Thank you.

Welcome.

Dr. Courtney Kerestes' on the same day that the Supreme Court overturned Roe v Wade.

Attorney General Davis has filed an emergency motion in federal court to dissolve the heartbeat bill, the so called Heartbeat Bill injunction.

A judge that same evening dissolved the injunction and an abortion ban after approximately six weeks of pregnancy became the law in Ohio.

That was all in a day.

And I wonder what were the what was in your head at that time?

You know, you're on the ground.

You're in the front lines.

What were you thinking about how you manage this abrupt and crucial change?

Thank you.

So that day, June 24th, I actually was working in an abortion clinic providing care to a full slate of patients.

Everyone was busily moving around doing all of our different things, and then we all got notifications on her phone at the same time.

So we kept about our business because we were there.

And really our assumption we knew this Supreme Court decision was coming.

That was by no means a surprise.

We thought that might come the next week.

You know, that was a little bit of a surprise that it was that Friday and not the following week.

But we had just been operating under this assumption that here in Ohio, yes, we have this six feet, six week ban in place, but we would have a little bit of time to work things out.

It wasn't going to be instant.

So we provided care to patients that day.

I had a 15 year old patient who hadn't realized she was pregnant until she was about 13 weeks along.

We had a mom of five that just couldn't handle having another child.

She needed to get care, abortion care.

That day, someone who'd had prior complicated pregnancies and just felt like it wasn't safe for her to have another pregnancy.

And just the full gamut, who we see at Planned Parenthood every single day.

So, you know, it was really kind of shocking when we saw how quickly Ohio moved, how quickly they lifted the injunction and how soon we had to scramble and figure out what we were doing living under this six week ban.

That involved conversations with lawyers.

The Ohio Department of Health quickly put out a ruling.

We weren't quite sure if everyone would need multiple ultrasounds or not, but that was something that they said, yes, everyone's going to need an ultrasound both days.

And we had to adapt because our goal was to continue to provide abortion care.

And we did we could in that situation.

So what's it like now where you were?

So the state of providing abortions in Ohio has always been complicated, or at least as long as I've been here and for many years before I was here.

And all of the previous restrictions on abortion care that already existed still are in place.

So we still have a 24 hour waiting period in place.

So a patient has to come to the clinic in person two separate days, usually their first day there, they're going to have an ultrasound to determine how far along in the pregnancy they are.

We're doing it as a transvaginal ultrasound because the law requires us to use the best technology to determine if there is a fetal in a turkey.

Vaginal ultrasound is.

It's basically an ultrasound probe that goes in the vagina.

So it's an invasive exam.

It's something that, you know, is uncomfortable for patients in the best of times and they really want to be pregnant and are finding out.

But very uncomfortable for patients who don't want to be in that situation, patients with any history of abuse or assault that are particularly vulnerable.

That is something that we are required to do now to determine if a fetal heartbeat is present, and that happens somewhere around six weeks in pregnancy.

So that is very early in the pregnancy.

Medical terminology is weird in many ways.

One of them is that we calculate pregnancies from the first day of a period.

So you're not actually pregnant until two weeks after your period.

That would be when conception most likely would occur.

Two weeks after that, you would have your next missed period.

So that's maybe the earliest that you could find out that you were pregnant.

So we're already four weeks gestational age at that point, and if you don't have regular periods, you may not realize that you had a missed period that's around the same time that like a pregnancy test may come back positive.

But with the six week ban, we only then patients find out at four weeks and they only have until six weeks to figure out that they're pregnant and get to an abortion clinic, find care, pay for it, all of those different steps.

So consequently, there are patients who don't find out till they're after that six weeks.

But anyways, back to what the clinics do.

So we do that ultrasound.

Hopefully they are under six weeks and they don't have that fetal cardiac activity present.

They go through consent forms that we're required to do by the state of Ohio with some state mandated language on that.

And then they have to come back at least 24 hours later.

And oftentimes, just logistically, that ends up being two or three days later for their second visit.

And then they get another transvaginal ultrasound.

Because we also have to confirm right before the abortion is provided that they still don't have fetal cardiac activity.

So if that ultrasound still is good, then we are able to provide them with abortion care.

So it's all of these different steps, delays the process, prolongs it and is much more invasive for patients.

And we.

Yeah, we have to follow this because these are the laws they have for us right now.

So Mark Spindle, what about you?

This ruling comes down and then, you know, they they expedite the Harvey bill enactment, put it into law, put it into action.

What are you thinking from a legal standpoint at this point?

Well, a lot.

Let me just say, though, before I just wanted to say thanks to everybody for coming out today.

This is.

The kind of conversation that we're having and that the dean was describing is really both, uh, supportive for lots of people and so important to the, to the new era that we're in to have conversations, to talk across differences, and to be with one another and reflecting on what happened, you know, in a way that was nothing shocking.

