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  • Dr. Bow Tie

The Supreme Court Has Blood On Its Hands

A lot of women and people with uteruses are going to suffer, and many will die, because of the decision of the Supreme Court on June 24th, overturning what should have been settled law in Roe v. Wade and Planned Parenthood v. Casey.


On top of that, Clarence Thomas’s concurring opinion states that they should go after same-sex relationships and marriage as well as contraception next (and he assumes his own interracial marriage won’t be after that...how convenient).


But don’t worry, you can still concealed carry a gun anywhere without restriction (as long as you’re white - ask Philando Castile). Apparently states can’t put laws on that, even though they should govern uteruses.


Incidentally, the other day the Court also ruled that insurance companies could tell end-stage renal disease patients that their ability to get dialysis is limited and may end at some arbitrary point, essentially sentencing them to death on insurance company terms.


The Supreme Court has blood on its hands, and America’s veneer (because that’s all it is) of “freedom” is disintegrating.


ABORTION IS A PROCEDURE

Abortion is a healthcare procedure, involving removal or expulsion of a fetus. Sometimes this is spontaneous. A spontaneous abortion is sometimes called a miscarriage. In other cases, the abortion must be induced. Dilation & curettage, dilation and evacuation, mifepristone+misoprostol, are all ways to aid that process.


What kind of conditions, other than a spontaneous abortion, would merit any of these procedures? Are all other abortions simply a person's whim?


Abortion is rarely, if ever, a "simple" decision. It may seem that way to someone looking at the decision-maker, but there are many factors considered in that choice. Economic factors, safety factors, family/friend/other supports, and of course, general health. Sometimes the person's health makes the decision for them.


We have already discussed the spontaneous abortion or miscarriage - if the fetus does not exit by itself (or if it's only partial in its loss), that requires an abortion procedure. There is also a septic uterus or septic abortion (in which an infection develops in the uterus that can be potentially life-threatening), or an ectopic abortion (in which the embryo - the fertilized egg - implants somewhere other than the uterus, which is a very serious problem). Ectopic pregnancies can also lead to infection, but can also lead to a rupture of the ectopic pregnancy which can lead to hemorrhaging (excessive bleeding), shock, and can be deadly.


The treatment for these conditions is either a medical or surgical abortion. LiveAction (a noted anti-choice propaganda group) just tried to share memes claiming the opposite, that anti-choice laws don't affect the treatment of those dangerous conditions, but that is disinformation. There is no way around the fact that abortion is the treatment here. These are the indications for a healthcare procedure known as abortion (just like a heart attack may be an indication for an angiogram or a tumor may be an indication for surgical resection).


THE LEGAL IMPLICATIONS AND LACK OF LOOPHOLES

People will take solace in the fact that there are "exceptions for the life of the mother." The problem is, many of the laws being enacted now do not make exceptions for that (Arkansas, Idaho, Mississippi, Oklahoma, and both of the Dakotas). Even more states' new (or old) laws do not make exceptions for rape or incest. So a 13-year-old girl (not woman...girl) who is raped by a family member is now forced to carry that to birth, and if, God forbid, an infection or ectopic placement occurs, she WILL die. And even if she does not, she will have little to no economic safety net with which to raise it (see graphic below).



Even in states where exceptions are supposedly made, that relies too heavily on subjective judgements. As Dr. Danielle Jones (@mamadoctorjones) puts it, everything is higher risk when a person is pregnant. When does it become an emergency? When does the parent’s life become endangered? Everyone knows someone or is someone with a story of when a doctor missed something or underestimated a situation. Why can the impregnated person not advocate for themselves here and make their own choice?


Further, in some states abortion is now deemed a reportable offense. That means patients can no longer trust their doctors, NPs/PAs, nurses, or other healthcare providers not to turn them into the police (and healthcare suffers if patients are made to feel they cannot tell the truth to their providers). Meanwhile, the doctors are not sure if their judgment will be deemed adequate in a court of law - there are multiple states where a court of law may determine that it was not, in fact, an emergency, which means the doctor could go to jail for multiple years. Texas and other states are literally designing laws for this. In an ideal world, we would defy any law and put our patients first, but jail time is not something anyone wishes to face (and people have families and other obligations that don't exactly allow for >two years away from them).


