Analysis Maternity and Birthing

New Hampshire’s HB 217 May (Inadvertently?) Make Infertility Services in the State Scarce

Robin Marty

A change in a proposed bill in New Hampshire may leave infertile women and couples seeking in-vitro fertilization with few options.

When the New Hampshire legislature amended HB 217 to change the proposed fetal murder and homicide charges to apply only to fetuses of 24 weeks gestation and beyond, many politicians and advocates believed the bill was unlikely to have much effect on reproductive rights.

But a new definition in the final bill heading to the senate has infertility advocates concerned that it could undermine the willingness of doctors in the state to provide in vitro fertilization services — a change that could stop many families from having the children they have always dreamed of.

The issue, according to Resolve New England, an infertility information, support, and advocacy group, is that the senate judiciary decided to change the bill as means of granting person-hood rights to fertilized eggs through the back door.

In this section:

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(1) “Conception” means the fusion of a human spermatozoon with a human ovum.
(2) “Pregnant” means the female reproductive condition of having an unborn child in the woman’s body.
(3) “Unborn child” means the offspring of human beings from conception until birth.

By adding the amendment redefining a person, suddenly IVF is pushed into a murky, uncertain place in which doctors may or may not be opening themselves up to criminal charges. 

The original language in HB 217 reviewed by the senate judiciary committee limited the charge of “murder or homicide” to cases of at least 24 weeks gestational age, and provided an exception to “any medical procedure performed by a licensed medical professional at the request of a pregnant woman or her legal guardian, or to the dispensing or administration of any prescribed medication.”

But the committee removed the 24-week gestation language, and added a larger section defining when the charge of murder would not be applied:

V.(a) Nothing in this section or RSA 630:1-b, RSA 630:2, RSA 630:3, or RSA 630:4 shall apply to any act committed by the mother of the unborn child, to any medical procedure, including abortion, performed by a physician or other licensed medical professional at the request of the pregnant woman or her legal guardian, or to the lawful dispensation or administration of lawfully prescribed medication. For the purposes of this section and RSA 630:1-b, RSA 630:2, RSA 630:3, or RSA 630:4, “abortion” means the act of using or prescribing any instrument, medicine, drug, or any other substance, device, or means with the intent to terminate the clinically diagnosable pregnancy of a woman with knowledge that the termination by those means will, with reasonable likelihood,
cause the death of the unborn child. Such use, prescription, or means is not an abortion if done with the intent to save the life or preserve the health of an unborn child, or to remove a dead unborn child caused by spontaneous abortion, or to remove an ectopic pregnancy.

The problem, according to Keiko Zoll, Communications Director of Resolve New England, is that the new language, which covers almost every possible objection one could have with the law, ignores an important fact — pregnancy doesn’t begin at conception, which leaves women undergoing IVF in a lurch.

“Acts in the course of medical treatment by doctors and embryologists at IVF medical practices would not be protected from the operation of this bill,” said Zoll. “The only medical treatments that are exempted are those performed ‘at the request of the pregnant woman.’ By definition, the woman having infertility treatments is not ‘pregnant.'”

Erin Lasker, Resolve’s Executive Director, believes that the intention was not likely malicious, but careless, another example of legislators not being entirely aware of how attempts to legislate medical definitions can get in the way of medical best practices and health care.

“I honestly don’t think the legislators are thinking about IVF.  That is why they are referring only to a pregnant woman. And technically someone going through IVF is not pregnant when the sperm meets the egg.  I just think that if we don’t speak up that it could pass and have ramifications that the legislative body didn’t realize would occur.”

The legislature could easily fix this bill in a few simple ways — either through an amendment to specifically address the handling of embryos during infertility treatments, or by adding back the 24-week gestation language that was in the previous version. 

Resolve hopes that at least one of those changes occurs during the senate debate tomorrow, and urges people to speak out to the New Hampshire senate and remind them of the unintended effects that their bill could have on women already struggling to create the family so badly desire.

Analysis Law and Policy

Dr. Tiller’s Murderer May Have New Chance to Argue That Anti-Choice Violence Is Justifiable

Jessica Mason Pieklo

Convicted murderer Scott Roeder is set to be re-sentenced in connection with the death of Dr. George Tiller while his associate Angel Dillard will stand trial for threatening another Wichita, Kansas abortion provider. These are particularly alarming developments at a time when anti-choice violence has spiked.

