An Abortion Battle, Fought to the Death

An Abortion Battle, Fought to the Death
By DAVID BARSTOW
Copyright by the New York Times
Published: July 25, 2009
http://www.nytimes.com/2009/07/26/us/26tiller.html?_r=1&th&emc=th


WICHITA, Kan. — It did not take long for anti-abortion leaders to realize that George R. Tiller was more formidable than other doctors they had tried to shut down.

Shrewd and resourceful, Dr. Tiller made himself the nation’s pre-eminent abortion practitioner, advertising widely and drawing women to Wichita from all over with his willingness to perform late-term abortions, hundreds each year. As anti-abortion activists discovered, he gave as good as he got, wearing their contempt as a badge of honor. A “warrior,” they called him with grudging respect.

And so for more than 30 years the anti-abortion movement threw everything into driving Dr. Tiller out of business, certain that his defeat would deal a devastating blow to the “abortion industry” that has terminated roughly 50 million pregnancies since Roe v. Wade in 1973.

They blockaded his clinic; campaigned to have him prosecuted; boycotted his suppliers; tailed him with hidden cameras; branded him “Tiller the baby killer”; hit him with lawsuits, legislation and regulatory complaints; and protested relentlessly, even at his church. Some sent flowers pleading for him to quit. Some sent death threats. One bombed his clinic. Another tried to kill him in 1993, firing five shots, wounding both arms.

In short, they made George Tiller’s clinic the nation’s most visible abortion battleground, a magnet for activists from all corners of the country.

Dr. Tiller would not budge.

Instead he dug in, pouring his considerable profits into expanding his clinic and installing security cameras, bulletproof glass, metal detectors, fencing and floodlights. He hired armed guards, bought a bulletproof vest and drove an armored S.U.V. He spent hundreds of thousands of dollars on some of the state’s best lawyers and recruited an intensely loyal staff that dubbed itself Team Tiller. He lobbied politicians with large donations and photographs of severely deformed fetuses.

Confident and dryly mischievous, he told friends he had come to see himself as a general in an epic cultural war to keep abortion legal, to the point of giving employees plaques designating them “Freedom Fighters.” His willingness to abort fetuses so late in pregnancies put him at the medical and moral outer limits of abortion. Yet he portrayed those arrayed against him as religious zealots engaged in a campaign whose aim was nothing less than to subjugate women.

“If a stake has to be driven through the heart of the anti-abortion movement,” he said, “I want to have my hand on the hammer.”

The son of a prominent Wichita physician, married 45 years, the father of 4 and grandfather of 10, a former Navy flight surgeon, a longtime Republican, Dr. Tiller, 67, insisted that he would not be driven from his hometown, where he belonged to its oldest country club, was a devoted member of one of its largest churches, was active in Alcoholics Anonymous, was deeply involved in his alma mater, the University of Kansas, and adored his local Dairy Queen.

Indeed, he made a point of performing abortions the day after he was shot in the arms.

“His is the only abortion clinic we’ve never been able to close,” Troy Newman, president of Operation Rescue, said in an interview.

Yet what thousands could not achieve in three decades of relentless effort, a gunman accomplished on May 31 when he shot Dr. Tiller in the head at point-blank range while the doctor was ushering at church.

Scott Roeder, an abortion foe with the e-mail name “ServantofMessiah,” awaits trial in the murder. In a jailhouse interview, Mr. Roeder did not admit guilt but told a reporter that if he is convicted, his motive was to protect the unborn, a goal seemingly advanced when the Tiller family closed the clinic.

But in the weeks since the killing, supporters and opponents of Dr. Tiller have been measuring the larger ramifications. Implacably divided for so long, they now agree on a fundamental point: Dr. Tiller’s death represents an enormous loss for each side.

Abortion opponents are bracing for a drop in support, especially from those in the murky middle ground of the debate. Worse yet, after years of persuading supporters to work within the law, they say they have already lost credibility among the most ardent abortion opponents who cannot help pointing out that one gunman achieved what all their protests and prayers could not.

“The credit is going to go to him,” Mark S. Gietzen, chairman of the Kansas Coalition for Life, said of Mr. Roeder. “There are people who are agreeing with him.”

