Ethical Dimensions of Infant Abandonment Laws in a Post-Roe America
February 10, 2024Information
February 7, 2024
Program for Biomedical Ethics and Yale Pediatric Ethics Program:
Ethical Dimensions of Infant Abandonment Laws in a Post-Roe America
Lori Bruce, MA, MBE, HEC-C
Associate Director, Interdisciplinary Center for Bioethics, Yale University
Chair, Community Bioethics Forum, Yale School of Medicine
Affiliated Faculty, Solomon Center for Health Law and Policy, Yale Law School
ID11290
To CiteDCA Citation Guide
- 00:00OK, great. Hello and welcome
- 00:02to the Program for Biomedical
- 00:04Ethics evening seminar series.
- 00:05For those in Zoom, we're working
- 00:07on getting the video started,
- 00:09but in the meantime,
- 00:10you can all hear my voice.
- 00:12Just a quick introduction,
- 00:13I'm for those, I don't know,
- 00:15I'm Jennifer Miller.
- 00:15I'm the Co Director of the Program
- 00:17for Biomedical Ethics with Mark Mature
- 00:19and our wonderful leadership team and
- 00:21Associate Professor here in Internal
- 00:24Medicine and Biomedical Informatics.
- 00:25Tonight we have a fantastic speaker,
- 00:29our own Laurie Bruce.
- 00:31Laurie Bruce is the Associate
- 00:33Director and a bioethicist in the
- 00:36Interdisciplinary Center for Bioethics
- 00:38here at Yale and affiliated faculty
- 00:40at the Solomon Center for Health
- 00:42Law and Policy at Yale Law School.
- 00:44She's also an adjunct faculty member
- 00:47in the Bioethics Program at ICON
- 00:48School of Medicine at Mount Sinai,
- 00:50where she teaches courses on
- 00:53ethical policy making methods.
- 00:55Lori's also the founder of the
- 00:57Community Bioethics Forum here
- 00:59at Yale School of Medicine and
- 01:01on the leadership team at HOPE,
- 01:02a Psychedelic Ethics Institute at
- 01:04Oxford Center for Practical Ethics.
- 01:06She's a contributing editor for
- 01:08the Hastings Center Report and the
- 01:11Associate editor for Disability
- 01:13Inclusion and technology for
- 01:14the Journal of Human Technology
- 01:17Relations here at Yale.
- 01:18She also directs Yale Summer
- 01:20Institute in Bioethics.
- 01:21Serves on one of our IR BS and on both
- 01:26the Pediatric and Adult Ethics committees,
- 01:28the latter of which she chaired or
- 01:31she Co directed for three years.
- 01:34Her work has been published
- 01:35widely in journals including the
- 01:37Hastings Center Report,
- 01:38The American Journal of Bioethics
- 01:40and the Journal of Medical Ethics.
- 01:42And her scholarship has been
- 01:43covered by the popular media,
- 01:44some of which you might have heard,
- 01:46including the New York Times.
- 01:49Today, we have the great pleasure of
- 01:52hearing Lori Bruce talk about ethical
- 01:54dimensions of infant abandonment
- 01:55laws in a post row America.
- 01:58Thank you, Lori, and welcome.
- 02:08Hi everyone. Thanks so much for being here.
- 02:13Can you all hear me? OK, Great. OK.
- 02:17Thanks, Jen, for the warm welcome
- 02:20and I'm delighted to be here.
- 02:23So today we're going to talk about infant
- 02:26abandonment laws in post row America.
- 02:31I'll talk for about 45 minutes. Yeah.
- 02:33OK And then we'll open it up for some Q&A.
- 02:36Today we're going to discuss the
- 02:38ethical tensions related to infant
- 02:41abandonment within the United States.
- 02:43We'll talk about some recent trends,
- 02:45including the increasing,
- 02:47exponentially increasing numbers of
- 02:49infant abandonment baby boxes here in
- 02:52the US and we'll also touch upon some
- 02:55legislative improvements based on global
- 02:57best practices to increase the well-being
- 03:01and health of not only the infants,
- 03:04but the birth parents.
- 03:07So why are we talking about
- 03:10infant abandonment today?
- 03:11So I've examined these laws for many years
- 03:14and in our current political climate,
- 03:17we have this confluence of factors
- 03:19which leads to an increased
- 03:21need for these safety net laws.
- 03:23But this topic is also a good example of
- 03:25how policy making could benefit from a
- 03:28little bit more structure and process.
- 03:30And so we're going to use this topic
- 03:33as a bit of an example to kind of
- 03:35show how the fields of bioethics and
- 03:38policy analysis could merge together
- 03:40and help us to not only better
- 03:43serve stakeholders who are impacted
- 03:46by health law and health policy,
- 03:48but also to increase Community Trust
- 03:51in these kinds of dire topics.
- 03:54And so the methods I'll discuss
- 03:56today are easily applicable not
- 03:58just within public policy,
- 03:59but also within institutional
- 04:01policy settings such as IR, BS,
- 04:04hospital policy and other kinds
- 04:08of healthcare organizations.
- 04:11So parents are not permitted
- 04:14to abandon an infant,
- 04:16but some parents are unable to care for them,
- 04:19and so each state has a legal means
- 04:23of surrendering an unwanted infant.
- 04:26Texas was the first state to
- 04:28pass a safe haven law.
- 04:30That was back in 2000,
- 04:32and other states quickly followed
- 04:34within the next eight or nine years.
- 04:37And these laws always have
- 04:40strong bipartisan support.
- 04:41And since their passage,
- 04:454707 infants have been surrendered
- 04:49through these laws and another
- 04:541700 have been abandoned outside
- 04:56of the mechanisms of the law.
- 05:00And about 55% of those when found
- 05:04sadly had already passed away.
- 05:06And that's since 1999 two thousand.
