Sundance Review: Moving 'After Tiller' Makes the Case For Third-Trimester Abortions

"Everything has a risk to it," says the late Dr. George Tiller in the opening moments of "After Tiller." It's a prophetic statement that defines the movie's stance. In 2009, Tiller, one of only five licensed physicians performing third-trimester abortions, was shot to death by an extremist while the doctor was attending church. Directors Martha Shane and Lana Wilson follow the experiences of the remaining four in the wake of his death, emphasizing the nobility of their practice even as they face mounting pressure from the far right. The documentary compellingly illustrates how the regular perils of their profession make them martyrs for a tragic need.

This isn't entirely fresh turf in the non-fiction arena. Tony Kaye's stylized "Lake of Fire" provided a frantic overview of abortion protestors around the country, while Rachel Grady and Heidi Ewing's "12th and Delaware" explored the national division over the issue in more poetic terms. Eschewing complex formalism for straightforward portraiture, "After Tiller" provides an intimate look at the tremendous empathy involved in this daunting task. Following Tiller's former colleagues in Nebraska and New Mexico, the movie primarily emphasizes the process of dealing with third-trimester abortions, including glimpses of gloomy exchanges between the doctors and their patients. In most situations, the case for the late stage abortion seems justified, particularly when the would-be parents have discovered that their fetuses suffer from incurable illnesses or the possibility of a lifetime of pain.

Of course, none of that quells the efforts of religious activists doggedly hounding the doctors at every turn. Dr. Leroy Carhart faces the biggest hurdles: His life was threatened by arson 20 years ago; Nebraska legislation eventually forced him to take his practice elsewhere. The directors speak not only to the doctor but his committed wife, deepening the level of conviction that keeps him in the game. That personal dimension is also found with the equally assertive Dr. Warren Hern, whose mother has been on the receiving end of threatening calls.

The other doctors, former Tiller co-workers Susan Robinson and Shelley Sella, give voice to the mental workout involved in justifying their work. "We're a court of last resolve," one of them says, a statement illustrated through each behind-the-scenes glimpse. For privacy purposes, the filmmakers frame patients from the waist down as they discuss their reasons for seeking late term abortions, but the repeated angle also draws out the sense of ubiquity associated with the practice: They aren't random cases, but indicative of a service that's in demand.

This perspective is deepened by historical context: The doctors in "After Tiller" routinely assert that by ceding ground to protestors they would assist in the push-back against Roe v. Wade. While the third trimester situation illustrates the impetus for abortion in its most extreme cases, its ongoing legality assures that the broader institution of abortion stays viable in contemporary society. By displaying the nuance involved in determining when such operations can take place -- the camera captures several instances where the doctors turn patients down -- "After Tiller" demonstrates the necessity of abortion issues to remain in the control of seasoned practitioners rather than ideologues.

In constructing its gripping overview, "After Tiller" maintains a generally straightforward roundup of talking heads, but its unassuming construction gradually generates an authoritative voice. Only once the arguments have been plainly established does the emotion truly take hold, with the doctors expressing their own reservations about their perilous task. In describing the experience of delivering a stillborn child, Stella asserts, "That's not tissue. It's a baby." That line alone embodies the challenge of fighting for a cause that nobody wants to face in the first place.

Criticwire grade: A-

HOW WILL IT PLAY? Well-received at Sundance, the movie should see the hot-button topic generate continuing interest for the film on the documentary circuit and in ancillary markets.