Edit 7:23 AM: There is also a certain hollow relief expressed by those in states where abortion is still legal, that those seeking abortions will be able to go there for safe haven. However, multiple states are trying to push laws through that will forbid crossing state lines for an abortion (may be difficult to enforce, but we also thought Roe would not be overturned at one point). Just as scary, if a pregnant person travels to a state where it is no longer legal (for a sporting event or conference) and has a miscarriage or other issue, that person may not be able to get the healthcare they counted on. No one is actually safe from this.




"WHAT'S THE BIG DEAL? IF YOU DON'T WANT A BABY, JUST DON'T HAVE SEX!"

I've written about this before and talked about how stupid that notion is, because sex is a part of life and relationships, and how much it highlights the importance of access to reliable birth control (which is different from person to person).

With the latest events, I have been made aware of a horror I never considered because...well, I'm a guy. Multiple women have discussed how often they have been approached for sex (casually, maybe even in the course of a date) but when they tried to refuse for any reason, the man immediately turned aggressive, sometimes even violent. According to the National Sexual Assault Hotline, 1 out of every 6 American women have been the victim of attempted or completed rape in their lifetime. "Just don't have sex" is meaningless in a world where men continue to try to dominate women.


BEYOND SEX AND REPRODUCTION

Let's say none of this has convinced you. Let's talk, then, about how this has effects beyond the pregnancy. Many people are now facing difficulties obtaining medications for conditions like rheumatoid arthritis (methotrexate, which can be used for medically-induced abortions; patients are normally advised to be on multiple forms of birth control while on this medication for RA or other autoimmune conditions due to this effect), while others' doctors are forced to consider the possible implications of prescribing medications which may cause birth defects. Patient who are diagnosed with cancer often must terminate their pregnancies before they can start chemotherapy due to the risks to the fetus. This would normally be a discussion of risks and benefits between a patient and their doctor, but now in some states it can be reported - it may not result in jail time because of the circumstances, but no physician can hang their hat on that.




WHAT CAN WE DO (OR NOT DO)?

All of this is scary to think about. The implications of this overturn are vast. In the meantime, what can we do?

DO: donate to abortion funds. Planned Parenthood and NARAL (The National Association to Repeal Abortion Laws) are great (I donate annually) but they are large organizations and have decent backing (for now, at least). To get boots-on-the-ground help to people who need it, the local abortion fund is your best bet.


DO NOT: Use herbs or poultices or home remedies found on the Internet! There are SEVERAL TikToks going around with home solutions to induce abortion and many of these either do not work or they cause harmful and potentially deadly side effects.

  • Vitamin C overdoses (you'll just be pregnant with kidney stones which would suuuuuuck) (see paper below, made no difference in pregnancy)

  • Pennyroyal: Contains a chemical that is toxic to the liver and the nervous system and commonly causes death. PLEASE DO NOT TAKE IT

  • Parsley or other herbs in the vagina (or boiled in water or extracts): Poor data to support, and also causes a lot of harm including death

  • More examples in Dr. Jen Gunter's post (with toxicologists Dr. Ryan Marino and Dr. Josh Trebach) here: https://vajenda.substack.com/p/dont-take-advice-from-tiktok-on-herbal

DO: Call your Congressional representatives and tell them to support abortion as healthcare and reproductive justice.


DO: Continue to support safe, medically-supervised abortion because that will save lives. Abortion is not "killing babies." It is healthcare.


As always, I welcome your questions, assuming those questions are in good faith.


Unintended Pregnancy Rates (as in, the people most affected by this):

https://www.contraceptionjournal.org/article/S0010-7824(11)00472-0/fulltext


Abortion Is Healthcare: https://www.nature.com/articles/d41586-022-01249-2

https://www.nature.com/articles/d41586-022-01775-z

https://www.nejm.org/doi/full/10.1056/NEJMe2208288

https://www.nature.com/articles/d41586-021-02834-7

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00870-4/fulltext


Donate: https://abortionfunds.org/

I got social media-screamed at by a man from Florida in response to one of my Reels discussing this issue, so I decided to donate to a Florida abortion fund in addition to the National Network of Abortion Funds.





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