The air might’ve felt a little thinner than usual in Utah when “After Tiller” made its premiere earlier this year at Sundance, the type of atmosphere that should’ve been expected when the film at hand concerned the four remaining practitioners of late-term abortions in the United States. Yet while Martha Shane and Lana Wilson’s moving portrait of the doctors that continue to risk their lives to carry out the increasingly rare procedure would ultimately leave the audience completely breathless, the filmmakers were holding their breath, unsure of how the film would play not only for their first audience, but for their subjects, some of whom were sitting in the crowd.
For that reason, it was even more intense than it would’ve been already when “After Tiller” reaches a climactic scene in which Dr. Susan Robinson, one of the physicians featured in the film, screams out in exasperation “Nobody fucking wants an abortion” in an empty room, after dealing with a patient who’s wavering in their decision, a moment which led someone in the crowd to scream back at the screen, “Nobody DOES fucking want an abortion!”
Yet Shane and Wilson were actually encouraged by the audience participation upon realizing it was in fact Dr. Robinson who said it again. Only this time, it served as a moment of liberation for herself, Dr. LeRoy Carhart, Dr. Warren Hern and Dr. Shelley Sella, the three other doctors featured in “After Tiller” and yes, the film’s co-directors who were gratified to have an opportunity to present a quartet who have been so often talked about, but have rarely spoken out themselves.
“These doctors have had little awards from pro-choice organizations and there are some people in the pro-choice community who are very supportive of them, and they get thanked by the patients, but really by no one else,” says Wilson. “But every day they go past protesters and receive hate mail, so to have them come out on stage after the premiere at Sundance and this incredible standing ovation for them was just the most rewarding part of [making this]. People are using the word ‘hero’ with them, which has never happened before.”
Structured in such a way that brings out the physicians’ quiet dignity while showing their daily struggle, “After Tiller” takes a step away from the heated national debate to look at the complexities surrounding the issue of abortion from a distinctly human perspective. While in Los Angeles earlier this summer at Outfest, Shane and Wilson took the time to explain their approach to the divisive subject matter, learning of Dr. George Tiller, the specialist whose murder galvanized the four other physicians to carry on, and why it was unnecessary to be objective.
I’m always surprised by knowing how big an issue this is and seeing these small clinics in the middle of America. Was there a bit of a culture shock for you?
Lana Wilson: Yeah, we were definitely shocked at how divorced the real situations on the ground are from the rhetoric of the national debate, which is so much about these big philosophical issues that tend to drive people to extremes because you’re talking about these very abstract ideas. People are always going, “Well, when does life begin?” But then when you meet these women, you see that they’re dealing with these very practical realities [such as] their pregnancy is deeply compromised or they do not have enough money to take care of another child.
It just seemed to us like a lot of the specifics of the situation that these women were in just isn’t part of the national debate, probably because it’s really hard to sum up in a sound bite and it’s not something that will rally you on either side of the issue because it’s very complex. We were immediately struck by how the conversations that these women were having in the rooms with those doctors were really different than the conversations in the national debate.
I understand it was through those conversations with the patients that you found your way into the film. How much of an idea did you have of what this film would be and how did it change through those conversations?
Martha Shane: We were originally planning to have it be portraits of these doctors in their everyday lives, asking this question of what it’s like to do this job where you’re at such risk, enduring so many threats and so much harassment, and what would really motivate someone to keep doing this day after day? At first, we didn’t know the patients would be such a big part of it, but as we started spending time with the doctors, it just became clear that those interactions with the patients were what really motivated them to keep going and seeing the transformation that happens over the course of the time they’re at the clinic for three or four days.
These interactions became the emotional part of the movie in a lot of ways and [allowed us] to make the film even more complex — not to just show what it’s like for these doctors, but what it’s like for these women that are coming in and have to make these incredibly difficult decisions for them and their families.
It all makes sense if you think about it because there are so few, but did you know immediately that all four doctors actually had a personal connection to Dr. George Tiller?
LW: I think we did. Once we found out there had only been four [practicing since Dr. Tiller’s death], it was obvious they all knew Tiller, but we didn’t realize that three had trained with Tiller and worked at his clinic in alternating shifts and that the other one, Dr. Hern was really close with Tiller. He went to Tiller’s daughter’s wedding, they went skiing together and it seems like Hern even spent Christmas with him once, so we had no idea that it was that level of closeness.
There’s a whole other movie that could be made about Dr. Tiller’s life and what he and his family went through, but it makes sense because it’s a bit like being in the military. When you’re the only people [doing this procedure] and you’re totally under siege, you can see why they become so incredibly close. I think Dr. Sella says in the film at one point how she always wants to call Dr. Tiller and that’s something they all did a lot [when he was alive], even when they were in different places, because there was no one else to talk to about this. No one else can give medical advice because no one else is doing it, but then also just no one else understands the emotional drain that it takes on them.
One of the things I’ve heard Lana say is that part of the incredible access you received to the patients was due to the fact that by being there you made the patients feel less alone in this vulnerable time. Was that true overall?
