"It comes down to who is the patient. Is the woman the patient, or is the fetus the patient? One or other is the patient. I’ve never heard a fetus talk to me. I’ve heard thousands and thousands of women share their pain, their desperation, and their hopelessness."

These words were spoken to me some twenty years ago by Dr. George Tiller, as I was researching a book on abortion providers’ experiences before and after Roe v Wade. Tiller, who was brutally assassinated in his church on May 31, was one of the most compassionate– and feminist– individuals I have ever encountered. "Trust women" was his well-known motto, prominently displayed at his clinic in Wichita, Kansas.

He was asked repeatedly by friends how he could continue his work in the face of the unending violence and legal harassment that he endured in the years leading up to his murder: his home and office were frequently blockaded (I recall hearing that he and his wife had to be helicoptered out of their house to attend a child’s wedding, as antiabortion fanatics were surrounding his home); he was shot in both arms in 1993; and he was subjected to numerous lawsuits brought by a grandstanding anti-abortion Attorney General in Kansas and by Operation Rescue operatives, all of which he ultimately won, but which took a huge toll, financially and emotionally. His answer was always the same: "Where else can these women go?"

Tiller’s answer was not a rhetorical one. He was one of the very few physicians in the United States who provided abortion care well into the third trimester of pregnancy. It is this fact that made him so reviled in antiabortion circles, and unquestionably the most controversial abortion provider in the country. Operation Rescue relocated their offices to Wichita a few years ago, with the specific intent of closing him down. Each day, the women who came to him from all over the U.S., and from abroad as well, had to go through a gauntlet of protestors holding grotesque posters and screaming about "Tiller the baby killer."

It is hardly surprising that antiabortion zealots would find Dr. Tiller such a convenient target, focusing on his late term procedures. What has been more surprising, and disappointing, to me has been the inadequate coverage of Tiller’s work in most of the mainstream media in the days since his murder. I myself have spoken to a fair number of reporters, have read numerous stories from papers across the country, and consumed a great deal of television and radio reporting on this event. I have been struck that although all reporters mention that he offered late term abortions, as a way of explaining his notoriety in antiabortion circles, remarkably few of these print or radio and television journalists explained why Tiller did this, and who actually were the recipients of these procedures. The fact that so many of those reporting on Tiller were so oblivious of the circumstances of his patients is in itself a powerful indication of the marginality of both abortion providers and patients in American culture.

In simplest terms, many of those who came to George Tiller’s clinic for late second or third trimester abortions were women (and their partners) who were carrying much wanted pregnancies that had gone horribly wrong. These were women in many cases who had already set up cribs and had baby showers. Some of these women had fetuses with heartbreaking anomalies, that were discovered only later in pregnancy, such as anencephaly, a lethal birth defect in which most of the brain and parts of the skull are missing. Other women had themselves become very ill in the course of a pregnancy, such as the onset of cancer, which demanded a course of chemotherapy. Tiller, himself a practicing Christian, had set aside a space in his clinic — a Quiet Room — for grieving parents, who could if they wished, be counseled by a chaplain on staff, and participate in a baptism or other blessings for the lost pregnancy.

In a perceptive piece written immediately after Tiller’s death, the journalist Michelle Goldberg points out the irony that many of the procedures that he performed, for wanted pregnancies that had gone terribly wrong, "are as far away from the much-reviled concept of ‘abortion on demand’ that one could get… Almost anyone of childbearing age could end up needing Tiller’s services."

To be sure, not all of the abortions that Tiller performed were for difficult medical situations. Some were for wrenching social situations. Tiller was commonly referred to as "Saint George" within the abortion providing community, not only because he persisted in his practice for so long in the face of constant threats, but because he took on cases no one else would. To relate just one of numerous instances I have heard, a clinic director in the deep South was faced with a situation of a young girl, brought to the clinic by her mother: "a very pregnant eleven years, blond, blue eyes, and small… too far in the pregnancy for us to help." The girl had been raped by a relative. The solution chosen was a familiar one in the abortion providing world. The clinic staff donated money to the indigent family for travel expenses, sent them off to Wichita, and Tiller performed her abortion for free.

Why did Dr. Tiller receive a constant stream of referrals from his colleagues across the country? Why are there only one or two other doctors remaining in the U.S. who have a practice similar to his? The answer lies in a combination of highly restrictive state laws and hospital regulations governing later abortions, inadequate training opportunities for these more complex procedures, and, of course, the kind of unbearable scrutiny that likely awaits anyone willing to undergo this work.

In the wake of this horrific murder, many have rightly called for a more widespread condemnation of the violence that has plagued the abortion providing community for years. As Gloria Feldt, former president of Planned Parenthood aptly put it, "George Tiller needs more than candlelight vigils," and his death demands "massive outrage" from all sectors of society, particularly political leaders.

But I also believe that another response to this killing must be to demand that the mainstream medical community acknowledge the reality that there will always be some women who need abortions later on in pregnancy. Local medical institutions must make provision for these cases — especially since these women can no longer be sent off to Kansas, out of sight and mind of "respectable" doctors and hospitals. In the abstract, late term abortions are understandably distasteful to many. When considered in the context of real women’s lives, however, these procedures are essential. This is what George Tiller understood. This will hopefully be his legacy.

This piece was originally published in the Beacon Broadside.