Advocates of abortion rights, meanwhile, are reeling from the loss of one of their most experienced and savviest leaders. One of only three doctors in the United States who openly and regularly performed late-term abortions, Dr. Tiller mentored abortion providers across the country. Some of the nation’s most influential women’s groups celebrated him as an American hero.

Dr. Tiller’s career in abortion began with family tragedy.

In August 1970, his parents, sister and sister’s husband were killed when the small private plane his father was piloting crashed near Yellowstone National Park. Dr. Tiller, who had carried his father’s bag on house calls as a boy, left the Navy and returned home to care for his grandparents and wind down his father’s family practice. He and his wife, Jeanne, adopted his sister’s baby son, and he talked of settling into life as a dermatologist.

But he discovered his father had been performing significant numbers of illegal abortions, and before long women began turning to him for abortions, too, often under desperate circumstances. “The women taught him about life in Wichita,” said Linda Stoner, who worked for Dr. Tiller for a decade. The more skilled he became, the more referrals he got, the more he undercut prices of competitors, the more he began to specialize in abortion, making it the main focus of his practice by the late 1970s.

Friends said Dr. Tiller knew he would become a target. Pickets first showed up in 1975, two years after he performed his first abortion. Years later, an anti-abortion group put him on a “wanted” poster of prominent abortion providers and offered $5,000 for information leading to his arrest. When an abortion provider in Florida was assassinated in 1994, Dr. Tiller spent the next few years under the protection of federal marshals. By 1997, he had been labeled “the most infamous abortionist in the United States” by James C. Dobson, founder of Focus on the Family.

“He chose his life,” said Dan Monnat, his longtime lawyer. “And having chosen it, he wasn’t going to complain about the restrictions on his liberty by those who saw it another way.”

Dr. Tiller also accepted that his career would inevitably bring scrutiny of his private life, including his struggle with substance abuse, which resulted in a 1984 arrest for driving under the influence and an agreement with the Kansas State Board of Healing Arts to seek treatment. (He would later serve on the Kansas Medical Society’s impaired physicians committee.)

Still, his family strongly supported his choice. He described his daughters, two of whom became physicians, coming into his study during one especially stressful period. “What they said to me was, ‘Daddy, if not now, when? If not you, who?’ ” he recalled this spring in a court hearing.

Dozens of anti-abortion groups of varying sizes and philosophies were out to shut down his clinic, Women’s Health Care Services. While their tactics constantly changed, they shared the same basic goal. “We wanted it to get to the point where it was no longer feasible to stay open,” Mr. Gietzen of the Coalition for Life said.

Every vendor who showed up at the clinic was warned that if they continued to do business with Dr. Tiller they would be boycotted. Those who ignored the threat were listed on anti-abortion Web sites. “We had nobody in town that would deliver pizza,” said an employee, Linda Joslin.

Protesters confronted his employees, demanding that they quit. If they refused, activists passed out fliers in their neighborhood accusing them of working for a baby killer.

Patients would encounter a gantlet of protest.

They would see a “Truth Truck,” its side panels displaying large color photographs of dismembered fetuses. Over the clinic gate, strung between two poles, they might see a banner, “Please Do Not Kill Your Baby.” Planted in the grass by the sidewalk were 167 white crosses, representing the average number of abortions that protesters said were performed there each month.

Protesters approached patients’ cars, offering them baby blankets and urging them to visit an anti-abortion pregnancy clinic they had set up next door. Sometimes they followed patients to their hotels and slipped pamphlets under their doors. A few years ago anti-abortion campaigners spent weeks in a hotel room with a view of the Tiller clinic entrance. Using a powerful telephoto lens, they took photographs of patients, which were posted on a Web site with their faces blurred.

Much of this activity was methodically tracked by Mr. Gietzen, who said he presides over a network of 600 volunteers, some of whom drove hundreds of miles for a protest “shift.” Protesters counted cars entering the clinic gate, and they tracked “saves” — patients who changed their minds. According to Mr. Gietzen’s data, over the last five years they had 395 “saves” for an “overall save rate” of 3.77 percent.

They also kept detailed “incident reports” of unusual activity. It was a bonanza if an ambulance was summoned; photographs were quickly posted as evidence of another “botched” abortion.

There seemed an endless supply of fresh accusations.

“Wichita shoppers unknowingly sprinkled with the burnt ash of fetal remains,” declared one news release, referring to the clinic’s crematorium.

