Welcome to the Nexus of Ethics, Psychology, Morality, Philosophy and Health Care

Welcome to the nexus of ethics, psychology, morality, technology, health care, and philosophy
Showing posts with label Reproductive Rights. Show all posts
Showing posts with label Reproductive Rights. Show all posts

Thursday, April 18, 2024

An artificial womb could build a bridge to health for premature babies

Rob Stein
npr.org
Originally posted 12 April 24

Here is an excerpt:

Scientific progress prompts ethical concerns

But the possibility of an artificial womb is also raising many questions. When might it be safe to try an artificial womb for a human? Which preterm babies would be the right candidates? What should they be called? Fetuses? Babies?

"It matters in terms of how we assign moral status to individuals," says Mercurio, the Yale bioethicist. "How much their interests — how much their welfare — should count. And what one can and cannot do for them or to them."

But Mercurio is optimistic those issues can be resolved, and the potential promise of the technology clearly warrants pursuing it.

The Food and Drug Administration held a workshop in September 2023 to discuss the latest scientific efforts to create an artificial womb, the ethical issues the technology raises, and what questions would have to be answered before allowing an artificial womb to be tested for humans.

"I am absolutely pro the technology because I think it has great potential to save babies," says Vardit Ravitsky, president and CEO of The Hastings Center, a bioethics think tank.

But there are particular issues raised by the current political and legal environment.

"My concern is that pregnant people will be forced to allow fetuses to be taken out of their bodies and put into an artificial womb rather than being allowed to terminate their pregnancies — basically, a new way of taking away abortion rights," Ravitsky says.

She also wonders: What if it becomes possible to use artificial wombs to gestate fetuses for an entire pregnancy, making natural pregnancy unnecessary?


Here are some general ethical concerns:

The use of artificial wombs raises several ethical and moral concerns. One key issue is the potential for artificial wombs to be used to extend the limits of fetal viability, which could complicate debates around abortion access and the moral status of the fetus. There are also concerns that artificial wombs could enable "designer babies" through genetic engineering and lead to the commodification of human reproduction. Additionally, some argue that developing a baby outside of a woman's uterus is inherently "unnatural" and could undermine the maternal-fetal bond.

 However, proponents contend that artificial wombs could save the lives of premature infants and provide options for women with high-risk pregnancies.  

 Ultimately, the ethics of artificial womb technology will require careful consideration of principles like autonomy, beneficence, and justice as this technology continues to advance.

Wednesday, February 28, 2024

Scientists are on the verge of a male birth-control pill. Will men take it?

Jill Filipovic
The Guardian
Originally posted 18 Dec 23

Here is an excerpt:

The overwhelming share of responsibility for preventing pregnancy has always fallen on women. Throughout human history, women have gone to great lengths to prevent pregnancies they didn’t want, and end those they couldn’t prevent. Safe and reliable contraceptive methods are, in the context of how long women have sought to interrupt conception, still incredibly new. Measured by the lifespan of anyone reading this article, though, they are well established, and have for many decades been a normal part of life for millions of women around the world.

To some degree, and if only for obvious biological reasons, it makes sense that pregnancy prevention has historically fallen on women. But it also, as they say, takes two to tango – and only one of the partners has been doing all the work. Luckily, things are changing: thanks to generations of women who have gained unprecedented freedoms and planned their families using highly effective contraception methods, and thanks to men who have shifted their own gender expectations and become more involved partners and fathers, women and men have moved closer to equality than ever.

Among politically progressive couples especially, it’s now standard to expect that a male partner will do his fair share of the household management and childrearing (whether he actually does is a separate question, but the expectation is there). What men generally cannot do, though, is carry pregnancies and birth babies.


Here are some themes worthy of discussion:

Shifting responsibility: The potential availability of a reliable male contraceptive marks a significant departure from the historical norm where the burden of pregnancy prevention was primarily borne by women. This shift raises thought-provoking questions that delve into various aspects of societal dynamics.

Gender equality: A crucial consideration is whether men will willingly share responsibility for contraception on an equal footing, or whether societal norms will continue to exert pressure on women to take the lead in this regard.

Reproductive autonomy: The advent of accessible male contraception prompts contemplation on whether it will empower women to exert greater control over their reproductive choices, shaping the landscape of family planning.

Informed consent: An important facet of this shift involves how men will be informed about potential side effects and risks associated with the male contraceptive, particularly in comparison to existing female contraceptives.

Accessibility and equity: Concerns emerge regarding equitable access to the male contraceptive, particularly for marginalized communities. Questions arise about whether affordable and culturally appropriate access will be universally available, regardless of socioeconomic status or geographic location.

