Ethical and Legal Obligations for Research Involving Pregnant Persons in a Post-Dobbs Context

In light of a history of categorical exclusion, it is critical that pregnant people are included in research to help improve the knowledge base and interventions needed to address public health. Yet the volatile legal landscape around reproductive rights in the United States threatens to undue recent progress made toward the greater inclusion of pregnant people in research. We offer ethical and practical guidance for researchers, sponsors, and institutional review boards to take specific steps to minimize legal risks and ensure the ethical conduct of research with pregnant people in an evolving legal environment.

From Constitutional Protections to Medical Ethics: The Future of Pregnant Patients' Medical Self-Determination Rights After Dobbs

This article argues that the Supreme Court's decision in Dobbs is likely to impact medical decision-making by pregnant patients in a variety of contexts. Of particular concern are situations where a patient declines treatment recommended for its potential benefit to the fetus and situations where treatment is withheld due to potential risk to the fetus. The Court's elevation of fetal interests, combined with a history of courts using abortion jurisprudence to guide their reasoning in compelled treatment cases, means that Dobbs has the potential to limit patient autonomy in a wide array of clinical settings. The article calls on professional medical associations to issue ethical guidance affirming the duty to respect the medical self-determination of pregnant patients.

Leveraging the Tools Available: Using the Hyde Amendment to Preserve Minimum Abortion Access and Mitigate Harms in Restrictive States

The overturn of Roe v. Wade has resulted in fewer rights and resources for people seeking abortion care, particularly in the South. The Hyde Amendment has historically restricted abortion access for those enrolled in Medicaid. We argue here that its guarantees of minimum abortion coverage should be leveraged to offset harms where possible.

Reproductive Justice Beyond Borders: Global Feminist Solidarity in the Post-Roe Era

The global impact of Dobbs v. Jackson Women's Health Organization and the backlash towards reproductive justice that it represents warrant a global feminist response informed by broad theoretical and geopolitical lenses. We consider how a solidaristic, transnational feminist movement might learn from Latin American feminist movements that have been successful in uniting broad coalitions in the fight for reproductive justice as situated within far-reaching political goals. The success of such a global movement must be decolonial and must contend with the fact that overlapping realities of global inequality, severe poverty, extractivism, and western-backed violence are fundamentally implicated in reproductive justice.

Dobbs v. Jackson Women's Health: Undermining Public Health, Facilitating Reproductive Coercion

Dobbs v. Jackson Women's Health continues a trajectory of U.S. Supreme Court jurisprudence that undermines the normative foundation of public health - the idea that the state is obligated to provide a robust set of supports for healthcare services and the underlying social determinants of health. Dobbs furthers a longstanding ideology of individual responsibility in public health, neglecting collective responsibility for better health outcomes. Such an ideology on individual responsibility not only enables a shrinking of public health infrastructure for reproductive health, it facilitates the rise of reproductive coercion and a criminal legal response to pregnancy and abortion. This commentary situates Dobbs in the context of a long historical shift in public health that increasingly places burdens on individuals for their own reproductive health care, moving away from the possibility of a robust state public health infrastructure.

Abortion Rights and the Child Welfare System: How Dobbs Exacerbates Existing Racial Inequities and Further Traumatizes Black Families

This article explores how abortion bans in states with large Black populations will exacerbate existing racial inequities in those states' child welfare systems.

Beyond Roe: Implications for End-of-Life Decision-Making During Pregnancy

The end of Roe v. Wade has significant implications for the autonomy of pregnant patients at the end of life. At least thirty states restrict the choice to withhold/withdraw life-sustaining treatments from pregnant patients without decisional capacity, invalidating prior advance directives and prohibiting others from choosing these options for the patient. Many restrictions are based on the Roe framework, applying after "viability" or similar considerations of fetal development or prospect for live birth. Scholars have also relied on the abortion framework, arguing that the restrictions impose an undue burden. The end of Roe will free states from having to craft limited restrictions designed to work around prior abortion jurisprudence. Similarly, advocates will no longer be able to draw support from the abortion framework, forcing them to rely instead on cases supporting rights to autonomy/bodily integrity in medical decision-making.

The impact of hostile abortion legislation on the United States maternal mortality crisis: a call for increased abortion education

The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women's Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate already existing racial inequities in maternal and neonatal outcomes. The United States is facing a Black maternal health crisis where Black birthing people are more than twice as likely to experience maternal mortality and severe maternal morbidity compared to White birthing people. Restrictions creating geographic, transportation, and financial barriers to obtaining an abortion can result in increased rates of maternal death and adverse outcomes across all groups but especially among Black birthing people. Restrictive abortion laws in certain states will decrease already limited training opportunities in abortion care for medical professionals, despite the existing abortion provider shortage. There is an immediate need for federal legislation codifying broad abortion care access into law and expanding access to abortion training across medical education. This commentary explores the impact of restrictive abortion laws on the Black maternal health crisis through multiple pathways in a logic model. By identifying current barriers to abortion education in medical school and residency, we created a list of action items to expand abortion education and access.

