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Do No Harm: Lana Wilson and Martha Shane on After Tiller

Dr. Susan Robinson in After Tiller

While making After Tiller, Lana Wilson and Martha Shane struggled to get support from granting agencies cautious about supporting a film about such a hot-button topic as third-trimester abortion. In response to the pair’s bid for support, one major film grant organization said, “We’re waiting to see where this movie comes down.” Or, in other words, “We can’t support the film unless we support the way you depict this contentious issue.”

The genius of After Tiller is that it doesn’t “come down” anywhere. It doesn’t make a case or take sides. At a time when documentaries about major political and social issues, with very few exceptions, unabashedly and openly push one agenda or another, Wilson and Shane’s film stands out by taking an utterly humanist, rather than polemical, approach to depicting its chosen topic.

The pair first began thinking about late-term abortions when, in 2009, Dr. George Tiller, attending his local church in Wichita, Kan., was shot through the eye and killed by anti-abortion activist Scott Roeder. Tiller had been one of the very few doctors in the U.S. who carried out legal late-term abortions, and for the duration of his career as an abortion provider he had been the target of violence, having survived the firebombing of his clinic in 1986 and being shot multiple times in 1993.

What was originally conceived as a look at Tiller’s life and the debate surrounding late-term abortion in the U.S. evolved into a portrait of the four doctors — two women, Dr. Shelley Sella and Dr. Susan Robinson, and two men, Dr. LeRoy Carhart and Dr. Warren Hern — who continue Tiller’s work after his murder. After Tiller assumes no bias in its viewers on the subject and makes no attempt to do anything but straightforwardly show the doctors and their interactions with patients, women facing situations so extreme that they are forced to consider a termination at the most unthinkable of times.

Even for the most toughened filmgoer, the prospect of watching a film about abortion seems daunting. However, After Tiller is not a grueling experience. It is, rather, the most compelling and important documentary of the year, a profoundly moving and  genuinely inspiring piece of cinema that is a crucial contribution to the conversation on abortion rights. Cinematographers Hillary Spera and Emily Topper shoot the action simply, capturing the heartbreaking doctor-patient counseling sessions with graceful restraint, shooting only the hands of the patients as they explain the events that have lead them to this point. The editing, too, is elegant, as Wilson and Shane trust the inherent power of the material they have captured, not just the pregnant women’s tales but also the lives of the doctors, who approach their difficult work with incredible compassion, and in some cases, have sacrificed a great deal personally, too, because of their professional lives.

After Tiller premiered in competition this past January at the Sundance Film Festival and was subsequently acquired by Oscilloscope, who will release the film theatrically on Sept. 20. Filmmaker sat down with Wilson and Shane to discuss the unique challenges they faced in making their film.


How did you two first meet? Shane: We both studied film at Wesleyan University, graduated in 2005. We were roommates in New York for one year after college.

And did you collaborate together at Wesleyan?  Wilson: No.

Shane: There’s not a ton of production classes at Wesleyan.

Wilson: But I do remember I hated working with crews. There were just three of us [on After Tiller]: me, Martha and the cinematographer. There’s something nice about just having this tiny crew, where it just feels like we’re all working. One of us was doing sound, and the other directing, but also producing and dealing with [any] crises coming up. So it just felt like everyone’s time was being used efficiently. I love that feeling at the end of the day where it’s been 14 hours, and you’ve given it everything, and there’s been no tedious waiting.

How did the idea for After Tiller originate? Wilson: I came up with it from watching the news coverage of Dr. Tiller’s death on TV. I was obsessed with what had happened and shocked by how it was being covered in the news. [It was] “A controversial doctor’s been killed,” and then they get a talking point from each side of the issue. But they didn’t really say anything about who this guy was or why he was doing this. First, I thought, “Wow, he’s been killed in a church, a church he’s been going to with his family for 30 years.” And I was really surprised that the number one target of the anti-abortion movement was a religious Christian. And then, I discovered he’d been shot once before in the ’90s, and he’d gone back to work the next day. Who would do that? It’s completely insane. Then I wondered, why would a woman seek a late abortion? Neither of us had any idea whether, now that he’d died, there was anyone left to replace him. So I thought, “This is going to be a movie about Tiller. I’ve gotta make this movie about Tiller.” And then a friend said, “Well, what about the doctors who are left now?” I was like, “You’re right. That’s a great way to do that, to see who’s left now.”