Coercion: There is a potential concern that the availability of a male contraceptive might be exploited to coerce women into sexual activity without their full and informed consent.

Psychological and social impact: The introduction of a male contraceptive brings with it potential psychological and social consequences that may not be immediately apparent.

Changes in sexual behavior: The availability of a male contraceptive may influence sexual practices and attitudes towards sex, prompting a reevaluation of societal norms.

Impact on relationships: The shift in responsibility for contraception could potentially cause tension or conflict in existing relationships as couples navigate the evolving dynamics.

Masculinity and stigma: The use of a male contraceptive may challenge traditional notions of masculinity, possibly leading to social stigma that individuals using the contraceptive may face.

Saturday, February 24, 2024

Living in an abortion ban state is bad for mental health

Keren Landman
vox.com
Originally posted 20 Feb 24

Here is an excerpt:

What they found was, frankly, predictable: Before the Court’s decision, anxiety and depression scores were already higher in trigger states — a population-wide average of 3.5 compared with 3.3 in non-trigger states. After the decision, that difference widened significantly, largely due to changes in the mental health of women 18 to 45, what the authors defined as childbearing age. Among this subgroup, anxiety and depression scores subtly ticked up in those living in trigger states (from 4.62 to 4.76) — and dropped in those living in non-trigger states (from 4.57 to 4.49). There was no similar effect in older women, nor in men.

These differences were small but statistically meaningful, especially since they sampled the entire population, not just women considering an abortion. Moreover, they were consistent across trigger states, whether their policies and political battles around abortion had been high- or low-profile. Even when the researchers omitted data from states with particularly severe restrictions on women’s reproductive health (looking at you, Texas), the results held up.

It’s notable that the different levels of mental distress across states after Roe was overturned weren’t just a consequence of worsened anxiety and depression in states with trigger bans. Also contributing: an improvement in these symptoms in states without these bans. We can’t tell from the study exactly why that is, but it seems plausible that women living in states that protect their right to access necessary health care simply feel some relief.


Here is the citation to the study:

Thornburg B, Kennedy-Hendricks A, Rosen JD, Eisenberg MD. Anxiety and Depression Symptoms After the Dobbs Abortion Decision. JAMA. 2024;331(4):294–301. doi:10.1001/jama.2023.25599

Conclusions and Relevance  In this study of US survey data from December 2021 to January 2023, residence in states with abortion trigger laws compared with residence in states without such laws was associated with a small but significantly greater increase in anxiety and depression symptoms after the Dobbs decision.

Friday, July 7, 2023

The Dobbs Decision — Exacerbating U.S. Health Inequity

Harvey, S. M., et al. (2023).
New England Journal of Medicine, 
388(16), 1444–1447. 

Here is an excerpt:

In 2019, half of U.S. women living below the FPL were insured by Medicaid. Medicaid coverage rates were higher in certain groups, including women who described their health as fair or poor, women from marginalized racial or ethnic groups, and single mothers. Approximately two thirds of adult women enrolled in Medicaid are in their reproductive years and are potentially at risk for an unintended pregnancy. For many low-income people, however, federal and state funding restrictions created substantial financial and other barriers to accessing abortion services even before Dobbs. Notably, the Hyde Amendment greatly disadvantaged low-income people by blocking use of federal Medicaid funds for abortion services except in cases of rape or incest or to save the pregnant person’s life. In 32 states, Medicaid programs adhere to the strict guidelines of the Hyde Amendment, making it difficult for low-income people to access abortion services in these states.

Before the fall of Roe, Medicaid coverage could determine whether women in some states did or did not receive abortion services. Since the implementation of the post-Dobbs abortion bans, abortion care is even more restricted in entire regions of the country. Access to abortion services under Medicaid will continue to vary by place of residence and depend on the confluence of restrictions or bans on abortion care and Medicaid policies currently in effect within each state. In the new landscape (see map), obtaining abortion services has become even more challenging for low-income women in most of the country, despite the fact that most states have expanded Medicaid coverage.

After Dobbs, complete or partial bans on abortion went into effect in more than a dozen states, forcing people in those states to travel to other states to access abortion care. More than a third of women of reproductive age now live more than an hour from an abortion facility and will probably face additional barriers, including costs for travel and child care and the need to take time off from work. Regrettably, people who already had poorer-than-average access pre-Dobbs face even greater health burdens and risks. For example, members of marginalized racial and ethnic groups that face disproportionate burdens of pregnancy-related mortality are more likely than other groups to have to travel longer distances to get an abortion post-Dobbs.