It only took a jury about half an hour in 2010 to convict Scott Roeder of first-degree murder for the 2009 shooting death of Dr. George Tiller at Tiller’s church in Wichita, Kansas. Roeder admitted during the trial that he had thought about and planned Tiller’s murder for years. He offered no witnesses in his defense. Instead, Roeder argued that he was justified in Tiller’s murder because it was the only way to end abortion in Wichita.

Roeder was sentenced to life with no chance for parole for 50 years, otherwise known as a “hard 50.” But in 2013, the U.S. Supreme Court decision ruled juries, not judges, needed to make certain criminal sentencing decisions. Though a jury convicted Roeder of the crime of first-degree murder, a judge issued his sentence. That means Roeder’s underlying murder conviction stands, but the amount of time he’s supposed to serve is now up for grabs. On Wednesday, a judge ruled that a new jury will have to decide if Roeder’s “hard 50” sentence was justified. And with that potential new sentencing comes a fresh opportunity for Roeder and his attorneys to advance the radical legal argument that the murder of abortion doctors is justified under the law—a particularly alarming sentiment at a time when anti-choice violence has spiked.

The necessity defense invoked by Roeder is an actual, legitimate legal defense where the defendant argues they committed a particular crime in order to avoid a greater “harm or evil” being committed.  To that extent, it is not so much an “I didn’t do it” defense as it is a “there’s a good reason why I did it, and so you should go easy on me” defense. In Roeder’s case, as echoed by other anti-choice radicals, murdering abortion doctors is “necessary” to prevent the greater evil of legal abortion.

Not all states recognize the necessity defense; Kansas generally doesn’t. And suffice it to say that no court has recognized the defense in connection with the murder of a doctor for doing his job. But that didn’t stop Roeder and his attorneys from arguing it anyway, and it won’t stop them from doing it again this summer. 

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Nor, for that matter, did it stop Sedgwick County District Court Judge Warren Wilbert from saying Wednesday that Roeder may have a constitutional right to present his evidence for why the necessity defense should apply to his case. Essentially, Roeder and his attorneys can potentially outline for a new jury all the reasons Roeder felt his killing of Tiller was for the greater good. 

This is not the first time Wilbert has indicated a willingness to consider Roeder’s “necessity” defense. Wilbert also oversaw Roeder’s initial criminal trial and ruled that Roeder couldn’t specifically argue the necessity defense because Kansas law does not recognize it. But Wilbert did leave the door open for Roeder to present during his first trial evidence and arguments that he murdered Tiller to defend the lives of “the unborn.” That opening could have allowed jurors to find Roeder guilty of a lesser charge like voluntary manslaughter, defined under Kansas law as the “unreasonable but honest belief that circumstances existed that justified deadly force.” That didn’t happen, thankfully, and the jury convicted Roeder of intentional first-degree murder, a crime that carries an automatic sentence of life in prison. Now, because of the 2013 Supreme Court ruling, a jury will determine whether Roeder must serve at least 25 or 50 years of his life sentence before he is eligible for a parole hearing.

Roeder’s next scheduled hearing is on April 29, when Roeder’s attorneys have been instructed by the court to provide any “mitigating factors” a jury should consider in weighing Roeder’s sentence. Roeder’s actual sentencing hearing has not yet been scheduled.

Roeder’s re-sentencing may seem like one of those “procedural” issues that doesn’t change much. The chance of Roeder, who was 51 when convicted, of dying in prison is likelier than him ever being paroled. But it is a procedural issue that comes at an inauspicious time for the issue of violence against abortion providers, especially in Kansas.

Angel Dillard, a woman who claims to be a “minister” to Scott Roeder, is set to stand trial in Kansas on May 3 for claims she threatened Dr. Mila Means, another Wichita abortion provider, out of taking over Tiller’s clinic following his murder. According to reports, Dillard told Means in a 2011 letter that thousands of people across the country were looking into her background. “They will know your habits and routines,” the letter read. “They know where you you shop, who your friends are, what you drive, where you live. You will be checking under your car [every day]—because maybe today is the day someone places an explosive under it.” That letter prompted the Department of Justice to bring a Freedom of Access to Clinic Entrances (FACE) Act claim against Dillard. Initially, a federal court ruled Dillard’s letter was protected free speech, but a federal appeals court overturned that decision and ordered Dillard to stand trial.

