Dr. M Blatstein's Blog

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The Thomas Court – Denying Women The ‘Freedom To Choose’ Their Medical Reproductive Healthcare

Justice Thomas’s Message, Next: contraception, same-sex marriage…

Inside the Court’s ruling, Justice Thomas wrote that

• “in future cases, we should reconsider all of this Court’s substantive due process precedents.”
• “Because any substantive due process decision is ‘demonstrably erroneous,’ we have a duty to ‘correct the error’ established in those precedents.”  Just food for thought…

The More Restrictive States

Louisiana.

Louisiana is an example of extreme regulations, which defines “a viable in vitro fertilized human ovum” as a “juridical person which shall not be intentionally destroyed,” along with at least five states, that have introduced bills establishing fetal personhood. Now,

• the ’embryo’ may be considered an individual, and if a couple is undergoing IVF, your criminal liability implications have suddenly exploded.
• Why, because all of the embryos will have to be used.

IVF – Fertility Treatments

IVF and in some cases, even genetic screening, is seeing extreme statements from extreme states;

Will patients have to use all the embryos they develop,

• a) which forces an individual or couple to expand their family before they can afford to do so, or
• b) forgo the opportunity to have children, or
• c) suggests that the couple limit the number of embryos to one or two, and hope that they are chromosomally balanced and will result in a live birth, but if not…
• d) putting them through IVF stimulation over and over again, associated with the financial, emotional, psychological, and physical implications.

For states that take abortion bans to the extreme, and specify that,

Life begins at fertilization,

• a) each excess embryo would have the same rights as an embryo,
• b) all the embryos would then have to be implanted (by law), and
• c) which could lead to financial hardships for an unprepared family to have multiple children all at once, high-risk pregnancy, multiple babies, risking the life of the mother and/or the children,
• d) or regarding the fear of prosecution, the couple would decide not to have any children or
• e) they would elect to move to another state.
• Added to all this; are threats of violence that extremists have targeted at our behavior and beliefs, while representatives have kept quiet, and made this acceptable behavior.

Pregnancy Loss or Miscarriage.

Pregnancy Loss (NIH) | Miscarriage (Cleveland Clinic).

• Some miscarriages require immediate medical interventions to prevent life-threatening infections or tubal rupture. Every year between 10% and 20% of known pregnancies end in miscarriages, mostly because the fetus is not developing normally, according to the Mayo Clinic.
• Post Dobb’s, providers may now fear that the ‘state’ may view their treatment – as if they are providing abortion services, even if they have the necessary training and clinical skills, albeit the services may be similar.
• If there is a malpractice (or negligence) claim where the provider was handicapped by the laws of their state, how then will this be reflected in their malpractice and liability carriers’ representation(s) going forward?

But it is in those most restrictive states, that women of color (and not those of means) could see even higher maternal mortality rates, increased child poverty, and face a greater risk of prosecution for seeking illegal abortions.

Religion

Religious freedom in America should mean that we all have a right to our religious beliefs. But it should not give us the right to use religion and beliefs to discriminate against others who do not share them—especially when doing so risks lives.

Attorneys – You Can Hear The Dam Breaking

Bloomberg Law – “There is so much confusion”

‘Aiding and Abetting’

Abortion bans before six weeks in some states can depend on enforcement through lawsuits filed by private citizens. Possible targets: abortion providers and anyone who aids and abets an abortion – after an assumed heartbeat is detected – which is a “flutter (or the beginning of our pacemaker),” and not a heartbeat.

Hospitals, Healthcare Systems, Telehealth providers, Pharmacists, Nurses, and Providers are all looking for answers (and to date, getting few). I am sure that most of you are getting calls (if not, you will), as confusion reigns, from Coast to Coast.

Regulations

The Emergency Medical Treatment and Labor Act obligates all Medicare-participating hospitals with emergency departments to furnish all medical conditions that pose serious jeopardy to health, bodily severe impairment, or serious organ damage. This duty extends to emergency care for pregnancy or pregnancy loss.

• Regarding Catholic Hospitals, the ACLU has collected numerous stories of women being denied emergency care at Catholic Hospitals, with more emerging all the time.

Medical Societies Speak Out

The American Psychiatric Association

By dismantling nearly 50 years of legal precedent, the Court has jeopardized millions of American women’s physical and mental health and undermined the physician-patient relationship’s privacy.

This move will disproportionately impact our most vulnerable populations, such as communities of color, people living in rural areas, and those with low incomes who may have to travel long distances to receive abortions.

Today’s ruling will put many pregnant women and their families into life-threatening and/or traumatic situations.

American Society and Association, of Clinical Oncology

Unfortunately, with the implementation of Dobbs, doctors have been handicapped in this critical patient-doctor decision-making process. Still, ASCO will work to help our members navigate this new situation and preserve their patients’ access to the highest quality care by providing evidence-based clinical guidance, including fertility preservation, and by advocating for access to all the components of high-quality care.

The American College of Obstetricians and Gynecologists (ACOG)

“We are treating this as a disaster response,” Verma said. “We are in an emergency, and this is a disaster.” Its impact on situations will include miscarriage and in vitro fertilization. The practice of medicine will be reshaped, the group said, or even contradicted by “by-laws not founded in science or based on evidence.” She wondered, “Are surgeons going to be afraid to intervene when a pregnant patient ruptures their appendix because they might inadvertently end the pregnancy?”

The American Academy of Pediatrics (AAP)

Today’s ruling means that in many places in the United States, this evidence-based care will be difficult or impossible to access, threatening the health and safety of our patients and jeopardizing the patient-physician relationship.

New England Journal of Medicine

The Supreme Court’s fig-leaf justification behind these restrictions was that induced abortion was a dangerous procedure that required tighter regulation to protect the health of persons seeking that care. Facts belie this disingenuous rhetoric.1,2. Given these predictable consequences, the editors of the New England Journal of Medicine strongly condemn the U.S. Supreme Court’s decision.

AAMC (Association of American Medical Colleges)

These laws and policies restrict or otherwise interfere with the patient-physician relationship, putting patients at risk by limiting access to quality, evidence-based care.

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