As a result of the overturning of Roe, a substantial proportion of people who want abortion services will not have access to them and will end up carrying their pregnancies to term. For decades, research has demonstrated that abortion bans most severely affect low-income women and marginalized racial and ethnic groups that already struggle with barriers to accessing health care, including abortion. The economic, educational, and physical and mental health consequences of being denied a wanted abortion have been thoroughly documented in the landmark Turnaway Study. Thanks to nearly 50 years of legal abortion practice, we now have a robust body of research on the safety and efficacy of abortion and the impact of abortion restrictions on people’s socioeconomic circumstances, health, and well-being.

Innovative strategies, such as telemedicine for medication abortion services, can improve access to abortion care. Self-managed, at home, medication abortions are safe, effective, and acceptable to many patients. In states where abortions are legal that are bordered by states where abortions are banned, telemedicine could mean the difference between patients being able to simply drive across the state line, in order to be physically in the state providing care, and having to drive to a clinic that could be hundreds of miles away. In addition, Planned Parenthood affiliates have plans to launch mobile services and to open clinics along state borders where abortion is illegal in one state but legal in the other.

Thursday, February 16, 2023

Telehealth Providers Prepare for the Future

Phoebe Kolbert & Charlotte Engrav
msmagazine.com
Originally posted 9 FEB 23

Here is an excerpt:

Telehealth Abortion Care

The Guttmacher Institute reports that, in 2017, medication abortions accounted for 39 percent of all abortions performed. By 2020, medication abortion usage accounted for 53 percent.

Coplon attributes the rise in telehealth medication abortions to COVID, but the continued use of it, she says, “is due to people’s understanding and acceptance, and also providers being more comfortable with providing pills without having the testing that we prior thought we needed.” 

She would know. Since 2016, Coplon has been part of a coalition of researchers, lawyers and other clinicians looking at telehealth medication abortion and ways to increase access to telehealth services. She now serves as the director of clinical operations at Abortion on Demand. 

In 2018, state policies enacted to support reproductive health were almost triple the number restricting reproductive healthcare. It was the first year in at least two decades where protections outpaced restrictions. 

Restrictions were eased even more when the COVID-19 pandemic made social distancing necessary, and lawmakers loosened restrictions, allowing more healthcare to be practiced online via telehealth. However, the landscape completely changed again in June of this year when the Supreme Court overturned the longstanding precedent of Roe in their Dobbs decision. Now, 18 states have abortion bans, 14 of which are total or near total. Eight other states have abortion bans on the books that are currently blocked, and there has been a push from anti-abortion groups to rescind access to telehealth medication abortions altogether. 

Telemedicine abortion has many benefits beyond preventing the spread of COVID-19—which may be why anti-abortion groups have been so quick to target it. Telehealth can make abortions more accessible for those who want and need them, and they tend to be cheaper and easier to schedule quickly. Even before Roe’s fall, patients would sometimes have to travel out of state or drive hours to the only abortion clinic in their state. Now, people living in states with bans must travel an average of 276 miles each way. States without bans have seen a swell of out-of-state patients seeking legal abortions. Bloomberg News estimated Illinois could face an 8,000 percent increase in abortion seekers. Planned Parenthood of Illinois estimated an increase of 20,000-30,000 out-of-state patients. Some clinics are struggling to keep up. For these clinics and patients, Coplon notes, telehealth can make a huge difference in the post-Roe era.

Not only can telehealth provide appointments within just a day or two of scheduling, as opposed to the potentially weeks-long waits at clinics in some overburdened states, it can also help reduce the overall burden on those in-person clinics—freeing up space for their own clients. 

Friday, February 3, 2023

Contraceptive Coverage Expanded: No More ‘Moral’ Exemptions for Employers

Ari Blaff
Yahoo News
Originally posted 30 JAN 23

Here is an excerpt:

The proposed new rule released today by the Departments of Health and Human Services (HHS), Labor, and Treasury would remove the ability of employers to opt out for “moral” reasons, but it would retain the existing protections on “religious” grounds.

For employees covered by insurers with religious exemptions, the new policy will create an “independent pathway” that permits them to access contraceptives through a third-party provider free of charge.

“We had to really think through how to do this in the right way to satisfy both sides, but we think we found that way,” a senior HHS official told CNN.

Planned Parenthood applauded the announcement. “Employers and universities should not be able to dictate personal health-care decisions and impose their views on their employees or students,” the organization’s chief, Alexis McGill Johnson, told CNN. “The ACA mandates that health insurance plans cover all forms of birth control without out-of-pocket costs. Now, more than ever, we must protect this fundamental freedom.”

