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What Alabama's IVF Ruling Means for Healthcare · CareTalk: Healthcare. Unfiltered.

• 0:00
  The Alabama Supreme Court ruled that frozen embryos created for in vitro fertilization are children.
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  The immediate result is to stop IVF in Alabama and put Republicans who were to overturn Roe vs Wade on the defensive.
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  What are the broader implications of this ruling?
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  And what does it mean to be pro -life but anti -IVF?
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  you Welcome to Care Talk, America's home for incisive debate about healthcare business and policy.
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  I'm David Williams, president of Health Business Group.
• 0:37
  And I'm John Driscoll, the president of Walgreens Health.
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  while you're at it.
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  David, David, David, making fun of this really important ruling.
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  Well, let's maybe step back and see what is IVF and why has this got everyone from mothers to Republican leaders and Democratic scolds all active.
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  But let's step back.
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  What is IVF?
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  So John, IVF is in vitro fertilization, and it's a so -called test tube babies.
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  where the embryo is created outside of the womb by bringing a sperm and an egg together, nurturing it, and then being able to implant it for a regular pregnancy.
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  That's in vitro fertilization.
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  So the in vitro is sort of in glass.
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  And then that's where fertilization occurs and then is carried to term in the normal way.
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  And it's a pretty complicated for a lot of families, husbands and wives, but people who want to be parents, that has been a game changer because it has allowed patients who are going through cancer therapy where they can become infertile to actually be able to preserve their ability to have kids.
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  It's created as particularly as parents are more typically getting older, the ability to have kids is becoming more challenged.
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  It does allow them to kind of freeze their healthier eggs earlier.
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  potentially, if they're having a hard time getting pregnant, be more targeted and thoughtful by going through hormonal treatments to make those less fertile parents more fertile.
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  So it's really been a game changer across everything from cancer patients to older parents to others who have a really hard time having kids in the first place.
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  And, you know, I think 2 % out of all births in the United States are IVF, but...
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  70 % of even the Republicans are in favor of supporting IVF.
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  So once we've established, okay, this is a really, this is an elemental part now of the way many parents preserve the ability to have kids or have kids, what's up with this Alabama ruling?
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  Yeah.
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  John, you're right.
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  There is, I'll answer the Alabama question and then we can go back maybe to some of these broader topics.
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  So.
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  What happened here is that there is, as a part of the anti -abortion movement and the determination to try to overturn Roe versus Wade is the concept that life begins at conception.
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  And therefore you can't destroy a life in the womb because it's already been conceived.
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  And then what's happened in some states, including Alabama, is that concept has been extended that says not just does life begin, but that a person, you know, that a fetus is the same as a person.
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  So the sort of fetal personhood movement is what's happened.
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  Now, what happened in Alabama is that some couples sued a hospital because they had frozen embryos there that were destroyed.
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  And originally this case was actually was thrown out, but then the judges actually said, well, there's a statute that says that you're allowed to sue for wrongful death of a child.
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  And that applies to an unborn child as well.
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  And, that there's no exception for what they called extra uterine children, meaning a fetus that is, you know, still in vitro is not actually implanted.
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  And that still counts as a child, an embryo, just as much as a fetus and the woman, just as much as a person walking the earth.
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  So that's how it kind of started.
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  And that was only possible because of Roe versus Wade, because before Roe versus Wade was overturned, you would have said, well, Alabama may say that, you know, fetus is child, but that's not the case.
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  But the Dobbs decision, which is the Supreme Court decision that, that sort of overturned Roe v Wade and really undermined the universal access that was embedded in the Supreme Court's decision around privacy.
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  And once that was overturned, there's a number of pieces of argument in that decision.
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  which was a majority decision in the Supreme Court, which permits the states now to regulate abortion in a much more, as restrictive a way as they'd like.
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  It's sort of almost preset to this, but it's really a substantial reversal of where society has been for honestly the last 30 years.
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  Yeah.
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  Well, John, I think what's happened is you can understand, I can see the logic.
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  where if you consider, okay, you shouldn't harm a child.
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  And then if you consider that you shouldn't harm a fetus, and then if, well, then that means a fetus is a child.