You know, the opinion that the court ultimately issued in basic form was leaked to the public in a really, really, really unusual way, the details of which we still don't fully understand.

And in fact, there were arguments about there being multiple leaks, you know, sort of about voting patterns.

So this was a shocking irregular decision.

But the from a legal perspective, t here are deep, deep rule of law and norms about how the Supreme Court is supposed to do its job, not to make big sudden moves to sort of move.

There's a famous expression by Oliver Wendell Holmes, the describing the common law, but it's apt here to move from molar to molecular motion, maybe little movements in the development of the law.

And what was so striking both about the leaked opinion and the final opinion, were the great leaps that the court's opinion took, declaring rules that had been established reaffirmed multiple times as recently as just a couple of years before, as settled law, law that so many people in the country, whether they ever themselves, might need to avail themselves of the rights that Roe, protected or otherwise really just understood as the freedoms that American women and other pregnant people had and would always have, because despite the earlier challenges, they were reaffirmed.

So even though there was this leaked [Blank Caption] opinion and you could read it like you could literally read this leaked opinion, the thought was somebody is going to have to get some sense, you know, sort of and pull the court back, you know, sort of pull the court back from the precipice, pull it back from doing this unthinkable, constitutionally unthinkable.

Scenarios of what the topic would be.

Yeah, you got the giant leaping, you know.

And so, you know, it's just like it's just unthinkable for a lot of people.

Even after they read the leaked opinion, read about the leaked opinion, thought about the leaked opinion, thought.

There's just no way when it comes down to game time that the court is going to do this.

The chief justice is going to have to save us and he's going to have to save us sort of based on the voting patterns by grabbing a hold of Brett Kavanaugh and getting him to join in a more modest opinion, which in context was not modest at all, but a turnabout of the chief justice's own view.

So I think, you know, there was a level on which it's like, no, I can't do it, I can't do it.

And then they did it.

And then I think, Did they do?

And then it sinks in and then it sinks in and it's still sinking.

And when the doctor was talking about, you know, transvaginal ultrasounds, I mean, you know, sort of folks here might recall some of the debates about I mean, what's really at stake is here is the state mandating an invasion of people's bodies this really unusual way.

And that just doesn't seem to be consistent with the norms of freedom, the norms of bodily autonomy, the norms of equality that so many people have taken for granted, and that it's a new era.

And even now, weeks and weeks after the decision, much longer than the leaked opinion, I think it's still I heard somebody recently saying she was only getting just now getting the feeling in her fingers and toes back.

And it struck me both as a as a truth about what was happening, but also as a recognition of the way in which the decision literally caused people to feel.

Many people to be elated, of course, but other people to feel deeply hurled out of their bodies, to lose a sense of their own touch with their embodiment.

Like these decisions really affect us psychically and our bodies, although obviously not everybody the same.

And then we've got it playing out in 50 different states, too.

It's not just one ruling.

It's going to be across 50 states.

Yeah.

And I'm wondering what you're hearing, Doctor, from your colleagues across the country.

You're all in a different kind of a place.

Mm hmm.

Yeah.

We're a small network of providers in terms of medical communities in general, and we talk to each other, and you kind of like us, know how we were talking to the people in Texas to be like.

What happened because they were living with a six week ban for since last September.

They had already been in this reality.

And we're trying to learn from them what they could do medically, what they could do to help their patients and support them at that time.

But now it's like what happened on Texas, but every state is going through that.

So there's the people living in supportive states just trying to figure out what they can do to expand the volume, protect patients who come to them.

Any ways that they can open up their doors and accept whoever [Blank Caption] needs to come, wherever they are for care.

And then there's other colleagues like recently in Tennessee, they just had their total ban enacted a couple of weeks ago.

And they're just having devastating stories of having patients who are, you know, having these obstetric emergencies, these pre viable around 20 week cases where it's not safe for the mother to continue the pregnancy.

It's not safe to transfer her to a different state where she could actually get the care she needs.

But she's just stuck in limbo there because there is a fetus with a heartbeat and in that situation, there cannot be any abortions, no matter what risk is at stake for the mom.

So these are just extreme cases.

And I know, you know, this could be coming for us in Ohio.

Even right now.

Here we are in these situations.

The current six week ban does have exceptions for maternal health, are very limited exceptions for maternal health.

Basically, you have to cause significant permanent bodily harm or maternal death for us to be able to do an abortion.

But we get these patients in these very acute situations where it's really life or death.

And I hate that in that situation, rather than thinking, what is the best thing for this patient?

What do we need to do to take care of them?

It's instead, do we get the right paperwork filled out?

Is this going to be legal?

