Of Personhood and the Pill: What’s at Stake?

There are some doctors’ offices where you never expect to sit. In the reproductive endocrinologist’s waiting room, the women sit straight-backed and tense, and casual conversation between patients doesn’t happen. Some women leave smiling, but others leave in grim anxiety, or in quiet tears. Nobody looks at them, because sooner or later, that crying patient will probably be you.

I was 28 years old the summer I started infertility treatment. Popular misconceptions aside, I didn’t spend my twenties and thirties focusing on other priorities while my eggs dried up. Something went amiss in the dark corners of my brain, and it was quickly obvious that I wasn’t going to get pregnant without serious professional help. The next six months were full of miseries, large and small, as my doctors tried various unsuccessful treatments. We debated skipping straight to IVF, but eventually decided to first do intrauterine insemination (“artificial insemination,” or IUI) cycle, to see how I responded to the IVF medications.

Because we are incredibly and undeservedly fortunate, that “practice” cycle concluded in a pair of blue-eyed daughters, followed by a younger brother who came along as we pondered a return to that unpleasant waiting room. My children are five and three now, and grocery-store strangers no longer coo over the tiny babies before asking if they’re “natural.” This November, though, those same strangers will be voting on a constitutional amendment which will decide what treatment options will be available in Mississippi for infertile women like me.

The only problem is that almost nobody knows it. The Personhood Amendment, MS26, is a deceptively simple sentence: “The term ‘person’ or ‘persons’ shall include every human being from the moment of fertilization, cloning or the functional equivalent thereof.” There’s not a word about IVF, or about contraception, or about ectopic pregnancy treatment or miscarriages. Anyone who considers himself or herself pro-life will almost certainly reflexively agree with it.

The implications, though, are drastic. Because there’s no established legal standard for what rights are conveyed by the term “personhood,” it can be applied as broadly as the state legislature and judicial system will support. Everyone, supporters and dissenters alike, agrees that it will prohibit elective abortion, the morning-after pill, and discarding frozen embryos. What else, though, might be prohibited under the same logic?

If the amendment as written will protect embryos from being deliberately and knowingly killed, this must derive from their being people with the right not to be murdered. However, do these “embryonic people” also have the right not to be handled in a manner which, if applied to newborn infants, would be considered negligent manslaughter or child endangerment?

21 Not-So-Simple Words

Unfortunately, IVF just doesn’t really work all that well. 70% of the women who start an IVF cycle will not take home a baby nine months later. When those cycles fail, it is much easier and less expensive to use frozen embryos from a previous cycle than it is to create new embryos. Viable, healthy embryos are never discarded, because embryos are a precious resource. Every woman who undergoes IVF is viscerally aware that those embryos might, one day, be carefully wrapped in a blanket and tucked into a car seat for the first ride home. Many save pictures of their embryos, in the hope of making them the first entry in a baby book.

The process of embryo cryopreservation is a necessary part of IVF. Doctors aim to retrieve approximately 10 eggs from a woman undergoing IVF, knowing that only 25% will fertilize and develop into embryos which can be transferred back to the mother. In a typical cycle, two embryos are transferred, to give the mother the best chance at getting pregnant at all without risking high-order multiples. However, this isn’t an exact science. There is no way to know in advance how many eggs will fertilize, or how many embryos will develop. If a woman has more embryos than can be transferred, doctors pick the two best, and freeze the remaining embryos for later use.

However, the sad fact is that about half of the embryos which are cryopreserved won’t even survive the freezing and thawing process. We take healthy embryos and subject them to a process which offers no direct medical benefit to them, knowing that 50% of them will die in the process. Just imagine the parallel to healthy newborns: subjecting them to a medical treatment which doesn’t offer any benefit to the babies, and which is known in advance to kill 50% of them.

Surely, if IVF embryos are people who possess the fundamental rights to life, such a thing could not possibly be allowed. Yet personhood advocates claim that the amendment (which, let’s remember, does not say a word about IVF or frozen embryos) won’t restrict access to IVF at all. That is, it will somehow distinguish between murder and manslaughter, and protect frozen embryos from being discarded while continuing to permit embryos to be frozen (and die during the process) in the first place.

Personally, I find the logical and scientific contradictions impossible to resolve. Nor has the pro-personhood campaign offered any better rationale than “IVF won’t be restricted, because we said so.” Unfortunately, political ads don’t carry any legal weight at all. Given that a large wing of the pro-life force is ideologically opposed to infertility treatment, I find myself unwilling to simply take their word for it.

The same contradictions are evident when we talk about ectopic pregnancy treatment. Significant controversy exists about the appropriate pro-life approach to ectopic pregnancy treatment. Some doctors are comfortable preemptively treating doomed pregnancies by using the chemotherapy drug methotrexate to induce a miscarriage. Others, notably Catholic physicians, do not believe in such direct intervention; they prefer to wait first for the pregnancy to end spontaneously, then if a rupture still threatens, to surgically treat the pregnancy by removing the Fallopian tube with the developing embryo still in place. This approach carries some very serious physical risks to the mother, up to and including death and infertility; but for many pro-life people, it’s the only treatment compatible with the principle of double effect.

This even extends to contraception. Many pro-life people believe that the use of hormonal contraception and IUDs is incompatible with a view that life begins at conception, because of potential abortifacient effects. This view is by no means universal, but it’s common enough that it’s a fair question to ask whether personhood is incompatible with the Pill.

If the pro-life movement can’t agree even amongst itself, how are women supposed to be able to trust that those 21 words will protect their access to contraception less drastic forms of ectopic pregnancy treatment? Would you be willing to bet your health and fertility on it, and sign away your rights in exchange for promises that the eventual implementation will still have the necessary exceptions? Do you trust the men (and a handful of women) of the Mississippi legislature to make exactly the same choices you would?

Taking Responsibility

The weeks and months after my husband and I were diagnosed with infertility were the most difficult period of our marriage to date. We circled around the grief by discussing specifics of treatments, knowing that the unspoken corollary was always “if it’s the only way we can have a baby.” We weren’t what you’d call comfortable with the idea of IVF, and the question of frozen embryos loomed large for us. Neither of us believe that embryos are fully equivalent to people, but we still agreed that we would owe them some degree of responsibility. We did not ultimately have to sign the dotted line for that decision, but we did agree to go through IVF, and had organized the specifics of money and scheduling.

One of the silver linings of infertility is that I know to a nicety where I stand. We put so much prayer and thought and argument into working out our choices, both for infertility treatment and for some of the potential pregnancy complications we might, and did, face. It’s easy to say that you would never do X or Y in the abstract. It’s another thing entirely when the tense shifts out of the conditional, and becomes “what WILL I do?”

It seems vaguely ludicrous to me that Mississippi voters now get to decide that for me, mostly without any understanding that they’re doing so, and certainly without all the literal blood and tears and years of thought I spent on those questions. All I can do, once again, is pray and talk, and hope that the right decision gets made in November.