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  And if a fetus is a child, then an embryo is a child.
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  So why would life begin any later than that?
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  Why would it begin with the implantation?
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  So that's the logic if you take it from that way.
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  If you look at it from the other side, and the newspapers started to interview people that have been affected by this directly, because one thing that's happened is IVF has stopped.
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  Right.
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  I'll mention a person's name only because I think it's worth mentioning that there is, you know, like specifics there.
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  So one person quoted in the paper is somebody named Megan Ligursky.
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  She was pregnant after being implanted with an embryo that was created through IVF, but then she had a miscarriage.
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  So she and her partner have three more frozen embryos, which they'd like to, you know, to try to get pregnant with.
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  And she said, we have three frozen embryos.
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  We don't have three children.
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  Nobody thinks that she has a child in the sense of raising them, sending them to school, et cetera.
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  And I think that's where you have this tremendous clash.
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  So on the one hand, you can say, okay, well, if a fetus is a person which people have started to understand, then I can go all the way back.
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  But if you say, well, what is a child?
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  The essence of a child is not that it's an embryo.
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  I think this goes back to, there are very different religious beliefs regarding...
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  when life begins.
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  The Catholic Church has been very consistent, for example, in criticizing even the idea of an IVF birth being permitted.
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  Most Protestant Christian religions actually are supportive of it, and the majority, vast majority of evangelicals who are predominantly anti -abortion in general are supporters of IVF.
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  So you have a real range of opinions that are passionately held.
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  And then of course, you've got the rest of society where the majority of even, you know, before you get into the details of Republicans and Democrats support some elemental rights of women to choose, to have control over their body and birth.
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  They differ on obviously, based on the politics of how broad that.
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  flexibility or control is, but, you know, the adopts decision was, does not reflect the majority opinion of most Americans, not even most Republicans.
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  And now, but embedded in that is this notion that a fetus is a unique, is a genetically unique person that has the rights and privileges of someone who's actually alive and kicking.
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  And it becomes, maybe we delve into why that's so problematic.
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  from an IVF perspective, because I think it's really important that people understand the details here.
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  A lot of folks who are...
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  I mean, it's because of the potential for the providers of IVF therapy in Alabama to be prosecuted for murder effectively, they have stopped actually providing those services.
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  The clock's ticking for a number of people who are...
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  trying to get pregnant and trying to preserve their ability to get pregnant.
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  So that's a problem in the state for women and parents who want to be parents in the state.
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  The other thing is that this case surrounds the notion of destroyed embryos.
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  And the reality is that most of the process for people making healthy, fertilized eggs is actually kind of complicated.
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  So you often have...
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  a number of embryos that either have severe genetic abnormalities and challenges or they don't survive.
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  And now that you're referring to an embryo as a person, how does one think about that?
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  Does that mean you have to shoot for one embryo at a time?
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  Anytime there is hormonal treatment for women and the extraction of the fertilized egg, there's surgical risks there.
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  So we've basically if this ruling holds, considerably increased the medical risk for the women.
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  We've reduced the number of shots on goal, if you will, because you don't shoot for as many eggs if you think that some of them might be destroyed.
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  And you now get into the difficult area of what happens to those eggs, which one can actually now test for severe, in some cases lethal, genetic abnormalities.
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  Is that a person?
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  Is that, I mean, you get into really, it's harder for the moms, it's more problematic in terms of their health.
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  And you also get into other sort of thorny ethical questions, which is I think why the majority of Americans have pretty consistently said within certain limits, this needs to be up to the decision of the parents.
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  But it's a really problematic area.
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  And yet there is currently, A, you know, Speaker Johnson, our remarkably conservative speaker of the House of Representatives, is actually one of the co -sponsors of a bill that would embed this as part of federal law for the country.
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  So I think we're kind of hurtling towards sort of some radical legal changes that could be really problematic, particularly for parenting, for young parents who are having challenges.
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  Well, John, you're absolutely right.
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  There's a lot of complexity here.
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  So to be fair, the court decision didn't literally outlaw IVF, but it said an embryo is a person, right?
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  And therefore you can't destroy it or hurt it in some manner.