In 2018, the Trump administration sought to carve out an exception, based on “sincerely held religious beliefs,” to the ACA’s contraceptive mandate. The move triggered a Pennsylvania district court judge to issue a nationwide injunction in 2019, blocking the implementation of the change. However, in 2020, in Little Sisters of the Poor v. Pennsylvania, the Supreme Court, in a 7–2 ruling, defended the legality of the original Trump policy.

The Supreme Court’s overturning of Roe v. Wade in June 2022, in its Dobbs ruling, played a role in HHS’s decision to release the new proposal. Guaranteeing access to contraceptions at no cost to the individual “is a national public health imperative,” HHS said in the proposal. And the Dobbs ruling “has placed a heightened importance on access to contraceptive services nationwide.”

Wednesday, November 30, 2022

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew Wynia
September 15, 2022
N Engl J Med 2022; 387:959-961
DOI: 10.1056/NEJMp2210192

Here is an excerpt:

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

There are several arguments in favor of professional associations supporting civil disobedience by their members. First, collective civil disobedience by a professional group would avert the most common and powerful criticism leveled against civil disobedience, which is that it could lead to anarchy.

Civil disobedience is a “public, nonviolent, conscientious yet political act contrary to law,” carried out with the aim of bringing about a change in an unjust law.2 But respect for laws is necessary to maintain a civil society. Having each person choose which laws to obey and which to disobey is a recipe for chaos. The most well-known proponents of civil disobedience — Henry David Thoreau, Mahatma Gandhi, Martin Luther King, Jr. — all took seriously the threat of unrestrained disregard of laws under the guise of civil disobedience. In his 1963 Letter from Birmingham Jail, King argued that people must respect just laws, but he also wrote, “law and order exist for the purpose of establishing justice,” and he agreed with St. Augustine that “an unjust law is no law at all.” He described a “moral responsibility to disobey unjust laws” and laid out criteria to help people decide when laws, such as those upholding racial segregation, are sufficiently unjust as to warrant open disobedience. Gandhi was even more worried about chaos and launched hunger strikes to rein in his own supporters when he believed they had gone too far in their disobedience of laws.

But professional civil disobedience poses little threat of anarchy. Unlike a situation in which each person decides whether to obey or disobey a law, a professional group’s deciding together, after frank and rational debate, to support disobedience of an unjust law might eventually reinforce social cohesion, elevate trust in the profession, and help communities avoid tragic errors. Professions, after all, are expected to protect vulnerable people and core social values. Such a decision would still be contentious, however. Civil disobedience is nonviolent, but it elevates and highlights conflict and often leads to violence against people disobeying the law. Professional civil disobedience would undoubtedly require tremendous courage.

Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

Friday, November 4, 2022

Mental Health Implications of Abortion Restrictions for Historically Marginalized Populations

Ogbu-Nwobodo, L., Shim, R.S., et al.
October 27, 2022
N Engl J Med 2022; 387:1613-1617
DOI: 10.1056/NEJMms2211124

Here is an excerpt:

Abortion and Mental Health

To begin with, abortion does not lead to mental health harm — a fact that has been established by data and recognized by the National Academies of Sciences, Engineering, and Medicine and the American Psychological Association The Turnaway Study, a longitudinal study that compared mental health outcomes among people who obtained an abortion with those among people denied abortion care, found that abortion denial was associated with initially higher levels of stress, anxiety, and low self-esteem than was obtaining of wanted abortion care. People who had an abortion did not have an increased risk of any mental health disorder, including depression, anxiety, suicidal ideation, post-traumatic stress disorder, or substance use disorders. Whether people obtained or were denied an abortion, those at greatest risk for adverse psychological outcomes after seeking an abortion were those with a history of mental health conditions or of child abuse or neglect and those who perceived abortion stigma (i.e., they felt others would look down on them for seeking an abortion). Furthermore, people who are highly oppressed and marginalized by society are more vulnerable to psychological distress.

There is evidence that people seeking abortion have poorer baseline mental health, on average, than people who are not seeking an abortion. However, this poorer mental health results in part from structural inequities that disproportionately expose some populations to poverty, trauma, adverse childhood experiences (including physical and sexual abuse), and intimate partner violence. People seek abortion for many reasons, including (but not limited to) timing issues, the need to focus on their other children, concern for their own physical or mental health, the desire to avoid exposing a child to a violent or abusive partner, and the lack of financial security to raise a child.