MS: I think the main points for us as far as how we were able to get the access we did for the patients was to have this incredibly close collaboration with the counselors at the clinics. They were the ones who were telling [the patients] initially about the film and that felt like a pretty non-aggressive way to be introduced to the patients and then if they were interested, they could come talk to us. It was probably only 10 or 15 percent of the patients who wanted to talk to us any further about the project. But it also was just being young women and fairly unintimidating. A lot of people thought that we were students. We always explained that we were independent filmmakers, and I think a lot of people just felt comfortable with us.
As Lana says, we would find a woman who’s going through this experience by herself and I think this felt like it would be nice to have some people around to talk to so she won’t have to feel as isolated. It was great to feel like the patients didn’t find us intrusive and you can see in the film, which was a surprise even to us, the extent to which they totally forgot about the camera when we were filming in the counseling sessions because there was so much intense emotion happening between them and their partners and their doctors that I just don’t think there was space for anything else.
Was it difficult to keep your distance in those situations?
LW: I don’t think we really tried to keep any kind of emotional distance. We cried in the room sometimes too just as the doctors do. You see Dr. Robinson tearing up when she’s talking to patients. We hugged them all goodbye. We did feel really close to them and the one thing we did do is that Martha and I would crouch in tiny balls in the corner and look away [while we were filming]. One of us would be holding the microphone, but we’d literally, physically shrink and fill in against the wall and try to be very small.
But when we weren’t filming, we’d hang out and talk with them and get to know them, so we did have an emotional connection. It wasn’t like we were trying to be these reporters and keep distance from the subjects. It just wasn’t that kind of situation. We took our cues from the doctors in that way. We tried to treat them the same way that they did.
The structure of the film is subtle but ultimately quite powerful. How did you decide to arrange the patients’ cases so that they got more ethically murky?
MS: That was something we really came up with our editor [Greg O’Toole], who was an amazing collaborator on the film. We realized going into this that we didn’t really want to preach to the choir, but in terms of third-trimester abortion rights, there almost is no choir — 10 percent of Americans support the right to have a later abortion like the ones in our film, so we wanted to find a way to ease into the subject and make people over the course of the film consider the increasingly complex situations.
That’s why we put some of the [extreme fetal anomaly] cases upfront, which I think most people who have seen the film have found very easy to understand and identify with being in that situation and making that decision and then ending with the 16-year-old girl who has someone in her life — her boyfriend’s parents who say they’re willing to take the child —and to use that to really push people to say what does it mean to support this? What does it mean to be pro-choice? And to think about the fact that in order to be pro-choice, you really have to be willing to accept decisions that you might not even agree with, but that’s that person’s decision and not your own.
You’ve said some of the doctors were initially reluctant on participating in the film because they believe the focus should be on the patients. Over the course of the premieres you’ve had, does it seem like they’ve been glad to be a part of the film now?
LW: Absolutely. That’s been the most rewarding part for Martha and I. As soon as we got into Sundance, that’s when we said we’re going to show it to the doctors and we went on this trip where we visited each one of them. We were completely terrified of these people who put their lives in our hands and we hadn’t shown them anything yet because we wanted to be sure we had it at a really great place. We were also worried about how they’d react to seeing themselves on camera, especially about some stuff that might seem off-message to the pro-choice movement like how Dr. Sella [would] react to when she says on camera, “I think of them as babies.”
But that trip was incredible because they all absolutely loved it and I remember at our first screening at Sundance, one of the audience members even asked Dr. Sella, “How did you feel when you saw that “I think of them as babies” thing? And she said at first, she was a bit taken aback, but then she thought that’s just me being honest. And for her, the movie actually captured how she and Susan [Robinson] both do struggle with this work, but in different ways. For Dr. Sella, it is how she thinks of them as babies whereas with Dr. Robinson, her struggle is with that decision-making process, so they told us it helped them see stuff like that more easily.
You debuted at Sundance in January and since then, the debate over abortion rights has only grown more intense, particularly after what happened in Texas. What’s it been like to prepare for the release of this film you spent years making and seeing how timely it is?
MS: It feels so tied to everything and of course, we thought the abortion issue will probably always be topical in this country. But we had no idea that once we started making the film, this groundbreaking law in Nebraska would pass, which banned abortion after 20 weeks and the states would start falling almost like dominoes, passing these laws one right after one another.
After Texas, it was really heartening to see this outpouring of support for abortion rights, even though the legislature [ultimately] passed it, because people were paying attention. I totally understand this because we didn’t know very much about late abortion before we started making the film. Even my most pro-choice or politically active friends don’t often know very much about it, and it felt like these 20-week abortion bans have been passed in a lot of states without anybody really understanding what it means or how they might find themselves in a situation where they might be seeking this kind of abortion.
None of the patients in the film ever expected to find themselves in that situation and they come from such a huge range of political and religious backgrounds, so it was just really heartening to see the issue was finally getting some attention and hopefully the film can at least bring some more understanding to this issue regardless of where you stand politically.
“After Tiller” is currently playing in New York at Film Forum and Lincoln Center and opens on October 4th at the NuArt Theater in Los Angeles and the Bloor Hot Docs Cinema in Toronto. A full list of dates and screenings can be found here.