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Joel J Miller's avatar

This is an excellent review. Not an area I focus much on, but I’ve (almost) enjoyed Ruden’s work over the years. I found her translations of the gospels interesting if not ultimately satisfying and had the same reaction to her translation of Augustine’s Confessions. I’d have to go back and reread her book on Paul, which I recall (perhaps wrongly) as being more balanced, even positive, about the moral benefits of Christianity’s advent in antiquity. I have her biography of Perpetua but haven’t yet read it. Odd to hear her martyrdom described as essentially Perpetua being duped. I’ve always regarded Christian martyrdom as a striking assertion of individuality and self-determination that ultimately provided a different model for living in the ancient and then medieval world.

Ann Ledbetter's avatar

As a hospital-based midwife, and having read the ProPublica reporting, I agree that there is a sleight of hand here in some cases of medical negligence, which are being reported as a consequence of anti-abortion legislation. This case of a doctor giving Cytotec (misoprostol) to someone who was already bleeding heavily is definitely a deviation from standard care, but attributing the cause (legal fear due to abortion laws vs system issues vs individual error) requires more evidence than a single case can provide.

The truth is, D&C can be harder to arrange because it requires coordinating operating room staff, anesthesia, and surgical coverage—often at unpredictable times—so in practice there can be pressure to manage miscarriage expectantly or through medication when it is clinically reasonable. The incentive for doctors and hospitals to avoid the additional, unpredictable work of D&C may sometimes cloud their judgment. In some cases expectant management is absolutely the wrong decision and can result in massive hemorrhage or infection.

This claim by ProPublica is what needs to be investigated further: "And data analyses by ProPublica showed that sepsis rates and blood transfusions spiked among miscarrying women after the ban went into effect — an indicator of dangerous delays in care across the state." What evidence would actually show that changes in outcomes are due to legal constraints on care, rather than staffing, access, or clinical decision-making factors?

Is ProPublica onto something with their data analysis? Are doctors using anti-abortion legislation as an excuse to make bad medical decisions for miscarrying women? Or are they genuinely afraid of being prosecuted? Or is some other factor at play--like understaffed hospitals, not enough physicians, or lack of training/education? The other factor is that mifepristone plus misoprostol is a superior regimen for retained products of conception in miscarriage, but access to mifepristone can be limited by regulatory, legal, and institutional barriers, so in many settings (like my own) clinicians rely on misoprostol alone despite evidence that combination therapy is more effective to treat miscarriage. https://pubmed.ncbi.nlm.nih.gov/39444194/

The other conversation we really need to have, and aren't having as a consequence of the "pro-life" vs "pro-choice" binary, is the topic of if/when abortion protects the life of the mom. At what level of risk to the mom is abortion permissible to those on the side of pro-life? Even most staunchly pro-life folks agree abortion is morally acceptable when a mom's life is at risk. But does there need to be a 5% chance of death, a 50% chance? What are we talking about here? It feels like there is a tendency on the side of pro-life to brush off the fact that pregnancy can in fact be life-threatening.

I sit on my state's maternal mortality team. Time and time again, we see cases of people who come to pregnancy in a very poor state of psychological or physical health. Our medical system is not able to meet their needs. Their poor health, socioeconomic situations and lacking support systems lead to predictable, and often preventable death. While abortion is not a solution to any of the aforementioned problems, it is often true that had the mother had an abortion, she would not have died. Think, a mom who comes to pregnancy with diabetes, hypertension, chronic heart failure and weighing 400 lbs. Think, a mom who comes to pregnancy with severe mental illness and a history of multiple suicide attempts. Think, a mom with 4 prior C-sections who nearly died in her most recent surgery and has an unplanned, closely spaced pregnancy. I just wish we were having some of these more nuanced conversations. Let me know if Fairer Disputations is interested in an article/debate about this!

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