“If I can’t document it, I don’t say it,” Mr. Newman of Operation Rescue said, moments before suggesting without any proof that Dr. Tiller had bought off the local district attorney, Nola T. Foulston, by giving her a baby for adoption. He referred a reporter to a Web site that vaguely asserted that Dr. Tiller “may have delivered the ultimate bribe to Nola Foulston.” A spokeswoman for Ms. Foulston declined to discuss the accusation.

Anti-abortion activists routinely portrayed Dr. Tiller’s campaign contributions as “blood money” that co-opted politicians. “He owned the attorney general’s office,” Mr. Newman said. “He owned the governor’s office. He owned the district attorney’s office.”

They relished each confrontation, both for public relations value and for the legal costs inevitably incurred by Dr. Tiller. He spent years, for example, fighting a legal battle to stop them from planting the crosses, and just about every inch of land outside his clinic was subject to litigation or negotiation.

“We know what you can do on the blacktop,” Mr. Gietzen said. “We know what you can do on the driveway. We know what you can do on the sidewalk.”

In April 2006, though, a volunteer spotted an opportunity for confrontation in one small strip of pavement that he thought had been overlooked: the gutter running between the street and the clinic driveway. The volunteer knelt in the gutter to pray, placing himself in the path of vehicles entering the clinic.

According to the “incident report,” a clinic nurse pulled up and “laid on her horn repeatedly.” When the volunteer “acted as if he did not know that she was there,” the report continued, a clinic guard told him that he was reporting him to the police.

The next day, Mr. Gietzen was standing in the gutter with his volunteer discussing the new tactic when Dr. Tiller pulled up in his armored S.U.V. In another “incident report,” Mr. Gietzen wrote: “Tiller floored his accelerator, and aimed his Jeep directly at us!”

Mr. Gietzen claimed that Dr. Tiller’s vehicle hit him, causing bruising. He promptly filed a police report, generating more news coverage. He then wrote to Dr. Tiller demanding a $4,000 settlement. When that went nowhere, he sued. He also demanded that Ms. Foulston prosecute Dr. Tiller for attempted murder.

And when she refused, this became more proof of the public “corruption” they traced to Dr. Tiller.

Developing a Sense of Mission

Jacki G., 29, went to Dr. Tiller for an abortion in 1996 after she was raped. She can still remember her trepidation when she and her mother pulled up to the clinic a few weeks into her pregnancy.

In middle school in Wichita, she said, children chanted “Tiller, Tiller, the baby killer.” She recalled the gory Truth Trucks driving around town and the 1991 “Summer of Mercy” protests, when hundreds were arrested for blockading Dr. Tiller’s clinic.

“It makes an impression,” she said.

Not only did she fear the protesters, she also worried about whether Dr. Tiller would be gruff and cold, “only in it for the money,” as his critics alleged. It was almost a shock, she said, to instead meet a slightly nerdy doctor who gently explained every step and kept asking, “Are you doing O.K.?”

Employees said Dr. Tiller did not have moral qualms about his work, in part because he defined it as saving women’s lives and giving them freedom to determine their futures.

“We have made higher education possible,” he said in a speech. “We have helped correct some of the results of rape and incest. We have helped battered women escape to a safer life. We have made recovery from chemical dependency possible. We have helped women and families struggle to save their unwell, unborn child a lifetime of pain.”

Dr. Tiller recruited a staff that shared his outlook. Mostly women, several used the same word to describe the clinic: “sisterhood.”

They worked under intense pressure, caring for women in distress while constantly confronting protesters eager to pounce on their every mistake. Abortion protesters sent pregnant women into the clinic “under cover,” hoping to catch the staff violating Kansas abortion regulations. One employee, Ms. Joslin, 68, pulled out an anonymous letter she received a week before Dr. Tiller’s death. “Somebody should kill you, so you can’t kill anymore,” it said.

As Wichita’s three other abortion clinics closed under the pressure of protesters, Dr. Tiller cultivated a sense of mission. Throughout the clinic he hung hundreds of framed thank-you letters from patients. He posted a list of “Tillerisms” — his favorite axioms, including, “The only requirement for evil to triumph is for good people to do nothing.”

