Legal & Medical Implications of Abortion Bans

Recently I attended a discussion about Dobbs v. Jackson, the Supreme Court case which overturned the monumental Roe v. Wade decision in 1973. There were 2 panels that convened for this discussion – a Legal Panel and a Medical Panel. Both Dr. Tonja Jacobi, a Professor of Law at Emory Law School and Dr. Jacqueline Slaughter, M.D., the owner of several “Healthy Women” medical practices and the OBGYN Department Chair at a major Atlanta area hospital, spoke on these panels.

While neither of these women asserted their personal opinion about abortion, both expressed the significant effects of the Dobbs decision on women’s lives. As a Supreme Court scholar, Dr. Jacobi speaks on how inconsistent this decision was with longstanding precedent. Dr. Slaughter continues by sharing how drastically different physicians now care for their pregnant patients, with some wanting to avoid treating expecting women at all, even if her life is in danger.

Below is an excerpt from both Dr. Jacobi and Dr. Slaughter from this discussion addressing how much the Dobbs case has limited women’s rights, not only as it pertains to abortion, but overall, as women’s rights have been reduced in the United States. What’s next? (and with the current Supreme Court, there will be a next.) The banning of contraceptives? The right to travel? The reversal of gay rights? What rights will the Supreme Court take back next?

LEGAL DISCUSSION

Question: With the overturning of Roe v Wade, in the recent Dobbs case, talk to us about the Supreme Court’s majority opinion and reasoning in the case and to what extent it broke away from prior Supreme Court jurisprudence? 

Dr. Tonja Jacobi: Dobbs was radical in a lot of ways and was inconsistent with precedent, both with direct cases on point, and also the overall approach of the Court to the Constitution. First, and most obviously, in terms of the outcome, it was the first case where the Supreme Court had taken back the constitutional right that it recognized. There is a general and overwhelming trend toward the expansion of rights. 

If you think about the franchise, for example, the franchise started off as being for white property male owners and gradually was extended beyond property, to different races, to women, to people under 21, except that there's always been an expansion of rights. Dobbs is the first case that came along and said, we're going to actually take back a right that has been recognized. And it wasn't a right that was recognized recently, it was a right that was recognized almost 50 years ago.

That's really important because it says important things about the Supreme Court and about whether they change their opinions on major issues of constitutional interpretation, with just swings in personnel. It also has a huge effect on women throughout the United States. This ruling has had a massive effect on women's lives, and that's something that was meant to be considered in terms of whether a precedent is followed. Dobbs not only overturned Roe vs. Wade and Casey, but Casey set out the grounds on which a major case like this should be overturned.

One of the factors is, “Is there significant reliance (on a constitutional right)?” Women have been relying on having freedom over their bodies, freedom to work, and being part of the economy because they have control over their reproductive rights. Women had control over whether they choose the most fundamental thing of whether they had a child and when, and that's all been taken away. That's going to massively affect women's well-being, not just in the short term in terms of the sorts of procedures women are going to have to face otherwise, but also their ability to participate as equals in the economy.

In the very first paragraph of Dobbs, Justice Alito writes that some people believe that women's participation in the economy, women's right to control their bodies, and to be free and independent, essentially, is going to be adversely affected by them not being able to obtain an abortion. Alito continues by saying, that other people believe fervently that life begins at conception, and some people believe something in between. Throughout the opinion, Alito weighs these two things as if they're somehow equal and we can have differences of opinion on whether people have a right.

That's not how constitutional analysis is undertaken. If you disagree with whether I have a right to a gun, and whether I should have a gun, that doesn't affect whether I have a right to a gun. And the Court didn't say, we recognize the right to have a handgun, but we also recognize that people want to live and not be shot, and so, therefore, that's going to restrict the rights of the gun owner. 

This Court picks and chooses how it's going to apply its analysis. They’re not supposed to define people's rights according to other people's opinions about whether they should have those rights or exercise those rights.

Additionally, women's ability to be free and equal is a question that has been addressed empirically and well-established. It's not an opinion. It is weighing what has been well established against the opinion as to whether I think you should be able to have an abortion. And that's not generally a consideration that's taken into account.

The final thing I'll say is, even if you agree that life begins at conception, that doesn't answer the question about whether the Court can then come in and say, okay, life begins at conception, and therefore we're going to take this other person and make them risk their life and their health and their well-being because we recognize that life exists. 

Even if life begins at conception, the question is, what do you do about it? Should you impose the burden of protecting that life on a different person? We don't require people to agree to organ transplants, so we have more respect for the dead over their bodies than we do these days for women and their bodies.

