Nebraska has taken another step towards effectively banning abortion and criminalizing the practice of medicine. I want to try to clarify that this bill is not supported by the medical community. It does not seek to improve the lives of Nebraskans. In truth, this bill is not what it seems, and I hope you will take a minute with me to turn down the emotional noise from both sides and look at what this bill means if we allow it to become law.
“This act shall be known and may be cited as the Nebraska Heartbeat Act.”
Starting in section 1 of the act, we have already flooded emotion into what needs to be a level-headed space. I am a mother of two daughters who also had the experience of finding no heartbeat when once there was one. The silence was deafening. I want you to know that you are not alone in the deep emotions and memories a heartbeat stirs. As physicians, we listen for them daily, and each one matters professionally and personally. Women physicians are more likely to struggle with miscarriages and need fertility treatments than other women because medical training adds 11 to 13+ years of school after high school completion. These are important years for fertility. It’s a loss we are only starting to talk about to each other. Experiences we hide away to focus on the care of our patients. But I want you to know we feel this too, and calling this the “Heartbeat Act” was an intentional ploy to use our pain to pass a bill.
Turning down the emotion on this benchmark of a heartbeat, we can see that it was chosen not for the good of the mother, not for the good of the embryo, not for any medical reason, but just for the emotional impact. Yes, we see electrical conduction through groups of cells beginning to form an embryonic heart. It is not a heart as we know it. It could not be transplanted. We can’t even tell if it will develop into a working heart. A heartbeat is just a sign that these cells are functioning at this time, and unfortunately, as many of us know, it does not mean that a healthy baby is assured.
Next, the bill hides discriminatory health care practices amongst the emotional triggers of sexual assault, rape, and incest. The bill completely disregards mental health parity and specifies that mental health diagnoses and emergencies cannot be considered medical emergencies. Disregarding those with mental illness and addiction is more than callous. It is wrong in every way, and we have established, time and again, that mental health is medical health. Our brain does not float around separate from our body. No, we are whole humans. And whole humans struggle and suffer.
In fact, according to the CDC, mental health conditions, including suicide and substance use disorders, are the leading underlying causes of pregnancy-related deaths (23 percent). This rate is higher than bleeding complications (14 percent), infections (9 percent), cardiac conditions (13 percent), blood clots (9 percent), and other, traditionally more well-recognized, causes of death during pregnancy and in the first year after birth. This is no small issue. Women, especially women of color and socioeconomically disadvantaged, struggle and die from mental health conditions and emergencies. This point cannot be disregarded when we look at serious medical exclusions.
The bill returns to the emotional distractor of rape and incest, ensuring that there would be provisions for such occurrences. But in testimony, we learned that woman must disclose the rape or conception involving incest, and that information would need to be documented in her permanent medical record. Nothing about how the rape will be investigated and what invasive examinations must be performed. What if she is a minor? What if the perpetrator is her father, who has access to her medical records? In Nebraska, if she reports and the case is investigated, but there is no conviction, the biological father/rapist would have parental rights. Every step of this proposed exclusion to protect victims, in turn, revictimizes women, and no clarity from Senator Albrecht has been provided when asked about these critical issues.
Finally, the bill kindly ensures that “no woman upon whom an abortion is attempted, induced, or performed shall be liable for a violation of the Nebraska Heartbeat Act.” What at first seems like a caring stance, in reality is just the state saying, “not in our state.” Nebraska would see their pregnant women travel under significant burdens to other states to get life-saving medical care. Nebraska would rather risk increased complications from traveling and no continuity of care than take care of their pregnant women. Nebraska is already failing its families, especially those of lower income, those without white skin, and those without good social support. Nebraska is failing women with mental illness. They do not see you. They do not put themselves in your shoes. They can’t feel how desperate life can be without help.
That help, that we as their doctors learned to provide based on years of studies, ethical debate, education, practice, and standards of care, would no longer be legal.
This bill doesn’t end in a picture of happy, growing families. No, it ends with me facing the decision to either lose my license by referring a patient to a place for family planning and possibly termination or possibly involuntary hospitalization of desperate women who do not feel they can ensure their safety and if we are past six weeks, the forced continuation of pregnancy.
It is easy to say yes to a heartbeat; it resonates with our emotions and values. However, this isn’t a bill to ensure medical care for Nebraskans. It is a bill that forces doctors out of the exam room, patients out of the state and lets legislators who know nothing of what happens in those rooms make decisions about our bodies, families, community, and lives.