People's knowledge of and attitudes toward abortion laws before and after the Dobbs v. Jackson decision

Although media response to the Dobbs v. Jackson Women's Health Organization decision was widespread in the United States, the extent to which people were aware of the Mississippi law leading to the decision, the Dobbs v. Jackson case, is unclear, as are the resulting effects of the decision on legal abortion. As such, we examined people's awareness of abortion legality prior to and after the Dobbs v. Jackson decision announcement, as well as the potential implications associated with the decision (i.e. overturning of Roe v. Wade). We also examined people's attitudes toward abortion legality, specifically focusing on 15 weeks' gestation to correspond with the Mississippi law that led to Dobbs v. Jackson. Data were collected across two studies at different times. In Study 1, a 15-minute survey was administered to IPSOS' KnowledgePanel (N = 1014) prior to the decision announcement. A shorter version of that survey was administered to a second sample using NORC's AmeriSpeak Omnibus panel (N = 1002). Nearly half of that sample (42.2%) completed the survey prior to the decision announcement. People were generally unaware of the Mississippi law, the Dobbs v. Jackson case, and implications associated with the decision (e.g. overturning Roe v. Wade). People generally endorsed abortion being legal at 15 weeks or later, but this varied by circumstance. We did not find meaningful effects of the decision announcement on people's knowledge and attitudes. Our findings suggest that the intense response to the decision from the media and people involved in the abortion movement may not represent the general public's reaction.

Abortion Access for Women in Custody in the Wake of Dobbs v. Jackson Women's Health

The United States Supreme Court's decision in Dobbs v. Jackson Women's Health Organization made it drastically harder for women to access abortions. The Dobbs decision has had a disproportionate impact on women who are incarcerated or on some form of community supervision such as probation or parole. This Note analyzes a potential right to an abortion for women involved in the criminal justice system, even those living in states that have banned or deeply restricted abortion access after the Dobbs decision. In doing so, this Note looks for different constitutional avenues to protect incarcerated women's right to an abortion, including under the Eighth Amendment to the U.S. Constitution.

Abortion Policy: Legal, Clinical, and Medical Education Considerations

Abortion is a frequent topic of policy debate in America and a central issue in politics since the Dobbs v Jackson Women's Health Supreme Court decision. A number of states have completely or nearly completely banned abortion and criminalized health care providers. People seeking abortion care are turning to alternatives outside the formal health care system or traveling to states that have preserved access. Approximately half of US Obstetrics/Gynecology residents will train in a state where abortion is illegal, lending to a frightening future where Obstetrics/Gynecologists are not trained to provide this common, sometimes life-saving, health care.

Why Has a Progressive Court Failed to Protect the Prison Population against COVID-19? Mass Incarceration and Brazil's Supreme Court

Despite acknowledging the risks of the COVID-19 pandemic for the prison population, Brazil's Supreme Court declined to issue structural injunctions during the health crisis ordering lower courts to consider these risks when making incarceration-related decisions. These injunctions could have been crucial to mitigate mass incarceration and protect the prison population during the pandemic. Through an examination of the Supreme Court's rulings in structural cases and in a sample of over 4,000 habeas corpus decisions, this paper argues that granting these injunctions would have overwhelmed the court with an unmanageable influx of individual claims. Consequently, the Supreme Court acted strategically in anticipation of its limited institutional capacity to enforce compliance with structural injunctions among lower courts. This case study illustrates how practical considerations can hinder structural decisions in criminal law and highlights the limits of structural litigation and constitutional jurisdiction to address mass incarceration.

The Supreme Court's 303 Creative Decision and the Threat to LGBTQ+ Health Care

This Viewpoint examines the importance of the Supreme Court decision in 303 Creative and its possible effects on legislation safeguarding nondiscriminatory health care.

Institutional hybridity and policy-motivated reasoning structure public evaluations of the Supreme Court

How does the public assess the Supreme Court and its work? Using data from three surveys conducted over a span of ten years, we show that individuals' policy preferences drive evaluations of the Court and its willingness to reform the Court. We find strong evidence that the Court's hybrid legal-political nature enables a unique form of policy-motivated reasoning: respondents who agree with Court outputs view the Court and its work as more "legal" in nature, while those who disagree view both as more "political." Our findings stand in contrast to longstanding views in the literature that the public views the Court as a fundamentally different sort of institution that stands largely separate from politics. The fact that policy attitudes powerfully inform the public's assessment of the Court has crucial implications for the ongoing debates over Supreme Court power.

