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Potential effects of new anti-abortion laws and 2014 ‘personhood’ measure raise medical concerns in N. Dakota

And if North Dakota seems like an entirely different political landscape from Minnesota, with our much more purple electorate, think again.

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Dr. Stephanie Dahl

Among the patients Dr. Stephanie Dahl has treated so far this year were two college students with cancer. Both radiation and chemotherapy can destroy a woman’s fertility. So that each has the chance to have a family at a better time, Dahl, a reproductive endocrinologist in Fargo, N.D., fertilized eggs from each and froze the resulting embryos.

If North Dakota voters next year approve a radical proposal to define “personhood” as beginning the moment sperm meets egg, Dahl will have to stop offering in-vitro fertilization, among other services, or risk criminal charges.

“What if a catheter was dropped, or an embryo accidentally dropped during transfer from one dish to another,” said Dahl, whose specialized practice draws patients from as far away as eastern Montana. “That would be the death of a person. Could we be charged with murder?”

When personhood first came under discussion in North Dakota, like many others Dahl assumed its sole intent was to outlaw abortion. She knew the amendment would have drastic ramifications on everything from birth control to organ donation. Her efforts to educate lawmakers delivered a second shock.

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“Initially, I felt the senators and representatives didn’t realize what the law would do,” she recalled. “Now [that] I know they know, it’s intentional.”

And if North Dakota seems like an entirely different political landscape from Minnesota, with our much more purple electorate, think again. Personhood is on the ballot as a result of a new, deliberate and effective strategy — and despite the opposition of many of the state’s veteran pro-life politicians.  

“It’s not so abstract for us here in Minnesota,” said Sarah Stoesz, president and CEO of Planned Parenthood of Minnesota, North Dakota and South Dakota. “Mark Dayton won by 8,000 votes. If he had not won, we would have had Gov. Tom Emmer. [And] we have another election coming up.”

Passage of a personhood amendment in North Dakota would likely energize campaigns in other states, including Wisconsin, where the concept has been raised in recent years.

Nor is it abstract for Stoesz’s organization, the main reproductive rights advocacy group serving Minnesota and the Dakotas. “Minnesota is in this bubble,” she said. “But we have North Dakota, South Dakota and Wisconsin all around us passing these laws that are very damaging to women’s health.” 

A departure from usual tactics

The quest for personhood represents a fundamental departure from abortion opponents’ customary tactics, which aimed to chip away at access to legal abortions by creating thorny regulatory burdens for clinics and doctors, curtailing the number of weeks the procedures can be performed and forcing women to view ultrasounds of the fetus.

Personhood USA, the Colorado organization pushing the initiatives, defines its mission as a desire to “glorify Jesus Christ in a way that creates a culture of life so that all innocent human lives are protected by love and by law.” The term personhood had biblical roots.

Personhood laws and amendments have been put forth and rejected in a number of states in recent years, in part because many pro-life leaders fear ultimately they would backfire disastrously, even leading to a stronger U.S. Supreme Court decision upholding the right to choose than Roe v. Wade.

The efforts are frequently helped by confusion about the extent of the ramifications. In 2011 a proposed personhood amendment seemed headed for victory in Mississippi, with the support of gubernatorial candidates from both major parties. Just days before the vote, Gov. Haley Barbour expressed concerns. Ultimately 58 percent of voters rejected the measure.

Like Mississippi’s, North Dakota’s electorate is conservative and heavily religious; 40 percent of residents are Roman Catholic. Personhood legislation has been introduced in every legislative session in North Dakota since 2007. (State lawmakers convene every two years.)

Moderate conservative Republicans targeted

The first three times it was introduced, Republican lawmakers were among those who voted it down. Many of them were targeted in the 2012 elections by religious extremists who did not raise personhood on the campaign trail.

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Sarah Stoesz

“None of these issues were debated in the 2012 elections,” said Stoesz. “Once they took power in 2013 they began to do things that had never been discussed publicly before.”

As evidence, Stoesz noted that in June 2012, North Dakotans rejected a religious liberties proposition by 29 points. “Had they run on these issues they would not have been elected,” she said.

Nor is North Dakota the only place where moderate conservatives have been targeted by extremists who fail to disclose their entire political agenda, she said. “Wisconsin, South Dakota, Texas, Ohio — those are all examples of states now suffering conservative legislators who did not run on the agendas they are now advancing.”

In 2013, three separate personhood bills were introduced in North Dakota. The proposed constitutional amendment was the only one to pass both chambers. It will go directly on the 2014 general election ballot.

Two measures go into effect Aug. 1

Several other anti-abortion measures were introduced. One of the two that passed, a ban starting at the detection of a fetal heartbeat, which occurs about six weeks into pregnancy, will be the strictest in the country.

Another requiring doctors who perform the procedures to have hospital admitting privileges, sounds comparatively reasonable but will have the practical effect of preventing the three out-of-state doctors who travel to North Dakota from practicing in the state. This would shutter the lone clinic in Fargo and leave Great Plains residents from central Montana to Minneapolis without a provider.

Scheduled to go into effect Aug. 1, the laws will be the subjects of contentious legal battles that are expected to go on for years. The practical effect may be that millions of dollars will be raised and spent without a single abortion prevented, according to Planned Parenthood.

Medical disruptions predicted

A personhood amendment would also face an immediate legal challenge. As it played out, however, health-care delivery and scientific research and development would be severely disrupted.

Doctors fear they would not be able to treat women who experience miscarriages or complicated or ectopic pregnancies. Because embryos could not be frozen and providers could not dispose even of those with chromosomal defects that render them unviable, in-vitro fertilization would have to stop.

“We often see embryos that stop growing in the lab,” said Dahl. “Some do not fertilize normally. We do not keep those fertilized eggs we discard because they will not result in a live-born human.”

End-of-life issues would be affected, as would the viability of living wills and doctors’ ability to remove organs from donors on life support. A number of forms of birth control, including some pills, would become illegal.

The most extreme possibilities: Because a fertilized egg would become a person, legally, women who miscarry might be investigated to see if they caused the death. And because it’s impossible to know whether or when a woman’s eggs have become embryos, fertile women could be banned from taking certain drugs, including hormonal birth control pills.

Among the measures that did not pass the North Dakota statehouse were a bill that would have restricted doctors’ ability to use donor sperm and one that would ban birth control pills outright.

“It’s very aggressive,” said Dahl. “It’s eye-opening to me.”

The avalanche of anti-abortion activity sparked widespread consternation, added Stoesz. The North Dakota Medical Association advocated the bills’ defeat — the first time it has taken a public stance on abortion in its history.

Others who testified against the measures included a number of women’s health-care providers, the American Society for Reproductive Medicine, the Society for Assisted Reproductive Technology, the  American Medical Women’s Association and RESOLVE: The National Infertility Association.

Medical students say they’d probably leave state

In addition, a group of 26 medical students at the University of North Dakota testified that personhood would present such a barrier that they probably would not return to the state after their residencies.

“I acknowledge that North Dakota is a conservative state,” said Stoesz. “But that’s not the same as saying people want the state to interfere with medical decisions. … Which they are only doing in this particular realm which has to do with women’s health.”

In 2012 the Oklahoma Supreme Court struck down a personhood law. The U.S. Supreme Court let the decision stand. And there is reason to believe court challenges to the two abortion-restriction laws set to go into effect in North Dakota may be successful in the end.

“But we’re going to have to raise a lot of money and there is going to have to be a very careful, respectful conversation,” said Stoesz. “It’s unfortunate, given how many real human needs there are in the state.”

Human zygote sketch from the public domain via Wikimedia Commons.