Presidential candidates quiet on one health issue: abortion

Over the past year, this column (and the rest of the media) has spent a lot of time analyzing the big and small differences in the presidential candidates' health care reform plans—from tax breaks and mandates to tort reform and quality improvement. But there is one other health-related issue that may influence many voters' decisions between Sens. Barack Obama and John McCain: abortion.

For most of the campaign, the candidates have steered away from discussion of the issue, preferring to focus on the war and the economy. There was so little debate about abortion in the primary, in fact, that a spring survey by Planned Parenthood found that 23% of Mr. McCain's female, pro-choice supporters thought he was pro-choice and an additional half of the respondents didn't know his position.

It probably doesn't come as much of surprise that a significant chunk of American voters are uninformed on a particular issue, especially when the candidates have not made their views on it a focus of the campaign. Mr. McCain particularly has walked a fine middle line, floating the idea of former U.S. Secretary for Homeland Security Tom Ridge as a pro-choice vice-presidential nominee (before settling on Alaska Gov. Sarah Palin, an ardent pro-lifer), while reaffirming his belief that human rights begin at conception (a position that could raise complications on issues such as stem cell research and birth control).

Mr. Obama has avoided answering the when-life-begins question entirely. He is firmly pro-choice, although opposed to late-term procedures except when a woman's health is at risk. (No one has a short answer to any of these questions.) His party's new platform mentions support for both abortion rights and a woman's decision to have a child, and Mr. Obama has talked about a goal of reducing the number of abortions.

All of this discussion really gets back to one central issue, nominations to the Supreme Court. Both pro-life and pro-choice activists want to make sure the candidates will choose nominees on their side of Roe vs. Wade, while the candidates want to put themselves in the middle ground (don't like the idea of abortion, but don't want to outlaw it) where most voters reside.

But we don't have to wait for the retirement of a Supreme Court justice for the controversy to fire up. An electoral showdown about abortion that has pulled some physicians into the debate is already under way in South Dakota.

In July, a federal appeals court approved a state law that requires physicians who provide abortions to tell women that “the abortion will terminate the life of a whole, separate, unique, living human being” and that they have “an existing relationship with that unborn human being.”

Then on the ballot this November, South Dakota voters will determine whether to ban all abortions, except in cases of rape, incest and emergencies that threaten the health of the woman. Physicians in the state are campaigning on both sides of the measure, with proponents hoping it could lead to a reversal of Roe and opponents arguing that the language (which would allow jail terms for physicians who disregard “accepted standards of medical practice”) would entirely eliminate abortion services from South Dakota.

So far, it's mostly South Dakotans and activists who are getting animated about this ballot measure and its relationship to the presidential campaign. It remains to be seen whether other American voters will move their focus from war news and gas prices to decide on this always contentious issue. Although given the speed with which this long election season is coming to a close, any thematic shift will have to appear soon.

Because the election is so near, this will be the last edition of the Campaign Trail column. During the upcoming month, however, you can get up-to-date election coverage from ACP Internist on our blog. See you there and don't forget to vote!