In my early twenties, I worked as an abortion counselor. This was in the mid-1980’s before abortion providers’ lives were on the line and groups like Operation Rescue targeted clinics ruthlessly. Even then, late abortions were rare. During the two years I worked at the clinic, I can recollect only one woman needing a really late abortion. I thought about her after learning of Dr. George Tiller’s death this week, because she was sent to Kansas, possibly to Dr. Tiller himself. Married, with three children four and under, the baby not quite a year, she was breastfeeding (thus her periods had not returned). Her husband was unemployed. Being heavyset and postpartum, her body did not look particularly changed by the first two trimesters of pregnancy. She said, “I was tired, but three kids, one a baby, of course I was tired.” She felt “stupid” for not knowing she was pregnant. She also knew that her family—whether she desired another baby or not—could not support another child at the time. Their resources, financial and emotional, were strained. The decision, while painful, was very clear to her.

While pregnant with my second child, someone close to me was pregnant with her second child when the unimaginable occurred. Tests revealed that the baby would, if born, suffer a terribly painful, debilitating year or so of life and then die. I was told that her doctor, who did not support abortion rights, firmly directed her to terminate the pregnancy. It wasn’t my body, obviously, or my pregnancy, so all I can say is that everyone who loved this family shared in that sadness from a remove and everyone held their collective breath during her next pregnancy and rejoiced when her second, healthy boy arrived.

This week, I’ve thought a lot about the first woman, and how it’s been many, many years since she would have had the option to terminate an unexpected pregnancy discovered late. I thought about how many families experiencing financial stressors due to the economic downturn are quite possibly finding themselves in very similar situations. Making abortion inaccessible (earlier or later) restricts the women’s options. This particular squeeze also constricts people’s ability—it seems—to remain compassionate about others’ situations or choices. The last thing anyone in what feels an impossible situation—regardless of how she resolves it—needs is to feel unduly judged.

I’ve thought, too, about the second woman. At the time, we all took for granted that the revelation of this painful misfortune of the wanted baby’s terrible diagnosis came with an “out” clause, a very painful “solution” (that wasn’t a solution, but a safeguard against more pain for the family and the baby facing a short, physically tortured existence). I am pretty certain that when my peers decided to have prenatal diagnostic tests, they did so (most of them, at least) because they believed they could end a pregnancy they felt was unmanageable. With those options we hold onto a belief that we have—up to a certain moment in pregnancy—the ability to control our destinies.

Vicki Forman’s arresting memoir, This Lovely Life, is being published (Houghton Mifflin) next month. In her book, she writes of her complete surprise upon discovering—and in a different circumstance—that California law required a physician to save even an extremely premature baby’s life. Her twins were born at twenty-three weeks. Having struggled with infertility, she finds herself in an unexpected place; she writes “coming so early and so fragile, I had only one wish: to let them go.” Daughter, Ellie, dies four days later and son, Evan, survives with profound disabilities. Forman writes eloquently about ceding control, letting go of expectations and coming to terms with the losses and gains—ones she could never have fathomed—of parenting Evan. I found myself thinking about how this line—not of when life begins, but when we believe, medically or otherwise that we must sustain it—we now draw and redraw. Dr. Tiller’s work to help women obtain abortions later in pregnancy ran up against the work of obstetricians dealing with extremely premature babies; we are constantly redefining what we can and cannot do. To call these murky waters understates the complexity of both the medicine and the ethics, and doesn’t really begin to dive into such issues as the society’s responsibility or how all of this interfaces with women’s agency over their bodies. What I do know is that we’ve moved, in large part because of technological advances, beyond a time when simple principles are enough to answer what have become exceedingly complex questions about how to deliver equitable, compassionate and responsible reproductive health care.

In the wake of Dr. Tiller’s murder, I believe that we must separate condemning anti-abortion extremists’ violent responses from any conversations about abortion or viability. There are complex issues to wrestle with, and deciding how to navigate those truly grey areas must be left to rational people. Taking this moment in history as an opportunity—an imperative, really—for greater reflection and compassion, we must stand up against what’s obviously wrong—violence against women and their health care providers—before finding a less judgmental and more compassionate, smart place from which to grapple with new, complex territory.