Past viability, no doctor will terminate a pregnancy without a compelling reason. But what is a compelling reason, and who decides? Some would count a serious fetal abnormality, mental or physical; others would not. What if the baby has a 50 percent chance of surviving outside the womb? A 30 percent chance? While most of us navigate these questions in theory, Carhart deals with them in practice. At Tiller’s clinic, he saw a rape victim in the third trimester of pregnancy. Every time she felt the baby move, she said, it brought back the rape all over again. She’d made three suicide attempts. Carhart performed her abortion. “If a woman is going to kill herself, then I think you have to look at it for her health,” he says. The day before Tiller’s death, a woman came into Carhart’s Nebraska clinic 28 weeks along. Carhart asked her what she would do if she had to carry the baby to term. “She didn’t say she was going to kill herself,” he says. “She said she would put it up [for adoption].” He turned her away.

Carhart has a few firm lines; he won’t, for example, do elective abortions past 24 weeks, because the fetus is likely viable. “It just makes sense to me,” says Carhart. “After a certain point in time, the fetus is viable and we have to look at it differently than if it were not viable.” And at 24 weeks, many studies show a fetus’s chance of survival to be above 50 percent. Any earlier and the survival rate is lower; at 22 weeks it’s less than 10 percent. But Carhart admits that such clear guidelines rarely present themselves. “There are times when abortion is the right answer,” he says. “There are times when abortion is not the right answer. I hope I get it right.”…

But if Carhart is proud of his practice, he seems equally burdened by it. He talks about being an abortion doctor not necessarily as a career choice, but as a job he had to take since few others would. “It’s like that quotation: ‘If not you, who? If not now, when?’ That whole thing,” he says, giving a modified version of a Hillel quotation (“If I am not for myself, who will be for me? And if I am always for myself, what am I?”). He won’t take long vacations because “you can’t leave the women waiting, or at least don’t want to.” He maintains medical licenses in seven states so that if another provider is “hurt, retired, or killed,” he can step in. If women need this service, Carhart reasons, who is he to say no? If he won’t provide these complex and challenging abortions, who will?