The Abortion Evangelist

There are many circumstances that can bring a woman to seek a late-term abortion. But whether she is that suicidal rape victim or a well-heeled New Yorker who just discovered a fatal fetal defect, her options for ending the pregnancy are limited. Since Tiller's death, there are fewer than 10 doctors across the country willing to help. LeRoy Carhart is one of them.

In the wake of Tiller's assassination, Carhart began offering late-term abortions in his own practice—before, he'd done so only at Tiller's Wichita clinic—and started planning a new late-term clinic to replace Tiller's, where he could see women in the late second and early third trimesters. He's fielded calls from three physicians who want to learn how to do abortions. Two have already begun training. "I think the only thing I can do…is just train as many doctors as I can to go out on their own and provide abortions and get enough people providing them," says Carhart. "That makes [the anti-abortion activist's] job 10 times harder because there are now 10 times more of us."

Carhart is 67, heavy-set and deliberate in his movements and speech, a man who looks as if he could use a good rest more than a five-hour drive to Wichita. If his life had taken a different course, he would be thinking about wrapping up an uneventful career as a general surgeon in Omaha. That's where he founded an emergency walk-in clinic in 1985, after a 21-year career as an Air Force surgeon. Carhart had trained as a fighter pilot in Texas and England—although he never flew in combat—and got his medical degree, from Hahnemann Medical College in Philadelphia, while still in uniform. He was a surgeon at Ouffett Air Force Base near Omaha before retiring as a lieutenant colonel. His life seemed set in a comfortable mold—married to his -elementary-school sweetheart with two teenage children and a 62-acre farm outside town. It all changed in 1987, when a nurse prevailed on him to spend a day at the abortion clinic where she worked. Talking to the women reminded him of the patients he had seen as a medical student, in the days before Roe: women whose botched abortions, anywhere from the first to the third trimester, left them with perforated uteruses, intestines protruding from the vagina, or untreatable pelvic infections. The way Carhart remembers it, it was a good week for the emergency room if only five women died. Soon after the visit he trained at an abortion clinic in Philadelphia, performing more than 500 abortions in four months. When he returned to Omaha, Carhart began splitting his time between his friend's abortion clinic and his own emergency facility. Some specialists, who objected to his abortion work, refused to see patients Carhart referred to them, even if the patients came from his emergency practice. When his farm burned down in 1991, Carhart got defiant: he added an abortion practice to his walk-in clinic. His two physician assistants quit in protest.

It was at Tiller's clinic that Carhart first performed late-term abortions. The two met in 1988 at a National Abortion Federation meeting and quickly became friends and confidants: two unassuming Midwestern doctors who were both risking community pressure—if not yet their lives—doing abortions in conservative states. "He would always be there," says Carhart. "He would call me if he had a hard patient; I would call him when I needed someone to talk to. We became each other's therapists." When Kansas passed a law in the mid-1990s requiring second consultations for abortion, Carhart would do Tiller's over the phone. In 1998 he began assisting with surgeries in Tiller's clinic, and starting in 2004 he spent every third week there.

At the same time, Carhart began challenging partial-birth-abortion bans, first the one in Nebraska and then the federal law. The bans, which state legislatures began to pass in the mid-1990s, generally targeted a procedure called intact dilation and extraction, in which the dead fetus is removed intact after the skull is crushed. It is a rare procedure, used in 2,200 of the 1.3 million abortions performed in 2000, and only in cases where doctors believed it was the best option for minimizing risks to a woman's health, according to the Guttmacher Institute. Carhart worried that the Nebraska law, passed in 1997, wouldn't just ban intact D&E but was vague enough to criminalize other types of abortion. Backed by the Center for Reproductive Rights, Carhart filed a suit against Nebraska's attorney general. The case made it to the Supreme Court in 2000 and was decided in his favor, overturning the Nebraska ban for both its vagueness and its lack of an exception for women's health. When Congress passed a national ban in 2003, Carhart challenged again and returned to the Supreme Court. The court then ruled against him, leaving a national ban intact today. Carhart became a pro-choice hero, receiving awards from NARAL and Planned Parenthood for his activism.

Carhart can't pinpoint how exactly he went from reluctant visitor to controversial abortion provider, why he chose a job that attracts death threats and protesters. Part of it is stubbornness; he won't be bullied out of what he sees as a legitimate medical specialty. "Abortion is not a four-letter word," he says. "I'm proud of what I do."

But if Carhart is proud of his practice, he seems equally burdened by it. He talks about being an abortion doctor not necessarily as a career choice, but as a job he had to take since few others would. "It's like that quotation: 'If not you, who? If not now, when?' That whole thing," he says, giving a modified version of a Hillel quotation ("If I am not for myself, who will be for me? And if I am always for myself, what am I?"). He won't take long vacations because "you can't leave the women waiting, or at least don't want to." He maintains medical licenses in seven states so that if another provider is "hurt, retired, or killed," he can step in. If women need this service, Carhart reasons, who is he to say no? If he won't provide these complex and challenging abortions, who will?