Can we actually do this?

Can we send them somewhere else?

Is it safe enough to send them to Michigan or somewhere that has a more favorable environment?

That's not that's not what I'm trained to do.

I mean, I do that all the time.

But, you know, we want to just be taking care of our patients and what they need, not dealing with all these laws.

West Virginia lawmakers today passed a bill to ban nearly all abortions today.

A lawmaker who opposed the ban asked kind of, I guess rhetorically whether proponents weren't concerned that such a law could drive away OB-GYNs from the state of West Virginia, where there already are vast deserts of health care.

But what are you and your colleagues talking about on that score?

We are worried about that for all of the states that are banning abortion because most people and training are staying in the same state they train in.

And now in a state like West Virginia residents, their trainees would not be able to get training in abortion care.

That particular type of training is something that tends to attract residents to those programs.

So we're worried that the states and the programs without abortion access are going to get less high quality people coming in to get trained there.

And then those are going to be the doctors that stay there and provide care in the future.

So it could really impact the care of generations of people because it just trickles down over time.

And then you get to the point where no one is trained in those states to provide abortion care D and E care, take care of these complex situations.

And all of the providers are clustered on the coasts or in these blue states.

It's a real concern.

It's something that we've thought about how we can attract high quality residents without being able to guarantee to them that they will get this kind of training that they want to have.

We talked a few weeks ago, Mark, about whether, you know, physicians could travel to other states to help out where they need help because a lot of patients are traveling to other states where it's still legal.

What are the what are your thoughts about the legal ramifications of that?

What are the what do you think the questions are?

Yeah.

So the Supreme Court's decision in this case called Dobbs the big case.

Includes a separate concurring opinion by Justice Brett Kavanaugh.

And that opinion, even though the question was not before the court in the case, seemed quite clearly to take the view that there is a right to interstate travel to seek or obtain reproductive health care, including abortion, and that notwithstanding the possibility that states might seek to ban the practice within borders and also the possibility that they might seek to ban travel interstate, the idea is there's a right to protect that protects this decision to travel interstate.

But we'll see what happens if and when the case comes.

Up for physicians as it is for patients.

Well, I.

Mean, a physician say is prohibited from doing it in Ohio.

Yeah.

Would they be able to go to another state, you know, to help out?

Yeah, I guess so.

Yeah.

Yeah.

Yeah.

So this is something I've been looking into a lot, and it's a gray area.

There's.

Because it's going to depend on the state where you travel to what their laws are, the state where you're coming from, where.

And if you, you know, you have to hold a medical license in a different state to be able to travel there and practice medicine.

Butler What we're concerned about right now is that even if we're practicing under a different state's license, when we're in that different state, perhaps Ohio could still take action against us for doing that and doing something that's against the law here in Ohio.

And I guess the bottom line is you just don't know.

Yeah.

And how do you find stuff like that?

Oh, Mark.

I mean, is it somebody is going to have to break a law that we don't know exists yet or what.

Or challenge the law before.

But you have to have standing and.

Yeah.

It's it's it's not obvious exactly what the case will look like.

But, you know, I think as people find their ground again after the decision, they're likely will be different kinds of challenges, trying to sort of lean in and find what remaining protections there are for.

Abortions that are provided in cases not just where a pregnant person's life is in danger, but health, whether that's protected, if the state doesn't give the protections by statute or in the kind of cases that you're imagining, I mean, there are going to be more lawsuits if the mean, which is, you know, part of the idea of Dobbs was we're getting out of the abortion rights business.

The court says we're going to leave this to politics.

But, you know, sort of the next generation of cases, not only in the direction of protecting a right to choose, but also in the direction of, in a sense, constitutionally getting a ruling that outlaws abortions as a constitutional matter.

So no state can allow them.

They're already happening.

So the courts in the next generation of cases, not out of the business.

Right.

So you you made that point that they turn it over to politicians essentially because they're leaving it up to, you know, the legislatures, the state legislatures to decide.

And I'm wondering, what's the significance of that from a legal standpoint?

I mean, the states are already enacting all different kinds of laws anyway.

It's already been a patchwork quilt since 1992.

Right.

Since.

What's that?

Casey Anthony guns.

Casey.

So so you know the the way that abortion rights politics.

Pro-Choice mostly you know sort of in some states and pro-life in others mostly in other jurisdictions have played out as they've played out against the backdrop or baseline of existing protections.

So even as pro-life legislators were enacting laws regulating or banning abortion, they did so with an understanding that the courts in some number of these cases were likely to strike those measures down.

Now, the on the ground politics have changed in light of the changes in the background rules at the Supreme Court.

So pro-life legislators pass laws now knowing that the laws are much, much more likely to stick and so are much, much more likely to be being held accountable for the laws that they enact in pro-life directions.

