The 9-year-old girl had been raped by her father. She was 18 weeks pregnant. Carrying the baby to term, going through labor and delivery, would have ripped her small body apart.

There was no doctor in her rural Southern town to provide her with an abortion. No area hospital would even consider taking her case.

Susan Hill, the president of the National Women’s Health Foundation, which operates reproductive health clinics in areas where abortion services are scarce or nonexisistent, called Dr. George Tiller, the Wichita, Kan., ob-gyn who last Sunday was shot to death by an abortion foe in the entry foyer of his church.

She begged.

“I only asked him for a favor when it was a really desperate story, not a semi-desperate story,” she told me this week. Tiller was known to abortion providers—and opponents—as the “doctor of last resort”—the one who took the patients no one else would touch.

“He took her for free,” she said. “He kept her three days. He checked her himself every few hours. She and her sister came back to me and said he couldn’t have been more wonderful. That’s just the way he was.”

Other patients of Dr. Tiller’s shared their stories this week on a special “Kansas Stories” page hosted by the Web site “A Heartbreaking Choice.”

One New York mother wrote of having been referred by an obstetrician to Tiller after learning, in her 27th week of pregnancy, that her soon-to-be son was “so very sick” that, once born, he’d have nothing more than “a brief life of respirators, dialysis, surgeries and pain.” In-state doctors refused to perform an abortion.

“The day I drove up to the clinic in Wichita, Kansas, to undergo the procedure that would end the life of my precious son, I also walked into the nightmare of abortion politics. In this world, reality rarely gets through the rhetoric,” wrote another mother, from Texas, of the shouts, graphic posters and protesters’ video camera that greeted her when she came to see Tiller.

Our understanding of what late abortion is like has been almost entirely shaped in public discourse by the opponents of abortion rights. In recent years, discussions of the issue have been filled with the gory details of so-called partial-birth abortion; the grim miseries that drive some women and girls to end their pregnancies after the first trimester have somehow been elided.

“Late abortion is not a failure of contraception. It’s for medical reasons,” Eleanor Smeal, the president of the Feminist Majority Foundation, who has worked to defend abortion providers like Tiller against harassment and violence since the mid-1980s, told me this week. “We’ve made pregnancy a fairy tale where there are no fetal complications, there’s no cancer, no terrible abuse of girls, no cases where to make a girl go all the way through a pregnancy is to destroy her. These are the realities of the story. That’s what Dr. Tiller worked with—the realities.”

There was a great deal of emotion in the air this week as the reality of Tiller’s death set in. Much of it was mournful, some was celebratory, some was cynical and self-serving.

There were the requisite expressions of disapproval and disavowal by politicians from both sides of the abortion divide. And yet it seemed to me that even from pro-choice politicians, the response was muted. In death, as in life, no one wanted to embrace this man who had specialized in helping women who learned late in their pregnancies that their fetuses had gross abnormalities.

It seemed that no one wanted to be too closely associated with the muck and mire of what Tiller had to do in carrying out the risky and emotionally traumatic second- and third-trimester abortions that other doctors and hospitals refused to do. In news reports, there was a tendency to frame the “abortion doctor’s” murder almost as a kind of combat death: a natural occupational hazard.

Yet Tiller—who went to work in a bulletproof vest, lived in a gated community and drove a bulletproof car—was a doctor, not a soldier. And it is precisely this kind of thinking—this viewing of his life and work through the lens of our most gruesome cultural warfare, this slippage and mixing up of medicine and politics—that left him largely unprotected at the time of his death.

Someone resembling Scott Roeder, the man charged in Dr. Tiller’s murder, was seen on Saturday trying to pour glue into the lock on the back door of a Kansas City clinic. Before that, abortion providers around the country had been telling local law enforcement and the United States Justice Department that harassment at their clinics was on the rise, and they were scared. The Feminist Majority Foundation had been hearing all spring that the atmosphere outside clinics was heating up in the wake of the new pro-choice president’s election. “We all lived through Clinton, the shootings in ‘93 and ‘94. We were concerned some of the extremists said they had to take the fight ‘back to the streets,’” Smeal said.

There are legal protections in place that ought to keep abortion providers like Tiller safe. The Freedom of Access to Clinic Entrances (FACE) Act, passed by Congress after the 1993 murder of Dr. David Gunn outside his Pensacola, Fla., women’s health clinic and the attempted murder of Tiller that same year, prohibits property damage, acts or threats of force, and interference with and intimidation of anyone entering a reproductive health care facility.

When the federal law is backed by complementary state laws, and when local law enforcement officers apply those laws assiduously, serious violence greatly declines. When the law’s not applied strenuously, when vandalism goes uninvestigated, when protesters are allowed to photograph or videotape patients arriving at women’s health clinics, when death threats aren’t followed up, more serious acts of physical violence follow. In fact, when intimidation occurs at a clinic, the reported rate of violence triples, the Feminist Majority Federation’s 2008 National Clinic Violence Survey found.

“We really do need to arrest people who are trespassing. Arrest people who are gluing locks. Committing more minor violations of the law so criminal activity doesn’t escalate, so these criminals don’t feel emboldened,” said Vicki Saporta, the president of the National Abortion Federation. “In places where the laws are enforced, you don’t see violence escalate. Protesters generally go someplace where there’s a more hospitable climate,” she told me. But, she added, in a lot of communities, law enforcement views clinic violence as a political problem. “They don’t view it for what it is: criminal activity outside of a commercial establishment,” she said. “Law enforcement can’t treat this as a political issue. It’s a criminal issue.”

We as a nation cannot continue to provide a hospitable environment for the likes of Roeder because the thought of what happens to fetuses in late abortions turns our stomachs. We have to accept that sometimes terrible things happen to young girls. We have to face the fact that sometimes desired pregnancies go tragically wrong. We have to weigh our repugnance for late abortion against the consequences for women and girls of being denied life-saving medical treatment.

Only a tiny handful of doctors in this country will, like Dr. Tiller, provide abortion services for girls or women who are advanced in their pregnancies. These doctors aren’t well known to patients or even to other doctors, but they’re closely monitored by anti-abortion groups, who know where they work, where they live and where they worship. Roeder may have been a lone gunman, but in the largest possible sense, he did not act alone. The location of Tiller’s gated community was prominently featured on an easily-accessed Web site, along with a map of the streets surrounding his house. It was really only a matter of time before someone was unbalanced enough to take the bait.

Most Americans, I’m sure, do not believe that a 9-year-old should be forced to bear a child, or that a woman should have no choice but to risk her life to carry a pregnancy to term.

By averting our eyes from the ugliness and tragedy that accompany some pregnancies, we have allowed anti-abortion activists to define the dilemma of late abortion. We have allowed them to isolate and vilify doctors like Tiller.

We can no longer be complicit—through our muted disapproval or our complacency—in domestic terror.

— warner.blogs.nytimes.com, June 4, 2009