In the wake of the US Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision (“the Dobbs ruling”) in 2022, health professionals have been grappling with subsequent legislation from various states that affects medical decision-making and treatment for fetal and maternal health.
To inform policymakers of the implications of current and proposed law, last week pediatric surgeons and fetal specialists representing the ACS and the American Pediatric Surgical Association (APSA) met with two White House health policy advisors to discuss how the Dobbs decision is challenging the safety and autonomy of mothers.
The meeting came out of conversations at the APSA meeting in June about the impact of Dobbs on pediatric surgeons who specialize in fetal intervention. Prior to that meeting, White House representatives expressed an interest in talking with surgeons to become educated on the state of the art in fetal interventions.
ACS President Henri R. Ford, MD, MHA, FACS, Patrick V. Bailey, MD, MLS, JD, FACS, ACS Medical Director of Advocacy, and other pediatric surgeons participated in a meeting on August 8 with Katie Keith, Senior Advisor, and Lina Volin, Chief of Staff and Advisor to the White House Gender Policy Council.
The group communicated how restrictive laws regarding reproductive health affect pregnant women and their fetuses. They noted:
- The Dobbs ruling creates ambiguity. Fetal surgery is associated with a risk of fetal demise and pregnancy loss, which might be interpreted as termination. As such, physicians may be discouraged from intervening when indicated for fear of causing pregnancy loss and suffering legal consequences; or, conversely, may over-use medical intervention based on the on the principle that “everything must be done” to save the fetus.
- Multiple gestations may lead to complex decisions. Fetal intervention may be withheld if only one twin appears sick for fear of harming the other, even if intervention would benefit both; conversely, fetal intervention on a sick twin may be seen as “doing everything possible” but pose a risk to the unaffected twin.
- Unclear interpretation of a law meant to preserve fetal life at all costs may introduce misinformation and hamper medical progress. Fear of prosecution may interfere with a physician’s ability to offer evidence-based medical information and may discourage innovation, hampering current and future forms of fetal intervention.
Those in attendance engaged in a robust conversation and were able to provide background on both the impact Dobbs has had on their practices and the uncertainty Dobbs has created when providing prenatal counseling.
It is anticipated that further input will be sought after Keith and Volin determine how these important considerations fit into their broader policy agenda.
In addition to Drs. Ford and Bailey, pediatric surgeon attendees included:
- Holly L. Hedrick, MD, FACS, Louise Schnaufer Endowed Chair in Pediatric Surgery at Children’s Hospital of Philadelphia, PA
- Francois I. Luks, MD, PhD, FACS, Murray Beardsley Professor of Pediatric Surgery at the Alpert Medical School of Brown University in Providence, RI
- Oluyinka O. Olutoye, MD, PhD, FACS, Thomas Boles Jr. Chair of Pediatric Surgery at The Ohio State University in Columbus
- Thomas F. Tracy Jr., MD, MBA, FACS, APSA executive director and president-elect
In addition, Tippi Mackenzie, MD, FACS, John G. Bowes Distinguished Professor in Stem Cell and Tissue Biology and professor of surgery at the University of California, San Francisco, participated in the discussions the group undertook prior to the meeting.
