No Room for Ambiguity: ASH’s Advocacy for Maternal Health After the Dobbs Decision, Part 2

I recently argued in this column (The Hematologist. 2022;19[5]:2) that lawmakers could not possibly have foreseen all of the downstream consequences of the Dobbs decision and the subsequent trigger laws that now govern maternal health care in much of the United States. In some states, abortion is prohibited, full stop, whereas in others there are specific exclusions that allow for pregnancy termination to “save the life of the mother,” but still leave much to interpretation by hospital attorneys and hospital “ethics” panels. Given so much gray area and room for misapprehension, I called on ASH members to inform our lawmakers and the voting public of the terrifying situation we now face in trying to provide state-of-the-art care for our patients with hematologic malignancies and disorders. To this end, I traveled to New Orleans, the site of the 2022 ASH Annual Meeting, to meet with Gov. John Bel Edwards of Louisiana. I was joined by Dr. Chancellor Donald of Tulane University who is chair of ASH’s Committee on Practice, and by Dr. Laura Finn of Ochsner Health, a member of ASH’s Committee on Government Affairs — both long-standing members of the Louisiana medical community and busy clinicians on the ground in New Orleans. ASH staff joined by Zoom.

Our primary objective was to inform Gov. Edwards of ASH’s commitment to maternal health care. There is nothing more impactful than the true stories of our patients. I wanted to share real-life examples that illustrate how abortion restrictions interfere with the delivery of optimal patient care and put the lives of young pregnant women at risk. I told the story of a 22-year-old patient of mine with relapsed Hodgkin lymphoma who became pregnant during radiotherapy just prior to a planned admission for an autologous stem cell transplant. Gov. Edwards was visibly moved by our clinical cases and shared that lawmakers had not considered the impact of abortion restrictions on the care of our patients.

Following the Dobbs decision, the Louisiana Legislature revised the “trigger” law that governed maternal health care in the state to specifically exclude the following from the abortion ban: 1) a medical procedure performed to save the life or preserve the health of the unborn; 2) removal of a dead unborn child or inducement or delivery of uterine contents in the event of spontaneous miscarriage, spontaneous abortion, missed abortion, incomplete abortion, or septic abortion; 3) removal of an ectopic pregnancy; 4) use of methotrexate to treat an ectopic pregnancy; 5) a medical procedure needed to prevent the death or substantial risk of death to the pregnant woman due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of the pregnant woman; 6) removal of an unborn child deemed medically futile … and 7) the sale, use, prescription, or administration of a contraceptive or an emergency contraceptive.

Unexpectedly, the complexity of patient management and decision-making became quickly apparent to the governor when we tried to apply these criteria to one of our clinical scenarios. It was clear that much would depend on interpretation and that this ambiguity could affect shared decision-making because of the physician’s fear of retribution. We suggested that perhaps instead of requiring “a substantial risk of death” or “impairment of a life-sustaining organ” to qualify for an abortion, that we instead exempt from the ban patients with malignancies or hematologic disorders. That a pregnant patient with an active “cancer” or other hematologic disorder requiring therapy be permitted to make a decision weighing risks and benefits jointly with her physicians seemed reasonable to the governor, who invited us to try to develop language for a future amendment to the current law. It will likely be challenging to develop a strategy that includes all hematologic disorders as exclusions, and Gov. Edwards suggested that we partner with other medical societies that serve patient populations with similar concerns. We committed to working together to wordsmith an amendment to the statute and to serving as a resource to the governor.

We also wanted to provide the governor with the projected financial impact of the ASH annual meeting on the local and state economies. Although we are committed to holding the upcoming meeting, now less than three months away, in New Orleans, some members are advocating for ASH to hold future meetings only in states that have maternal health care that includes the right to abortion. The long-term impact on New Orleans, its hospitality industry, and convention center should we move upcoming meetings from Louisiana, was appreciated by the Governor.

For the upcoming meeting in New Orleans, ASH has taken the belt-and-suspenders approach to ensuring the safety of our attendees by working with local health care providers to provide concierge service should there be an obstetrical emergency and by sponsoring evacuation insurance to all^* who register. This insurance covers any medical emergency, including maternal health care. The information is on the ASH website (www.hematology.org/meetings/annual-meeting/attendee-resources/health-and-safety-protocols).

We have begun a dialogue with Gov. Edwards and his staff, who were very receptive to our concerns. ASH leadership is committed to keeping the conversation going. Please make your voices heard as well. Join the ASH Grassroots Network (www.hematology.org/advocacy), speak to your state legislators, and be sure to vote. Hematologists should not have to risk criminal prosecution to provide the kind of care our patients deserve.

It has been an honor and privilege to serve as president of this society. My special thanks to the officers, members of the Executive Committee, and ASH staff for their support during this tumultuous year. I will soon be passing the gavel to Dr. Rob Brodsky, who will ably lead the Society in 2023.