During their initial investigation of Dillard, the Obama administration had tried, unsuccessfully, to find out what connection she had to Roeder after prison logs revealed Roeder had several communications with Dillard and Rev. Michael Bray. Bray, an Ohio anti-choice radical, also promotes the use of lethal force in the battle over abortion rights, and spent four years in prison in connection with attacks on several abortion clinics in the Washington, D.C. area.

When Dillard’s trial begins in May, the Justice Department could, through other evidentiary means, be able to make the specific connections between Roeder, Dillard, and Bray without relying on testimony from any of them. Justice Department attorneys may even be able to connect Tiller’s murder, and the threats against Means, to other Wichita-based anti-choice activists like Operation Rescue’s Troy Newman. When Roeder was arrested, for example, he had Newman’s second-in-command Cheryl Sullenger’s phone number in his car. Sullenger served almost two years in prison after pleading guilty to her role in a 1988 plan to bomb a California abortion clinic.

And, of course, the consequences of these operations reach beyond Wichita or anti-choicers’ direct contacts. Most recently Sullenger and Newman have admitted to their roles in “consulting” with the radical anti-choice Center for Medical Progress, an organization set up by David Daleiden and others to try and prove through infiltration that Planned Parenthood and other providers were selling unlawfully selling fetal tissue for profit. Planned Parenthood has not been found guilty of any wrongdoing. But CMP’s videos, and the dozens of baseless state and federal investigations they’ve inspired, have produced a significant uptick in violent threats and activities against abortion providers, such as the Black Friday siege of a Planned Parenthood in Colorado Springs, Colorado. The attack ended in the shooting deaths of three people; the accused shooter, Robert Lewis Dear Jr., has said he committed the murders to “save the babies.”

Dear had initially said he planned to plead guilty to the murder charges connected with the Planned Parenthood attacks. He has apparently changed his mind and, if found competent to stand trial, would now like to plead not guilty.

There is no evidence, at least none disclosed, that Dear had any direct contact with anti-choice radicals like Newman or Sullenger, or that he even knows who they are. The Colorado Supreme Court recently ordered documents related to Dear’s arrest unsealed. They could be disclosed as soon as next week, and could provide more answers as to any relationships Dear has with the broader anti-choice movement.

Roeder, Dillard, Dear. All three cases will be going on this summer as anti-choice activists descend in July on Wichita to mark the 25th anniversary of the Summer of Mercy, a massive protest organized by radicals to try and make Wichita “abortion free.” Operation Rescue first orchestrated the 46-day campaign in 1991; Operation Save America (OSA) has since picked up the mantle. According to Rusty Thomas, director of OSA, July’s protest will focus on “states defying a tyrannical court” that recognized the right to an abortion.

“They must do their duty to interpose and nullify that lawless decree and protect the preborn,” Thomas told Christian Newswire.

Thomas insists July’s protests will be peaceful. But anti-choice radicals also insist their rhetoric and propaganda have no link to violence against abortion providers, even in the face of evidence to the contrary. So even if Thomas is correct and July’s protests produce no immediate acts of violence, the Roeder, Dillard, and Dear trials show “peaceful” anti-choice activity is an oxymoron.

Many anti-choice radicals hold Roeder up as a hero, and his re-sentencing hearing provides an opportunity to rally against the “lawless decree” of Roe v. Wade, as well as the courts that protect abortion rights and  convicted Roeder of his crimes. It also provides as a forum for Roeder and his attorneys to yet again advance, even fruitlessly, the legal argument that murder of an abortion doctor can sometimes be justified if the murderer really truly believes they are preventing a greater evil. Dillard will be arguing in her trial that her letter to Dr. Means suggesting she’d wake up to a bomb under her car wasn’t truly a threat because abortion providers should just expect those kinds of letters. Roeder, Dillard, and their attorneys will be in courts of law in Kansas arguing for not just the normalization of violence against abortion providers, but the legal justification for it. And Dear’s trial will be displaying the natural extension of that rhetoric.

Meanwhile, Thomas will be calling on their supporters and the courts to ignore the rule of law. That is troubling—to say the least.

Commentary Law and Policy

Personhood Amendments Would Hurt Families Who Want Children

Keiko Zoll

The amendments in Colorado and North Dakota giving legal rights to fetuses would leave people seeking in vitro fertilization in the dust.

