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PaperclipPerfector  2mo ago (text post)   29662 thread views

Culture War Roundup for the week of September 16, 2024

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So, after she arrived at the hospital, do you think they should have operated sooner or no? Or do you think we don't have enough information to make a determination?

I'm not a physician, so it's not clear to me whether the article gives enough information on this particular choice or not. The committee (which I assume includes some medical personnel, but which apparently does not consist exclusively of physicians) seems to think the operation should have occurred sooner, and that doesn't seem obviously wrong to me:

After reviewing Thurman’s case, the committee highlighted Piedmont’s “lack of policies/procedures in place to evacuate uterus immediately” and recommended all hospitals implement policies “to treat a septic abortion on an ongoing basis.”

The claim that Georgia's abortion law is specifically responsible for the "lack of policies/procedures" in question does not appear justified by the evidence available. Nobody in a position to know ever said, "we delayed this critical operation because of the law," and the article always stops just short of actually making that assertion. The whole essay is an exercise in suggesting a certain interpretation of events. From a purely technical standpoint, it's well-crafted propaganda. Ultimately, the story doesn't hold up, but in order to do the work it appears intended to do, the story doesn't have to hold up. It just needs the approximate "truthiness" of statements like "Haitian immigrants in Springfield, Ohio are eating cats."

There's... also a really morbid question, whether the law clearly excludes the D&C here from its coverage. The statute is available online:

No abortion is authorized or shall be performed if an unborn child has been determined in accordance with Code Section 31-9B-2 to have a detectable human heartbeat except when: A physician determines, in reasonable medical judgment, that a medical emergency exists; [rape or incest and genetic abnormalities exceptions not relevant here]

What is 'medical emergency' defined as?

'Medical emergency' means a condition in which an abortion is necessary in order to prevent the death of the pregnant woman or the substantial and irreversible physical impairment of a major bodily function of the pregnant woman. No such greater risk shall be deemed to exist if it is based on a diagnosis or claim of a mental or emotional condition of the pregnant woman or that the pregnant woman will purposefully engage in conduct which she intends to result in her death or in substantial and irreversible physical impairment of a major bodily function.

There are certainly some state laws that have overly restrictive rules, but these exceptions seem, at least to my layman's eyes, reasonably well-written to include serious dangers to physical health, while excluding mental health or suicide/self-harm risk. There are fair arguments regarding whether it is good policy. There are probably even non-crazy reasons to argue that some of the other exceptions are insufficiently clear -- there's some clear tradeoffs around the fuzzy area between 'spontaneous miscarriage' and 'tots not self-induced'.

I've not seen a particularly credible argument why this case doesn't fall under this exception, even well considering hindsight bias. ProPublica doesn't seem to link the leaked report (for some reason!), but I don't think you need to wait til 9AM ("organs failing") or 645AM ("taken to the intensive care unit") is necessary, and the doctors here waited until 2PM. I think there's a very strong support about medical necessity 930PM the night before. That seems especially true given that these laws have literally never been used against a doctor in Georgia, where we have countless examples of insufficient care medical liability in the same time period. I don't think anyone individually made cackling laughter and then wrote down 'kill her' on Thurman's medical history eight hours in, but there's pretty serious and systemic errors if 'vomiting blood' and 'acute severe sepsis' isn't being considered a medical emergency.

It's a really controversial claim to propose that hospital as systems are willing to fuck around in deniable ways to make politically-useful arguments, while playing with their patient's lives, and incredibly bad claim if true. I would like to get some set of more serious arguments against it than other ProPublica authors are willing to attempt, because I'm gonna make it.

Instead, a clinic employee offered Thurman a two-pill abortion regimen approved by the U.S. Food and Drug Administration, mifepristone and misoprostol. Her pregnancy was well within the standard of care for that treatment.

D&C

No abortion is authorized or shall be performed if an unborn child has been determined in accordance with Code Section 31-9B-2 to have a detectable human heartbeat except when

I am in agreement with you that there would have been no violation of the law as you have quoted, and that the hospital's behavior here sounds egregiously negligent. Under what circumstances is it permissible to wait 5 hours to treat acute sepsis? D&C is usually indicated when a fetus has no heartbeat, and the combination of mifepristone and misoprostol will stop the fetus's heart (mifepristone=shed uterine lining, killing the fetus, misoprostol=induce contractions to push the dead fetus out). So when she showed up at a clinic in Georgia, performing a D&C would have been within the letter of the law.

To steelman the opposing side, perhaps there is another exemption in the law for "care which aids and abets an illegal abortion," or the clinic was critically slow in offering treatment because there was no technician available to check for fetal heartbeats (ultrasound), and this nuance was lost on the journalist.

Anyway, after hearing about the sepsis the lesson is to never visit Georgia, and if you do, never go to Piedmont Henry Hospital in Stockbridge. Never know if doctors there will wait three hours to treat your heart attack because your wife is pregnant.

To steelman the opposing side, perhaps there is another exemption in the law for "care which aids and abets an illegal abortion,"

Don't steelman this. Let someone point to it, or check the law yourself. Otherwise you're simply failing to let yourself come to an accurate conclusion.

Fair point. That text is not in the law. Removing.

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