As they say on Games of Thrones, “winter is coming.” With the recent assent of King Geoffrey to the United States presidential throne in King’s Landing, our nation appears to be sliding into a dark season of mean. The Id has been given leave to grab crotches and run free during daylight as well as at night. Entitlement has been elevated to a constitutionally protected right. Noble dissent, as well as free press, is punishable by beheading. Daenerys Targaryen, the woman who could not be burned, has been exiled and Black lives don’t matter unless they are preborn.
To no one’s surprise, the subjugation of American values to the ascendancy of the alt right and the conservative values movement has emboldened the last remnants of the Confederacy to saddle up and, once again, ride the night; the last, best chance, to right the wrongs committed against their perverted sense of property rights. In the South, odd notions of who belonged to whom led to the bloodiest war in the nation’s history; a Federal offense to Southern heritage which remains a sore point and an insult which still demands redress.
As Obstetricians-Gynecologists we are again preparing to head to Columbia to speak to South Carolina’s legislature about the regressive foolishness of over-reaching legislation. State legislation designed to dominate women and defy the supremacy of Federal law; a butternut gray and musket totting reassertion of political ideology. Who better to decide about reproductive health issues than a bunch of angry, old white guys in Columbia? Remember, it’s about property. Property owners make the rules and decide who sits at the table.
One of the two hot topics is South Carolina House Bill #3530, known as the “Personhood Act of South Carolina”, which establishes the right to life for each born and preborn human being at the time of fertilization. The second is House Bill #3548, affectionately named “South Carolina Unborn Child Protection from Dismemberment Abortion Act.”
Let’s talk about the Personhood bill. It’s a simple document full of religious mandates which somehow slipped through the separation of church and state checkpoint. Why burden something that is so straightforward with a lot of unnecessary detail. Basically, all the rights and protections of personhood are bestowed upon you at the time of fertilization (scientifically–within the fallopian tube in the first 24 hours after ovulation). There are five brief legalistic clauses. “All persons are endowed by their Creator with unalienable rights.” “South Carolina contains the sovereign people’s acknowledgment of God,” and that “Personhood is God-given, as all men are created in the image of God.”
Don’t you wish sometimes that the apostles had taken just a little literary license and said that all men and women were created in God’s image? That one little oversight has sure been a source of continuing problems. It raises questions, though. What if a fertilized egg is female? Is that human being not covered by personhood since it wasn’t created in the image of God?
Of course, with the designation of personhood, the state bestows rights and privileges, which if denied, can be rectified by both civil and criminal penalties. Remember, if you’re going to be a property owner, you’re going to need an overseer to periodically crack the whip to keep your chattel in line.
For all its simplistic beauty, the Personhood Bill does leave a few questions in limbo.
What do we do with the “person” who has gotten stuck in the fallopian tube or abdominal cavity as an ectopic pregnancy? The law would insist that we wait for it to rupture, the mother to bleed out and the “person” to die before we surgically intervene rather that treating the mother medically. What should we do if the “person” is a genetically abnormal molar pregnancy? A molar pregnancy is technically a fertilized eggs that is rapidly growing while hemorrhaging. The molar pregnancy “person” won’t die until the mother does.
What do we do when the needs of the “person” is causing the mother to choke to death with heart failure, to bleed to death from placental hemorrhage, to suffer strokes or seizures from uncontrolled pre-eclampsia/eclampsia, to put off life-saving chemotherapy or irradiation, to suffer debilitating emotional distress or mental illness? The bill, unfortunately, only establishes state ownership of the “person.” It doesn’t get into the weeds over what to do when the “person” is killing its host. Well, there’re going to be causalities in any war over property.
The above doesn’t even get into the sadly trivialized questions of what to do when the “person” has taken up residence as a consequence of rape or incest of a thirteen year old. It doesn’t answer the question of what to do when the “person” is severely and irreversibly, mentally or physically disabled. The state is fascinated with protecting that “person” until it’s born, but after that, the state seems less interested in providing catastrophic health care coverage, humane custodial care, home health care assistance, parental subsidies for lost work due to childcare, special education, or state of the art rehabilitative care. The “born” have somehow become less worthy of protection than the “preborn.”
Even if you are a parent with only boys, you should still be interested. Little Johnnie Jr. steals some Vodka from your liquor cabinet and some Xanax from your medicine cabinet to help spice up PROM night. PROM night works out better than expected and he gets lucky with lovely young Betsy in the back seat of his dad’s 2008 Oldsmobile 98 Custom Brougham with crushed velvet interior. Two hours later (after fertilization) the inebriated Johnnie wrecks the Olds and six weeks later Betsy has a miscarriage. Hopefully the local prosecutor is not a strict Constitutionalist with political aspirations. The law would make Johnnie guilty of involuntary manslaughter while under the influence of drugs and alcohol. At best, Johnnie has no shot at the Palmetto scholarship to Clemson.