At the end of the day, the Dobbs decision is radical in terms of constitutional interpretation, in terms of the outcome, and in terms of the significant number of decisions that are being overturned. 

MEDICAL DISCUSSION

Question: How has the Dobbs decision impacted your medical practice and how has it changed the way you interact with your patients? 

Dr. Slaughter: So, I own a couple of medical practices called the “Healthy Woman” in Georgia. I'm also the chair of our OBGYN department at a hospital. There are several things that have changed, specifically with the passing of the GA House Bill 481, also known as “The LIFE Act,” for a lot of us.

First, as far as talking to patients, we no longer offer certain contraceptives, because they do not meet the criteria of law in Georgia. But let me walk you through a few scenarios that have changed for us. An ectopic pregnancy, which is a pregnancy implanted outside of the uterus, is allowed to be surgically managed. However, you can also have a pregnancy that is in the corner of your uterus, which can still be life-threatening. Now physicians are becoming scared of how to manage these types of pregnancies. Not only the physicians but the pharmacists too. So, if I have a patient that needs to have their pregnancy stopped through medication, I am having some pushback from pharmacists who are wanting more information before they disseminate a medication like Cytotec. 

Also, radiologists. If we as doctors determine that a pregnancy is not in the right place, the radiologists are the ones that make that call. Radiologists are sometimes nervous, and it is sometimes confusing for them to determine whether this pregnancy is in the tube or in the corner of the uterus. At hospitals, we are also having challenges with

physicians being afraid to call a pregnancy abnormal. That can be life-threatening because if it is not treated, a woman could have a serious outcome. Now, more documentation from physicians is needed to call abnormal pregnancies abnormal and for medical emergencies.

Georgia law does have caveats. We have the opportunity to say that a termination is medically necessary to help in preventing universal damage or the death of a woman. But that can be very subjective for physicians. We were trained as OBGYN doctors and surgeons that if a pregnancy looked like it was going to harm a woman or result in her death or infection, we could ask that woman, do you want this pregnancy? And if she said no, then we were more likely to treat her and stop the pregnancy. Those are things that have definitely changed in medicine. The training that we have now is different. It's not about if you want to continue this pregnancy, it's about do we think the pregnancy

is going to actually hurt you or kill you. And that can be a difficult thing for physicians.

We also have to determine if the pregnancy is medically futile. That's the thing that I think a lot of people don't really talk about regarding abortion. It’s not just, I don't want to be pregnant. There are pregnancies that are abnormal, and science has allowed us to figure out which ones are abnormal before they actually come out. Patients can have different types of abnormal chromosomes, including Trisomy 21, Trisomy 18, and Trisomy 15. Some of these are compatible with some life. Some of them are compatible with no life. They're also cases where things are wrong with a baby's brain.

Again, science has given us the ability to determine if a pregnancy is going to look a certain way and the choice that women had to stop that pregnancy has been taken away. As physicians dealing with this loose language of what is a medically futile pregnancy is something that has changed for us. We now have to decide if we think a pregnancy is actually medically futile, and if it’s medically futile, having to produce the documentation, knowing that I could be challenged and possibly be legally liable if somebody else doesn't think it was.

Finally, as a physician, I'm worried about my patients' care in other physicians’ hands because physicians who have other specialties are afraid that if they do something to save a woman's life, it could also end a pregnancy. Georgia law states that there is a defense if a physician ended up, unfortunately, stopping a pregnancy to save a woman's life who was, for example, in a terrible car accident. What if they do a surgery and they hit the uterus while they were trying to repair something else, but ended the pregnancy?

That could be a defense for that physician, but maybe that physician doesn’t want to treat pregnant patients. Maybe they're not going to want to do a procedure on them to help save their life. Maybe they're not going to do a procedure because they're afraid of injuring a pregnancy. So, I am concerned our patients may be suffering and physicians are concerned they could have some type of legal ramifications if what they do helps the woman but hurts the pregnancy. Even though it is a legal defense, they still don't want to be involved.

Domestic violence is a situation that many people have encountered either personally or through a friend or family member. Most people believe that domestic abuse cannot happen to them. Their response is, “If it was me, I would leave, or I would fight back” But very few people fully understand why and how domestic violence happens. Domestic violence happens because the batterer wants power and control. There are several forms of abuse that batterers use such as physical and sexual violence, threats and intimidation, emotional manipulation, and economic deprivation.

Another question we hear is “Why would anyone stay in an abusive relationship?” Survivors of domestic violence face overwhelming obstacles to escaping an abusive relationship. Barriers can be financial, legal, and housing problems as well as a partner’s ever-increasing violence to create an environment where it seems impossible to exit. 

