However, their decision should be based on all the facts and not the selective narrative of abortion providers. It is unfortunate that families with life-threatening fetal anomalies are often given no hope and coerced into pursuing an abortion that they later regret.
By Tom Perille November 9, 2023
There are some things I have a hard time understanding. Why do people who profess a Christian worldview support a presidential candidate who is crude, cruel, vindictive, misogynistic, narcissistic, and does not pretend to know, much less follow, basic Christian moral teachings? When the prenatal human rights movement becomes associated with such figures, we lose moral credibility and ultimately, electoral power. And why do people who are otherwise loving and compassionate fail to demonstrate any love or compassion for the preborn human being before they are killed in elective abortions? Why is it either the mother or the preborn baby and not both? Why do people go out of the way to knock down perceived barriers to abortion access, but seem disinterested in eliminating the socioeconomic barriers to giving birth and parenting? Why do people feel the only way to achieve equity between the sexes is to deny the biological realities of the sexes? Why do we primarily deal with the asymmetric burdens of human reproduction by promoting abortion? Why can’t we honor a woman’s different role by making social and economic accommodations for women so that their education and careers are prioritized during their reproductive years? Why is it that many of the same people who characterize themselves as “anti-racist” fail to recognize the systemic issues and underlying racism that result in many more preborn babies of color being aborted than White preborn babies? I don’t profess to have all the answers. But what I do know is why I am prolife. I am a physician. In medical school, I studied embryology and marveled at the remarkable and seamless journey from zygote to human birth. My textbook unequivocally stated that “development begins at fertilization, when a sperm fuses with an ovum to form a zygote; this cell is the beginning of a new human being”. Any attempt to distinguish a human being from a human person is philosophically and scientifically arbitrary. As part of my educational training at medical school, I had the terrifying experience of viewing a recently aborted second trimester baby at the bottom of a surgical bucket. You can’t unsee that. As a medical student, I witnessed an OB/GYN attending physician flaunt her wealth by driving a Rolls Royce – only to learn her wealth was predicated on a very lucrative abortion clinic practice. I know that during the most common second trimester abortion procedure, an abortionist literally dismembers the fetus without the benefit of any anesthesia. I know that during abortions after fetal viability (22 weeks), the fetus is commonly injected with a drug, digoxin, which I have witnessed causing nausea, retching, abdominal pain, and delirium at toxic levels in my adult patients. It can take up to 4 hours to kill a fetus if the drug is injected directly into the body and up to 24 hours if it is injected into the amniotic fluid surrounding the fetus. That is up to 24 hours of fetal torture/anguish. Because I am a physician, I understand that there is no connection between abortion restrictions and the medical management of a miscarriage. Because I am a physician, I know that abortion restrictions never prevent a physician from responding to a medical emergency in a pregnant patient. I know that for rare medical complications during pregnancy, a physician must deliver a baby prematurely – even if delivering the baby will foreseeably result in the death of the baby. Because I am a physician, I know that the scare tactics employed by abortion advocates are just that – scare tactics. If a woman must go to another state for urgent/emergent complications of her pregnancy, it is because of malpractice, not because of abortion restrictions. I have had men and women yell and swear at me because of my prolife position who ultimately break down in tears, and admit they were angry because they aborted their child and knew it was wrong. I have had an elderly woman come up to me outside an abortion clinic where I was offering help to abortion vulnerable women and thank me as she cried and said that if I had been there 50 years ago, she many have not made the worst decision of her life and had an abortion. I have had a woman stop her car in the middle of the street outside an abortion clinic and smile from ear to ear, explaining that because I was there two years ago, her little boy was now two years old. I know that abortion hurts women and men alike. I know that many women feel coerced by their financial situation or partners, but there is help and we won't let them stand alone. I know that sanctioning violence in the wound leads to increasing violence in our culture. I know that when we start dividing human beings into those that are worthy of rights/protections and those that are unworthy of rights/protections we undermine our own human dignity/value. So why is a majority of the electorate voting against abortion restrictions? It is true that if the mainstream media would cover the issue objectively, more could discern the truth about the reality of abortion. I also believe that if more could see what I see, they would vote to protect innocent human life in the womb. And I know that I will fight to protect the dignity and value of every human being until the day I take my last breath. I hope more of you join me. Thomas J. Perille MD
By Tom Perille November 6, 2023
Krista Kafer nailed it. A small faction of abortion rights extremists strong-armed the Democratic caucus and pushed through SB23-190 which punitively targeted Pregnancy Resource Centers which are commonly affiliated with religious organizations. Not only did they blatantly challenge the first amendment rights of these centers, but they also didn’t hide their animus in hours of testimony at the state capitol. The bill also sought to ban the use of progesterone to mitigate the abortifacient effects of mifepristone – the first pill in the two-drug medication abortion regimen. Eliminating this option has nothing to do with improving abortion access but rather is all about denying a woman’s agency and removing her choices. Opposition to abortion pill reversal was never about the science since there is low-level, but multifaceted and compelling evidence to support the practice. Instead, their true motivations were revealed in testimony from ACOG to the Medical Board – they didn’t want to acknowledge that women change their minds about abortion since it would contradict their preferred narrative and lead to “abortion stigma”. They cared little about the desperate woman in their exam room who believed she made a tragic mistake and wanted to save her baby. I hope my fellow Democrats take the judge’s decision as a wake-up call. It is past time to look beyond a narrow proabortion focus and support all attempts to serve women who face a challenging pregnancy. Thomas J. Perille MD President, Democrats for Life of Colorado