Lastly, the Personhood Bill makes me worried about the Reproductive Infertility doctors. Not worried for them; I’m worried about them. Reproductive Infertility doctors spend all day, every day fertilizing eggs and storing them in a deep freeze. According to the law, Personhood is God-given and is vested at fertilization. The last thing our Reproductive Infertility doctors need is another affirmation of their God-like capabilities.
Along those lines, what does become of all those “people” stranded in the deep freeze? Do they need to be thawed out and placed in a plastic bag and returned to the mother like circus goldfish? Are the Reproductive Infertility specialists legally the adoptive parents, and if so, what are their legal and financial obligations to the frozen “people?” If a weekend power outage causes a lethal thawing of the cryo-preservation tubes, is S.C. Electric and Gas criminally liable for a mass murder?
A guiding principle of medicine and at the ethical core of our profession is patient autonomy. We can diagnose, counsel and educate patients, but we understand that we cannot know better for our patients than they can know for themselves. Only a woman, and a woman herself, armed with medically accurate information, can make decisions that affect her body, her life, as well as the lives of her children and families. It may not be South Carolina law, but it has long been Federal law. Only the state Legislature has enough hubris to believe that they can substitute their judgement for those of pregnant women.
Medicine must transcend patriarchy, politics and political ideology. The legislature is not the “person” they think they are and the women of South Carolina do not belong to them.
The other piece of legislation is House Bill # 3548 which is even briefer. It is a bill that protects unborn children from dismemberment abortion. It provides for injunctive relief, civil remedies and criminal penalties for dismemberment. Sure sounds good doesn’t it? The only problem is that all abortions, from the earliest to the latest, involve dismemberment. Maybe everyone doesn’t already know that, but the legislature sure does.
This bill is the product of conservative think tanks who receive big bucks to come up with slogans and branding ideas that help sway public opinion. They are really good at it. They helped get President Geoffrey elected because the majority of American’s were convinced that they hated “ObamaCare.” That has since become a bit problematic because the majority of Americans love the “Affordable Care Act” and are now surprised to find out that they are the same thing.
Another one of those clever slogans is the “right to life.” How can anyone argue with a right to life? Well, what if that right to life is only achievable through the erosion of someone else’s rights. Federal law has already established the balance between the fetal right to life and the mother’s right control her own body and make her own health care choices. Two hundred years ago, slaves had no right to life. Why wasn’t it a good slogan then? Well, it was because slaves were the property of the slave owners.
I don’t really have that much against House Bill #3548. It isn’t disingenuous. It is straightforward, albeit clever. It looks good and it sounds good. It just smells bad. It is unquestionably unconstitutional, but that has never stopped the South Carolina Legislature from spending our tax money on hopeless legal challenges in order to score political points. It also seems a bit cowardly. If you don’t want abortions to happen, then propose a bill that bans abortion. See if the public supports it and see if the judiciary allows it. But don’t try to pass a half-way bill that curries public favor because they don’t know what you’re really up to and the word “dismemberment” sure sounds bad.
It is extremely dangerous for legislators to presume that they are better equipped than medically trained physicians to fully inform women and recommend what treatment options are the best and safest for an individual patient. Women deserve laws that allow them to choose from a full range of safe treatment options based on their personal circumstances and beliefs.
As a high risk Obstetrician-Gynecologist, I have encountered literally hundreds of women confronting unexpected and tragic obstetrical complications. A wide variety of decisions have been made in those circumstances, however, there is one consistency. Preconceived notions about how anyone would handle such a life-altering situation are never sufficient. Reality has a way of slapping you in the face. That slap always demands a reevaluation of life, core beliefs and health care options. From there, a decision is made as to how to proceed. Sometimes pregnancies are interrupted, sometimes not. Sometimes, nature takes its course, sometimes not. But the one thing every woman will tell you, the belief in a one size fits all solution is a fantasy.
So, if you are happening to be reading this, and have the “radical leftist” belief that reproductive choices are best left to the individual women and her health provider, then call your legislator and voice your opposition to House Bills #3530 and #3548. It’s your body and you’re not their property. If there is anything I’ve learned about South Carolinians is that they are genetically disinclined to being told what to do. Suggest to your legislator that they may want turn their attention away from your “naughty parts”, to bigger problems such as education, poverty, health care or infrastructure.
For this particular topic, it was difficult to find a really appropriate Springsteen song although he does have several that address political over-reach in areas other than reproductive rights. I settled on one of his early classics, Rosalita (Come Out Tonight) which is one of his legendary set closers. It is a call out to a young girlfriend to defy paternity and rebel against control. “I ain’t here on business, I’m only here for fun.” Clemon’s sax is the glue holding the story together, carrying from verse to verse,while the rest of the band surges and drops back in turn with an unmistakeable melange of bass, organ and piano.
I am a Professor and Maas Endowed Chair of Reproductive Sciences. As always, the above represent my personal opinion and not that of my employer which is the Medical University of South Carolina