Per Georgia Coalition Against Domestic Violence statistical data, about 1 in 4 women and nearly 1 in 10 men experience domestic violence in their lifetime. Georgia is one of the worst states for the rate at which women are murdered by men. 75% of homicide occurs during a period of separation.

Leaving is a complex process. Battered women stay or return in order to survive. They plan to increase their safety and prepare in advance for further violence. Battered women usually leave the residence they share with the batterer. Batterers often strike back when they think that a battered woman is leaving the relationship. For those who are survivors/overcomers can provide great knowledge to victims of domestic violence.  

When attempting to assist someone experiencing domestic violence planting seeds of hope is important during the process. Below are suggested strategies to help a victim.

· Do not be judgmental, but be supportive

· Never pressure a victim to leave or only talk about the abuse

· Express your concern for their safety

· Encourage contact with other survivors: support group, friends, neighbors, etc.

· Encourage focus on healing and rest.

· Share resource information with the victim

               o 24 Hour Statewide Crisis Line:

               o 1-800-33-HAVEN (800-334-2836)

               o Georgia Coalition Against Domestic Violence www.gcadv.org

In conclusion, domestic violence is a serious community problem that affects millions of Americans. We all should seek to shed light on the cause of domestic violence and to encourage people to join the undertaking to eliminate the problem. If we can remove the problem, it will create a world where everyone is safe in their relationships.  

About Rose Bud Transitional Home: 

This article was provided by the co-founders (Stephanie McKenzie-Domestic Violence Survivor) and (Jennifer Floyd-Advocate) of The Rose Bud Transitional Home Inc. The Rose Bud Transitional Home is a 501C3 nonprofit organization. The Rose Bud Transitional Home Inc. provides basic understanding of the dynamics of domestic abuse/Intimate partner abuse.  We believe that knowledge is the key to a successful transformation. The home is not currently open, but program services are provided in financial literacy, independent living skills, personal, and professional development. 

We hope you will consider becoming a donor to help support the women survivors of domestic violence. Your donations will allow us to add new services and events for our clients coming out of situations where their learning, growth, and enjoyment have been stifled. You will help us bring joy back into their lives.  

Web Address: rosebudhome.org 

Mailing address: P.O. Box 465404 Lawrenceville, GA 30044

Email Address: contactus@rosebudhome.org

I remember when I was a little girl in East Point, GA living with my mom and sister, seeing and talking with Dad often, running track, participating in Girl Scouts and ballet and playing with my friends. I grew up during a time where kids played outside most of the time and attended school with neighborhood friends; thus the children and teenagers spent a lot of time together and our families were interconnected.  

When I was around 10, I remember learning that the mother of our three peers living directly from us died of cancer. Over the years, three other neighborhood friends’ lives were upended by cancer. I knew these mothers. I knew these families. I knew how much my friends loved their mothers and how much their mothers loved them. At that time, cancer was in the shadows, especially cancers of the breast, prostate and reproductive organs but not anymore. 

I pray that disorders of the brain, mind and spirit will continue to come from under the stigma and out of the shadows. The complex traumatic experiences of systemic racism, sexualized racism, racialized sexism have resulted in high numbers of un and undertreated mental illness, the highest prevalence of completed suicide, and continually high numbers of domestic violence and sexual abuse. There’s too much suffering. 

Reducing the stigma of mental health is required for us to be well and for our communities to be well. A variety of changes are needed individually, collectively and systemically to improve mental health awareness. It will take time but mental health and mental illness treatment can be commonly discussed in our families just as breast cancer, breast cancer awareness, mammograms, and BRCA1-2 genes are discussed. 

This article will focus on individual changes that adults and parents can make NOW including:

1) Make the topic of mental health an expected part of your conversation during meals, while driving to and from school, work, and activities, while leisurely watching TV, and in casual conversation especially with those you are closest to.

What does it mean to be Mentally Healthy?

- Flexibility

- A positive individual and collective identity

- Having multiple reciprocal, relationships (5-7) that nurture us and are fulfilling

- Having multiple activities (20) that are fulfilling and add value

- Practicing a variety of coping and problem-solving skills (20) 

- The ability to view life realistically

How to bring the topic up? 

Say things like, I’ve been thinking about… I was reading this article…. Mental health isn’t a topic that I bring up often…. Mental health is a topic that we don’t talk about much but I want to start discussing mental health [or our mental health more.] 