- 05:10So our numbers are likely under
- 05:12reported because it's hard to track
- 05:15and because states aren't required
- 05:17to categorize or track them.
- 05:22So infant abandonment and neonioside
- 05:24have always been a part of
- 05:27society and getting this feedback.
- 05:33All right, let's Yeah,
- 05:35it's still coming. It's me.
- 05:42Are we OK now? OK, we're good.
- 05:45All right, so, so unwanted pregnancies
- 05:48happen to people of all religions,
- 05:51socio economic levels and races and
- 05:54at risk Parents face intolerable
- 05:57social or economic consequences
- 05:59to just for being pregnant or
- 06:03sometimes for having another child.
- 06:05And so that's why these laws were
- 06:08created and they offer a fast track
- 06:12adoption to a pre approved family
- 06:14that's been very heavily screened
- 06:17and it triggers the rapid cessation
- 06:19of the birth parents rights.
- 06:22Families want safe haven babies.
- 06:25This rapid cessation of the birth
- 06:29families rights create an environment
- 06:31such that the adoptive families feel
- 06:34that these babies are, you know,
- 06:36less risky or these adoptions are
- 06:38less risky or less complicated
- 06:40than a traditional adoption.
- 06:42But there are a lot of gotcha
- 06:44clauses in these laws.
- 06:45And so the surrendering parent,
- 06:47for instance,
- 06:48is not entitled often to legal immunity
- 06:51unless they follow the letter of the law.
- 06:54And some of the clauses,
- 06:56for instance,
- 06:56are that the infant can't suffer any harm.
- 07:00And that seems reasonable until
- 07:02we think about the conditions
- 07:05under which these births happen.
- 07:08And when a birthing parents is trying
- 07:11to hide A pregnancy or is unable to
- 07:14have that disclosed in their medical chart,
- 07:17they're not going to be giving
- 07:19birth in a hospital.
- 07:20It's going to be somewhere private
- 07:23where they have no assistance.
- 07:25And so it's really tricky to sometimes
- 07:29know what harm means in the law.
- 07:31And so a lot of families are
- 07:33scared away by these laws.
- 07:36And in certain states,
- 07:38such as Texas,
- 07:40even if someone follows the absolute
- 07:42letter of the law and transitions the
- 07:47baby in the specific location within
- 07:51the certain amount of within the
- 07:54specific time frame and all of the
- 07:56other components of that state's law,
- 08:00in places like Texas,
- 08:02there's still no guarantee
- 08:03of immunity from prosecution.
- 08:05So when these laws are closely examined,
- 08:09they're often called impulsive responses.
- 08:11They're called empirically doubtful
- 08:13of dubious efficacy and akin to a
- 08:17mere Band-Aid of on top of some
- 08:22policies that make things really
- 08:25difficult for families in this case.
- 08:27And so there's a good amount of
- 08:30literature on how to implement policies
- 08:32to reduce the numbers of unwanted
- 08:35births and unwanted pregnancies,
- 08:37literature that's not often read by the
- 08:40legislators who are writing safe haven laws.
- 08:43These laws are state based and
- 08:45many states only have a part time
- 08:48legislative window and these are
- 08:50short windows to design law which
- 08:52promote hastily written policies.
- 08:54Like here in Connecticut we have a very
- 08:56short window and when that legislative
- 08:58window opens people just have to try
- 09:00and pass something really quickly in
- 09:02the in the amount of time they have
- 09:05garnering support from stakeholders and
- 09:08not able to kind of have a very thoughtful,
- 09:11slow process.
- 09:11So, but what we do know is that
- 09:14there are all sorts of things that
- 09:17can reduce unwanted births including
- 09:20access to reproductive education,
- 09:22access to contraception and abortion
- 09:25and affordable prenatal support.
- 09:28But in many places in the US right now,
- 09:31the current conditions don't permit many,
- 09:35if any,
- 09:36of of these important policies.
- 09:39And in fact,
- 09:40more than 19,000,000 women here
- 09:42in the US of reproductive age
- 09:44are in need of publicly funded
- 09:46contraceptive contraception.
- 09:48But they're living in what's
- 09:50called a contraceptive desert.
- 09:54So another gotcha clause of safe
- 09:57haven laws relate to the tox screen.
- 10:00The public often believes that the
- 10:02surrendered child is going to go to
- 10:05one of the pre approved happy homes
- 10:06that often makes the appearance on TV.
- 10:08We've all seen these stories on
- 10:10the news and they're they're
- 10:12positioned as as really warm,
- 10:14happy kind of news stories, right.
- 10:17But they don't know that there's a
- 10:19whole process behind the scenes when
- 10:22a baby is potentially going to go
- 10:25down the safe haven policy track.
- 10:27And so if an infant has been
- 10:30presented as a safe haven baby but
- 10:32is positive for their talk screen,
- 10:35they are not eligible for
- 10:37safe haven in most states.
- 10:39Instead,
- 10:39they are moved into the foster care system,
- 10:42which has a very different approach.
- 10:45And often those those little ones are not
- 10:50getting assigned to their permanent home
- 10:52until right around the one year mark,
- 10:55which puts children,
- 10:56as we know,
- 10:57at risk for a lot of social
- 11:00and behavioral challenges.
- 11:01So we see disparities in placement.
- 11:04We're also seeing in this post Dobs world
- 11:09increases in unplanned and unwanted births.
- 11:12And we're also seeing the profile
- 11:14of the traditional parent who the
- 11:17parent who would more like be
- 11:19more likely to surrender a child
- 11:21is no longer an extreme outlier.
- 11:26And there's lots of data,
- 11:27that data that I could talk about today.
- 11:29But part of what I'll just kind of
- 11:31quickly go through is that there is
- 11:33the national Safe Haven hotline and
- 11:36there's been a very steep rise in
- 11:38the number of calls to this hotline.