Read more of our articles on “personhood” measures here.

Next week, voters in Colorado and North Dakota will take to the polls to vote on amendments that would give legal rights to zygotes, embryos, and fetuses, also known as “personhood” laws. Measure 1 in North Dakota seeks to recognize and protect the “inalienable right to life of every human being at any stage of development”; meanwhile, Colorado’s Amendment 67 asks voters to add “unborn human beings” to the state’s criminal code. Though Personhood USA, which is backing Amendment 67, may define “personhood” as the “cultural and legal recognition of the equal and unalienable rights of human beings,” make no mistake: The personhood movement is an attempt to undermine the legality of reproductive choice in America. This doesn’t just put abortion in danger; it also leaves some of the people wanting children the most—the infertility community—in the dust.

My own journey to motherhood was a textbook case of in vitro fertilization (IVF). Five years ago, I was diagnosed with premature ovarian failure, a sort of “end of the line” infertility diagnosis. In order to get pregnant, my doctor told us, I had a single choice: IVF with donor eggs, as my own were virtually nonexistent at the age of 26. While I grieved the loss of having a child with my own genes, I found hope and healing in the possibility of experiencing pregnancy and birth. Without IVF, we wouldn’t have the family we have right now.

I still have the grainy black-and-white photograph, taken just before my embryo transfer, of our two three-day-old, ten-cell blastocysts. I often wonder which of those two nearly transparent spheres became the charming, talkative toddler I now chase after.

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Even though I know that my son and one of those two balls of cells are the same, however, at no point when I look at that photo do I see a family portrait, much less a person. At that stage of human development, they were merely dividing tissue to me: They had no names, no genders, no sentience. But proponents of the personhood movement, who would legally define life as beginning at conception, evidently see a completely different picture. And it’s one that could make it much more difficult, if not impossible, for the as many as 7.4 million American women with infertility to create a family of their choice by seeking the treatments they need.

Here’s a basic primer of how IVF works: A woman’s ovaries are stimulated to produce multiple eggs. She may be the prospective parent, an egg donor, or even a gestational carrier who both donates her eggs and carries the pregnancy. Doctors then retrieve the eggs and fertilize them in the lab with the prospective father’s sperm from a provided sample. Three to five days after fertilization, medical professionals transfer one to three tiny embryos into the recipient uterus. Any excess embryos—on average, there are about 15—are often frozen and kept in cryopreserved storage until patients use them or discard them.

If personhood amendments were to pass, doctors would presumably have to treat all those embryos, or even the fertilized eggs, as if they had human rights. This, care providers point out, has no basis in medical fact—and it could severely hamper their ability to do their jobs safely and effectively.

“Among the many, many problems with these so-called personhood measures is they simply do not in any way reflect scientific reality,” Sean Tipton, chief advocacy and policy officer for the American Society for Reproductive Medicine (ASRM), told Rewire. “For physicians providing infertility care, the disconnect between the legal language and actual medicine is very dangerous. The reality is that most fertilized eggs will not develop into babies.”

Tipton fears that Amendment 67 and Measure 1, among other personhood measures, would place a question of potential murder on physicians trying to give their patients the best care possible. About those extra embryos, for example, he wondered, “Will doctors be forced to transfer them into their female patients anyway? Do they provide the best care for their patient, or do they risk facing a homicide charge?”

When it comes to the matters of how many embryos to transfer at once, there is no “one size fits all” recommendation. However, current ASRM guidelines call for the use of elective single embryo transfer (eSET) whenever possible in most favorable conditions, such as if it is the patient’s first IVF cycle or the embryos are of good quality. For most women younger than 37, ASRM recommends that doctors transfer a maximum of two blastocysts at once; for patients older than 38, it recommends no more than three. ASRM and the Society for Assisted Reproductive Technology (SART) specifically set up these guidelines to reduce the number of potentially dangerous multiple births resulting from IVF, including twins, triplets, quads, and higher-order multiples.

In our case, our egg donor—with whom my husband and I are close friends—provided us with 20 eggs then fertilized with my husband’s sperm. Six of those developed into embryos. My doctor transferred two embryos into my uterus; one implanted. Currently, we have four high-grade embryos “on ice”—and no hard-and-fast decisions yet on what to do with them.