Continue the conversation by asking, What does it mean to be mentally healthy?  What does mental health look like for me? What did each of us to work on regarding our mental health today? [At the beginning of the day], what can each of us to work on our mental health today? What parts of being mentally healthy are working? What parts of being mental healthy are not working as well as they can?  How can I support you in making changes and improvements? 

The more we talk about mental health, the less awkward and uncomfortable it will become and the more we can practice being well. Remember, Practice makes Improvements (Les Brown). 

2) The biological – spiritual conflict perpetuates the stigma of discussing how we view brain and mental health and their respective treatment.  I absolutely agree that the concept of a chemical basis of feelings and mood is hard to conceptualize.  As a physician, I understand that the body is made up of atoms that come together to create particles which coalesce to make our organs, tissues, skin, the objects we use every day, the environment, and everything around us. It remains very difficult for me to fully grasp how it all fits together. As a believer in God, I believe that all things will be revealed, I do not have the capacity to fully understand it all, and I trust and believe that God’s Plan and Why is only for my good. 

Saying that, the brain is the organizer of all systems, feedback loops, processes of the body. Therefore what I put in my body affects my brain. Just as I can improve the health of my kidneys, heart, liver, and gastrointestinal system, I can improve the health of my brain by: 

-Eating adequate healthy, nutritious food so that my brain has the Dopamine, Serotonin, Norepinephrine, GABA and Melatonin which are needed for attention and concentration, execution of tasks, clarity of thought, restful sleep, flexibility of mind, and regulated mood and management of anxiety and worry. Your body needs healthy foods for your body to make neurochemicals. 

-High calorie, high sugary, and high fat food drive inflammation. We once thought inflammation was only part of the pain process for years but now we understand that inflammation is a main driver of the breakdown of blood vessels and healthy metabolic function throughout the body. Thus, excess inflammation exacerbates depression so fast and unhealthy eaten too often contribute to brain disease and mental illness. 

-Exercise boosts Serotonin, which is the main neurochemical involved in depression, anxiety and it is broken down to make Melatonin. 

-Adequate hydration helps us to feel more alert and awake.  Dehydration can slow us down, make us feel sluggish and if we are not careful this can result in low energy, lack of accomplishment, or lack of initiative.

So, what can families do? Vigilantly incorporate healthy eating, exercising, adequate hydration into family conversation and action.  Parents who exercise increase the likelihood of children and teens that exercise. Parents who eat healthy foods and drink the appropriate amount of water increase the likelihood that their children and teens will eat healthy foods and are hydrated.  Depression, anxiety, helplessness and overwhelm are less in healthy brains. 

3). Specifically incorporating the purpose of coping skill or tools into our normal conversations is essential to mental health. It’s important to utilize a variety of coping strategies to address the multitude of experiences, thoughts, reactions, slights and feelings that we experience throughout the day. A coping skill is an activity or action that helps us manage and distract ourselves from unwanted thoughts and/or emotions. Coping tools do not replace problem-solving; thus both are needed at times to feel better and grow. 

*I personally suggest that people have at least +- 20 TWENTY (Most people only have 3-4 coping skills).* Indigo Daya, Researcher and Mental Health Advocate, suggests developing and practice coping skills in the following categories including: 

· Distraction

· Grounding

· Self-Love 

· Accessing one’s higher self

· Thought Challenging 

· Emotional Release

Additional coping skill categories from other wellness leaders include Crisis Planning, Mindfulness, Self - Soothing or Opposite Action. Additional tips include: 

To be effective, write down your coping skills.

To be effective, practice your coping skills daily.

Consider asking healthy, trusted people in your life to remind you of your coping skills.

Again, individuals and parents who have a variety of coping and problem-solving skills, verbalize when coping and problem-solving skills are being used, and encourage coping skills and problem-solving utilization in those around them have healthier relationships and life experiences.  

4) Lastly, it’s important that we all recognize that time is needed to be healthy and well. Time is needed to understand ourselves, build our self – awareness, identify which tools and practices work best for us, and cultivate communication that encourages authenticity and validation of the self and of others.  In our busy life, we are busy, we rush, we try to make things fit, assume everything is fine because we don’t have time to fix it, don’t want to address it or don’t have the skills to assist. If you are too busy to be well, you are too busy. If you are too stressed to be healthy, you are too stressed.

Parents, connecting with your child may not come on your terms; it is our responsibilities as parents to meet our children and teens where they are and nurture health and well-being within them.  Mental Health and Wellness is possible for us all and there are factors that we as individuals can and must do to obtain them.

For additional information, visit Dr. Sherri Broadwater at www.drsherripsych.net