- 11:40And that's a very strong predictor
- 11:42of the increased numbers of children
- 11:45who will be abandoned in 2000.
- 11:50In 2021, they had they were getting
- 11:53right around 500 calls a year and that
- 11:56was their pretty consistent number.
- 11:58But starting in 2022,
- 12:00those calls have doubled and they
- 12:02haven't and they've been consistently
- 12:04right around the 1000 mark per year.
- 12:07Also, we know that there are a number.
- 12:08There's a rise in the number
- 12:10of births in restricted states.
- 12:12Approximately 32,000 additional annual
- 12:16births are resulting from abortion bans.
- 12:20That number does seem high,
- 12:23but I I have seen it in a number
- 12:25of studies but it's still it still
- 12:27seems quite high to me.
- 12:29We also know that there's a rise
- 12:31in the number of rape related
- 12:33pregnancies in restricted states.
- 12:35Nearly 65,000 survivors of rape within
- 12:38the US could not get an abortion in
- 12:41their States and stops been passed.
- 12:46So if we assume that you know that we,
- 12:49we know that the rape related pregnancy
- 12:51rate is usually right around 5%.
- 12:53So that's about 3200 births and stabs
- 12:57just from sexual assaults alone.
- 13:02We're also seeing a rise in a new phenomenon,
- 13:04but in some European countries like Finland,
- 13:09there's this idea of a baby box.
- 13:12Every pregnant person receives a baby box,
- 13:15and it's a starter kit.
- 13:17It gives you infant essentials,
- 13:19It helps give all babies
- 13:21an equal start in life,
- 13:23and it helps to reduce infant
- 13:25mortality rates from sits.
- 13:26But baby boxes in the United
- 13:29States look different.
- 13:31Baby boxes here mean something
- 13:33different because there are now
- 13:35these privately funded baby boxes
- 13:36that are modern versions of the
- 13:39medieval abandonment wheels that are
- 13:40being installed in so many states
- 13:43that some say they're actually
- 13:45shaping a national infrastructure.
- 13:49They do not have any kind of testing
- 13:52protocol that has been approved by the FDA.
- 13:55It's just the testing that the
- 13:59designer is doing on their own.
- 14:01And there have already been 37
- 14:04survivor surrenders to these boxes.
- 14:06And here's what they look like.
- 14:09There are 186 of these boxes in the
- 14:13United States right now and just
- 14:15six months ago when I was giving
- 14:17another talk on this subject,
- 14:19there were 138.
- 14:20So it gives you a sense as to how they're,
- 14:23they're really exponentially
- 14:24growing right now.
- 14:26And then the local groups who are usually
- 14:31local churches that raise the funding
- 14:34through PIE sales and through local,
- 14:36local events, they,
- 14:38they raise the funds for these
- 14:41boxes and then they reach out to
- 14:43their legislators and they say,
- 14:44look, you know,
- 14:45we want safe haven laws to be
- 14:48updated to include these boxes.
- 14:50And indeed that's been happening.
- 14:53And I think it's,
- 14:55you know,
- 14:56part of the story here is that the
- 14:58groups that are pushing for that
- 15:00kind of a change to the law may
- 15:03not necessarily be representative
- 15:05of a state's constituents.
- 15:08So some of the states where these
- 15:10laws are being updated to permit
- 15:12these baby boxes include Arkansas
- 15:16and Pennsylvania and Virginia and
- 15:19Ohio and Indiana and and Louisiana.
- 15:23There are over 100 baby boxes for
- 15:27abandonment in Indiana alone.
- 15:30And to put it in perspective,
- 15:31there are 104 Dunkin' Donuts in Indiana.
- 15:35So they're just about as many places
- 15:37to surrender an infant as there
- 15:39are places to get a cup of Joe.
- 15:42And
- 15:44and and other states certainly don't
- 15:47have the numbers that Indiana does
- 15:51because Indiana is where the founder
- 15:54of these boxes resides and has worked
- 15:57with a number of church groups.
- 15:58But we are seeing numbers
- 16:00in many other states rise.
- 16:02There used to be a national calendar,
- 16:05but it's not up right now.
- 16:07So it's really interesting to learn about
- 16:12how these boxes have been rolled out.
- 16:15They're around 20,000 apiece,
- 16:18and so that totals around 3.7 million.
- 16:23Indiana plans to install more,
- 16:26having recently approved an additional
- 16:281,000,000 in baby box funds.
- 16:31But we also know that 19% of single
- 16:33moms in Indiana live in poverty.
- 16:36We know that many don't have access
- 16:39to birth control or abortion.
- 16:41We know that half of all pregnancies
- 16:44in Indiana are unwanted or unplanned,
- 16:47and there's no access to anonymous
- 16:50labor or delivery.
- 16:51And so these circumstances
- 16:53are perhaps not accidental,
- 16:55but the result of current laws and
- 16:57policies and reflective of parent
- 17:00circumstances across the country.
- 17:02Some suggest that these baby box funds
- 17:05could instead have financed accessible
- 17:07birth control or perhaps childcare,
- 17:09so that the parents could then
- 17:12keep the babies and seek employment
- 17:15and become self-sufficient.
- 17:17Some say that the scaled up use of
- 17:20baby boxes is a sign that people are
- 17:22increasingly placed into unwanted childbirth.
- 17:25And others are saying that perhaps
- 17:27there are an indicator of mistrust
- 17:30between communities and state sponsored
- 17:32services because perhaps due to bias
- 17:35or judgment people don't always feel
- 17:37safe at the other safe surrender sites
- 17:39like the fire station and hospitals.
- 17:43And so baby box policies are
- 17:47fast tracking these children to
- 17:50pre approved economically secure
- 17:52families while the birth parents
- 17:54rights are rapidly terminated.
- 17:57So some say that perhaps these
- 17:59baby boxes show that while we may
- 18:02care a lot about the babies,
- 18:04we might not be extending this care to the
- 18:07birth parents or to struggling families.
