The people filing into the once-a-year public board meeting at Abington Memorial Hospital knew just where to sit.
On one side of the room, an 81/2-by-11 sheet of paper had been taped to the wall with "Pro Life" printed on it. The 50 people crowding into that side, sitting on folding chairs, didn't need to look at the sign. They had done this for years.
A few spilled over into the folding chairs on the other side of the room, chairs that had been largely empty. On the wall above those chairs was a sheet of paper with the words "Pro Choice."
Abortion is the most divisive issue in America. It nearly sank the health-care bill in Congress.
The number of abortions has been dropping slowly but steadily for 20 years, now about 1.2 million annually. State records for 2008 show 38,807 abortions in Pennsylvania, 21,933 in the five-county Philadelphia area, and 47 at Abington Hospital.
Since the U.S. Supreme Court's 1973 Roe v. Wade decision, abortion has been legal. But community hospitals such as Abington are not required to perform them, and many in the region are doing fewer procedures each year.
For as long as anyone at Abington can remember, one subject has dominated the public portion of the annual meeting: abortion.
Members of the antiabortion community, filling the room, hoped and prayed this would be the year, finally, the board would change its policy.
Choosing to listen
John Durham, chairman of Abington's board, welcomed visitors to the February meeting. "Thank you for your interest in a fine hospital," he said.
He said state law required one annual meeting that the public could observe.
"This does not include talking at the public meeting," he said. "This is something we have done here not because of the act but because we choose to."
The abortion opponents went first.
The Rev. Mark Rudolph, rector at St. John the Evangelist Anglican Church, had four minutes. He compared the unborn of today with American slaves - both considered, he said, less than whole persons.
"We know the courts of our day have explicitly stated the word person does not include the unborn," he said. "For us, this is a gut-level, in-your-face matter of life and death. It's about a human being in his or her mother's womb struggling to stay alive and to avoid the curettage suction tube of a doctor. . . . It's about a person's right to survive and to live."
Rudolph then, like other speakers, made it personal.
"This hospital saved the life of one of my sons last October after a serious car accident. Your science, skill, as well as a dedicated staff not only kept him alive but helped him regain his faculties.
"How can a hospital that's so committed in skill and ability to preserving life also have a hand in destroying it?"
Victoria Petty, an obstetrician at Abington who delivers babies but opposes the abortion policy, argued that young resident physicians didn't need to perform abortions as part of their medical education. They can get the same experience doing procedures after a miscarriage, she argued. (The other side disputes both points vigorously.)
Then came Jeff Nitz, director of Bethany Christian Services, who addressed the conflict between two fundamental rights: "self-determination and choice for adults" and "protecting vulnerable human life."
"Choice and self-determination are important values to protect for the patients here in Abington Memorial Hospital," he said. "But those values do not and cannot trump life as a value. Human life at every stage needs to be protected and held as precious."
Patrick Stanton was the next speaker. He was born at Abington, as were many siblings. One brother died there; another's life was saved with "saintly care" after he was burned in a fire. His mother had her knees replaced there.
He had one minute:
"For over 30 years, I've been maintaining a prayer vigil here," he began. "For 30 years, the first Sunday of the month, we walk and pray outside your hospital. Our hospital. Last year for 40 days, we prayed from 9 in the morning until 9 in the night to stop this horrible practice here. Today I have brought you 4,000 signed petitions from the people in our community.
"Last year we gave you 3,000. These are signed by people in Glenside, Abington, Roslyn, Willow Grove, and Jenkintown. We want to send a strong message that we in the community object to the policy here. We live here, work here, worship here. The community has raised its voice against the policy.
"We want you to have a good answer when you meet the Judgment Day. So we pray that you please change this policy."
Louis Welsh, a retired physician who practiced at Abington for more than 30 years, spoke for 30 seconds:
"I've watched this place grow. . . . Do any of you remember the imperative 'Thou shalt not kill'? Have you forgotten the Hippocratic oath? I didn't go to medical school 50 years ago to kill people. I came to save lives, to alleviate pain, do the best I could. . . .
"I say to you members of the board, you're compliant in supporting murder of the unborn, and for this I hold you responsible."
Fifteen minutes were up.
A shift to clinics
After Roe v. Wade, 54 percent of abortions were done in hospitals.
Today, almost 95 percent of abortions occur in clinics. Five percent are in hospitals.
Four Planned Parenthood clinics - Center City, Northeast Philadelphia, Warminster, and Chester - did 11,447 abortions in 2008, nearly a third of all in Pennsylvania.
Abortion-rights advocates say this is good and bad.
"Moving it into clinic settings, there was control over the price and control over the attitudes of how women were treated," said Carol Petraitis, director of the Clara Bell Duvall Reproductive Freedom Project with the Pennsylvania American Civil Liberties Union.
But here's the downside:
"Abortion has been ghettoized because of the stigma, and it's been separated out from routine health care for women," said Susan Schewel, executive director of the Women's Medical Fund, an abortion-access group.
"And that's not good for health of women and health of families. It should be integrated into routine OB-GYN care."
Schewel said she was grateful for clinics, but wished abortions were done in doctors' offices, and in hospitals when necessary.
Some hospital executives were happy to see abortions moved to clinics, say abortion-rights advocates. Hospitals didn't want controversy, protests, threats of violence. And board members at many community hospitals had moral objections to abortion.
The shift to clinics sped up in the 1990s when federal law forbade using Medicaid to pay for abortions for poor women. Without a reimbursement, hospitals had another reason to cede abortions to clinics.