This helps partly to explain why, although lots of people expected very quick movement in pro-life directions to completely occupy the field or as much as anybody thought reasonably possible, the many legislators, many [Blank Caption] legislatures have moved more slowly, even though they're dominated by pro-life legislators than people were expecting.

So it's changing sort of the sense of who's accountable in what ways in politics, in ways that the justices of the Supreme Court might or might not have anticipated when they issued the ruling.

See, I think I'm supposed to tell you right now that on you I want to invite you to ask questions.

The microphone, as earlier noted, is right there for you.

If you want to line up, I will continue talking with the panelists for a few more minutes.

But if you have any questions for them that you'd like to ask, I really, really welcome them.

So I almost want to throw in a phone number right now, but you just walk right up to that Lincoln and ask us.

Dr..

Senator Graham Lindsey Graham of South Carolina has introduced legislation that would institute a federal ban on abortions after 15 weeks of pregnancy.

I kind of want to ask about the what the legal [Blank Caption] relevance is of that, about that to the states, to you, Marc.

But it's been so it's gotten so much shade thrown at it today.

I mean, it doesn't look like anybody's interested in following through with a federal ban or a federal, you know, a federal ban on abortions.

But Senator Graham is calling his proposed legislation a late term abortion ban.

And I'm wondering how you would describe a 15 week ban.

That's still an extreme ban on abortion is not a late term abortion ban by any means.

At 15 weeks of pregnancy, many people still don't know they're pregnant, number one.

Also, most fetal anomalies are major complications of the pregnancy aren't going to be discovered until 18 or 20 weeks.

So we often will get very devastating cases that, you know, someone has their ultrasound at 20 weeks of pregnancy and finds out that there's some kind of lethal fetal condition going on.

They would never have known about it at 15 weeks.

And in the case where those abortions are banned, they're forced to carry this pregnancy of a fetus that will never survive to term, which is harmful to their health and just emotionally can be very traumatizing.

So it's still a very extreme ban.

And so they try to make it sound more palatable, sound like, oh, everyone can just go have their abortion before 15 weeks, that's fine, which their side doesn't like either.

It's not making anyone really happy, but it is [Blank Caption] still extreme to have a 15 week abortion ban.

Ohio House Republicans introduced a bill in the Ohio General Assembly that would ban all abortions in Ohio, with the exception of being when the life of the mother is endangered.

The text of House Bill 704.

It requires Ohio to recognize the personhood and protect the constitutional rights of unborn, quote, unborn human individuals from the moment of conception, end quote.

The bill doesn't appear to give precedence to the fetus over the pregnant person.

And I'm wondering how that works, Mark.

I mean, you know.

Who's on first, who's on second here?

I think we're going to find out if and when the measure passes and if and when it's challenged.

It's striking, as you were describing it, that there's a life exception, but no health exception, even in cases where there are serious risks to physical bodily health and function.

I mean, it is science, but it is it.

It's not.

And I mean.

There's no absolutes, right?

When you say that there's threat to the physical well-being that is along a continuum, right?

Yeah.

I mean, it puts us in a situation that we're like, well, is it bad enough now?

Can we do it now because they're sick enough and that's we want to take care of people before they get that sick.

That's the whole point of medicine.

We're going to help people out before they get to that very desperate last step.

But it makes it really grave for providers, and different hospitals will interpret it differently.

Different doctors will interpret these things differently, but it's a whole lot of gray area with those kinds of exceptions.

Okay.

Well, thank you.

Let's just turn to the audience questions.

And I. Hi.

If you would like.

Oh, you ask the question.

It's about.

Oh, I love cheese.

Okay.

Okay.

I was saving your spot.

My question is, it's about Justice Thomas's concurring opinion in Dobbs and his reasoning, as I understand it, that calls into question a constitutional right to privacy and thing and the and the rights that flow from there.

The right to marry who one chooses, the right to access birth control.

And I'm wondering what you think.

Does that have legs?

Is that going to go anywhere?

Thanks for the question.

Um, so just to make sure everybody sort of understands where the question is coming from, the majority opinion in Dobbs, written by Justice Samuel Alito, takes an approach to constitutional interpretation known as originalism.

A little bit more precisely, it's a conservative form of originalism that holds that the Constitution's meaning is determined by the text of the Constitution, and where the text doesn't answer the question by looking to see, in a sense, what people in the public, but sometimes known as the original public understanding, understood the text effectively to imply.

The court's decision says back in 1868, when the 14th Amendment was enacted, it in the public enacted constitutional provision, the 14th Amendment, that contained no express provisions about the right to abortion.

And that when you look to the original public understanding, there was no original public understanding that a right to abortion was implied by the text of the Constitution, the Constitution's 14th Amendment.

