On Pentecost Sunday 2009, Scott Roeder entered Wichita’s Reformation Lutheran Church and fired a single round into the forehead of George Tiller, a 67-year-old late-term abortion provider who was serving the congregation as an usher that morning. News that Tiller had been killed in church softened his public image, and tributes from family and colleagues seemed to cut against the conservative media’s portrait of him as a cold and calculating killer. For years Bill O’Reilly had referred to him simply as “Tiller the Baby Killer,” but in his last act the doctor was the victim, rather than the perpetrator, of violence.

That image continues in After Tiller, a new documentary by filmmakers Martha Shane and Lana Wilson. The film, which debuted at Sundance and was screened at my hometown’s True/False Film Festival, offers a soft and humanizing portrait of the nation’s four remaining late-term abortion providers (three of whom were trained by Tiller). Doctors Leroy Carhart, Shelley Sella, Warren Hern, and Susan Robinson are simultaneously the protagonists and heroes of the film. All have families they love, all struggle with the work they do, and all are subject to public scorn and protest for their chosen profession.

After Tiller paints an emotional and challenging portrait of women who are faced with the heart-wrenching news that their six- or seven-month-old unborn child has been diagnosed with a seemingly impossible and perhaps even fatal medical condition. As the documentary opens, the decision to end the life of a child in such a circumstance is depicted as merciful and even right.

In one scene, Dr. Sella counsels a patient whose baby has a rare congenital disorder in which part of the brain—the corpus callosum—fails to form. The woman is emotionally distraught and struggles with the guilt she feels for choosing abortion. Yet she is tormented by the thought that she might “bring him into this world and then he doesn’t have any quality of life.”

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In an interview, Sella confesses her own struggles. “I think about what I do all the time,” she says. “And I recognize what I do. And at times I struggle, and at times I don’t. But I always come back to the woman and what she’s going through. And, often, what life will this baby have? What will it mean to be alive with horrific fetal abnormalities? It’s not just about being alive. It’s about life and what does it mean.”

In the context of the debate over late-term abortion, Sella’s subtle contention is that killing a disabled baby can be an act of mercy and compassion. Although Nazi analogies are rarely helpful when talking about contemporary issues, it is hard not to think of the old German concept of lebensunwertes Leben, or life unworthy of life. In their now infamous book by that title, German professors Karl Binder and Alfred Hoche questioned “whether the vigorous continued preservation of such lives, as evidence of the inviolability of life, deserves preference, or whether permitting their termination, to the relief of everyone involved, would seem the lesser evil.”

The film unquestionably depicts the termination of severely disabled or malformed children as the lesser evil. By the end, however, After Tiller also pushes its viewers to consider the morality of late-term abortion for reasons unrelated to the health or life quality of the child.

At one point, Dr. Robinson confronts a young Catholic woman who is wracked by guilt at the thought of committing what her Church considers a mortal sin. Her parents, the father of the baby, and the father’s parents all plead with her not to have an abortion. Robinson lays out the decision to her this way:

You have three choices. You can have a kid that you say you can’t take good care of. You can have a kid and give it to somebody else, who you know or don’t know. Or you can have an abortion, which you think is the wrong thing to do. Those are your three choices. They all suck.

In putting the options this way, Robinson does not shy away from the fact that abortion ends a life; this is precisely why, to use her phrase, abortion sucks. Throughout the film there is no pretending that a child’s life is not at stake or that what is at issue is merely a clump of cells. At one point, a patient expresses her hope that her baby will become an angel and go to heaven. Later Sella confesses, “I think of them as babies.”

By accepting the humanity of the unborn, After Tiller broaches the question of whether, and in what circumstances, it is morally permissible to end the life of human beings at any age, since the reasons and justifications for ending the life of a child are not dependent, in principle, on its being an unborn child. Pro-choice philosophers and academics have acknowledged this at least since the 1970s, but it has taken several decades for the logic to manifest itself in our culture.

A prescient editorial in a 1970 issue of California Medicine, which supported abortion reform, highlighted the principles at stake in the early abortion debates. “The traditional Western ethic,” the article noted, “has always placed great emphasis on the intrinsic worth and equal value of every human life regardless of its stage or condition.” It was this “reverence for each and every human life” that had “caused physicians to try to preserve, protect, repair, prolong and enhance every human life which comes under their surveillance.”

Yet in the modern world there had been a shift toward a new relative morality “distinctly at variance with the Judeo-Christian ethic.” Since the old ethic had not “yet been fully displaced,” however, it had become necessary for abortion reform proponents “to separate the idea of abortion from the idea of killing.” The article observed:

The result has been a curious avoidance of the scientific fact, which everyone really knows, that human life begins at conception and is continuous whether intra- or extra-uterine until death. The very considerable semantic gymnastics which are required to rationalize abortion as anything but taking a human life would be ludicrous if they were not often put forth under socially impeccable auspices. It is suggested that this schizophrenic sort of subterfuge is necessary because while a new ethic is being accepted the old one has not yet been rejected.

In academic moral philosophy a very different trend started in the 1970s. Instead of maintaining the subterfuge that abortion was not the taking of a human life, philosophers questioned our very taboo against killing human beings before and after birth. While the Supreme Court was hearing oral arguments in the case of Roe v. Wade, Michael Tooley offered the first academic defense of infanticide in the journal Philosophy & Public Affairs. “One reason the question of the morality of infanticide is worth examining,” Tooley wrote, “is that it seems very difficult to formulate a completely satisfactory liberal position on abortion without coming to grips with infanticide.”

Tooley’s argument was that there was no reason in principle to allow abortion but disallow infanticide, at least “during a time interval shortly after birth.” The argument has gone through various iterations over the years, and one example is found in a recent Journal of Medical Ethics article provocatively titled, “After-Birth Abortion: Why Should the Baby Live?” The short answer, from ethicists Alberto Giubilini and Francesca Minerva, is it shouldn’t. “Both a fetus and a newborn are human beings,” they write, “but neither is a ‘person’ in the sense of ‘subject of a moral right to life.’”

Even if unwittingly, the extreme position staked out in academic philosophy journals is the very position to which viewers of After Tiller are being pushed. Once we accept the humanity of unborn children (as the doctors in the film do) and approve the deliberate killing of unborn children diagnosed with severe disabilities, the logical next question is, why not also allow the euthanasia of disabled infants? And if we are prepared to accept other justifications for abortion beyond fetal disabilities, then why not also accept these as justifications for infanticide?

For years those in the pro-life movement have assumed that technology is on their side, because they have assumed that the debate was about when life begins. In an era where friends share 4-D pictures of unborn children on their Facebook pages, a case for the humanity of the unborn is easy to make. Yet it is not enough. After Tiller is a reminder that the debate today is much more about why life is valuable than when life begins. The “traditional Western ethic” holds that life is valuable and inviolate simply because human life is good and it is not ours to take. That ethic is increasingly challenged in our culture, and communicating the pro-life message creatively and winsomely remains a vital task for the generation after Tiller.