Sundance Review: After Tiller

I was more than a little uncertain going in what I’d think about After Tiller, the documentary by filmmakers Martha Shane and Lana Wilson about the last four remaining doctors in the United States who are qualified to perform late-term abortions. All four were colleagues of Dr. George Tiller, the controversial abortion doctor who was gunned down in 2009 by an anti-abortion activist at his church in Wichita, Kansas. As the title implies, this film isn’t so much about Tiller, or even about late-term abortion as it is about what happened to his colleagues – and the desperate women seeking their help – after Dr. Tiller was assassinated.

The film introduces us to the four: Dr. LeRoy Carhart, who started providing third-trimester abortions in Nebraska in response to Dr. Tiller’s death; Dr. Warren Hern, a 74-year-old longtime late abortion provider who’s given up a personal life, dealt with constant death threats, and worried over the harassment of his feisty elderly mother, but still won’t retire because there’s no one there to fill his shoes; and Dr. Susan Robinson and Dr. Shelley Sella, two female providers who worked with Dr. Tiller and now jointly run a clinic in Albuquerque.

As a staunchly pro-choice feminist, I support the right of women to terminate a pregnancy; but like many even on the pro-choice side of this fiercely debated issue, late-term abortion is a bit more of a slippery slope for me. On the one hand, I don’t have a problem at all with a third-trimester abortion when there’s a fatal or severe fetal anomaly that would lead to a questionable, or even painful, quality of life for the child. Nor do I have a problem accepting that there are times when the endangerment to the life or mental health of the mother overrides the moral implications of euthanizing an otherwise healthy viable fetus. But when you get into cases where a woman wants to abort a viable pregnancy just because she doesn’t want to carry it to term or give it up for adoption, I, like many people who are otherwise pro-choice, have a harder time with the moral implications of a late-term termination.

What the filmmakers capture beautifully, sometimes agonizingly here is that these doctors wrestle with this same quandary themselves, even as they provide this service to the women and girls who come to them for help. So too do the counseling sessions with women seeking third-trimester abortions help to shed a different sort of light on this difficult issue. Listening to these women and their partners, the vast majority of whom are there because their much loved and wanted baby has been diagnosed with some terrible anomaly, was agonizingly wrenching.

Imagine being pregnant with a lovingly anticipated child, having what you thought was a normal pregnancy, preparing the baby’s room, dreaming about the future the child kicking inside you will have – and then learning late in the pregnancy that your child has something terribly wrong with it, so wrong that the most humane choice you can make is to allow a doctor to gently euthanize him in the womb so that you can go through the pain of labor and delivery to push forth your already dead child. I know women who have had to make that awful choice. I’m grateful I never had to.

The four doctors put a very human face on an abstract issue; we see their fierce determination not to be bullied by anti-abortion fanatics; their passionate desire to help these women; and perhaps most importantly, the way each of them wrestles with the moral issues of this job. The two women, interestingly, provide the more complex look at this side of things. Dr. Sella, a former midwife, struggles with delivering dead babies instead of live ones, and emphasizes that because of that, she has to acknowledge honestly to herself that these late-term abortions are euthanizing babies, not fetuses or pieces of tissue, and it’s clear that she sometimes really struggles with that moral dilemma.

Dr. Robinson provides some of the film’s most wrenching moments, as she deals with the fact that in Kansas, another doctor had to help make the decision whether a particular late-term pregnancy could be ended, whereas in New Mexico that decision falls squarely upon her shoulders. It’s clear that in general, she has a much easier time with cases of fetal anomaly and a harder time with viable pregnancies that the woman just does not want to see through, but even so, she feels strongly that it’s not generally her place to make that decision for a woman unless the pregnancy is just too far along for the procedure to be safe.

After Tiller touches lightly on the anti-abortion side of the debate, so lightly that it could perhaps be said to be a little one-sided, but this isn’t really a film about the morality of late-term abortion, per se, as much as it is about these four doctors and how they personally deal with the personal and political implications of their jobs; the filmmakers do a terrific job of showing rather than telling (though not in the graphic sense) to make their argument. For instance, they counter the anti-abortion stance that a fetus past 20 weeks is capable of feeling pain and that the process of terminating the pregnancy is cruel and painful with both the scientific opinion on that subject, and by showing us one of the counselors explaining to a potential patient exactly how the late-term procedure will be performed (by first euthanizing the fetus in utero, and then inducing labor for a natural delivery).

What comes through most of all in all four interwoven stories is how deeply and very personally each of these doctors feel about what they’re doing, the compassion and sensitivity with which they help the women who come to them seeking their help, and the dedication with which they continue to persevere in spite of death threats, harassment and the toll on their personal lives. After Tiller is a terrific documentary that handles sensitively this controversial and heated topic; don’t expect those on the other side of the debate to appreciate that aspect of this film, though. The public screening at Sundance had heightened security and metal detectors, something I would expect to also be needed at any future screenings of the film. The passion and anger on both sides isn’t something that’s going to go away anytime soon, but this film, by focusing on these doctors and their own humanity in the face of being demonized by anti-abortion activists, makes a solid case for why the work they do is so crucial to the women they serve.

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