Film Follows Doctors Who Provide Third-Trimester Abortions

Nov 14, 2013
Originally published on November 11, 2013 3:19 pm

In May of 2009, Dr. George Tiller, a Kansas doctor who openly provided third-trimester abortions, was shot and killed while in church.

Tiller was no stranger to risk: he had been shot before, his clinic was bombed, yet he continued to see patients and perform third-trimester abortions.

After his death, filmmakers Martha Shane and Lana Wilson started thinking — what would drive people to put themselves in such danger? So they decided to ask.

It becomes impossible to become judgmental towards these women.
–Martha Shane, filmmaker

Their documentary, “After Tiller,” goes into the lives and clinics of the last four doctors who openly perform third-trimester abortions.

“We came into the film both being pro-choice, but knowing very little about third trimester abortions,” Shane told Here & Now’s Jeremy Hobson. “It was a process of evolving. At first you can have a gut reaction to be judgmental … But when you actually listen to these patients stories, you realize that their lives are so incredibly complicated, and there are so many factors, and they are so desperate, and I think it becomes impossible to become judgmental towards these women.”

Dr. LeRoy Carhart is one of the doctors profiled in “After Tiller.”

The threats against him began almost immediately: his clinic was attacked, his barn set on fire — burning his beloved horses and animals alive – and his family was threatened.

But he continued to practice, even moving to Maryland after the procedure was criminalized in his home state of Nebraska.

“The mild personal price that we pay is nothing compared to the price the women are paying everyday to get the care that they so rightly deserve,” Carhart told Here & Now.


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It has been more than four years since Dr. George Tiller was shot and killed while in church in Kansas. Tiller was one of the country's only doctors who openly provided third-trimester abortions. Now he is the subject of a documentary about what has happened since his death. It's called "After Tiller."

In the film, we hear from Tiller about the danger of his job. Before being murdered, he had been shot and his clinic was bombed.


HOBSON: A clip from the new documentary "After Tiller." One of the directors is Martha Shane, and she is with us now from New York. Martha, welcome.

MARTHA SHANE: Thank you, thanks for having me.

HOBSON: Well, why did you decide to make this film?

SHANE: You know, the idea, I'd been working in documentary for a little while, and my co-director had the idea while watching the news coverage of Dr. Tiller's assassination. And we talked a lot about the fact that the news, the mainstream news media, couldn't really cover this the way you would want it to. It was always a controversial abortion doctor has been killed, and then you would have a pro-choice talking point and an anti-abortion talking point, and that would be about it.

And we realized that there were so many intriguing details about this story. First of all that Dr. Tiller, who was, you know, the number one villain of the pro-life movement in this country, was actually a deeply religious Christian himself and then learning that he had actually been shot before in the arm by a protester and had showed up at work the next day to see his patients.

So we just started to think about, you know, what would motivate somebody to do this work when the risks are so great and the harassment is so regular. And we started to look at that. At first, we had the idea of making a documentary about Dr. Tiller, but then we thought it would be actually more interesting to spend time with the doctors who are still doing this work. And when we began looking into it, we discovered that there are only four in the country, and we were really shocked to discover that in a country of this size that there would be only four doctors who are openly providing these later abortions.

HOBSON: And we're going to speaking to one of them in just a couple of moments, but when you say the media wasn't covering this the way that they should be, what do you mean by that? How should they be covering it?

SHANE: You know, I think that it was just a question of feeling like it was being treated in such a politicized way and feeling like there was a need to change the tone of the conversation and to take a more intimate look at the doctors and the patients, who are the people at the heart, at the center of this storm.

HOBSON: It is very heavy, though, very even difficult to watch at times in the movie. People are going to have very different reactions to it. Did your thoughts on late-term abortions change at all in the making of this film?

SHANE: You know, that's a great question. We came into the film both being pro-choice but knowing very little about third trimester abortions, I think like most Americans. We didn't know the reasons why a woman would seek a third trimester abortion.

And so yeah, it was a process of evolving. And I think at first, you know, you can have a gut reaction, which is to be judgmental, to say, well, why did this woman wait so long, or it just seems irresponsible in some way. But when you actually listen to these patients' stories, you realize that their lives are so incredibly complicated, and there are so many factors, and they are so desperate, and I think it becomes impossible to become judgmental towards these women.

I think you realize that in order to get to these clinics, to these four doctors, that you have to be absolutely committed to this decision and have thought through this. This isn't a decision that women make cavalierly. It's a very involved and well-thought-out decision.

HOBSON: Which is not to say that everybody who sees this will agree with that decision. But you got access to some of the people wrestling with this decision firsthand. Let's take a listen to a counseling session here going on with one couple.


HOBSON: And of course many of the cases of third-trimester abortions are - they're done for medical reasons but not all of them. You actually spoke to some people who just simply didn't want to be mothers, right?

SHANE: Yes, you know, it was important to us that we show the full range of reasons why women were seeking third-trimester abortions. So yes, fetal anomalies, the cases where there's something wrong with the baby is part of that. But then the other reasons can be sometimes it's a young woman who didn't realize she was pregnant until very late in the pregnancy.

Sometimes it's a woman who's been trying to access an abortion for a long time but for financial or logistical or personal reasons is not able to. Sometimes it's a rape victim who is in denial. So, yes, so we felt like it was really important to include that full range and also in that way we push people, not just people who are anti-abortion but also people who are pro-choice to think more deeply about their own philosophy on this issue and their own position.

HOBSON: We're speaking with Martha Shane, who made the film "After Tiller," which goes into the lives of the last four doctors in the United States who openly perform third-trimester abortions. We will hear from one of those doctors in a moment. You're listening to HERE AND NOW.