Approach it from a different angle. Wilson: I wanted to get away from these talking points, people screaming at each other on the news, because so often these philosophical points feel very abstract and intellectual — when does life begin, theoretically? That’s so far removed from what the real situations that the women and the doctors are in. [I realized] a film like this could be really focused on them and look at it in a different way. I hadn’t made a film before, and Martha had been making films. So I asked her if she would collaborate. Luckily, she agreed. [Laughs]

Shane: It seemed shocking to me that in a country of this size that there would be only four other doctors who were open about doing these later abortions. And then there’s such a human interest angle. I really came at it just with a lot of curiosity — and not a very political perspective — about what would motivate anybody to do this work despite the risks.

I feel like a great strength of the film is that it treats a politically charged subject from a humanist standpoint. Shane: We were really set from the beginning on just letting the doctors tell their stories in their own words. And we were so lucky that the doctors were so candid with us in the interviews. They weren’t repeating political talking points. They were really honest about their own personal struggles with this work. Third trimester abortions are very different from first trimester abortions for the patient and the provider. [They are] much more ethically and morally complex. And so, I think we were really lucky that they were willing to share their struggles with us.

After Tiller directors Martha Shane and Lana Wilson
After Tiller directors Martha Shane and Lana Wilson

How did you approach getting access? Was that something you did early on, or did you do a lot of preliminary research before that? Wilson: That was the first thing [we did]. We wrote a short proposal for the film and sent it to the male doctors [Drs. Hern and Carhart]. [They were] the ones we knew about first because they were public figures. [We said we wanted] to come visit and talk, and we stressed that we wouldn’t bring cameras. We just wanted to get to know them. Dr. Carhart agreed really easily. Dr. Hern was very skeptical and pessimistic about the whole idea — he’s been in this fight for so long — but we finally convinced him to let us come visit too.  He’s one of those people who can be harsh, but he has such a soft side to him. As soon as we met him, he got it and agreed. He was like, “Yeah, we’ve never told our stories before.” The doctors are so in the shadows and stigmatized, and no one ever hears from them. The women [Drs. Robinson and Sella] we got in touch with right at the start, and right away they just said, “No way.” Dr. Tiller never did press himself. That was his policy, and I think they believed in that. He was like, “It’s not about me. It’s about the patients. It shouldn’t be about me at all.” We kept in touch with [the female doctors] over the course of a year before they agreed to even meet us. We just said, “Yes, it is about the patients. It shouldn’t be about you, but the thing is that these other people have made you the focal point and the target of their entire movement. You don’t tell your story at all. It’s so easy to vilify you and to make you less of a human being.” And then we finally got to meet them and they just liked us and trusted us and agreed. I think also because they knew we wanted to put the patients’ stories in the movie. I think all these doctors universally feel like if people — not just the general public, but [also] the legislators — can just hear the patients’ stories, they will have a better understanding. Also, they didn’t want the guys to be [seen as] the only abortion providers. Dr. Sella was like, “How cool it’ll be to have a lesbian provider, maybe someone in the audience will look at her and see, ‘Yes, lesbians can do this too.’”

So at the start did you have a visual aesthetic for the film? Shane: We did, definitely. It evolved, of course, over time, but we were clear that we wanted to have a lot of long takes, long shots, and we wanted the film to have a stillness to it. We looked at cinematography in some other recent documentaries that we loved, Last Train Home and Iraq in Fragments. I think maybe the most challenging part was figuring out a style for showing the patients. We’re not showing their faces. We experimented a lot with all the different angles. Some were straight-on angles, but in the end we found that just focusing on their hands and the feet was the most emotionally expressive way to portray the patients without hiding their identities. I think people have really responded to that well, because it almost gives you a sense that this could be anyone. And there is a lot of emotional power to seeing the pregnant women’s stomachs, seeing the hands. That was a big turning point in how we made the film.