By Tom Perille October 18, 2023
Excerpts from Democrats for Life of Colorado's President, Thomas Perille MD, to the Colorado Medical, Nursing and Pharmacy Boards which walks through the evidence in support of abortion pill reversal: Members of the Colorado Medical Board, Board of Nursing and Board of Pharmacy, With the signature of SB23-190 into law by Governor Polis, you have been asked to evaluate a specific medical intervention to determine if it is a “generally accepted standard of practice”. As someone who has reviewed several cases for the Medical Board to determine if a provider deviated from accepted community standards, I would like to provide my perspective based on a careful review of the evidence. So called “abortion pill reversal” (APR) protocols were developed in response to the rare situation in which a woman pursuing a medication abortion regrets her choice after taking the first pill, mifepristone, but before taking the second drug, misoprostol, in the two-drug regimen. The purpose of APR is to mitigate the abortifacient effects of mifepristone and increase the odds of a continuing pregnancy. It should be no surprise that some women harbor significant ambivalence about their abortion decision. The Turnaway Study (page 126) reported that within one week of being denied an abortion, 35% of women no longer wished to have an abortion. In 2022, 31 Colorado women (approximately 0.4% of medication abortion patients) sought to pursue APR through the most prominent organization dedicated to APR – Heartbeat International . As a matter of principle, clinicians routinely honor a patient’s right to withdraw consent from any medical or surgical intervention. Therefore, addressing the needs of women who change their mind about their medication abortion should not be controversial. Mifepristone was developed in the 1980s as a progesterone antagonist. It is one drug in a whole class of Selective Progesterone Receptor Modulators (SPRMs). The drug binds progesterone receptors twice as avidly as progesterone. In the early 1990s it was studied primarily as a means to terminate early pregnancy . APR is based on the premise that mifepristone competition for the progesterone receptors is a dynamic process. By flooding the receptors with natural progesterone, one could theoretically overcome the binding of mifepristone to progesterone receptors and reduce its abortifacient effects. Some abortion researchers have questioned the potential for high dose progesterone to significantly impact mifepristone’s binding to progesterone receptors. They cite the observation that women treated with mifepristone for abortion have high progesterone levels and therefore it would seem implausible that more progesterone would make any difference. They also point to a study of the very potent progestin contraceptive implant, etonogestrel. When it was administered immediately after the ingestion of mifepristone, it did not reduce the percentage of successful medication abortions. There are animal and human data to counter these arguments. Early in the research on mifepristone it was recognized that its binding to the progesterone receptor could be reduced by increasing progesterone levels. In a study in pregnant rats, those that received mifepristone only had 33% of pups survive. In contrast, those that were given progesterone with mifepristone, 100% of pups survived. A second study in rats demonstrated a clear progesterone mediated reversal of mifepristone induced pregnancy termination in a rat model. As early as 1991, a medical review of mifepristone use in medication abortions recognized that the mifepristone binding to the progesterone receptor could be reversed by adding progesterone. Collectively, these provide proof of principle for APR. The fact that progestin can interfere with the action of a SPRM in humans is a documented concern outside of mifepristone use for medication abortion. The FDA recommends that progesterone containing hormonal contraceptives not be administered within 5 days of taking the SPRM, ulipristal, so as not to reduce its effectiveness as a form of emergency contraception. Compelling evidence that a progestin can specifically interfere with a mifepristone (and misoprostol) in a medication abortion was found during a large, randomized, multinational study of depot medroxyprogesterone acetate use as a post-abortive contraceptive. In this study, the administration of medroxyprogesterone in conjunction with the ingestion of mifepristone (Quickstart) was associated with a 400% increase in the odds of a continuing pregnancy compared to delaying the administration of medroxyprogesterone after a mifepristone/misoprostol abortion (Afterstart). While the absolute difference was small (0.9% to 3.6%), the results were statistically significant. Some researchers speculated that depot medroxyprogesterone acetate differs from other progestins, such as etonogestrel, because of its potency and rapid achievement of peak levels. The first known use of high dose progesterone to mitigate the effects of mifepristone during the course of a medication abortion was in 2006 by Dr. Matthew Harrison. A desperate woman who immediately regretted her medication abortion decision sought his help. Based on the known mechanism of action and the record of safety using progesterone to treat miscarriages, he initiated a course of high dose parenteral progesterone. This resulted in the delivery of a healthy baby girl. I would argue that even this early adoption of the APR concept met the criteria for a “generally accepted standard of practice” as defined by the Colorado Medical Board. The strategy was plausible based on the known mechanism of action of mifepristone – competitive inhibition of the progesterone receptor. Animal research supported the approach. The intervention was deemed safe in analogous OB indications (miscarriage prevention) at the time. And most importantly, the potential benefit - a life saved- justified an unproven intervention. The only alternative course of action was expectant management which would be anticipated to result in only a 20-40% chance of embryonic survival based on WHO data from 1997. In 2012, the first case series utilizing progesterone to block the abortifacient effects of mifepristone was published. Four of six (66%) women who were administered parenteral progesterone after taking mifepristone carried their pregnancies to term. A second small case series in 2017 also demonstrated a 66% continuing pregnancy rate after administration of progesterone following mifepristone. This compares to a historical rate of >>risk). The only alternative – expectant management – is associated with a much poorer outcomes and potentially worse safety - twice the embryo/fetus mortality and a possible greater risk of hemorrhage for the woman. Thank you for your consideration. Thomas J. Perille MD FACP FHM President, Democrats for Life of Colorado
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