A shifting of the political ground
The ruling in and of itself does not mark a really major assault on individual freedom. Intact dilation and extraction is a very rare form of abortion, generally used only in unusual situations; so very few individuals will be affected by it, and when an actual case arises, it's anyone's guess whether any prosecutor will really want to try to imprison a doctor for helping a desperate woman. But the key point is that the Supreme Court rejected an almost identical law in 2000; the only difference in the present case is that there are two new Bush appointees (Roberts and Alito) on the Court. Moreover, the ruling flies in the face of precedents since 1973 and also six lower federal court rulings on the same law. This shows that the fears of individual-choice advocates, that a President influenced by the Christian Right could ultimately undermine abortion rights via Supreme Court appointments, rest on a solid foundation.
And while the law which the Court has validated bans only one rare form of abortion, it is alarmingly draconian in other ways. It does not contain an exception for cases where the woman's health is at stake (though there is an exception for life-and-death cases). It provides criminal penalties for doctors -- up to two years imprisonment. And it is a federal law, overriding all state laws which are more permissive. So much for the anti-abortionists' earlier position that such laws should be left to the states.
How can we be sure the Supreme Court won't later approve even worse restrictions, especially if one or more additional judges are appointed by a conservative President? A threat which has been hypothetical has moved into the realm of the actual. This changes the political calculus fundamentally. The NYT quotes Giuliani as saying that the Court “reached the correct conclusion." If this statement is sincerely meant (something I can't easily judge, given the nature of the maneuvering necessarily involved in seeking the Republican nomination), it certainly calls his acceptability into question, from my viewpoint. I note that Clinton, Obama, and Edwards all firmly oppose the ruling.
The specter of theocracy has just become a little more solid, a little more menacing. It's time to be on guard, and reconsider our options.