In addition, for people with a history of mental illness, pregnancy and the postpartum period are a time of high risk, with increased rates of recurrence of psychiatric symptoms and of adverse pregnancy and birth outcomes. Because of stigma and discrimination, birthing or pregnant people with serious mental illnesses or substance use disorders are more likely to be counseled by health professionals to avoid or terminate pregnancies, as highlighted by a small study of women with bipolar disorder. One study found that among women with mental health conditions, the rate of readmission to a psychiatric hospital was not elevated around the time of abortion, but there was an increased rate of hospitalization in psychiatric facilities at the time of childbirth. Data also indicate that for people with preexisting mental health conditions, mental health outcomes are poor whether they obtain an abortion or give birth.

The Role of Structural Racism

Structural racism — defined as ongoing interactions between macro-level systems and institutions that constrain the resources, opportunities, and power of marginalized racial and ethnic groups — is widely considered a fundamental cause of poor health and racial inequities, including adverse maternal health outcomes. Structural racism ensures the inequitable distribution of a broad range of health-promoting resources and opportunities that unfairly advantage White people and unfairly disadvantage historically marginalized racial and ethnic groups (e.g., education, paid leave from work, access to high-quality health care, safe neighborhoods, and affordable housing). In addition, structural racism is responsible for inequities and poor mental health outcomes among many diverse populations.


Thursday, October 27, 2022

Frequently asked questions about abortion laws and psychology practice

American Psychological Association
Updated 1 SEPT 2022

Since the U.S. Supreme Court issued its decision to overturn Roe v. Wade, many states have proposed, enacted, or resurrected a range of laws to either prohibit, significantly restrict, or protect reproductive rights and health care. Currently, the main targets of these laws appear to be medical providers who provide abortions or individuals seeking to obtain an abortion.

APA and APA Services Inc. are striving to provide psychologists with accurate and adequate information about the potential impact on them of reproductive health care laws. Since psychologists have embraced telehealth and many use technology to provide services across state lines, it’s important to be familiar with the laws governing the jurisdiction(s) where you are licensed as well as the jurisdiction(s) where your patients live.

In addition to this FAQ and other APA resources, psychologists will want to be familiar with guidance issued by federal and state agencies, their state licensing board(s), and their liability carrier. Some frequently asked questions follow.

While the situation is dynamic, good psychological practice remains unchanged. The changing landscape in states regarding access to reproductive health care does not change the fundamental approach to psychological care. Psychologists should continue to prioritize the welfare of their patients, protect confidentiality, and ensure their patients’ safety.

Practicing in states with changing abortion laws

Am I practicing in a state where abortion is, or is soon to be, illegal under all or certain circumstances?

The Supreme Court’s decision to overturn Roe v. Wade has put the regulation of abortion in the hands of states. In anticipation of the ruling, 13 states enacted “trigger laws,” designed to ban or restrict abortion upon the Supreme Court’s reversal of Roe v. Wade. Not all trigger laws immediately kicked in, and some that did were immediately challenged in court, delaying their enforcement.

Staying current on laws affecting the states where you practice is important. For a list of existing abortion bans and restrictions within each state, the Center for Reproductive Rights has provided a map that is updated in real time. The Guttmacher Institute, a well-respected research group that collects information on abortion laws across the United States, also tracks current state abortion-related laws.

Wednesday, September 21, 2022

Professional Civil Disobedience — Medical-Society Responsibilities after Dobbs

Matthew K. Wynia
The New England Journal of Medicine
September 15, 2022, 387:959-961

Here are two excerpts:

The AMA called Dobbs “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient–physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services.” The American Academy of Family Physicians wrote that the decision “negatively impacts our practices and our patients by undermining the patient–physician relationship and potentially criminalizing evidence-based medical care.” The American College of Physicians stated, “A patient’s decision about whether to continue a pregnancy should be a private decision made in consultation with a physician or other health care professional, without interference from the government.” And the CEO of the American College of Obstetricians and Gynecologists called Dobbs “tragic” for patients, “the boldest act of legislative interference that we have seen in this country,” and “an affront to all that drew my colleagues and me into medicine.”

Medical organizations are rarely so united. Yet even many physicians who oppose abortion recognize that medically nuanced decisions are best left in the hands of individual patients and their physicians — not state lawmakers. Abortion bans are already pushing physicians in some states to wait until patients become critically ill before intervening in cases of ectopic pregnancy or septic miscarriage, among other problems.