HOBSON: This is HERE AND NOW. Let's get back to our conversation about "After Tiller," a new documentary that explores the lives of the last four doctors in the U.S. who openly perform third-trimester abortions. Before the break I was speaking with Martha Shane, who is one of the filmmakers.

Now I want to bring in Dr. LeRoy Carhart. He is one of the doctors featured in the film. And Dr. Carhart, you decided to start performing this procedure after Dr. Tiller's death, beginning in your native state of Nebraska and then relocating to Maryland when Nebraska outlawed abortions after 20 weeks. Your decision has come at a very high personal cost. Tell us what has happened.

LEROY CARHART: We've had arson once at the clinic and once at our farm, which the one at the farm was extremely devastating. But I think that the mild personal price that we pay is nothing compared to the price that the women are paying every day to get the care that they so rightly deserve. The risk and the involvement that we put into this voluntarily in reality is not much different than the postal workers put into going to work, that the Navy workers put into going to work, certainly no more greater risk than I put in every day in the military going to work knowing that somewhere in the world somebody was trying to kill us.

And part of the reason there are only four people that openly - and I think there are more doctors in the country, in fact I know there are, that do the procedures, there really is not a need for many more than four of us to do that. It's something that - it's technically very specialized, and like any other process in medicine or any other thing that you do in life, the more you do of something the better you get at it.

So four people doing quite a few are much better than hundreds of people doing one or two a year with the complications. So it's not really scary that there are only four of us. What's scary is there are - we all have grandchildren or at least are old enough to have grandchildren, so...

HOBSON: Well, are there days, though, that you, over the course of your career, have thought about what you're doing and thought maybe I won't do this, it would be a lot easier for me personally if I didn't certainly?

CARHART: Well, I think every day I realize it would be much easier if I didn't, but I think every day I realize how much I believe that it's necessary, and until I can find people willing to replace me and keep the service available. But there's no way that I can quit.

HOBSON: Well, what do you say to people, though? Because I'm sure there are people listening to this interview right now thinking, well, if these abortions are so necessary, why didn't the mother do it in the first trimester or at least the second trimester? What do you say to that?

CARHART: Many women, especially young women, find out that they are pregnant after they've spent months or weeks of either having - you know, a 14-year-old woman today, or that we've seen just recently, her periods are irregular to start with. She may not have periods every month, so maybe every two or three months.

And in addition, many women that are pregnant have periods well into the third, fourth, fifth, sixth month of pregnancy. So couple that together, and it's very easy for these young women who maybe have had sex only once or have been raped and trying to deny that it happened, and then they finally start to realize that their body is not normal, they're well into the twenty-third, fourth week before they know what's happening.

And yes, we do see these women, but it's almost always between 22 weeks and 26, 28 weeks. It's very, very rare to have a patient that's elective - and by that I mean not carrying a fatally flawed fetus or at least a severely flawed fetus, to be over 28 weeks that we do. Most of them we talk to, and they have or make other decisions that are - other options that are better for them.

But occasionally it's the right option, and you know, it's something that nobody else in the world has a right to interfere with that person and what they believe in and their physician.

HOBSON: In the film we hear from your colleague, Dr. Shelley Sella, who says this is not always easy. I want to hear a clip from her.


HOBSON: Dr. Carhart, have you ever counseled one of your patients - or how often do you counsel them against the procedure after speaking with them?

CARHART: I personally don't believe that it's my right to counsel anyone for or against abortion. Every patient I've ever seen, before they ever come, I tell them that that's not what I'm here for. I am here to take care of a problem that that person and their physician and their religious leader that they are involved with, a decision that they came up with, I'm there to help them with it.

HOBSON: There's a scene in the movie when you walk past some of the people who are out in front of your office protesting. What do you think of those people?

CARHART: I kind of think that unfortunately many of them are there without a clue why they're there. They're there because they heard somebody tell them that abortion's a bad thing, and that's about the furthest thought they've put into the process. It would be like me saying, you know, that a radical - as a layperson, not as a physician, saying that a radical mastectomy is never indicated because we can do all these other things now.

But that's not a true statement. Unless I understand the impact of what's going on with a particular patient and her doctor and what he can do, there's no way I can make an educated decision. To me this is the most moral choice that people can make, if their heart and religion leads them to.

HOBSON: Martha Shane, I just want to finally go back to you and ask you how the film has been received. What kind of comments have you gotten from people?

SHANE: You know, we premiered the film at Sundance this year and had just an incredibly emotional screening with the doctors present. And, you know, there was a ton of security because of their presence, but then they got a standing ovation, and I think it was amazing for them to be receiving so much warmth and gratitude for the work that they're doing when there are so many people who disagree with it or who protest or harass them.

And then since then we've shown the film for audiences all over the country, and I think the most, you know, common reaction is just I didn't realize this was so complicated. And you hear that from people who are anti-abortion, and you hear that from people who are pro-choice, and that's really what we were hoping to achieve with the film. So we're glad that that's been the major reaction.

HOBSON: Dr. Carhart, has this film created more problems for you, or has it helped just to tell your side of the story?

CARHART: I don't believe it's my side of the story, but I hope - I think it's enlightened many, many people that there are two sides to the story and that they both, you know, both have a place of being considered before a patient can make her mind up.

HOBSON: The film is "After Tiller." It is currently in theaters. You can see a trailer at our website, Dr. LeRoy Carhart is an abortion provider who is featured in the film. Thanks so much for speaking with us.

CARHART: Thank you so much for asking me to be here.

HOBSON: And thanks also to Martha Shane, co-director and co-producer of the film. Thanks, Martha.

SHANE: Thank you.

HOBSON: We welcome your thoughts on this story. You can go to This is HERE AND NOW. Transcript provided by NPR, Copyright NPR.