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  So you're pointing out the best practice for IVF is to have multiple embryos, because one is not viable and so on and so forth.
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  And so it really would completely change IVF and change the risk profile, the cost, which is already high.
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  and so on, where this becomes the other complexity is actually on the political side and what it means.
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  So just to underline what you were saying, if you look at the current leader of the Republican Party, everyone's sort of fallen in line behind him on things like foreign policy, where instead of saying Russia is the enemy, it turns out Russia is the ally and people have made a big switch there.
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  This is a little different.
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  Uh, so, you know, vice president Pence, for example, was well known for following along with whatever his boss said, which, which is the case, you know, typically you see with vice presidents.
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  Well, he and his wife, Karen Pence did IVF multiple times.
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  So are they suddenly going to fall behind a group that, you know, that, that, that is, that is against it.
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  So at the same time that you've got, um, candidates, including the front runner, the Republican party saying, you know, no, no, you favor IVF.
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  Although they also saying, of course Roe versus Wade.
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  against and actually, you know, managed to get rid of it unlike others.
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  And then you've got the person in second place saying, you know, well, embryos are people, but, you know, she supports IVF or maybe she does, maybe she doesn't.
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  You've got in the Senate.
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  The candidates for presidency and the Republican side are really, are really waffling because they've come out and said, you know, we're very in favor of IVF and they're also in favor of the ruling that makes the IVF.
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  providers in the state of Alabama, that's why they've stopped.
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  I mean, like, so you can be for it in general, but not in a way that perhaps the providers can actually provide the service.
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  Yeah, that makes it hard.
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  So you mentioned what's going on in the House.
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  In the Senate, Senator Tammy Duckworth, who has used IVF herself, introduced a bill to protect IVF.
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  But she says sort of tellingly that no Republicans have contacted her to sign on to it.
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  And so that where one reason why this will stay in the news for a while is because it does continue the narrative, which I would say is hard to refute that, you know, overturning Roe with the Dobbs decision is not just a very specific thing, but as part of a broader agenda.
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  And also because it's so difficult, if not impossible for people to square the circle between, between being pro -life, you know, and in favor of not having IVF.
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  or having IVF, like which is it?
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  That's a very difficult one to reconcile.
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  Look, this is an entirely tricky area and you've got to respect the fact people genuinely, unlike a lot of political issues, this is one where people have moral convictions and religious traditions that substantially differ.
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  The challenge is in a pluralistic society, in a society like America where we've got many different religions.
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  independent of what some of the theocrats on the right want to argue.
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  We've got a respect for many religions and these are complex ethical questions.
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  I just think what I think people are reacting to, the reason why the Democrats have been so successful at weaponizing this issue as a way to engage their female and the male base of voters who feel very strongly that choice should be largely left to families is that the majority of people disagree with how far the party has gone.
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  But what's interesting to me is the particular issue of IVF, because it's so complicated, because you're talking about people who are going through cancer, who become infertile, preserving their ability to have families, helping those families that want to have you.
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  We don't have a replacement rate of population in the US.
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  Our actual ability to support the population at a reasonable ratio or the birth rates have actually been going down.
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  And so this could run the risk of damaging it even further.
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  But I also think this is very personal even for conservatives, even for folks with conservative religious traditions.
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  Many of those really want to preserve this.
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  And the challenge is when you have an absolute standard legally and a complex standard medically, how do you interpret that?
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  And I think that's the, this is one where I think it will continue to be a challenge.
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  And what I feel most for are these families that are potentially medically compromised, and this just is gonna make their challenge of having a baby even harder.
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  Let's talk maybe on a pragmatic basis, this has got nothing to do with really religion or with...
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  politics about a cancer patient.
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  We've mentioned that a couple of times.
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  So, you know, what happens when someone has cancer used to be just focused on like how to survive.
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  Now what's happened is, first of all, we seem to have this trend of younger people getting cancer.
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  So people who maybe haven't had children yet and both cancer itself and cancer treatments can impact fertility.
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  So you talk about chemotherapy, you know, which is toxic and goes after fast dividing cells, which are cancer cells, but also reproductive.