Wilson: When we started, our cinematographer was getting tons of angles, doing pans. Personally, I hate camera movement most of the time. It’s just like a reality show, like you’re chasing someone down all the time. Our cinematographers — we had two of them — helped us by being completely patient and still and letting [the subjects] be framed by hallways and doorways. We also found that angles matter so much. Because it’s such emotional content, we only shot things straight on, middle-height angle for almost everything otherwise it felt sensational. Our cinematographer [Hillary Spera] said that she just decided she was shooting this as though it was Deliverance, which I thought was amazing because it’s such sensational material but shot like a nature film. The camera work is beautiful and observational. It doesn’t call any attention to itself.

Shane: We were so lucky in our choice of cinematographers. When we started working on the project, we came up with a list of every female cinematographer we could find.

Wilson: A short list.

Shane: Fifteen [of those] people were really experienced with documentary. We wanted to have a female cinematographerbecause we felt like we wouldn’t be able to have access, or the comfort level of patients would be different, if we had a male cinematographer. I had posted looking for recommendations for female cinematographers on a documentary listserv and it caused a firestorm. All these male cinematographers were like, “That’s discrimination. You can’t say you only want to work with a female.” It’s like, I don’t think the opportunities for male cinematographers are limited, so give me a break. Both our cinematographers [Spera and Emily Topper] turned out to be great. We were in a lot of high stress situations and they just were so calm. I think you can see that in the shot of Dr. Hern hugging this patient, where it just goes on forever. Most cinematographers would have changed the angle or tried to move around. Hillary just held on that shot, which is so smart.

Wilson: It’s funny. Emily, she’s a very calm presence. Hillary is not so much, but it’s amazing watching her. Without a tripod, she basically holds her breath most of the time and makes the camera so still. She’d get these perfectly still shots. We were pushing ourselves to physical extremes.

How did it work with getting permissions, particularly from the patients? Wilson: [When patients would] come in [for an] initial counseling session, the counselor would say, “There’s a camera in the clinic, but don’t worry, they’re not going to film you unless you want. They’re making a movie about our doctor.” If it was a third trimester patient, they would say, “They’re looking for some patients who are here for third tri abortions who are willing to share their stories so they can help people understand why you’d get a third trimester abortion.” I’d say usually one patient a week would agree, so we’d do a lot of waiting around. But the ones who did agree, they would get [the film] better than anyone. If you think of where they are in their lives, no one expects they’ll be needing a third trimester abortion. How would they explain it to their friends and family? They have to go across the country to a clinic. And then they have to go home and explain why they’re not pregnant anymore.

You embedded yourselves in doctor’s surgeries? How did it work logistically? Shane: We set up our little office off to the side, and we would try to stay out of sight as much as possible. We spent a lot of time filming other things that were happening in the clinic, and then whenever there was a patient who was willing to share their story, we would just try to be there for as much of the process as the patient was comfortable with. We tried to stay with the doctors whenever we could, filming them filling out paperwork or making phone calls or eating lunch.

How long did you film for? Wilson: Well, the first year was just filming the men, and then the women came in. Our total shooting time was over a year and a half to two years. I think we spent about 12 weeks in the clinics total, plus extra weeks at their homes. Usually, we’d go to each clinic for a week at a time because the patients are there for four days, and we wanted to be there the whole stretch. A week is where you start to drive people insane, honestly. [Laughs] They’re just like, “[Get] out of here!”
Shane: We didn’t want to make anyone crazy. At the same time, because there was so much happening in the doctor/patient interactions, they really did forget about us. Even though we were there with these bulky cameras, they were so intent, and what they were going through was so intense, that I think that we became invisible to them.

What did you shoot on? Shane: We shot the interviews on the Canon 7D and 5D. And then we shot most of the rest of the footage on the [Sony] EX3 with the Letus adapter, which lets you use 35 millimeter vintage prime lenses.

The crew was generally just the three of you? Shane: Yeah.
Wilson: Us and Emily or Hillary. We would just crouch in a ball or lean against a wall. I always found that not making eye contact actually helps because then [the subjects are] not going to get distracted and look at you. You can blend in more like office furniture if you’re not looking at them.