- 18:10The media is full of stories that
- 18:13celebrate the surrendering parents
- 18:15as being heroic or selfless.
- 18:17But the stories don't mention how the
- 18:20birth parent might be hemorrhaging
- 18:22or developing complications from
- 18:24having birthed alone without access
- 18:27to medical care or trauma counseling
- 18:30out of fear for being discovered.
- 18:33And so some of my community members,
- 18:38who have analyzed a number of different
- 18:41policies with me and provided community
- 18:43feedback on a number of health policies,
- 18:47have mentioned how these women are
- 18:49not just incubators to complete
- 18:51other people's families.
- 18:53And so we know that because
- 18:55of the rollback of Roe,
- 18:57economists anticipate 3040,
- 18:59some even as high as 50,000 additional
- 19:03unplanned or unwanted births annually.
- 19:06So this means that current U.S.
- 19:09policy is contributing to 10s
- 19:11of thousands of family families
- 19:14that are experiencing grief and
- 19:16anxiety and sometimes trauma.
- 19:22So it begs the question of who's
- 19:24worthy for these government resources,
- 19:27something that I talk about
- 19:28in a number of articles.
- 19:32And so when we consider the idea
- 19:35of an ethical policy making,
- 19:37we perhaps want to consider
- 19:40whose values matter,
- 19:41whose interests matter and what what
- 19:44values are guiding our policy design
- 19:47and whether or not our policy design
- 19:50is even actualizing our policies goals.
- 19:54And what are the goals of safe haven anyhow?
- 19:56And so you know, when we write
- 19:59institutional policy and public policy,
- 20:01we often talk to our colleagues who
- 20:03are in who are in similar positions,
- 20:05and then we replicate those policies.
- 20:07And sometimes that can work,
- 20:09but sometimes, like in this case,
- 20:11a copy and paste approach
- 20:13isn't benefiting those who are.
- 20:17Being impacted by the policy.
- 20:19And so in my bioethics work,
- 20:21I've increasingly leveraged my policy
- 20:23analysis background to kind of
- 20:25bring the world's of policy analysis
- 20:28and bioethics closer together.
- 20:29And so when I'm working with
- 20:32legislators or hospitals,
- 20:33I tend to use a logic model that
- 20:36helps us to step back and define
- 20:39and engage with our stakeholders
- 20:41and really consider what a policy's
- 20:43short and long term goals are.
- 20:45So the root of all policy analysis
- 20:48methods are to think about what
- 20:50does a policy do so that we can get
- 20:53something out of the policy right?
- 20:55So if I'm writing a policy to try to
- 20:58decrease children from using vaping pens,
- 21:00we would say OK,
- 21:02we want to create an age limit or
- 21:04create some kind of carrots and sticks
- 21:07to get the results that we want,
- 21:10which is less children vaping.
- 21:12So similarly here,
- 21:15in any kind of logic bottle,
- 21:16we want to not only think about
- 21:18the DO and the get,
- 21:19but I encourage us to also consider
- 21:24what values are the ones that should
- 21:27be shaping any specific policy,
- 21:29and therefore who ought we include
- 21:32to achieve those values.
- 21:34And these aren't usually explicit
- 21:37questions and institutional policy making.
- 21:39But I find that this method
- 21:42is often quite helpful.
- 21:44And we're not thinking about the
- 21:46values of any individual in the room,
- 21:49but we're thinking about what values
- 21:51should undergird any specific policy.
- 21:56So I find that a critical addendum
- 21:58to this work is to document the
- 22:01assumptions that are underlying
- 22:03any policy that you are developing.
- 22:05And even though it's those
- 22:07are fairly documented.
- 22:09And it might even seem a little
- 22:10silly to take the time and say
- 22:12what are what are we assuming when
- 22:14we're writing these policies?
- 22:16Documenting our assumptions
- 22:18helps us to examine whether our
- 22:20inherent beliefs are on track
- 22:25and so placing a value on
- 22:28collaboration and inclusion over time.
- 22:30I've engaged with multidisciplinary
- 22:32stakeholders across the US about these laws.
- 22:35I've spoken with many community members,
- 22:37including my Community Bioethics Forum,
- 22:40high school students including a
- 22:42wonderful bioethics class at the
- 22:44River School led by Julian Willard,
- 22:45and I'm also on a national task
- 22:47force that's writing best practice
- 22:49guidelines for these laws.
- 22:53And I've written a bunch of op eds
- 22:57across the US and most often choosing
- 22:59to co-author with other scholars and
- 23:02advocates specifically from those regions.
- 23:04Because even though this
- 23:06is a very global issue,
- 23:08it's also about dynamics at the micro level.
- 23:11It's about communities,
- 23:13and it requires small community
- 23:16discussions about shame,
- 23:17about desperation and about
- 23:19what meaningful help could
- 23:20really look like to people who
- 23:22are placed in this position.
- 23:26And so there are just a number of articles
- 23:29that we've issued in all over the US,
- 23:35which have prompted articles
- 23:37in Sweden and Australia and New
- 23:40Zealand and all over the place.
- 23:42And through this work,
- 23:43I've examined what a broad what a
- 23:45broader community would really want
- 23:47us to value in safe haven laws,
- 23:49and what folks really wish we
- 23:51would do through these laws.
- 23:53And so using an ethical
- 23:54policy making approach,
- 23:55we would also be encouraged to examine how
- 23:59others would approach infant abandonment.
- 24:02And so I've also conducted a
- 24:05global policy review and find that
- 24:07we could really gain value from
- 24:11examining what Austria has done,
- 24:13what Japan has done,
- 24:15and what France did before
- 24:18abortion was legal,
- 24:20because that echoes some of our
- 24:23current conditions in Austria.
