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with broad generalities. That is why I tried to pin you down on the equal rights amendment. We either have to vote yes or no. We cannot say, generally, we are for the principles that sound nice. You vote yes or no, but you are not in that position yet where you want to say, this is the best proposal. I mean, you point out that there are certain questions that remain.

Mr. VANDERHOEF. Yes. I think the position will become clear, both to the committee and certainly in its final form, as we have the hearings on the legal ramifications of exact wording. And for that reason, I think that those hearings are essential before the final draft, and I am sure that this committee would be able to drum

Senator Bayh. Well, I certainly hope you will feel free to communicate with us in the future, as you have in the past.

Are there any other areas where you might find some flexibility relative to the competing lives—for example, in the case of rape, incest, genetic congenital disease of certain types? Is there any flexibility there?

Mr. VANDERHOEF. Again, I think we are talking about ultimately resolving the problem of two innocent lives, and none of those, as I see, would be a defect in the rights of the unborn that would warrant its destruction. Certainly, as far as the medical criteria for deformity and this type of thing, Dr. Jefferson addressed herself to that. But I think the specific items that you mentioned, none of them would constitute, under due process or equal protection of either the 5th or 14th amendments, any reason to take the life of the unborn child. And for that reason, we would hope that the committee would, in its draft, to gain support from this Nation, that it protect both of those lives. If, in fact, in the--again, I hate to use the word—an execption is drawn someplace, it would have to be drawn in the light of the fact that, for some reason, due process and equal protection did not apply to the unborn.

Senator Bayh. Let me express the concern in other terms. We have not yet explored the legal ramifications by which I think you could perhaps draw a due process decision where you have consenting adults participating in the exception. We have one problem in that situation; if you have a woman who is not voluntarily participating in those acts, but is forced into a situation that leads to an exception, the exception is forced upon here. Now, does that give any running room in the rape situation, as far as you are concerned?

Mr. VANDERHOEF. I do not believe it does answer the-
Senator BAYH. In the case of a minor child, a minor girl!

Mr. VAN DERHOEF. Tragic as those situations are—and again, as I mentioned, we do not lose our sensitivities to them—we must hope for a solution then, and I find it difficult to imagine that the solution would be to destroy the innocent life because of the circumstances that begot that child. So I think again, there are other ways, I would think, of solving this; and again, based on the fact that we are talking here, constitutionally, of what has that child, the distinct, conceived child, done to warrant the forfeiture of its life?

And so, I think the difficulty is that the circumstances that have just been described by you deal with the mother, and that certainly is a very vital part that must be considered. Does it override, how

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ever, the fact that as a result of that, we now have a second life? Because I think tragedies happen in a family that are every bit as tragic to the mother and to her well-being—perhaps after the child is born, and we do not afford that. So again, it gets back to the very basic question; has that child, who now has a separate existence, forfeited that because of some act of the mother, or some act of a third party to her mother? And I do not think it can be resolved by saying it is a forfeiting of a constitutional right.

Senator Bayh. You have four children. Do you feel that same way if it was one of your daughters?


Dr. JEFFERSON. There are some other considerations, I think, that are often overlooked in this kind of discussion. As a physician, I am well aware of the fact that we like to have safeguards, and we also like to have escape hatches. We like to have that little bit of extra protection. But I think as physicians we must face up to what medicine is in 1974, and what that practice of medicine is.

When one deals with the matter of rape and incest and so on, we must look a little bit more carefully, as well as the genetic screening that you mentioned, of what we are dealing with. Rape, for example often, in the discussions, we do not have adequate review of just what the pregnancy complication of rape is. Pregnancy is not the commonest complication of rape; veneral disease and injuries are. Obviously, in the one young woman who did become pregnant as a result of rape, it is a problem. But even with that, one has to look a little bit more closely at the woman involved. A first pregnancy may be the only pregnancy. It may not be that ending the pregnancy is best for that particular young woman or girl. The matter of rape is a difficult scene. It creates psychological scars. You cannot erase the fact of the rape or punish the rapist by aborting a pregnancy that develops. However, you may seriously handicap this woman's reproductive future if she is very young, and if that is her first pregnancy that is interrupted.

I think one thing is that I do not look upon pregnancy as quite the burden as some other people may. Even though I have not been pregnant, I have been at least watching pregnant people all of my life, and I just do not see it as quite this great, awful burden that some people seem to see.

Senator BAYH. Well, then, it is extremely difficult for some of us who have not been raped to share that experience with somebody who has.

Dr. JEFFERSON. I have known people who have. I have known many people in many circumstances. I also grew up watching 12, 13 and 14-year-old girls going through pregnancies delivered by midwives, so that the matter of the attitude toward the pregnancy and the rape situation are things which require very careful handling, and there is a way of glossing over what is happening to the young woman in the rape situation when the focus is on abortion—to get rid of the consequences of the rape—and that social circumstance-we ignore doing something about the rapist, and with the focus on the young woman, we simply do not do the things necessary.