And one of you was doing sound? Shane: We would alternate who was doing sound. We basically taught ourselves how to do sound.
Wilson: Hillary’s boyfriend at the time was a sound mixer, so he literally instructed us over the phone how to operate the different pieces of equipment. We were constantly calling him. There were some disastrous days we forgot to turn on the mixers…
Shane: We learned the hard way. That way you never forget.
Wilson: There was one humiliating incident where I was holding the boom and the doctor was doing a counseling session. It was at the end of the counseling session, but the head of the boom just broke and fell on them and everyone screamed. That was the most embarrassing moment.

What was it like emotionally for you making this film? Shane: The shooting days were really intense. The people in the clinic really enjoyed the work that they were doing, and they’re not always down and serious. They’re friends with each other. They’re close. There [are] a lot of lighthearted moments in the clinic too. But it’s an intense job and afterwards we would always have to go out to dinner and talk things over and get a break. And we really needed those nights and a margarita or two to relax after a long day of shooting. [Laughs]
Wilson: Oh, those fine Mexican restaurants.
Shane: But it’s not a depressing place to be in any way. I mean, it’s an amazing place to be and see how people’s lives are transformed and see what their experience is like over the four days that they’re there. Doctors really get to know the patients. And we really got to know the patients.

Dr. Warren Hern hugs a patient in After Tiller
Dr. Warren Hern hugs a patient in After Tiller

Did you ever get caught up in the more emotional moments you were shooting? Wilson: I remember crying a little during that counseling scene at the start of the film. It was the first time we were in a room with a group where it was obvious just how wrenching and how guilt-stricken these patients were, and how [they were] between a rock and a hard place. It was the sadness and the guilt and grieving these kids that they’d wanted. That was very, very emotional. I think all of it was very emotional. I didn’t personally feel any professional distance, really.
Shane: The doctors are also not cold with the patients. They allow themselves to express emotions; Dr. Robinson does sometimes tear up or cry. So I think that was an interesting model that it was okay to go through this experience with them and not be cold and distant.

Did you talk to the patient subjects beforehand? Shane: We did. We would talk to them in depth about the project and be clear about what our goals were. The film started out being much more profiles of the doctors, and then as we spent more time with them, it became clear that the patients are the motivation, and that’s the core of this work, so that became an almost equally important part.

Did how you thought of the film shift over time? Shane: We didn’t know a lot about third trimester abortion when we started doing this, so I think that we envisioned a film that would humanize these doctors and give you some insight into why they’re doing this work. We didn’t necessarily know that we were going to be seeing these really complex situations play out and see these doctors struggling with those things. I think that’s what allows people on both sides of the abortion debate into the film is that you see even within the clinic, people have differing ideas about what’s right and what’s wrong in terms of abortion. We didn’t know that these two female doctors, in particular, were going to be struggling with that while we were filming. That really, really changed [the film].

Given the subject matter, how was it finding funding? Shane: It was very hard. We were lucky to find a few private individuals who were willing to support it in the earlier stages. We got very little institutional funding until it was being finished because [abortion is] such a delicate subject. People wanted to see exactly how it was going to be treated before they were willing to get involved. So right at the end, when we just got into Sundance, we finally got some amazing institutional support from the Sundance Documentary Fund and IDA and NYSCA and a bunch of others.
Wilson: There was one period where we just ran out of money and had to stop. But we also made a promise. We were like, “Okay, we’re not going to be those filmmakers who just run up credit cards. We can’t do that.” But then, within a matter of weeks, we were like, “How many credit cards can we open?” We got to a point where neither of us were allowed any more credit cards. We maxed them all out. But the few people who did agree to support it [were amazing]. This is not a popular topic for anyone. It’s very complicated. We can disagree on this issue, but people shouldn’t be shooting doctors over this. [We said], let’s do a movie that calms us down and looks at it in a more straight way.
Shane: It felt like this is what we wanted to be doing, so it didn’t feel like a risk, really. It could have turned out so many other ways. We were very lucky to get into Sundance, of course, and the film seems like it will have this really great life. But I think even if that hadn’t happened, we still would have been really glad to have spent these years in this way. It felt like a privilege to [make] this film because there were such powerful stories and such incredible documentary subjects.

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