- 24:25Their rate of neonatacides was the
- 24:27highest across all of Western Europe
- 24:29and they were really bothered by this.
- 24:31And so they spent a lot of time trying
- 24:34to figure out how to get the rate down.
- 24:36And they found that anonymous child,
- 24:40anonymous delivery and coupled with
- 24:45a marketing campaign to let everyone
- 24:48know about this option really
- 24:51helped to have their rate plummet.
- 24:54And then it became one of the
- 24:56lowest in all of Europe and in
- 24:58Japan and in France as well,
- 25:00they have offered confidential
- 25:02or anonymous labor and delivery,
- 25:04allowing someone to come to the
- 25:06hospital and not making them give
- 25:08their name and just saying that they
- 25:11need to have a delivery without
- 25:14disclosing any personal information.
- 25:16So we've found that that has been
- 25:21globally a very successful policy
- 25:23that the US has not really considered,
- 25:27at least at this point.
- 25:28And so when we examine all of the
- 25:31community responses that I've gotten
- 25:33from my op Eds and from my work
- 25:36across the US and with a number of
- 25:39different collaborative engagements,
- 25:41we found that hospitals don't always
- 25:44feel safe to many people in the
- 25:46US They've said, you know,
- 25:49everyone's designed these policies
- 25:51around the hospital being the
- 25:53main site of surrender.
- 25:55But many of us don't feel
- 25:57safe walking into an ER.
- 25:59It certainly doesn't feel anonymous
- 26:01to a lot of people when there are
- 26:04cameras and neighbors all around.
- 26:06And also for many people,
- 26:08they've said that even the act of
- 26:11walking through the ER doors seems
- 26:14to them to be a traumatic event.
- 26:17They've had loved ones pass away,
- 26:18or they faced bias,
- 26:20or they've had a whole host of
- 26:23experiences that to them don't
- 26:25create a feeling of safety.
- 26:26So policy makers and legislators always say,
- 26:30well, you know,
- 26:31of course everyone feels safe
- 26:32in the hospital,
- 26:32but that's actually not
- 26:34the case for many people.
- 26:36Others have said, you know,
- 26:37it's a safe haven for whom, right?
- 26:39Why are we only prioritizing
- 26:41the babies after they're born?
- 26:43Can't we also think about that
- 26:45developing fetus who needs to
- 26:47have prenatal care but can't get
- 26:49it because the woman has to give
- 26:52her name in order to receive
- 26:53services? So I can't go into all of the
- 26:58details, but another point that I think is
- 27:04perhaps especially relevant relates to
- 27:07how these laws make assumptions about
- 27:10the moral fitness of the people who
- 27:12are having to surrender their baby.
- 27:14Because a certain percentage of
- 27:16people in this position would indeed
- 27:18commit neonatacide if they did
- 27:20not have the option of safe haven.
- 27:22But that is a subset of all of these parents,
- 27:26especially under current
- 27:27political conditions.
- 27:29And so many community members
- 27:32have said to me,
- 27:33let's think about it more in terms
- 27:35of what's going on for someone as
- 27:37opposed to what's wrong with them.
- 27:39And I am borrowing the words
- 27:41of Uche Anani and Liz Lanfier,
- 27:44who have written some wonderful articles
- 27:47about how to integrate the idea of
- 27:50trauma informed principles that focus
- 27:53on collaboration and inclusivity and
- 27:56not only clinical ethics consultations,
- 27:58but also within the policy setting.
- 28:00So those are some of the
- 28:02things that we've learned.
- 28:06And we've also learned that parents
- 28:08have been denied safe haven.
- 28:10Sometimes clinicians don't want
- 28:12to encourage others to abandon
- 28:15their baby so they might hide the
- 28:17safe haven signs, for instance.
- 28:19And there are many stories
- 28:21we've heard about how
- 28:25the policies in practice aren't
- 28:27working the way they were anticipated.
- 28:31So community members, if,
- 28:35if we look at kind of summarizing
- 28:37their feedback, they said, yes,
- 28:39of course we need to be more collaborative.
- 28:41We need to be more inclusive in these laws.
- 28:43But we also of course need to
- 28:45think about what how we can really
- 28:49actualize more equitable care.
- 28:50And we need to also think about the
- 28:52safety and health of the birthing parent.
- 28:54We need to think about emotional and
- 28:57physical safety of the surrendering parent.
- 28:59And they, you know,
- 29:02working together with them.
- 29:04We've come up with some options,
- 29:05which not only include anonymous
- 29:07labor and delivery and prenatal care,
- 29:09but the idea of working with the
- 29:13911 system so that someone could.
- 29:15You know, it's it's hard for someone,
- 29:17especially if someone already
- 29:19has other children,
- 29:20it's hard for them to get to an ER
- 29:24knowing that they're going to have
- 29:26to meet with the nurse face to face.
- 29:28Neighbors might be all around.
- 29:30And so the idea of being able to call
- 29:33911 at any time that's convenient
- 29:36for someone and meet that person in
- 29:39a location that feels safe to them
- 29:41might be a way to really decrease
- 29:44the numbers of unsafe abandonments
- 29:46in this country.
- 29:47Another idea too is to think about
- 29:50the use of community Health Workers.
- 29:53These are people who share the
- 29:55same lived experience and cultural
- 29:57background as those they are serving.
- 29:59They are a wonderful third party
- 30:01that has had multiple success
- 30:04stories in this country.
- 30:05They were more traditionally used for
- 30:09just within the public health realm,
- 30:10but even here locally,
- 30:12we've started using more community health
- 30:15workers in a variety of ways and had
- 30:17have had really wonderful successes.
- 30:21And so the goals of this policy are not
- 30:25just to have less unsafe abandonments,
- 30:28but perhaps also to provide basic
- 30:30medical care for the birthing
- 30:32parent with a longer term goal of
- 30:35increased trust within medicine.