He also paid well and gave bonuses to mark legal victories. In 2001, after heavy protests, he held a party and gave each employee a dozen roses, a medal engraved with the torch of liberty, a T-shirt depicting Rosie the Riveter and the words, “We can do it Team Tiller,” and an American flag that had flown over the clinic.

His defiance was as relentless as the protests. When his clinic was bombed, he put up a sign that said “Hell, no. We won’t go!” In a fit of anger, he once told an anti-abortion leader, “Too bad your mother’s abortion failed.” Employees and protesters alike said he even drove into his clinic “with attitude,” accelerating slightly as if to emphasize that protesters had no right to block his gate. And when he drove by Mr. Gietzen, he sometimes smiled and lifted an editorial cartoon depicting Mr. Gietzen as a lunatic.

In 2001, protesters began appearing at Dr. Tiller’s church with Truth Trucks and a demand that the church ex-communicate the Tiller family.

“They were abusively shouting at people not to take their children into the church because there was a murderer there,” recalled the Rev. Sally C. Fahrenthold, then the interim pastor at the church, Reformation Lutheran.

For at least two years, protesters showed up each Sunday, sometimes disrupting services from the pews. Protesters obtained a copy of the membership address book and sent all members postcards showing aborted fetuses.

Years earlier, friends said, the Tillers had been asked to leave another church because of his abortion practice. Reformation Lutheran made no such request. The Tillers were mainstays in the church. Jeanne Tiller sings in the choir, and her husband was a regular in Bible study. Still, the Tillers were saddened by the protests, Pastor Fahrenthold said, and a couple of families left the church.

Eventually the Sunday protests petered out, although every so often protesters returned. Last fall, when the church was recruiting a new pastor, it listed abortion as one of the main challenges facing the membership. “Everybody there was not on the same page on this issue,” the new pastor, Lowell Michelson, said in an interview.

Pastor Michelson said he and Dr. Tiller sometimes spoke about abortion. This, he said, is how he learned of adoptions Dr. Tiller sometimes arranged for his patients, in some cases even having women live with his family until after childbirth. “He was giving women in the most desperate of situations options when they had none,” he said.

One lingering question in the church, though, was whether to improve security, and there was talk about buying a camera for the church entrance. Dr. Tiller did not perceive any significant threat. He did not, at least in recent years, take his guards to church.

“The church was the one place he felt safe,” Ms. Joslin said.

Several years ago it became clear to anti-abortion leaders that they needed a new strategy to shut down Dr. Tiller. They eased off their more combative protest tactics and resolved to rely more on the courts, the Kansas Legislature and the news media to attack him.

They also decided to sharpen their focus on late-term abortions.

Dr. Tiller’s clinic Web site boasted that he had more experience with late-term abortions “than anyone else currently practicing in the Western Hemisphere.” Since 1998, interviews and state statistics show, his clinic performed about 4,800 late-term abortions, at least 22 weeks into gestation, around the earliest point at which a fetus can survive outside the womb. At 22 weeks, the average fetus is 11 inches long, weighs a pound and is starting to respond to noise.

About 2,000 of these abortions involved fetuses that could not have survived outside the womb, either because they had catastrophic genetic defects or they were simply too small.

But the other 2,800 abortions involved viable fetuses. Some had serious but survivable abnormalities, like Down syndrome. Many were perfectly healthy.

Like many states, Kansas has long placed limits on late-term abortions of viable fetuses. They can be done only to save the woman’s life or because continuing the pregnancy would cause her a “substantial and irreversible impairment of a major bodily function,” a phrase that Kansas legal authorities, citing United States Supreme Court cases, have said encompasses the woman’s physical and mental health. The state also requires the approval of a second Kansas physician “not legally or financially affiliated” with the doctor performing the abortion.

Even so, Kansas law gives considerable deference to physicians’ judgments. Dr. Tiller and his staff said they had a rigorous screening process to comply with the law.

The vast majority of women seeking late-term abortions from Dr. Tiller’s clinic were from other states, records and testimony show. Dozens more came each year from Canada and other countries. Many were referred by their obstetrician. Law enforcement officials sometimes gave Dr. Tiller’s name to victims of rape or incest.

Prospective patients were required to submit a battery of medical records. They were asked whether they had considered adoption. Before meeting Dr. Tiller, women were interviewed by at least two clinic counselors. Many of the questions — about appetite, sleep habits, thoughts of suicide — were intended to detect symptoms of severe mental illness. Patients were also examined by a second physician, as required by law.

