The Pennsylvania General Assembly has been working overtime to insert itself into my exam rooms. As an obstetrician-gynecologist, I want to make clear that they are not welcome there.
On Monday, the Pa. House of Representatives approved legislation (HB 1890) that would require that the tissue resulting from miscarriages and abortions be treated the same as a dead body.
Of course, we don’t need a law to deal with fetal remains in Pennsylvania, because we already have one. As a practicing OBGYN in Pennsylvania, I follow that law, which states that any fetal remains from a pregnancy past 16 weeks must be disposed of by the medical examiner or a funeral home.
It is already a devastating conversation to have. Unfortunately, I have it often. While patients are giving consent for the procedure that will remove the tissue from a lost pregnancy, I am obligated to tell them that due to Pennsylvania state law, they must sign an additional consent form to relinquish the fetal remains.
This consent states that the fetal remains are given to our contracted funeral home, then cremated with other human remains and placed into group burial.
Patients are already allowed to hire and pay for a private burial if they prefer, but almost none of my patients choose to do so. Most aren’t in an emotional or financial place to make those arrangements. They choose to grapple with their loss in whatever way feels right to them.
House Bill 1890 will force that conversation onto countless more patients in my care.
Sometimes, a patient will learn of a pregnancy on the same day that an ultrasound will reveal that it’s over. Others will hear this news weeks after having seen the first outlines of their pregnancy on a grainy screen. This bill makes no distinctions between the two.
This bill would remove that 16-week gestational age minimum, expanding it to include zygotes, blastocysts, and embryos, beginning with fertilization.
Under this legislation, a miscarriage at six weeks would result in the tissue being buried. Perhaps even the chemical pregnancy at five weeks that never made it to discernible gestational sac would require burial. Same for an aborted pregnancy at seven weeks or an ectopic pregnancy at four weeks.
No moment is too early, because this bill changes the definition of when a “fetal death” can occur to the moment an egg is fertilized. This measure attempts to set a precedent about what is or is not a person — with potentially drastic consequences.
I can tell that legislators drafted this bill without any medical or scientific input, because fertilized eggs and embryos are undetectable until implantation. Fertilized eggs that fail to implant in the uterine lining are routinely expelled from the body during menstruation. Under this bill, if there was a way to identify those embryos within a period, they would be subject to the ritual disposal requirement.
In some states, pregnant people can already be jailed if they are deemed at fault for a miscarriage. If a fertilized egg before implantation is an “unborn child” with the need for burial, then health-care providers who take care of pregnant patients — and focus on caring for the pregnant person first — are at risk of becoming criminals. Patients seeking medical care for failed pregnancy are at risk of becoming criminals. This law is solely aimed at policing pregnant bodies and the health-care providers who respectfully care for them.
When I talk to patients about their pregnancy losses, they depend on me to provide compassionate, patient-centered care during an often difficult and confusing time. State legislators have no business inserting themselves and their personal, nonmedical views, into that delicate conversation.