- 30:40And so those kinds of themes are
- 30:42echoed by a recent piece that
- 30:44Jen Herbst and I wrote about,
- 30:46which talks more generally about
- 30:48extending trauma informed principles
- 30:50to hospital system policy.
- 30:54And as mentioned,
- 30:56we have a strategic working group
- 31:00that has that consists of lots of
- 31:04folks working on the front lines of
- 31:09families and infants in crisis
- 31:11and people working in adoption
- 31:13law and in foster care systems.
- 31:15And they've been working hard to
- 31:19better ensure safety for these
- 31:21families and are now together.
- 31:24We're now proposing streamlined
- 31:26and more uniform legislation at
- 31:30the state level and perhaps even
- 31:31a a federal legislation that will
- 31:33help to resolve a lot of the
- 31:36inconsistencies we are seeing across
- 31:37the state when it comes to these laws.
- 31:41One of the one of the biggest
- 31:45sticky points with these laws
- 31:48relates to how individuals have to
- 31:50deliver outside of the hospital.
- 31:53And so one of the points that
- 31:55we're also pushing for is to be
- 31:57allowed to relinquish relinquish
- 31:59in the hospital right after birth.
- 32:02Some even when it was first
- 32:03rolled out here in Connecticut.
- 32:05The law has since been updated
- 32:07and was updated very quickly,
- 32:09which was a testament to how
- 32:10speedy things can be here.
- 32:12But initially,
- 32:13if a woman had given birth and
- 32:16needed to surrender that infant,
- 32:19they would have to wheel her around
- 32:21the hospital and bring her to the ER so
- 32:24that she would be eligible for the law.
- 32:26So we were glad to see that
- 32:30law quickly updated.
- 32:31And of course,
- 32:32good ethics relies on good data.
- 32:35And so another,
- 32:37the component that our task force is
- 32:41pushing for is to require tracking
- 32:44of numbers and to require some
- 32:46federal fund funding to help get
- 32:49those numbers reported and tracked
- 32:51so that we can get a better sense
- 32:54as to the conditions under which
- 32:57these abandonments are happening.
- 32:59We are starting to see changes.
- 33:02Legislators are beginning to question
- 33:04the design of safe haven laws as the
- 33:08numbers are rising across the nation.
- 33:11They're beginning to think about what
- 33:14location is safe to a surrendering parent.
- 33:19And I really find this to
- 33:21be a very local there,
- 33:24that there's a very local answer.
- 33:25What might be safe,
- 33:27what might feel safe to someone in
- 33:29Arkansas might be really different to what
- 33:32someone might feel safe here in New Haven.
- 33:35And they're all sorts of different people
- 33:37who feel safe in different places,
- 33:39right?
- 33:40So it really does require
- 33:43not just community feedback,
- 33:45but feedback from diverse communities
- 33:48in in places across the United States.
- 33:52Another factor about these laws
- 33:55relates to the surrender window.
- 33:57When they were first created,
- 33:59there was no window and so families
- 34:03across the US were actually going to
- 34:06the few states that had these laws.
- 34:12And the the states that had no
- 34:14limitation found that there were
- 34:16many older children with severe
- 34:18disabilities that were being surrendered,
- 34:21which points to another problem
- 34:23of course in our system. But
- 34:29I think
- 34:32another point that we might want to
- 34:34consider is just this way of kind of
- 34:38summarizing trauma informed care from
- 34:40the Islamfir and Uche Anani and thinking
- 34:43about how hospitals can really work
- 34:45with policy makers on finding ways to
- 34:48roll these policies out in a way that
- 34:50is more empathic and more inclusive.
- 34:57And so there are many policy analysis
- 34:59methods that can be really helpful
- 35:02not only for infant safe haven laws,
- 35:04but for a wide range of policies.
- 35:09We've we've used it a bit here when
- 35:12we were looking at ethical discharge
- 35:15policies and some other policy solutions
- 35:18here on the adult Ethics Committee.
- 35:21And today, I've just touched upon
- 35:22a couple of those, but I'm always
- 35:24happy to talk more about those.
- 35:26And so we know of course that we
- 35:28need to push for full spectrum
- 35:31reproductive care in this country.
- 35:33But in its absence,
- 35:35I think examining the effective laws
- 35:38in countries before they had access to
- 35:41abortion can be really helpful to us.
- 35:44Next steps include continuing to work
- 35:47with our strategic working group,
- 35:49pushing out more op Eds across the
- 35:53US to help shine a light on the
- 35:56dimensions of the baby boxes as well
- 35:58as the dimensions of the local laws,
- 36:01and working in partnership with legislators.
- 36:06So I whenever I give a talk on Safe Haven,
- 36:11I always put up our national
- 36:13the national hotline number.
- 36:15This is Heather Berner.
- 36:18She's the executive director of
- 36:19the National Safe Haven Alliance.
- 36:21She is the one who's running
- 36:23the national task force.
- 36:25And her organization has a specific focus
- 36:29on family preservation and providing
- 36:35all sorts of resources and connecting
- 36:37people to all sorts of resources and
- 36:40safe options that can be available
- 36:41to someone at the very end of their
- 36:44pregnancy or when they have a newborn. So
- 36:50in closing, of course I have to
- 36:53give a pitch for my summer program.
- 36:56In addition to other work I do,
- 36:58I direct our summer institute in
- 37:01bioethics and this year we will have
- 37:05a our foundations program which is an
- 37:08intro to bioethics which I typically
- 37:11squish into four really intense days.
- 37:13But we're finding that a number
- 37:16of folks want longer time with
- 37:19the curriculum at a slower pace.
- 37:21So this year we'll be offering
- 37:24foundations remotely again,
- 37:25but we're going to be offering
- 37:27it slowly over a two week period
- 37:30and you are all welcome to join.