Beyond issuing strongly worded statements, what actions should medical organizations take in the face of laws that threaten patients’ well-being? Should they support establishing committees to decide when a pregnant person’s life is in sufficient danger to warrant an abortion? Should they advocate for allowing patients to travel elsewhere for care? Or should they encourage their members to provide evidence-based medical care, even if doing so means accepting — en masse — fines, suspensions of licensure, and potential imprisonment? How long could a dangerous state law survive if the medical profession, as a whole, refused to be intimidated into harming patients, even if such a refusal meant that many physicians might go to jail?

(cut)

Proposing professional civil disobedience of state laws prohibiting abortion might seem naive. Historically, physicians have rarely been radical, and most have conformed with bad laws and policies, even horrific ones — such as those authorizing forced-sterilization programs in the United States and Nazi Germany, the use of psychiatric hospitals as political prisons in the Soviet Union, and police brutality under apartheid in South Africa. Too often, organized medicine has failed to fulfill its duty to protect patients when doing so required acting against state authority. Although there are many examples of courageous individual physicians defying unjust laws or regulations, examples of open support for these physicians by their professional associations — such as the AMA’s offer to support physicians who refused to be involved in “enhanced” interrogations (i.e., torture) during the Iraq War — are uncommon. And profession-wide civil disobedience — such as Dutch physicians choosing to collectively turn in their licenses rather than practice under Nazi rule — is rare.

Thursday, July 28, 2022

Justice Alito's bad theology: Abortion foes don't have "morality" on their side

E. M. Freese & A. T. Taylor
Salon.com
Originally posted 26 JUL 22

Here is an excerpt:

Morality has thus become the reigning justification for the state to infringe upon the liberty of female Americans and to subjugate their reproductive labor to its power. An interrogation of this morality, however, reveals that it is underpinned by a theology that both erases and assumes the subjugation of female gestational labor in procreation to patriarchy. We must shatter this male-dominant moral logic and foreground female personhood and agency in order for every American to be equally free.

According to Alito, moral concern for "an unborn human being" apparently exempts pregnant people from the right to "liberty" otherwise guaranteed by the 14th Amendment. In other words, the supposed immorality of abortion is weighty enough to restrict bodily autonomy for all pregnant people in this country and to terrorize potentially pregnant females more broadly. This logic implies that pregnant people also lack 13th Amendment protection from "involuntary servitude," contrary to the strong argument made by legal scholar Michele Goodwin in a recent New York Times op-ed. Consequently, the court has now granted permission to states to force pregnant people to gestate against their will.

To be clear, the 13th and 14th Amendments are specifically about bodily autonomy and freedom from forced labor. They were created after the Civil War in an attempt to end slavery for good, and forced reproduction was correctly understood as a dimension of slavery. But Justice Alito asserts that abortion morality puts pregnant bodies in a "different" category with fewer rights. What, exactly, is the logic here?

At its heart, the theological premise of the anti-abortion argument is that male fertilization essentially equals procreation of a "life" that has equal moral and legal standing to a pregnant person, prior to any female gestation. In effect, this argument holds that the enormous female gestation labor over time, which is literally fundamental to the procreation of a viable "new life," can be ignored as a necessary precursor to the very existence of that life. On a practical level, this amounts to claiming that a habitable house exists at the stage of an architectural drawing, prior to any material labor by the general contractor and the construction workers who literally build it.

Abortion opponents draw upon the biblical story of creation found in the book of Genesis (chapters 1-3) to ostensibly ground their theology in tradition. But Genesis narrates that multiple participants labor at God's direction to create various forms of life through a material process over time, which actually contradicts a theology claiming that male fertilization equals instant-procreation. The real political value is the story's presumption of a male God's dominance and appropriation of others' labor for "His" ends. Using this frame, abortion opponents insert a "sovereign" God into the wombs of pregnant people — exactly at the moment of male fertilization. From that point, the colonization of the female body and female labor becomes not only morally acceptable, but necessary.

Monday, June 27, 2022

Confidence in U.S. Supreme Court Sinks to Historic Low

Jeffrey Jones
Gallup.com
Originally posted 23 JUN 22

Story Highlights
  • 25% of Americans have confidence in Supreme Court, down from 36% in 2021
  • Current reading is five percentage points lower than prior record low
  • Confidence is down among Democrats and independents this year
With the U.S. Supreme Court expected to overturn the 1973 Roe v. Wade decision before the end of its 2021-2022 term, Americans' confidence in the court has dropped sharply over the past year and reached a new low in Gallup's nearly 50-year trend. Twenty-five percent of U.S. adults say they have "a great deal" or "quite a lot" of confidence in the U.S. Supreme Court, down from 36% a year ago and five percentage points lower than the previous low recorded in 2014.