Had personhood been in effect at the time of my IVF cycle, however, I wouldn’t have had the option to transfer only two embryos. Our donor would have had to understand that any of the extras couldn’t legally be discarded. We, as prospective parents, would be left with only two options: Donate the remaining embryos to another couple trying to conceive, or transfer them all to my uterus.

The first option, explains New Hampshire reproductive and family lawyer Catherine Tucker, could dissuade known donors from trying to give an altruistic gift to a close friend. “Your known donor might be willing to donate only to you and not to strangers,” Tucker noted. “So [she] might refuse to donate to you simply because she’s not comfortable with her genetic material going to other prospective parents in the event you cannot use all the embryos yourself.”

With our donor, after careful consideration, discussion, and legal negotiation, we collectively decided that any excess embryos would be ours, and ours alone, to use for future cycles, discard, or donate to scientific study as we saw fit—but not to another recipient couple. Our friend made her generous offer to be an egg donor for us, and for no other third parties. Even in cases where the donor is open to the idea of embryos going elsewhere, though, finding other recipients would be a logistical nightmare, especially with no way to guarantee any excess embryos at all.

On the other hand, transferring all of the embryos could put patients’ safety at risk. Assuming my same 50 percent implantation rate, for example, if I had transferred all six embryos, I could have had a triplet pregnancy—and that’s outside of the risk of any of those embryos splitting into multiples of their own. These types of high-order pregnancies put the woman and the fetuses at risk for serious complications, including preeclampsia, gestational diabetes, premature birth, miscarriage, and even maternal death. This is to say nothing of the costs of raising an unexpected additional child, which can be an immense burden on infertility patients who have already spent thousands of dollars on their treatments.

Personhood laws could also cause a number of other legal ambiguities for those involved in the IVF process. Barbara Collura, executive director for RESOLVE: The National Infertility Association, pointed out to Rewire that the vague language of the proposed amendments generates myriad potential gray areas that voters likely haven’t considered.

“What about the infertility patient scheduled for her IVF procedure on November 5?” she pointed out. For that patient, Collura noted, it would be unclear as to whether she had a right to refuse any of her embryos, or if she must cancel her treatment entirely—which would still leave any fertilized eggs retrieved and created before the ballot vote in legal limbo.

Collura also brought up the issue of unused embryos awaiting possible transfer. She raised the questions, “If Amendment 67 and Measure 1 pass on November 4, what will happen to embryos that are currently frozen and in storage in those states? Will infertility patients be able to cross state lines now with these so-called ‘pre-born people?’” After all, if embryos do not survive the trip, their transporters could be held responsible.

Tucker, too, noted that such an action might leave individuals liable to prosecution. “Under personhood laws, IVF physicians and lab personnel who handle the embryos could face criminal punishment should anything happen to these embryos,” she noted in an email to Rewire.

As a result of potential ramifications like these, personhood laws would have devastating effects for reproductive facilities. Reproductive endocrinologists in North Dakota have warned that Measure 1 would effectively shut down the sole fertility clinic in the state, rendering them unable to treat their patients. Amendment 67 would also either shutter Colorado fertility clinics entirely or severely limit their doctors’ abilities to practice recommended standards of care. Although Personhood USA claims that the amendments would not affect IVF, the very nature of the treatment means that some fertilized eggs or embryos are going to be discarded—which is blatantly at odds with the provisions outlined in personhood laws.

Ultimately, personhood initiatives could have a chilling effect on the entire practice of reproductive medicine. While the average person “might think that an IVF laboratory shutting down on account of a personhood law sounds far-fetched,” noted Tucker, “the bottom line is that personhood laws will end the ability of prospective parents to form their families with the help of IVF, egg donation, and even gestational surrogacy.” When legal rights are granted to ten-cell balls of tissue, every aspect of the handling, care, diagnostics, and treatment of those embryos must be taken into consideration. Personhood rights would upend decades of improving standards of best practice.

Personhood proponents argue that they are “working to respect the God-given right to life” and “protecting every child by love and by law.” But for people like me in the infertility community—who want nothing more than to have children of our own—personhood would actually prevent us from having those children in the first place.

I’ll never forget what our friend said when she made her incredible offer to donate her eggs to me and my husband: “I think everyone who wants to have a family should be able to. If I can give you that chance, I want to help because you two deserve to be parents.” If personhood proponents had their way, we’d never have had that chance at all.