Otherwise, that idea of grounding the meaning of the 14th Amendment in text or original public understanding raises questions exactly along the lines that the question was framing up about other important constitutional rights, including around the decision whether to use contraception around the decision, whether and when to engage in adult consensual intimacies in the privacy of the home, and also deciding whom to marry, at least, or in particular, if it's someone of the same sex or gender that you're hoping to marry.

So the majority opinion is very clear that its decision, this originalist decision, is a one stop, 1a1 way ticket, and it's a one way ticket only involving abortion rights.

The majority opinion goes out of its way over and over again to say, if you're thinking about these other rights, don't worry, don't worry, they're safe.

Abortion is unique because only abortion involves the death of either a potential life or if you're a hold, a different view of the life of the unborn.

Only abortion among these other rights involves the ending of an actual or potential human life.

The majority opinion says.

Justice Thomas writes The sole opinion that says.

Pay no attention to that.

The originalist method that the majority has adopted that I.

Justice Thomas also agree with in principle mows down those other rights and shows the folly in the sense of thinking that there's a constitutional right to privacy, which itself is not expressly provided for by the text of the Constitution, but famously found in its its shadows to go back and use some of the language from the old case that recognize that Griswold against Connecticut, all of those rights, just as Thomas says, are exactly implicated by the majority's decision.

Now, I think it's a matter of vote counting.

There's reason to hold some hope that if the court's membership stays the same, what we're learning is that there aren't the votes to take the Stobbs decision and apply its originalist method to those other rights.

But should the court's composition change, then all bets are off.

Some people already think all bets are off, given the kinds of promises that were made during confirmation hearings and and so forth.

But I think that there's at least some reason to not fully, you know, sort of think that Justice Thomas is writing for anybody in the case other than himself, because the justices in the case, if they had wanted to agree with his position, other justices could have agreed with it.

And he wrote a lone dissent.

So is it a possibility?

Absolutely.

Will it materialize?

Let's wait and see.

Hi.

I've got three.

You could tip them, like, down a little bit.

Those of us who are challenged.

Well, maybe it's not going to play.

I'll just talk loud.

Okay.

So I have three questions, and they're for.

Well, there's one for everybody, but two.

Is there any possible way to find out before someone is four weeks pregnant that they're pregnant?

Is there any kind of hormonal test?

Any way to find out before four weeks?

Not really.

Some pregnancy tests.

The most sensitive ones might get you at 26 days, not 28 days.

But that's about the best thing there is.

The pregnancy hasn't even implanted in the uterus at that point.

So it's technically, by some definitions, it's not even a pregnancy till that four week point.

Okay.

Then my other question is with this, um, transvaginal ultrasound, is there.

I mean, you're talking about it being very invasive and painful.

Is there any way that that ultrasound could cause a miscarriage or damage to the fetus or the pregnant person?

No, it's, um, it's, you know, it's mostly uncomfortable.

I wouldn't say painful for most people.

And it's it's within the vagina, not within the uterus.

So it's not going to cause any kind of problems for the actual pregnancy itself.

And it's something we use commonly across obstetrics for people with both unwanted and wanted pregnancies.

Why is transvaginal ultrasound required?

What what's the thought behind that?

Well, so our alternative would be a trans abdominal ultrasound.

So on just on top of the belly, the more customary one you'll see in movies and things.

And that's typically started to be done around 8 to 10 weeks of pregnancy.

Um, but the vaginal approach, it just is better pictures so we can see things more clearly for the really early pregnancies.

Is that what detects the fetal cardiac activity?

Yep.

That's where we can see that fetal cardiac active.

You can't get that from the we put that age.

That early on, we probably wouldn't be able to see it.

We kind of we're like, well, can we just switch and do abdominal ultrasounds for everyone?

And it might push things back a week.

But the way the law is written, we do have to use the standard of care for that detection.

So we have to do the batch and the method.

Thank you.

Mm hmm.

So my last question and this may be something that's addressed later is.

What can we do?

How can we help?

I mean, I know that I've been in touch with different organizations, and at this point they're saying, well, send money.

At this point, the best thing to do is to send money.

Is there anything we can do on the ground to help people who are needing or wanting abortions?

Yeah, well, money is good for all these organizations.

The staff of both the abortion clinics have been under a lot of stress during this time.

But also the abortion funds, primarily the abortion fund of Ohio, used to be women have options Ohio, but they only have a limited staff and they're trying to now coordinate all of these patients who are too far along to get an abortion in Ohio, trying to get them to travel.

And from at least what I heard from them earlier this summer is that they were stretched so thin that it wasn't really helpful to have more volunteer people around because they knew what they had to do and they didn't have the means to train a bunch of new people, at least at that point in time.