These results are based on a June 1-20 Gallup poll that included Gallup's annual update on confidence in U.S. institutions. The survey was completed before the end of the court's term and before it issued its major rulings for that term. Many institutions have suffered a decline in confidence this year, but the 11-point drop in confidence in the Supreme Court is roughly double what it is for most institutions that experienced a decline. Gallup will release the remainder of the confidence in institutions results in early July.

The Supreme Court is likely to issue a ruling in the Dobbs v. Jackson Women's Health Organization case before its summer recess. The decision will determine the constitutionality of a Mississippi law that would ban most abortions after 15 weeks of pregnancy. A leaked draft majority opinion in the case suggests that the high court will not only allow the Mississippi law to stand, but also overturn Roe v. Wade, the 1973 court ruling that prohibits restrictions on abortion during the first trimester of pregnancy. Americans oppose overturning Roe by a nearly 2-to-1 margin.

In September, Gallup found the Supreme Court's job approval rating at a new low and public trust in the judicial branch of the federal government down sharply. These changes occurred after the Supreme Court declined to block a Texas law banning most abortions after six weeks of pregnancy, among other controversial decisions at that time. Given these prior results, it is unclear if the drop in confidence in the Supreme Court measured in the current poll is related to the anticipated Dobbs decision or had occurred several months before the leak.

Thursday, June 23, 2022

Thousands of Medical Professionals Urge Supreme Court To Uphold Roe: ‘Provide Patients With the Treatment They Need’

Phoebe Kolbert
Ms. Magazine
Originally posted 21 JUN 22

Any day now, the Supreme Court will issue its decision in Dobbs v. Jackson Women’s Health Organization, which many predict will overturn or severely gut Roe v. Wade. Since the start of the Dobbs v. Jackson hearings in December, medical professionals have warned of the drastic health impacts brought on by abortion bans. Now, over 2,500 healthcare professionals from all 50 states have signed a letter urging the Supreme Court to scrap their leaked Dobbs draft opinion and uphold Roe.  

Within 30 days of a decision to overturn Roe, at least 26 states will ban abortion. Clinics in remaining pro-abortion states are preparing for increased violence from anti-abortion extremists and an influx of out-of-state patients. The number of legal abortions performed nationwide is projected to fall by about 13 percent. Many abortion clinics in states with bans will be forced to close their doors, if they haven’t already. The loss of these clinics also comes with the loss of the other essential reproductive healthcare they provide, including STI screenings and treatment, birth control and cervical cancer screenings.

The letter, titled “Medical Professionals Urge Supreme Court to Uphold Roe v. Wade, Protect Abortion Access,” argues that decisions around pregnancy and abortion should be made by patients and their doctors, not the courts.


Here is how the letter begins:

Medical Professionals Urge Supreme Court to Uphold Roe v. Wade, Protect Abortion Access

As physicians and health care professionals, we are gravely concerned that the U.S. Supreme Court appears prepared to end the constitutional right to an abortion. We urge the Supreme Court to to scrap their draft opinion, uphold the constitutional right to an abortion, and ensure that abortions remain legal nationwide, as allowed for in Roe v. Wade. In this moment of crisis, we want to make crystal clear the consequences to our patients’ health if they can no longer access abortions.

Abortions are safe, common and a critical part of health care and reproductive medicine. Medical professionals and medical associations agree, including the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Family Physicians, the American College of Nurse Midwives and many others.

Prohibiting access to safe and legal abortion has devastating implications for health care. Striking down Roe v. Wade would affect not just abortion access, but also maternal care as well as fertility treatments. Pregnancy changes a person’s physiology. These changes can potentially worsen existing diseases and medical conditions.

As physicians and medical professionals, we see the real-life consequences when an individual does not get the care that they know they need, including abortions. The woman who has suffered the violation and trauma of rape would be forced to carry a pregnancy.

Denying access to abortion from people who want one can adversely affect their health, safety and economic well-being, including delayed separation from a violent partner and increased likelihood of falling into poverty by four times. These outcomes can also have drastic impacts on their health.

Monday, June 20, 2022

The Christian Right is violating the First Amendment by banning abortion

Noah Berlatsky
NBC News Cultural Critic
Originally published 18 JUN 22

The anti-abortion rights movement is largely faith based. Catholics and evangelical Christians argue that life begins at conception, and that fetuses have souls. On those grounds, they want to prevent anyone from obtaining abortion services.