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  uh, radiation, of course is dangerous.
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  And then surgery, which actually, you know, may remove certain, uh, organs that would, uh, not enable you to have kids both on the, for men and for women.
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  And so that can impact fertility or hasten menopause.
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  And so the, you know, the typical advice now is to say, Hey, you're like, you know, we've got, we have approaches that can treat, put this in remission and we've got to move along with that quickly, typically, right?
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  You're not waiting for that.
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  but let's actually do something to store eggs or sperm or embryos in order to give you an opportunity.
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  Now, this isn't just a pragmatic thing.
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  It's also when you're considering about like, you're facing a cancer diagnosis and you're about to go through this treatment, to then to have something possibly to look forward to as opposed to saying, well, even if I do survive this, I'm not gonna be able to have a family.
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  That's gonna be pretty devastating.
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  So these kind of theoretical things and things that look nice on a slogan like a, you know, fetal personhood and so on comes to when you have people that are, I say real people, but people in the world walking around who are adults making decisions.
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  It has a big impact on, on people.
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  And it doesn't seem as though, uh, you know, the, somebody in a court state, uh, should be able to make that much of a dramatic change.
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  Again, we, we, we're, we're in a very different world.
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  I mean, in the last 10, 15 years, you've seen, cancer rates increase for people under 50.
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  You've got, you know, all incisive cancer, but early onset breast cancer is up 8%, early onset GI cancer is up 15%.
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  And the protocols we have to take care of those folks, many of whom are of childbearing age, includes, to your point, therapies that kill the ability that either through early onset menopause or just through the toxic effects.
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  you do sort of eliminate or substantially eliminate the ability to have kids.
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  The IVF was a game changer for them.
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  And now to take that away, make it more problematic, make it more medically challenging and potentially risky.
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  It just seems unfair.
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  I think this is going to be a tricky one, David, because I think that there is going to be some really interesting federal state back and forth because even though certain folks feel it, that there needs to be absolute rights and eliminations and clarity on this.
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  The reality of the complexity of the medicine and the medical outcomes here are going to be a challenge.
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  And you see that in the majority, even though the Republican Party, one party has been very consistent in pushing for personhood and protections for what they consider all forms of life.
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  even their supporters are very mixed on whether the solutions match the problem.
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  I mean, it's a, I think unfortunately, this is one where the simplicity of legal doesn't do a very good job with the complexity of healthcare.
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  John, I think in, maybe to finish up here, you know, in the near term, I do believe we're going to see more rulings that are like this.
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  There's 14 other states that have a fetal personhood bills in one form or another.
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  Yeah, that are either, you know, that are have been introduced and some getting ready for enactment.
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  There'll be other state courts that are like this.
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  And I think that'll have the impact on the campaign here in 2024.
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  I think longer term, there'll be a shift back, probably, with more moderation.
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  And depending on how this personhood thing works out, depending if the frozen embryos are allowed to register to vote and to vote, then their opinions may eventually...
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  come to the floor as well when they turn 18.
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  I mean, it's, it's, it's, it's, and then you're seeing now potential prosecutions of people helping people travel.
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  This, I think you're absolutely right.
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  This is, this is one where, um, we're, we're, we're not going to, we're not, we are just at the beginning innings of this debate and the politics around this.
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  And I think, you our job is to help people understand what the healthcare consequences and implications are.
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  But it's going to be interesting to see how this one plays out across the country.
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  It's fair to decide, John.
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  And I said that was the last question.
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  It was, it is, but you know, at your point, you're just making about restrictions on travel and so on about, you know, keeping somebody within one state versus another.
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  You know, overturning Roe versus Wade has incredibly broad implications and not just for abortion.
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  In any case, that's it for yet another episode of Care Talk.
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  We've been talking about the recent Supreme Court ruling in Alabama and the implications on IVF and beyond.
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  I'm David Williams, president of Health Business Group.
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  And I'm John Driscoll, president of Walgreens Health.
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  Hopefully we've helped you understand some of the implications of this complex issue.
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  But if you like what you heard or you didn't, we'd love you to subscribe on your favorite service.
• 22:11
  Thanks for listening.