According to sworn testimony by his staff, hundreds of women were turned away each year because they did not meet the legal requirements for a late-term abortion.

When late-term abortions were done, Dr. Tiller typically injected a lethal drug into the fetus’s heart, then induced labor after the heart stopped. The entire process typically took several days, and many patients have written tributes about the sensitive care they received.

Abortion opponents focused on a different aspect of the procedure: the fees. Describing Dr. Tiller’s “decadent, lavish lifestyle,” an Operation Rescue Web site included a photograph of his 8,500-square-foot home.

Based on Dr. Tiller’s sworn testimony, his clinic grossed at least $1.5 million in 2003 from late-term abortions, a small fraction of the total number of abortions his clinic performed. On average, he charged $6,000 for a late-term abortion, and by his calculation the clinic’s profit margin was 38 percent.

Anti-abortion leaders were determined to demonstrate that Dr. Tiller enriched himself by performing late-term abortions for trivial reasons, and they believed that Kansas law offered the key to exposing that and closing him down. A billboard in Wichita asked, “Is Tiller above the law?”

They found two powerful champions.

The first was Phill Kline, a conservative radio host and fierce abortion opponent who was elected attorney general of Kansas in 2002 and promptly opened an investigation into Dr. Tiller.

In 2004, Mr. Kline subpoenaed case files of 60 women and girls who had late-term abortions performed at Dr. Tiller’s clinic. (He also sought 30 files from Planned Parenthood in Overland Park.) Mr. Kline said his inquiry centered on potential violations of the late-term abortion law and a second law requiring physicians to report evidence of sexual abuse against minors.

The second champion was Bill O’Reilly of Fox News, host of the nation’s most-watched cable news program, who began attacking Dr. Tiller in 2005, eventually referring to him as simply “Tiller the baby killer.” Mr. Gietzen said he and other activists fed tips to Mr. O’Reilly’s staff. Mr. O’Reilly began one program this way: “In the state of Kansas, there is a doctor, George Tiller, who will execute babies for $5,000 if the mother is depressed.”

Dr. Tiller assembled a legal team to derail Mr. Kline’s investigation. While the Kansas Supreme Court refused to quash Mr. Kline’s subpoena, it was clearly uneasy. Noting that the files “could hardly be more sensitive,” the court ordered identifying information redacted and warned both sides to “resist any impulse” to publicize the case.

Mr. Kline’s investigators tried to identify patients anyway, court records show. Mr. Kline also hired medical experts recommended by anti-abortion groups and gave them access to the files without requiring them to pledge confidentiality.

One expert, Paul McHugh, a professor of psychiatry at Johns Hopkins, then discussed the files — though not identities — in a videotaped interview arranged by anti-abortion activists that quickly made its way to Mr. O’Reilly and others in the news media.

Calling Mr. Kline’s conduct “inexcusable,” the Kansas Supreme Court reprimanded him in an opinion that questioned his ethics and honesty. “Essentially, to Kline, the ends justify the means,” the justices said.

Legal Victories

Nonetheless, Dr. McHugh’s interview raised the question of whether Dr. Tiller had used readily treatable mental health maladies as a pretext to justify late-term abortions.

According to Dr. McHugh, the files he saw contained diagnoses like adjustment disorder, anxiety and depression that to his eyes were not “substantial and irreversible.” He also claimed that some women offered “trivial” reasons for wanting an abortion, like a desire to play sports. “I can only tell you,” he said in his taped interview, “that from these records, anybody could have gotten an abortion if they wanted one.”

Yet Dr. McHugh’s description of the files left out crucial bits of context. He failed to mention, for example, that one patient was a 10-year-old girl, 28 weeks pregnant, who had been raped by an adult relative. Asked about this omission by The New York Times, Dr. McHugh said that while the girl’s case was “terrible,” it did not change his assessment: “She did not have something irreversible that abortion could correct.” (Dr. Tiller’s lawyers, who have called Dr. McHugh’s description of the patient files “deeply misleading,” declined to discuss their contents.)

Not content to rely only on Mr. Kline, anti-abortion leaders also took advantage of an obscure Kansas statute allowing residents to petition for grand jury investigations. They gathered thousands of signatures to convene two grand juries focusing on Dr. Tiller.