They’ve had a good deal of success with that recently. A leaked Supreme Court draft opinion suggests the high court is set to overturn Roe v. Wade, effectively gutting the constitutional right to abortion. In anticipation, many conservative states have passed sweeping anti-abortion legislation.

But not everyone is Christian. And imposing Christian morality and Christian dogma on non-Christians is a good working definition of religious tyranny — which the First Amendment of the Constitution explicitly rejects. 

That principle of religious freedom is the basis of a lawsuit brought by Congregation L’Dor Va-Dor, a synagogue in Boynton Beach, Florida, against a sweeping state abortion ban set to take effect on July 1. Congregation L’Dor Va-Dor is challenging a single law on behalf of a single religion. But the case is also a broader challenge to the anti-abortion rights movement, which conflates a right-wing Christian demand for forced birth with universal morality, and insists on subjugating the country to a sectarian code.

The new Florida law bans most abortions after 15 weeks. There are no exceptions for cases of incest, rape or human trafficking. It does allow an abortion to save a pregnant person’s life or to prevent serious physical injury. But these exceptions aren’t enough to keep the law from violating the free exercise of the Jewish faith. The congregation’s lawsuit states that the Florida law violates Jewish religious beliefs holding that abortion “is required if necessary to protect the health, mental or physical well-being of the woman,” among other reasons.

Friday, June 11, 2021

Record-High 47% in U.S. Think Abortion Is Morally Acceptable

Megan Brenan
Gallup.com
Originally posted 9 June 21

Americans are sharply divided in their abortion views, including on its morality, with an equal split between those who believe it is morally acceptable and those who say it is morally wrong. The 47% who say it is acceptable is, by two percentage points, the highest Gallup has recorded in two decades of measurement. Just one point separates them from the 46% who think abortion is wrong from a moral perspective.

Since 2001, the gap between these readings has varied from zero to 20 points. The latest gap, based on a May 3-18 Gallup poll, is slightly smaller than last year's, when 47% thought abortion was morally wrong and 44% said it was morally acceptable. Americans have been typically more inclined to say abortion is morally wrong than morally acceptable, though the gap has narrowed in recent years. The average gap has been five points since 2013 (43% morally acceptable and 48% morally wrong), compared with 11 points between 2001 and 2012 (39% and 50%, respectively).

Democrats and political independents have become more likely to say abortion is morally acceptable. Sixty-four percent of Democrats, 51% of independents and 26% of Republicans currently hold this view.

Sunday, August 19, 2018

Druggists Shouldn't Act as Morality Police

The Editors
Scientific American
Originally published July 18, 2018

Here is an excerpt:

In states with conscience carve-outs for pharmacists, pharmacies honoring those policies should be required to preemptively notify state authorities and medical providers that they might refuse service.

That way, women and their doctors could make alternative arrangements to fill prescriptions at pharmacies that will give them the medications they need —avoiding situations like the recent one in Arizona. (This follows a model worked out in 2014, when the Supreme Court told the Obama administration that employers with moral objections did not have to offer an insurance plan with birth control coverage. But such employers did have to notify the Department of Health and Human Services so the government and insurers could provide birth control coverage via a private insurance plan or a government-sponsored one.)

And in situations where individual pharmacists may refuse service—even if their pharmacies generally fill family-planning prescriptions—there should be a legal requirement to automatically refer that prescription to another pharmacy within a certain reasonable distance or to have a backup pharmacist on call to do the work so that patients can get medications quickly and efficiently.

The information is here.

Tuesday, May 1, 2018

'They stole my life away': women forcibly sterilised by Japan speak out

Daniel Hurst
The Guardian
Originally published April 3, 2018

Here is an excerpt:

Between 1948 and 1996, about 25,000 people were sterilised under the law, including 16,500 who did not consent to the procedure. The youngest known patients were just nine or 10 years old. About 70% of the cases involved women or girls.

Yasutaka Ichinokawa, a sociology professor at the University of Tokyo, says psychiatrists identified patients whom they thought needed sterilisation. Carers at nursing homes for people with intellectual disabilities also had sterilisation initiatives. Outside such institutions, the key people were local welfare officers known as Minsei-iin.

“All of them worked with goodwill, and they thought sterilisations were for the interests of the people for whom they cared, but today we must see this as a violation of the reproductive rights of people with disabilities,” Ichinokawa says.

After peaking at 1,362 cases in a single year in the mid-1950s, the figures began to decline in tandem with a shift in public attitudes.

In 1972, the government triggered protests by proposing an amendment to the Eugenic Protection Law to allow pregnant women with disabled foetuses to have induced abortions.

The information is here.