Clinics in Pennsylvania are leading the way in the newest method of abortion, a pill, mifepristone, also known as RU-486. It prevents the fertilized egg from attaching to the uterus. No surgery or anesthesia is needed.
In Pennsylvania, nearly 6,000 women ended pregnancies this way in 2008. Planned Parenthood estimates that 20 percent of abortions at its clinics are medication abortions, which must occur in the first eight to nine weeks.
John Stanton, the father of Patrick Stanton, has for years coordinated area demonstrations outside clinics and hospitals that perform abortions. It is much harder to close down a clinic, he said, because it is "in the abortion business." Nonprofit hospitals are run by community leaders, responsive to the community, which is why at Abington he keeps trying.
Three spoke on behalf of abortion rights, including Maggie Groff, vice president for external affairs for Planned Parenthood Southeastern Pennsylvania.
She said her organization sent to Abington patients with complications that required a hospital. Many times, the referrals are women who "wanted to carry the pregnancy to term," but something had gone "horribly wrong" and they faced "heart-wrenching decisions."
Groff said she was grateful these patients, whatever they decided, would have the support of Abington's physicians.
The longest speaker, eight minutes, was Joel Polin, chair of obstetrics and gynecology at Abington for 29 years.
"There are many individuals in our department who in the past have spoken at this meeting but who have asked me to speak for them today," he said. "They still feel intensely and passionately about the importance of choice, but with the murder of Dr. George Tiller in Wichita, Kan., less than one year ago, a climate of fear has descended and inhibited their free speech.
"They say to me what can be best summarized as, 'I have small children at home, and I don't want to be the target of an assassination.' So I will be speaking for them today."
Polin described four recent abortion cases at Abington:
The first involved a woman "admitted to a nearby hospital" whose fetal membranes had ruptured at 19 weeks.
"The potential for a successful outcome of her pregnancy was essentially gone," Polin said. "After extensive counseling, she decided to terminate the pregnancy. Because that hospital did not allow terminations of pregnancy," the woman drove to Abington.
When she arrived, he said, infection threatened her life and her ability to become pregnant again.
"Had the patient been a patient of ours, this never would have happened," he said. "She would not have been sent out of the hospital to go somewhere else."
He described "a 16-year-old girl from Abington High School whose sexual behavior was just beginning to develop and found out that she was pregnant."
"After a deep discussion" with her mother, Polin said, "she came to AMH, where further counseling took place. They decided on a pregnancy termination procedure, which was carried out. Mother and daughter expressed their thanks that AMH physicians and nurses were there in their time of need."
Another case: "A 25-year-old woman with three children at home became pregnant when her method of birth control failed. Up to that point, she personally did not believe in abortion. However, she believed that another child would make it impossible for her and her husband" to support their family.
"She decided to terminate the pregnancy," Polin said. "Her husband, who also previously had not believed in abortion, supported her."
The final example: A 30-year-old pregnant with her third child. She had a 2-year-old boy at home. When she went for an ultrasound at 18 weeks, she found out "the baby's brain was totally malformed. She was devastated. The findings on the ultrasound were not compatible with life after birth."
"She did not want to go through the humiliation and depression of people congratulating her on a pregnancy when she knew the baby would die soon after it was born. She had the procedure and did well."
Polin, a medical resident from 1961 to 1965, when abortion was illegal, concluded:
"If we stop doing abortions, then it's back to the old days. Mutilation of women. Degradation of women. And death of women. . . . The people of our community come to us asking for help. It would be an abdication of our responsibility - human and medical - to turn them away."
'We disagree on this'
Just like that, it was over.
The board chairman asked if anyone else had a comment about some other topic.
No one ever does.
The Rev. K. Brewster Hastings of St. Anne's Episcopal Church in Abington stood up.
"I realize that the board's deliberations are private and confidential, and that's their prerogative," he said. "I think it would be a great help to the community if you would share the board's understanding of this, this complexity, and not just issue a pro forma public statement that the policy will remain as it is."
The board has not debated or voted on the issue publicly.
Jill Page, who was born at Abington and whose father recently died there, organizes the antiabortion speakers each year. She is with the Urban Family Council. She left the meeting with high hopes as usual.
"Each year I think, 'Wow, that was amazing. . . . They couldn't listen to that and not change the policy.' "
Polin and Patrick Stanton talked warmly after the meeting, as they do every year.
Polin said he considered Stanton a friend. "He's genuinely a good man," Polin said, "and he's done very charitable things in his life that I consider exceptional. We disagree on this."
Stanton said he loved Polin like a brother, and knows that he does so much good for the community, except for abetting and defending abortion at Abington. Stanton said he prayed for Polin's soul.
The Abington board was not persuaded to reconsider its position.
"The hospital's policy has been regularly reviewed by our trustees in the past," the hospital's new chief executive officer, Larry Merlis, wrote in an e-mail last week. "No modifications to that policy have been suggested by the trustees as a result of the discussion at the February board meeting."
The current policy states:
"Abington Memorial Hospital provides abortions to women who request them, to meet a legitimate community need, consistent with safe medical practice and the current laws of the nation and state, and as part of a full range of services that we provide to those who come to us and seek care. The hospital offers counseling services to all women considering this decision."
Merlis, who started in February, did say the board intended to change one policy - its format allowing comment at the public meeting.
"Our goal moving forward will be to provide an annual report of our service to the community rather than focus on one issue," he said.
Page, the antiabortion organizer, said she hoped, whatever the new format, the board would continue to allow abortion opponents to speak.
Many antiabortion supporters said their best hope for change rested in prayer.
And on this, the first Sunday of May, they plan to demonstrate outside Abington Hospital, as usual.