The first, in 2006, investigated the case of Christin A. Gilbert, a 19-year-old with Down syndrome who died two days after having an abortion at Dr. Tiller’s clinic. The autopsy concluded that Ms. Gilbert “died as a result of complications of a therapeutic abortion,” most likely infection. But the Kansas Board of Healing Arts, after an 11-month investigation by two separate panels, cleared Dr. Tiller of wrongdoing. The grand jury declined to indict.

Mr. Newman of Operation Rescue appeared before the second grand jury armed with a thick briefing book summarizing his group’s investigation into Dr. Tiller. The grand jury was also given access to medical records for more than 150 randomly selected patients who had late-term abortions.

It also declined to indict.

But it did so in a way that was less an exoneration than a criticism of the Legislature for failing to provide clearer guidelines. The law as written and interpreted, the grand jury complained in a statement, seemed to allow late-term abortions to prevent health problems that “as a matter of common interpretation” were not “substantial and irreversible.” The grand jury said lawmakers had intended to limit these late-term abortions to “only the gravest of circumstances,” yet Dr. Tiller’s files “revealed a number of questionable late-term abortions.”

In 2006, Mr. Kline lost his re-election bid by 17 percentage points to Paul J. Morrison, who made Mr. Kline’s abortion investigation a major issue. To anti-abortion activists, Mr. Kline’s defeat was yet another example of Dr. Tiller’s raw clout. Dr. Tiller, they said, had given hundreds of thousands of dollars to a political action committee that criticized Mr. Kline, who was labeled the “Snoop Dog.” They claimed that Dr. Tiller would press the new attorney general to end Mr. Kline’s investigation.

Instead, Mr. Morrison charged Dr. Tiller with 19 misdemeanor violations of the late-term abortion law involving the very files Mr. Kline had subpoenaed.

Dr. Tiller was charged with violating the provision requiring the independent approval of a second Kansas doctor. The same doctor, Ann K. Neuhaus, had signed off on all 19 cases. She typically saw patients at Dr. Tiller’s clinic once a week. Although patients paid her directly, prosecutors claimed that she and Dr. Tiller had a symbiotic relationship because his patients were her only source of income.

Dr. Tiller responded with customary self-confidence, insisting that he would take the stand.

The trial so long sought by abortion foes took place this March. It quickly became clear that the case was far from ironclad. The prosecutor produced no evidence of shared fees, partnership agreements or kickbacks. He was reduced to pointing out that Dr. Neuhaus had hugged Dr. Tiller before testifying.

Worse still, there was evidence that an official for the Kansas Board of Healing Arts had suggested the arrangement with Dr. Neuhaus, who had closed her own women’s health clinic to care for her diabetic son. There was also evidence that several times a year Dr. Neuhaus disagreed with Dr. Tiller about whether an abortion was necessary. As for Dr. Neuhaus examining women at his clinic, Dr. Tiller told jurors that was done to spare patients repeated confrontations with protesters.

Why, he was asked, were so few doctors in America willing to perform late-term abortions? “Because of the threat to themselves and to their family,” he replied.

Why had he not switched to another kind of medicine? “Well,” he said, “quit is not something I like to do.”

The jury took less than 30 minutes to acquit Dr. Tiller of all charges.

It was an enormous victory, but Dr. Tiller’s supporters feared a backlash. Anti-abortion activists who had attended court sessions were disgusted. Mr. Newman remembered one new face among the regulars in court — Scott Roeder, who told other protesters that the trial was a “sham” and had argued in years past that homicide was justifiable to stop abortions.

Facing the Risks

On Sunday, May 31, Reformation Lutheran Church celebrated the Festival of Pentecost with a special prelude of international music.

Most members were already settled in the pews, but Dr. Tiller, an usher that morning, was greeting stragglers in the foyer by the sanctuary entrance. His wife was in the sanctuary where Pastor Michelson, beating a darbuka drum, was midway through an African song called “Celebrate the Journey!”

Pastor Michelson heard a sharp noise but thought it was probably a child dropping a hymnal. Then an usher beckoned him toward the sanctuary entrance. “George has been shot,” the usher told him quietly.

Two church members were already performing CPR on Dr. Tiller by the juice and coffee table. Pastor Michelson heard someone say a gunman — later identified by the police as Mr. Roeder — had fled.