- 37:33In addition to our foundations program,
- 37:36we will also be having six weeks of in
- 37:39person programming and it'll be near our bio,
- 37:43our bioethics center by Science
- 37:45Hill and it's a very global program.
- 37:48It's a very multidisciplinary program
- 37:51and it's it covers a lot of ground
- 37:54in a very short amount of time.
- 37:56So I'm always happy to talk to people
- 37:59about my bioethics programs and with
- 38:02that I will open things up to questions.
- 38:07And I'm supposed to to remind everyone
- 38:10if you need the CE number that I
- 38:12have displayed it here in Redfont
- 38:14for those of you who should not be
- 38:16forgetting to to write the number down.
- 38:21OK. Well, thanks everyone for your time.
- 38:31Thank you, Lori.
- 38:33That was an incredibly important rich,
- 38:35thought and action provoking talk.
- 38:39Very lucky to have heard it
- 38:41and to have you here at Yale.
- 38:43So we have about 50 minutes.
- 38:47Sorry, 50 minutes for Q&A.
- 38:50Would anyone like to jump
- 38:52in and ask a question?
- 38:54Great, Sarah.
- 39:03Thank you, Lori, for that incredible
- 39:06and really informative talk.
- 39:08I feel like I have so many questions
- 39:10but the one that I really had to stifle,
- 39:13not just blurting out in the middle of your
- 39:15talk because I was so shocked by it was
- 39:17why did you. Can you explain sort of some
- 39:20of the rationale for why infants with a
- 39:24positive tox screen who seem like would
- 39:25be the ones in most need of a stable
- 39:28home right away are somehow
- 39:32not allowed to be adopted and
- 39:34put into the foster system?
- 39:35Which again I'm sure as you know
- 39:38much better than I and probably
- 39:39most people in this room is
- 39:40is fraught with issues. It it just
- 39:44it boggles the mind that it's like
- 39:46your a system is sort of
- 39:49intentionally doubly disadvantaging
- 39:50these these for kids and and why
- 39:54is that and and
- 39:56I I don't know I'm I'm just trying to wrap
- 39:58my head around it and and I and I can't
- 40:01yeah yeah thank you for bringing that
- 40:03up and it is this double disadvantage
- 40:06and I I'm like how you frame that
- 40:10in truth it's very likely an unintended
- 40:14consequence There's never been
- 40:16an intention of any state to say.
- 40:21Here's a child who needs more support.
- 40:23Let's not give him to the best families.
- 40:27But what does happen is that families
- 40:32create these processes for parents
- 40:34to be eligible for safe haven.
- 40:38They are screened heavily.
- 40:39In some states there is.
- 40:44There are families who know
- 40:45that they're next on the list,
- 40:46and so they'll get the crib.
- 40:48They'll get all ready for their
- 40:51safe haven baby because they they
- 40:54know that they're next on the list.
- 40:57And yet what's happened is,
- 40:59you know, when you create policy,
- 41:01there are just a lot of unintended
- 41:04consequences sometimes.
- 41:05But I would also argue that that
- 41:07would make sense in the first
- 41:08year of a policy being around.
- 41:10But one something has been defined
- 41:12as an unintended consequence.
- 41:14It will no longer be an unintended
- 41:16consequence if we choose not to take action,
- 41:19to have some sort of path to resolution.
- 41:22I do know that some states have been
- 41:26considering whether there might be a change,
- 41:29and there's a lot of variation
- 41:31across the states.
- 41:32California has one of the most robust
- 41:35responses to safe haven babies and
- 41:38a lot of support for these families,
- 41:40a lot of counseling for everyone involved.
- 41:45And so there there are efforts to
- 41:48think about, starting to address,
- 41:49address it, but without public pressure.
- 41:51I'm not sure if many states are
- 41:55really actively doing much about it,
- 41:58but I really do view it as something
- 42:01that hadn't been intended,
- 42:02but indeed is occurring,
- 42:04Which is why I always find it
- 42:08so helpful to bring in community
- 42:11members and stakeholders who may
- 42:13not be traditionally involved.
- 42:15These laws are often written by reaching
- 42:20out to hospital lobbying associations,
- 42:24hospital leadership,
- 42:27leadership at the fire stations
- 42:29and the police departments,
- 42:31which is good,
- 42:32and all of those people should be
- 42:34heavily involved.
- 42:35I would argue we'd also want to think
- 42:38about folks who are really in the trenches,
- 42:40who might have a deeper sense as to
- 42:44what a family or pregnant person might
- 42:48need when they're really in that position.
- 42:51And then that would help to curtail
- 42:54things like this when it happens.
- 42:56Sure.
- 43:03Hi. I was hoping you could talk
- 43:05a little bit about the surrender
- 43:07windows. Like, what are the
- 43:09ethical considerations that hold
- 43:10us back from having that be,
- 43:11like multiple years? Or like,
- 43:13just what are people thinking about
- 43:14when you make it seven days or 30 days?
- 43:17Yeah, that's a that's a great question.
- 43:20So the question related to surrender
- 43:23windows and what do we consider when,
- 43:26when we're deciding what any state would
- 43:31decide on for their surrender window?
- 43:36State laws differ and they should
- 43:39differ because of many reasons,
- 43:42including geography, right.
- 43:44So certain states are going to
- 43:47have different kinds of challenges
- 43:49because they may face tsunami threats
- 43:52or tornado threats or hurricane
- 43:53threats and others may not, right.
- 43:55So, So there's always going to be a
- 43:56lot of variation across state law.
- 43:58And and in this case,
- 44:00we see that certain states like
- 44:03Alaska would need a longer window
- 44:06because of geographic constraints.
- 44:09So that's one factor when
- 44:12considering the optimal window.
- 44:14What lots of people talk about with
- 44:17respect to infant abandonment is
- 44:19this critical 24 hour window and the
- 44:23the greatest threat to any baby is
- 44:27within the 1st 24 hours of their life.