So the actual money, because that means they can get a flight for the patients or a dry pay for gas and get a hotel for them.

That was the crucial point.

So those are things to do.

And then, of course, voting and getting people to vote and getting people to continue to care about this because and I feel like in our world, something that happened in June isn't necessarily still going to be front of mind in November, and it needs to be.

I think that's extremely important.

Thank you.

I just I'd add to that just a little bit, but there's a line in Justice Alito's opinion that's ostensibly meant as a reassurance to those who supported and who support Roe and Casey and the abortion rights that they protected.

And he says, you know, don't worry, returning this matter back to the political process is not the end of the road, because, after all, women who are on both sides of the or all of the sides of the abortion rights controversy retain political power.

And there's a little bit of a sense of what that might actually mean on the ground coming out of Kansas.

But I guess I'd also say.

Were they voted down or they.

Where there was a kind of support from many people, a surprising political rising of voices in support of reproductive choice.

One the thought was, well, it's Kansas.

So of course it will go the other way.

But I guess I'd also say that even being here and engaging in civic dialog and conversation and really working to build a new kind of political community beyond just the sort of individual instances or maybe multiple iterative instances of of giving and of course engaging in the major civic activity of voting.

But building community, in part because so many people who experienced jobs really did experience it in the way that that person that I heard experienced it is sort of deeply unnerving and isolating.

And the importance of community, I think, is really getting underscored by the decision, particularly in the sort of long new era that we're in.

So thank you for showing up and asking the question.

Thank you.

Thank you.

Just real quick, I wanted to ask him, please come on up to the mike.

But I just wanted to ask.

We haven't talked about self-managed abortion and medication abortion, Mark.

I mean, can you.

That's what I was going to ask.

If that's my talent.

Go ahead.

So on that note, I'm involved with repro rights organization, and I'm also in a community of people who care about this issue.

And when the decision dropped, a lot of resources were circulated about self-managed abortion and about medication abortion and the availability of medication abortion through platforms like aid access and Plan C pills.

And that's sort of like the links to the access website or the Plan C Pills website.

We're just like thrown out on every platform I was in.

And people's response to this decision was like, go to this Web site.

But one thing I've been thinking about ever since then was in terms of the interstate issue and the laws per state, these websites or services.

Where you can access medication, abortion online.

A lot of times the actual clinic that the abortion that the medication abortion is coming from is either not in the United States or not in the same state that the patient receiving the care is located in.

And so I've been wondering for a long time, and I haven't really been able to find any concrete answer or even like indication from anyone I've talked to about the legality of if you obtain a medication, abortion, if a person would obtain a medication, abortion from an out of state or international clinic and self-manage that abortion in their home state not in line with the home state's laws.

For example, in Ohio passed a fetal heartbeat detection or pulse detection.

Could you be criminalized for that?

And how would they know?

How would they know?

Because that's the thing.

Like they can't tell if you're accessing.

They can't they can't prove that you're accessing abortion medication as a preventative thing of like, oh, if I ever were to become pregnant, I would want to have access to this.

They can't tell if it's within the six week limit.

Well, I guess in Texas, someone could tell on you.

I mean, you know.

But yeah.

So I guess that's that's a question for the medical side.

And the question for the legal side is like how serious, where and how how robustly should we be monitoring our digital footprint and use of any form of communication or electronic media or how we access the websites?

For example, like how seriously should we be securing ourselves digitally in terms of accessing care online?

Hmm.

Great question.

So just briefly, self-managed abortion, you know, i t can be many different things.

The safest would be a medication abortion, which is basically the same thing, the same pills that you would get if you came into a clinic.

You can access them online from a variety of these websites.

Other people will try taking herbs or doing different physical trauma or things like that that can get very unsafe.

So that's not what I'm referring here, is what I'm talking about self-managed abortion.

But the short answer to your question about would they get criminalized in Ohio would be no, not under the heartbeat, Bill, because that is a law meant to criminalize doctors that is not meant to criminalize the pregnant person.

So from that standpoint, maybe they wouldn't be criminalized.

However, in multiple states, there's been cases like the Texas one where patients have been criminalized even for suspected self-managed abortion.

And these can be using different laws which you might be able to speak more of.

But it can be child abuse laws, child neglect laws, feticide laws which exist in certain states and states are really a patchwork.

But the cases where it has been prosecuted tend to be cases where the patient was further along in the pregnancy.

So there was an actual fetus that was delivered, not the very early medication, abortion, where it's mostly bleeding into a toilet and there is no evidence that anything happened.

It would be very hard for someone to prosecute that.

But with the your other part of the question, I think there is a big reason to be concerned.

And then one, back to what you said at the beginning.

