Thursday, July 28, 2022

Can technology defeat restrictions on reproductive health care?

 It may seem odd to analogize abortion rights to gun rights, but they share a commonality: They are both rights that can be restricted only because they cannot easily be exercised without the cooperation of others. Without the physician or the gunsmith, both rights are difficult to safely exercise (well, guns rights are pretty much impossible to safely exercise, but that's a different discussion).

One solution for people seeking to evade gun control has been to reduce the number of people required to create a gun. Ghost guns are constructed by the end user from a variety of parts. This, while still requiring more than one person, significantly reduces the number of people involved.  The other solution, scarier because it is only moderately difficult now and will become trivial as 3D printing technology further matures to include a variety of new materials, is to simply print a gun. Current 3D printed guns tend to degrade quickly because of the temperatures and pressures involved with printing a weapon, but there are already million dollar metal printers capable of making a gun comparable in quality to a properly manufactured weapon. How long until that technology reaches commodity pricing?

Reducing the number of people involved in a medical procedure is a very difficult proposition. If something goes wrong printing a gun, you can scrap the print and start over. If something goes wrong during an automated medical procedure, somebody might die. What blueprint might we follow to limit the government's ability to even know about abortions being performed? The magic number, of course, is one. If only one person knows it is happening (the woman seeking reproductive care), the government need never know it happened. So how do we get there?

Let's start with Da Vinci surgical robots, such as those by Intuitive Surgical.  They are set up in a hospital for the patient. The doctor gets behind a control console and manipulates incredibly sensitive and capable tools, doing surgery with a precision beyond that of an unassisted human hand. But they still require a hospital and a full care team. Oh, and they're way beyond the purchasing ability of all but a few thousand Americans.

This doesn't mean that it is impossible to do, however. Artificial intelligence can already operate aircraft and motor vehicles with better safety than most humans; can already read x-rays and find things that the best radiologists miss; can, in short, do that which humans alone have previously been able to do.

Let's be clear. This is a terrible place to be. Trying to figure out a way to safely deliver health care to woman whose ovaries and uterus have become property of the Gilead states. As between a legal, safe abortion and any other abortion method, the other methods are a distant and dangerous second. But we know woman will get abortions, so we are no longer in a "it must be done safely" mode. We're in the abortion analogue of harm reduction mode.  We know these alternatives won't be fully safe, so the harm reduction question is "can we make them as safe as possible given that the alternatives are more dangerous?"

An obvious line to draw is this: Abortion saves more women's lives than it takes if the rate of death from abortions is lower than the rate of death from childbirth. There are other critical benefits of abortion -- namely self-determination for women -- and different people will attach different values to that, but some risk of death is often accepted if it is the cost of freedom. So while a net savings in lives as compared to carrying to term is an easy line to draw, greater risk levels may well be acceptable to many women.

It should come as no surprise that the "pro-life" states have the highest maternal death rates (likely because they are really "pro-birth" and "anti-autonomy for women" more than they are "pro-life"). California, with safe and legal reproductive care enshrined in law, has the country's lowest maternal death rate at 4 deaths per 100,000 births. It is more than eight times more risky to give birth in Texas, almost almost fifteen times as risky to give birth in Louisiana. 

But given that it has become amateur hour at the US Supreme Court and older, cis white men are hard at work making reproductive health care a thing of the past for women in red states, somebody has to explore the alternatives. Thanks to additive printing and related technologies, there are huge numbers of people with the skill set to build a kit designed to provide abortions. Would it be safe? Well, safer than the alternatives, but not actually safe. This is similar to 3D printed guns. They normally work, but they aren't nearly as effective or safe as properly manufactured guns.

Another option is for elderly retired (but still licensed) doctors to perform the procedures. This idea is inspired by the elderly volunteers who helped Japan recover from a tsunami-triggered nuclear disaster. Somebody needed to go in and basically get a nearly fatal dose of radiation, and hundreds of people without many years left volunteered -- a final act of selflessness.  So Doctor Freedom (why not call her Doctor Freedom?), a retired OB/GYN, comes out of retirement at 80 years old and begins to provide reproductive health care to women in Texas. She's already transferred the vast majority of her wealth to her heirs, so she isn't afraid of being sued civilly for performing the procedure. She knows that she is unlikely to survive long enough to go to trial and be convicted -- and that getting a conviction against a 80 year old on a charge that many Texans think is bullshit will be hard due to jury nullification. After all, it just takes one "not guilty" vote to hang a jury.

It is remarkable that we even need to discuss this. The United States shouldn't be on a par with Afghanistan on women's health care, but republicans are doing their best to get there.

1 comment:

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