Pastor Michelson thought of the families, the children, in the sanctuary. An assistant pastor, trying to avoid panic, went ahead with the service. Dr. Tiller died in the foyer.

Long ago, he had accepted the possibility he might be assassinated. It was something he and his fellow abortion providers had quietly discussed, and friends said he had lost count of all the death threats.

Even so, there was a mood of stunned rage when local abortion rights advocates gathered the Friday after his killing at First Unitarian Universalist Church in Wichita.

Marla Patrick, the Kansas state coordinator of the National Organization for Women, spoke of all the other abortion providers who had been killed, injured or threatened. Including Dr. Tiller, four doctors have been slain in the United States since 1993. It was time, she said, for law enforcement to treat abortion violence as “domestic terrorism.”

Pedro L. Irigonegaray, a lawyer for Dr. Tiller, aimed his fury at Mr. Kline and Mr. O’Reilly, saying their “fraudulent charges” had surely been meant to incite “a response from radicals.”

But it was a demoralized group. In Topeka, the state capital, they have long been outmuscled by conservative Christians, who have been steadily chipping away at abortion rights. One woman, a lobbyist for abortion rights, described how some legislators literally turned their backs when she testified.

Gail Finney, a junior member of the Legislature, stood and asked why there had not been more outcry from the state’s leaders over Dr. Tiller’s killing.

“Where’s the anguish?” Ms. Finney said.

Not a single Kansas politician of statewide prominence showed up the next morning for Dr. Tiller’s funeral, which drew 1,200 mourners. Nor were any at Reformation Lutheran the next day, the first Sunday service after his death.

In the foyer where he was shot, the juice and coffee table had been turned into a memorial, with Dr. Tiller’s photograph next to a basket of buttons he had passed out by the boxful to patients, employees and friends. “Attitude is Everything,” they said.

Outside, Pastor Michelson greeted families with hugs. “There was no way I was going to hide inside,” he later said.

The Tiller clan took their usual spot in the pews, and Mrs. Tiller, radiant in red, was embraced again and again. Flowers from her husband’s funeral framed the altar.

The church was more crowded than usual.

In his sermon, Pastor Michelson openly acknowledged his own apprehensions. “Our sanctuary has been violated,” he said. He urged his congregation to rise above fear and anger, and took note of the supportive letters and e-mail messages from churches all over the country.

Only later, during an interview, did he mention all the hate mail.

An End to the Fight

The next morning the Tillers announced the clinic’s closing.

“We are proud of the service and courage shown by our husband and father and know that women’s health care needs have been met because of his dedication and service,” the family said in a statement. “That is a legacy that will never die.”

Mr. Gietzen absorbed the news in his dimly lighted basement, surrounded by dusty stacks of anti-abortion literature, news releases and petitions. Dozens of campaign signs, including one for Mr. Kline, covered one wall. In a corner he had built a crude assembly line for producing the crosses he planted at Dr. Tiller’s clinic. In his driveway was Truth Truck No. 3, proclaiming “Abortion is an ObamaNation.”

Mr. Gietzen juggled two phones, one for his volunteers and one for his Christian dating service.

A volunteer called and Mr. Gietzen issued instructions to call off a protest at the clinic. No need now, he said.

The phone rang again. A volunteer wondered whether the announcement was a trick.

“Listen, Donna,” he said, “I’m sure it’s not a ploy.”

Another call: The voice was jubilant. “God has his own way,” Mr. Gietzen replied, “but you can’t say our prayers weren’t answered.”

Yet later, Mr. Gietzen said his feelings were more complex. Many years ago, he explained, he had wrestled with the question of whether it would be moral to kill Dr. Tiller. Only after months of reading and praying, he said, did he conclude that violence could never be justified. Killing men like Dr. Tiller, he said, will only put off the day when abortion is outlawed altogether.

“He has killed more babies than he has saved,” Mr. Gietzen said of Mr. Roeder. “I don’t care how much fan mail he is getting.”

As he explained himself, Mr. Gietzen did something unexpected. He spoke admiringly of the man he reflexively referred to as “Abortionist Tiller.” He said he was “very smart” and a “great businessman.” He said that if he had been in town he would have attended Dr. Tiller’s funeral to pay his respects.

“A worthy adversary,” he said. “He was right back at us.”