Sorry, I'm jumping around here, but there are certain websites that it's you know, the main websites that would send it to Ohio are operating overseas because it would not be legal for a provider in a different state to send the pills to someone in Ohio.

The doctors in other United States, in the U.S. are not going to risk their licenses by knowingly s ending it to someone in Ohio.

But if that person in Ohio said that they lived in Pennsylvania, they could potentially get it mailed to Pennsylvania and sent here.

So at least the doctor in that circumstance would be somewhat protected and at least in good faith, thinking the patient was in the state that they were in.

But most of the websites, like eight Access, are sending them from overseas just to avoid that risk.

And then the issue about privacy when it comes to your digital queries.

Well.

I mean, I don't know.

There was that Facebook case, just Facebook messaging case a couple of weeks ago that the mom and daughter were texting about it.

And Facebook gave up the Facebook messaging data about a medication, abortion.

Once again, it was further on in the pregnancy and I believe it took some friend of the patient who told someone some law enforcement about it.

Oh, yeah.

So, I mean, so I.

Feel like there's going to be someone has to alert you.

There's alert the police or to something happening, but it's not completely safe.

Right.

Anything down there?

Oh, thank.

You.

Thanks.

This is going to be somewhat redundant.

Yeah, I'm afraid so.

Old.

I can't believe I'm having this conversation still.

What happens in the legal sense for someone who takes a person across state lines to have an abortion from the state of Ohio to another state?

Is there a liability?

Don't worry.

I want to if you're not.

You know.

There currently isn't any law both for like providers.

We can we can directly refer a patient out of state seizure help someone get out of state currently.

Yeah.

But I mean, physically drive them.

Yes.

Yeah.

There shouldn't be any restrictions under our current heartbeat.

Ban.

One of the proposed laws is more like what happened in Texas, where it's anyone who aids in the beds.

Yeah, an abortion?

Not yet.

But even then we still don't know because we don't.

Expecting something to come out and lame duck session you know after the election and the any it's really kind of up in the air is whatever goes through it's expected to pass yeah.

I'll try to be optimistic.

But for now, it's okay.

Hi.

I wanted to thank Dr. Christy's for her work.

And as an adolescent gynecologist, I have anecdotally seen an increase in long acting reversible contraception requests from teens after the dads decision.

But I wondered.

If you could talk specifically about.

Vulnerable populations, such as an adolescent who in the state of Ohio might need to seek a termination and.

What that process is.

For that patient?

Yes.

So in Ohio, there is a parental consent law.

So the parents must actually come with the patient to the clinic and sign the paperwork with the patient [Blank Caption] for them to have an abortion.

And it's a really tricky area, especially because adolescents tend to not have as regular of menstrual periods they and they tend not to track them as much.

So it's much more common for someone who's young to not realize they're pregnant until they're a few months in.

They're getting into the second trimester.

It's very common for us to see them presenting and having had no idea they were pregnant and then they're 15 weeks along.

So it makes it very hard because then they're in a situation both of having to tell their parents and bring them there, but also probably not be eligible for an abortion in Ohio, but not I honestly, I'm not exactly sure about the parental consent laws in the surrounding states, but I'm pretty sure most of them have similar laws where parents would still have to be part of their decision.

Is there anything on the legal scene.

That we're aware of that's coming down the pipeline for.

For teens?

No special protections.

Not specifically.

And the six week ban does not have any exceptions for rape or incest, which is also a very big issue for that particular population.

Think.

Well, I'm back again and I in the interest of dialog.

I'm wondering what you would say to people who have a truly, deeply heartfelt belief that that this unborn fetus is a human life and that there are I mean, peop there are people who truly believe that that this is a human life.

And so what would you say to them?

In terms of what you've already said to us.

I mean, it depends, because I do I do believe that there is a certain segment of the population who will never accept what I do.

And that's just how they're going to be and probably less beneficial to try to persuade the extreme end.

But at the same time, I always consider, you know, the life of the pregnant person in front of me and all of the value that that life has.

And the fact that by putting so much value on the life of a fetus, we're often just racing that pregnant person's life.

We're just not we're basically treating them as a vessel to carry this pregnancy to term no matter what happens to them in that time period.

And nine months is a very long time for anyone who's been pregnant in this room.

We know how long and hard pregnancies can be, and I would not wish that on anyone who did not want to be pregnant, who didn't enter into that willingly and excited for that outcome.

So that's that's where I start.

And then try to figure out, you know, often, I mean, I think it's important to talk about just anyone who doesn't want a pregnancy should have abortion care.

But there are those more extreme cases like I was talking about before, the people with fetal anomalies or medical conditions that would put them at risk.

And finding those areas where we might have some compromise that they might say, yes, there should be at least some abortions in these circumstances is a start.