For example, the families who know that they have a sociopaththis is particularly a concern in the matter of incest, because often

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the minor child who is raped or has been raped by some member of the family—so that there is a good deal in that situation which is glossed over when the focus is on what happens to the pregnancy. There is also the matter that we should look more closely into the matter of incest. What is wrong with it? What is wrong with the pregnancy? Why does it mean automatic ending of pregnancy that results from incest ? Much of the things said about the children that develop from incest are not borne out in the actual observations of the people. If we look at an experience like that of Sweden, that for some reason seems to have an especially high incidence of incest, the one that suffers in it is not usually the woman, the girl. It is usually the father who ends up in some kind of mental institution, and of the ones that have been followed, the young women seem not to have particular psychological problems after; and those followed have made successful marriages.

So that we have to look, I think, beyond what some of our set ideas are regarding these two areas. They are quite emotional in terms of the person who does not respond to the matter of a young woman pregnant as a result of rape or incest. But on the other hand, I think we need to look a little bit more as to whether or not ending the pregnancy is going to be in the best interest of that young woman; and the focus on it from the legislative area tends to push the matter of clearing out the complication to the detriment, sometimes, of young women involved. The matter of the genetic screening and the use of the diagnostic measures in a search-and-destroy manner bring up serious questions.

From a medical point of view, I have to look closely into the procedures themselves. Amniocentesis, for example, a procedure which requires exceptional skill for its use, a procedure which has its own risks, as a careful review of the complications of the procedure would turn up; but there is also another matter that I, as a physician watching what we do, must think of, and that is the matter that the increasing tendency of centers who do this to do the procedure with the assurance that the parents will agree to abortion if a defective child is found.

Now, ideally, we know that they are concerned about the family unit and the defective child. But on the other hand, we have to look at the very practical matter that if the operator doing the test has had something happen—maybe a few eye cells or a few other cells that should not have been removed have been removed. It is very simple to abort the child and avoid the malpractice case later. Those are also concerns that enter into this matter, which make the matter of genetic screening not quite the ideal that one may mention. But it also carries in the overlay, the underlying idea, that we have sort of flirted towards before. You mentioned the Nazi experience. The search-and-destroy mission is a preNazi attitude; the attitude of removing the burden from some society happened before the Nazis came to power in fact, I think it was in the 1920's, in Leipzig, a book was written by Hucke and Binding with a very awkward title which, translated into English, is something like On the Release of the Destruction of Live Devoid of Value. The ideas represented in that book were that there are some lives which are simply worthless. They are burdens to society. There should be no penalty for removing these

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burdens from society. Doctors are in the best position for removing such burdens from society, so doctors should suffer no penalty for removing such burdens and German medicine took this to heart; not the quacks, but the great professors. And long before Hitler came to power, they had undertaken to help remove the burdens from German society.

Many of my fellow physicians are quite interested in the new social medicine, and the new social medicine does indeed take a very aggressive attitude in removing such burdens of society. The immediate target is the Mongoloid child, because there is a way of determining and diagnosing it. There is the Tay-Sachs child, the Tay-Sachs child who is not visibly defective at the time it is born, and may even be at the early stages an unusual child, unusual in every physical aspects, until the disease effect catches up, and then the deterioration and death. But it is to prevent what happens later that the child is destroyed at that point. But I have not seen a single paper in the American literature that calls attention to the fact that in a long series of cases from Europe, for example, and England, that when first pregnancies are interrupted by abortion, there is an incidence of birth defects in subsequent children born of such women which is higher than the incidence of such genetic defects in the population.

So that we do not know that in medicine, that we are creating a reasonable circumstance. We can say that perhaps it is better to have deformed hips than it is to have Tay-Sachs Disease or have a Mongoloid child. But that is simply a value judgment. But I think we tend to emphasize a little too much the emotional aspects that my profession presents in wanting the safeguards or the escape hatch when someone is suggesting that the profession of medicine may remember the hippocratic tradition, which simply would not accept the kind of utilitarian uses that the new social medicine requires.

Senator Bays. Thank you very much. I appreciate both of you taking the time and trouble to be here with us, and we will continue to look for your thoughts as we pursue our study here. Thank you.

Mr. VANDERHOEF. Thank you.

Senator BAYH. Our next witness is Pat Goltz of the Feminists for Life.

Ms. Goltz. I would like to yield the floor to Randy Engel, if I may. She has another appointment.

Senator BAYH. All right. That will be fine.

Ms. ENGEL. Senator Bayh, this afternoon there are IUD hearings going on in the Food and Drug Administration, so I am scheduled to do that later on this afternoon.

Senator BAYH. Randy Engel, Director of U.S. Coalition for Life, we are glad to have you here. STATEMENT OF RANDY ENGEL, DIRECTOR, U.S. COALITION FOR

LIFE Ms. ENGEL. Thank you, Mr. Chairman. I am Randy Engel, National Director of the U.S. Coalition for Life. We are basically an international research center and clearinghouse with a specialty in Federal antilife programs both within the Department of HEW which would be domestic programs as well as for the Agency for International Development being foreign life programs.

I thank you for your invitation to appear before the subcommittee today in order that I might express the views of the coalition, its distinguished national and international board of advisors, some of whom have already testified at earlier hearings by this subcommittee, including Sir William Liley, KCMG, and those opinions of the thousands of grassroots people whom we have had the honor of serving on a day-to-day basis since the coalition opened its office almost 2 years ago.

Mr. Chairman, I would request at this time that my testimony in full, along with all attachments, be entered into the record? Is this satisfactory?

Senator Bays. Without objection it will be ordered. [The full statement of Ms. Engel follows.]

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