Why the South Carolina Republican in That Viral Abortion Video Voted for a New Ban

L ast week, a video went viral in which Republican South Carolina state representative Neal Collins, speaking during a committee hearing, recounted an awful story a doctor had told him about a pregnant 19-year-old woman who’d been denied immediate treatment when her water broke and she began to experience a miscarriage 15 weeks into her pregnancy, before a baby can survive outside the womb.

“The standard of care was to advise her that they could extract [the child] or she could go home. The attorneys told the doctors that because of the fetal-heartbeat bill — because that 15-week-old had a heartbeat — the doctors could not extract [the baby until its heartbeat stopped],” Collins said in the video, relaying what the doctor told him. “I voted for that [heartbeat] bill. These are affecting people. What we do matters.”

On Tuesday, a new abortion bill protecting life from conception was passed by the South Carolina House — with Collins voting in favor. Collins is now the subject of much ridicule and anger online. “Lawmaker Who Lost Sleep Over Abortion Ban Votes for Yet Another Strict Law,” reads the headline at the Daily Beast.

Collins told National Review that he voted for the new abortion bill because it includes exceptions for cases of rape and incest, and because it also includes language protecting the life and physical health of the mother that is even more explicit than the language in the heartbeat law.

The new House-passed abortion bill lists many specific health conditions — including miscarriage — that shall be “presumed” as falling under its life-and-physical-health-of-the-mother exception. “We reached out to a number of doctors to try to list as many legitimate situations as we could,” Collins said in a phone interview on Thursday.

One thing lost in the media firestorm over the video of Collins, which was featured on Meet the Press last Sunday, is that South Carolina’s fetal-heartbeat law already included a very clear exception that plainly protects immediate treatment of a woman whose water breaks before viability. As a National Review editorial explains:

The text of South Carolina’s heartbeat law explicitly states the ban “does not apply to a physician who performs a medical procedure that, by any reasonable medical judgment, is designed or intended to prevent the death of the pregnant woman or to prevent the serious risk of a substantial and irreversible impairment of a major bodily function of the pregnant woman.”

Hastening the end of the pregnancy of a woman whose water broke at 15 weeks — a woman at risk of developing sepsis if untreated — is obviously “intended to prevent the death of the pregnant woman.” A pregnant woman at risk of losing her uterus is obviously facing a “serious risk of a substantial and irreversible impairment of a major bodily function.” The South Carolina law does not include any requirement of waiting until the threat is “imminent,” and the law defers to “any reasonable medical judgment” of the physician.

It is not controversial, even among pro-life doctors and pro-life organizations, that a pregnant woman should be offered immediate treatment when her water breaks before viability. “I say this as a pro-life physician: It is appropriate to deliver at that point. Because we know that likelihood that four days, six days [later], she’s going to be clinically infected,” Dr. Ingrid Skop, director of medical affairs at the pro-life Charlotte Lozier Institute, told National Review.

Though Collins agrees that the language in the heartbeat bill should protect women in the situation he described in the video, he says he was happy to support the new bill because its language makes it explicit that that situation is covered. Collins says the issue in the case he recounted was that the heartbeat act was a “two-week-old law” when the mother’s water broke, and hospital attorneys were “being as conservative as possible for liability reasons.”

“The way that I read our six-week [heartbeat] ban language, I think [it] should have protected the 19-year-old,” says Collins. “This [new] language absolutely protects it — the situation. . . . I don’t know what else we can do to make it crystal clear that in common-sense situations we want to protect the life of the mother.”

Collins says that when he spoke in the viral video about being unwilling to vote for the new bill as it was written, his objection was that the bill did not include rape and incest exceptions, which were subsequently added to its text after Collins and other Republicans voted down a version lacking those exceptions. He adds that at the committee hearing, he recounted the story in the viral video simply to emphasize the importance of getting the legislation’s details right; he had privately discussed the case of the miscarrying 19-year-old with the bill’s lead sponsor before his speech, and the bill had already been modified to include the following long, specific (though not exhaustive) list of medical conditions for which providers could make an exception:

(C) It is presumed that the following medical conditions constitute a substantial risk of death or substantial risk of a substantial and irreversible physical impairment of a major bodily function of a pregnant woman: molar pregnancy, partial molar pregnancy, blighted ovum, ectopic pregnancy, severe preeclampsia, HELLP syndrome, abruptio placentae, severe physical maternal trauma, uterine rupture, intrauterine fetal demise, and miscarriage. However, when an unborn child is alive in utero, the physician must make all reasonable efforts to deliver and save the life of an unborn child during the process of separating the unborn child from the pregnant woman, to the extent it does not adversely affect the life or physical health of the pregnant woman, and in a manner consistent with reasonable medical practice. The enumeration of the medical conditions in this subsection is not intended to exclude or abrogate other conditions that satisfy the exclusions of subsection (A) or prevent other procedures that are not included in the definition of abortion in Section 44-41-810.

Before Roe, the many abortion laws that had been on the books for decades didn’t include lists of conditions “presumed” to qualify under the law’s exception, but physicians routinely treated such physical threats to pregnant women without fear of prosecution. No list of conditions could ever be comprehensive, and that is why the new South Carolina abortion bill is explicit that its “enumeration of the medical conditions” is not intended to prevent a doctor from exercising reasonable medical judgment to save a pregnant woman with a condition not mentioned in the bill if her life or health is seriously threatened.

If any advocates of a right to abortion still think the more explicit exception in the South Carolina bill isn’t enough to ensure all women are protected, they need to explain what would be. Many pro-choice members of Congress, the media, and medical organizations have stoked fears that any meaningful restrictions on abortion at any point in pregnancy will necessarily endanger women. They have insisted that unless the law permits abortion throughout all nine months of pregnancy whenever a midwife, nurse, or doctor says the procedure is needed to protect the mother’s emotional health, it will result in delays of life-saving care for women in dangerous situations. This argument is contradicted by decades of pre-Roe experience and the plain text of abortion laws.

To be sure, pro-life statesmen should do much more to ensure that hospitals are providing proper care to pregnant women. But even without specific language like that in the South Carolina bill, there is no good excuse for hospital lawyers to advise doctors not to provide legal and proper care to protect the life and physical health of a pregnant woman. All that the South Carolina bill does is remove their only basis for claiming otherwise.