In this Facebook Live interview, Daniel Grossman, MD, of the University of California San Francisco, talks with 鶹ý about an Ohio bill that would establish a felony called "." Physicians would face 15 years to life in prison for performing abortions, but they're off the hook if the mother's life is in danger -- and if they take all steps necessary to protect the fetus. In the case of ectopic pregnancy, the bill mandates that physicians transplant the embryo, which is impossible.
Grossman talks about the "evidence," or lack thereof, for ectopic pregnancy transplantation cited by the authors of the bill, and the dangers of legislators ignoring science when creating policy.
MPT: Remind us why transplanting an ectopic pregnancy is impossible.
Grossman: We just don't have the technology at the moment to make this a reality. It's just pure science fiction. The process of implantation for a developing pregnancy is very complex. It's just not like repotting a houseplant. Just the attempt to try to remove a developing pregnancy from its implantation site would be so disruptive that the pregnancy couldn't continue to develop. In addition, the endometrial lining of the uterus is really receptive to implantation for only a few days after ovulation. After that short window, the uterus just is no longer hospitable to a developing pregnancy. Maybe sometime in the future we will have the technology to do this, but at the moment, we just don't have the technology to transplant an ectopic pregnancy.
MPT: What "evidence" are these legislators relying on that "supports" transplantation?
Grossman: That's a very good question. The published literature, as far as I can tell, consists of two case reports. One of them is literally over a century old. It's from 1915. The other case report was published in 1990, but it's about a case that actually happened 10 years prior to that. Both of these are just very short case reports that have minimal details. I think it would be malpractice to try to base clinical care on the sketchy details in these case reports.
I found another report that was more recent in the literature about ectopic transplantation that actually turned out to be fraudulent, and the British doctor who published it was eventually fired from his position for making up the data. I think this is just about the flimsiest evidence that you could possibly find to base public policy on.
MPT: This isn't the first time language like this has been slipped into a bill from this Ohio legislature. Did you ever think you'd have to explain the impossibility of transplanting an ectopic pregnancy twice in one year?
Grossman: No, I didn't think this was going to happen twice in the same state in the same year, but unfortunately I think it's a sign of just how emboldened the anti-abortion movement has become in recent years. I think this is part of a dangerous trend of legislators advocating for unproven medical treatments, and especially around anything that's remotely related to abortion. It's only getting more extreme.
MPT: What are the dangers of legislators ignoring scientific expertise when creating legislation?
Grossman: I think this is dangerous for several reasons. This specific bill is dangerous because it puts women's lives at risk. Doctors could be charged with so-called "abortion murder" if they were to provide one of the evidence-based treatments for ectopic pregnancy such as surgery or methotrexate instead of ectopic transplantation. There is an exception if the condition threatens the life of the pregnant woman, but I could imagine that doctors could really feel like their hands are tied until they're 100% sure that their patient is going to die unless they intervene. That could lead to delays in treatment and really worse outcomes.
Ectopic pregnancy is the #1 cause of maternal mortality in the first trimester. Given that we are in the middle of a crisis of maternal mortality, particularly among black women in this country, I think it's just unconscionable to place obstacles in the way of timely treatment of ectopic pregnancy.
I think this bill is also harmful because of the way it could potentially retraumatize women who have survived an ectopic pregnancy. Many patients who have an ectopic pregnancy have a desired pregnancy and they really are devastated when they get the news that their pregnancy won't be able to continue. They ask us, as their physicians, if there's anything that we can do to save the pregnancy. Unfortunately, we have to tell them, "No, there's nothing that can be done."
The misinformation that is circulating around this bill might make these patients feel guilty in some way, that they didn't do all they could have done to try to save the pregnancy, when in reality, they did what they had to do to save their own lives.
As I kind of alluded to earlier, I think this bill is also dangerous because I see it as part of a larger trend of legislators ignoring science and medical evidence, especially when it comes to anything that's remotely related to abortion. I think this is a very disturbing trend and we as healthcare professionals need to stand up and be a loud voice of opposition to this kind of legislation.
MPT: Where do you think this bill is headed?
Grossman: I would have guessed the first bill would have died immediately and that didn't happen, so I think we're just going to have to wait and see what happens. But I hope that eventually scientific and medical evidence will win out.