Yeah, I guess I'd just add to that, you know, sort of partly because of the way that the Supreme Court really for so many decades was at the center of the national dialog around reproductive rights, that there is a way in which the broader community us have not really had to have the conversations that in the aftermath of Dobbs are necessary in order to see what possibilities there may be for political compromise, a kind of moderate position where everybody is unhappy, but everybody is happily engaged in a sense, sort of in in politics and in the conversation and feel like the law reflects their views and values, if not as much as they might like, as much as is realistically possible for those views to achieve politically.

So, you know, I think that, you know, it's it's an interesting moment to begin to think how do pro-choice folks who care about reproductive r ights or reproductive justice more broadly talk to people who have pro-life views along the lines that you're describing?

And how do we find space for being with one another rather than simply being against one another?

And we don't have practice as much as we might have had, you know, sort of under other sorts of circumstances.

But now it's important to start to think exactly along the lines.

You're asking, how do people talk across the differences?

Is there going to be conversation across the differences or will it be everybody just exercising the power they have to demand their views across the lines?

This is partly why it's so significant the way that and was describing before that sort of new positions are emerging where a pregnant person's health.

Is not even part of the exception regime.

That's a not very moderate position.

That's a quite strident position.

And it might be one of those positions that sort of causes many people to rethink their own views, because even for folks who do hold deep and sincere pro-life positions, although those positions can operate the way that the doctor was describing, there are also other considerations that people have, other values that they have at the same time.

And so the issue both on the pro-choice side and on the pro-life side of the debate, the debate, to oversimplify it, they're often more complex than the kind of caricatures of the positions that that we sometimes think of.

But it's going to require of us a new skill to listen and to be with and to really have the dialog that we're here having.

So thank you for the question.

Hi.

I'm going to preface the question by saying that I am I come from a different country.

So there's a lot of things that I still learning about the U.S. system, particularly as it pertains to things that are from the when they were written back then, you know, in the 1800s.

But how do how do this originalists or how would they think about new things that are happening in the world that are not going to be in the original writings?

Is there any openness to future changes thought like how how do they keep that option open so that we as we progress as a society, things are being able to turn in a different way and not how they were thought or written by back in 1800.

Yeah, thanks for the question.

So it's a little complicated, but I'll try to like let me try to sort of say it this way.

So if you look at Justice Alito's opinion, which says we ought to look at the 14th Amendment here because it doesn't say anything expressly about abortion rights, we ought to look at the views and values of the people who enacted it, you know, back in the late 1800s to see what they thought and understood to be implied.

And you look at what happened in the law and on and on.

But that posture is all aimed in the direction of reopening politics as the sphere where the law about abortion regulations are bans are to be decided.

That is, to say what they are saying in their own terms is we're not empowered to decide the in constitutional terms what the limits of what the people decide about abortion look like.

It should be up for the people broadly to determine themselves.

So if they're going to be pro-choice laws or pro-life laws, that's up for the people.

We don't have any special authorization under the Constitution to decide these things, to let the people decide.

That's sort of the initial cut of it.

There are now, as I mentioned before, already, and this is sort of very well documented in terms of what many people in the pro-life movements wish.

There's a deep desire that many have, consistent with the view from the last question that because the right to life is at stake.

Abortion, permissive laws violate the right of the unborn to be born.

And on this view, there are arguments already sort of being mobilized that seek to establish something like a right of fetal personhood where if it were to be recognized, the.

Possibility of legislation in pro-choice directions would be foreclosed.

That is the idea would be if you allow abortion, you violate this right to be born, the right to life, which again, if the courts were to recognize it, would move the abortion question from the ordinary operations of politics, constraining the possibility of political outputs.

At that point, what would be required would be a constitutional amendment to change the basic constitutional rules so that a person who had a decision would no longer stand.

But in the context of the decision in Dobbs, Justice Kavanaugh's opinion, again, quite significant in part because of where he was [Blank Caption] located among the conservative and less conservative justices at the kind of pivot point, his opinion i s very strong on the view that it.

And so the court is taking what he described as a scrupulously neutral position that he was saying, I'm not going for a personhood play and I'm also not going for for abortion rights play.

I'm staying out of this, except maybe in some unusual cases at the margins.

So the idea is that there is room for action, room for transformation against what the rules might have been or were back in the late 1800s, mainly through politics, with the possibility of a constitutional amendment as a backstop.

That is all the time we have.

I'm sorry.

I thought this was over because of the.

I just want to thank our audience.

Yeah.

7:00 on the dot.

Thank you so much for joining us tonight.

I hope you enjoyed checking out our new digs and we welcome you any time you can to join us again.

And to the panelists Marc Spillman, thanks for your time, as always.

And Dr. Courtney Kerestes, thank you so much for your time as well.

I appreciate it.