The Role of Telehealth in Promoting Equitable Abortion Access in the United States: Spatial Analysis

BACKGROUND

Even preceding the Supreme Court's 2022 Dobbs v. Jackson Women's Health Organization decision, patients in the United States faced exceptional barriers to reach abortion providers. Abortion restrictions disproportionately limited abortion access among people of color, young people, and those living on low incomes. Presently, clinics in states where abortion remains legal are experiencing an influx of out-of-state patients and wait times for in-person appointments are increasing. Direct-to-patient telehealth for abortion care has expanded since its introduction in the United States in 2020. However, the role of this telehealth model in addressing geographic barriers to and inequities in abortion access remains unclear.

OBJECTIVE

We sought to examine the amount of travel that patients averted by using telehealth for abortion care, and the role of telehealth in mitigating inequities in abortion access by race or ethnicity, age, pregnancy duration, socioeconomic status, rural residence, and distance to a facility.

METHODS

We used geospatial analyses and data from patients in the California Home Abortion by Telehealth Study, residing in 31 states and Washington DC, who obtained telehealth abortion care at 1 of 3 virtual abortion clinics. We used patients' residential ZIP code data and data from US abortion facility locations to document the round-trip driving distance in miles, driving time, and public transit time to the nearest abortion facility that patients averted by using telehealth abortion services from April 2021 to January 2022, before the Dobbs decision. We used binomial regression to assess whether patients reported that telehealth was more likely to make it possible to access a timely abortion among patients of color, those experiencing food insecurity, younger patients, those with longer pregnancy durations, rural patients, and those residing further from their closest abortion facility.

RESULTS

The 6027 patients averted a median of 10 (IQR 5-26) miles and 25 (IQR 14-46) minutes of round-trip driving, and 1 hour 25 minutes (IQR 46 minutes to 2 hours 30 minutes) of round-trip public transit time. Among a subsample of 1586 patients surveyed, 43% (n=683) reported that telehealth made it possible to obtain timely abortion care. Telehealth was most likely to make it possible to have a timely abortion for younger patients (prevalence ratio [PR] 1.4, 95% CI 1.2-1.6) for patients younger than 25 years of age compared to those 35 years of age or older), rural patients (PR 1.4, 95% CI 1.2-1.6), those experiencing food insecurity (PR 1.3, 95% CI 1.1-1.4), and those who averted over 100 miles of driving to their closest abortion facility (PR 1.6, 95% CI 1.3-1.9).

CONCLUSIONS

These findings support the role of telehealth in reducing abortion-related travel barriers in states where abortion remains legal, especially among patient populations who already face structural barriers to abortion care. Restrictions on telehealth abortion threaten health equity.

The future of FemTech ethics & privacy - a global perspective

We discuss the concept of women's empowerment in FemTech, considering cultural and legal differences, ethical concerns, and legal consequences. We claim that it is crucial to prioritize privacy, a fundamental right, especially in the case of changes in laws related to women's health, such as Roe v. Wade in the US.

Cancer and Pregnancy in the Post-Roe v. Wade Era: A Comprehensive Review

Cancer during pregnancy, affecting 1 in 1000 pregnancies, is rising in incidence due to delayed childbearing and improved detection. Common types include breast cancer, melanoma and cervical cancer and Hodgkin's Lymphoma. There are several physiological changes that occur during pregnancy that make its management a challenge to clinicians. Managing it requires multidisciplinary approaches and cautious test interpretation due to overlapping symptoms. To minimize fetal radiation exposure, non-ionizing imaging is preferred, and the interpretation of tumor markers is challenging due to inflammation and pregnancy effects. In terms of treatment, chemotherapy is avoided in the first trimester but may be considered later. Immunotherapy's safety is under investigation, and surgery depends on gestational age and cancer type. Ethical and legal concerns are growing, especially with changes in U.S. abortion laws. Access to abortion for medical reasons is vital for pregnant cancer patients needing urgent treatment. Maternal outcomes may depend on the type of cancer as well as chemotherapy received but, in general, they are similar to the non-pregnant population. Fetal outcomes are usually the same as the general population with treatment exposure from the second trimester onwards. Fertility preservation may be an important component of the treatment discussion depending on the patient's wishes, age and type of treatment. This article addresses the complicated nature of a diagnosis of cancer in pregnancy, touching upon the known medical literature as well as the ethical-legal implications of such a diagnosis, whose importance has increased in the light of recent judicial developments.