- 44:31That is when they are most at
- 44:33risk for neonatacide.
- 44:34If you can get the baby past
- 44:36that first 24 hour window,
- 44:38the rate of likelihood of them being a
- 44:42victim of of infanticide dramatically drops.
- 44:46So that's another factor that
- 44:48people think about and they say,
- 44:50OK, well,
- 44:51maybe it really shouldn't be that
- 44:53much longer past that one day.
- 44:55But it's really hard for people
- 44:59to know about their state's laws.
- 45:02And lots of people here in Connecticut say,
- 45:05of course,
- 45:06you just bring the baby to the fire station.
- 45:08It's actually impermissible to drop a
- 45:10baby off in Connecticut at a fire station.
- 45:13And so then that family would be would be
- 45:18susceptible to being prosecuted in New York.
- 45:21I think it's fine to drop
- 45:22off at a fire station,
- 45:23but here there's a good reason
- 45:26for that in that fire stations
- 45:30aren't always staffed 24/7.
- 45:31And so the idea here was to
- 45:34create a simple policy that
- 45:36everybody could remember and keep
- 45:38it as simple as possible.
- 45:40However,
- 45:40sometimes a simple policy
- 45:42isn't the one that's going to
- 45:46really work or or or be amenable to a
- 45:50range of people who are actually going
- 45:52to be impacted by it. And so there.
- 45:55So they're just a number of factors
- 45:57that can go into that number.
- 45:59But most states are,
- 46:03many states are at 48 hours,
- 46:05some are at 72, some are at two weeks,
- 46:07very few are at around 30 days.
- 46:10And I think the idea really is
- 46:12to allow someone to have enough
- 46:14time to kind of gather their wits.
- 46:16I mean, especially if you're giving birth
- 46:20and in your apartment without any help,
- 46:23it's going to be really hard within
- 46:2748 or 72 hours to to be able to know
- 46:30what to do and and how how to approach
- 46:33that and how to get yourself to an ER.
- 46:36Which is why I think the EMT or the
- 46:39community health worker who could
- 46:41actually meet someone wherever
- 46:42they are physically located and
- 46:44come to their apartment,
- 46:46could really be very helpful regardless
- 46:48of whatever that window of time might be.
- 46:58Thanks, Lori. I I wonder if you could
- 47:01unpack the experience of the baby boxes.
- 47:04I mean it it seems like A at least
- 47:07a reasonable component of a system.
- 47:09Do you have a can you tell us a
- 47:11little more about are they working
- 47:13or do they tend to work even in
- 47:16places where they where we might not
- 47:19think that they would work so well?
- 47:20What's happening in Indiana
- 47:23with all those baby boxes?
- 47:26Are they or they're being utilized
- 47:28or are families feeling well served?
- 47:31What can you tell us?
- 47:33I I know it's probably impossible
- 47:35to get that kind of follow up data,
- 47:37but I'm just wondering what
- 47:38what you can tell us.
- 47:40Yeah,
- 47:40it's it's a great question, Jack.
- 47:43So the the woman who has single handedly
- 47:49LED this initiative of baby boxes
- 47:53was abandoned herself at birth and
- 47:57she many years later was on vacation
- 48:01in Africa and she saw a foundling
- 48:05wheel and she said what is this?
- 48:07And she learned how unwanted
- 48:10infants can be abandoned.
- 48:12And she thought that that sounded like
- 48:16a really viable solution to something
- 48:21that she had always considered to be
- 48:24really pivotal to her life story.
- 48:27And she's from Indiana.
- 48:29And so she went back and she started
- 48:32creating them herself with her husband.
- 48:34And so it's the two of them
- 48:36that build these boxes.
- 48:37And
- 48:41in in any policy, you want to think about
- 48:45what is the do and what is the get,
- 48:47You know what what what are the
- 48:48what are the goals of the policy.
- 48:50And if the goal of a policy is purely
- 48:54to reduce the numbers of unsafely
- 48:57abandoned babies in our current climate,
- 49:01where there is distrust in the
- 49:03medical system and people don't feel
- 49:05safe at the other surrender sites,
- 49:08that can indeed fulfill the mission of
- 49:11a policy that's seeking to reduce the
- 49:14numbers of unsafely abandoned infants.
- 49:16And so these boxes have been used.
- 49:20The FDA has declined to consider
- 49:23them a medical device.
- 49:25And so while they are tested,
- 49:30they are tested by someone who's
- 49:32not an engineer,
- 49:33who saw a box in Africa and and decided
- 49:39to create a more modern version of it.
- 49:42They are installed.
- 49:43They are supposed to be installed only
- 49:46in places where there's 24/7 support.
- 49:49They've been criticized for perhaps
- 49:53not having tougher language that
- 49:57requires essential staff to be
- 50:00very on top of regular checks.
- 50:04They are intended to be
- 50:08temperature controlled.
- 50:09Many people are worried that an alarm
- 50:12might not go off because someone
- 50:14might not find an infant in time,
- 50:16especially because while there is testing,
- 50:21it isn't according to any sort of testing
- 50:26standard that's ever been developed.
- 50:29And so
- 50:32every time an infant is
- 50:34abandoned in one of these boxes,
- 50:37the local news rushes over and they
- 50:40interview the family who is now deemed
- 50:43complete by their by their new baby.
- 50:47And so those news stories always
- 50:50are very quick to lift up and
- 50:54praise the surrendering parent.
- 50:57But that's the only mention of that parent.
- 51:01And I worry a lot about the numbers and the,
- 51:08you know, in five years and 10 years,
- 51:11how many families are going to have
- 51:14this as part of their legacy and
- 51:18what's happening to these birthing
- 51:21parents who have no medical care?
- 51:25And so I wouldn't.
- 51:27And we know that you know that
- 51:30$3.72 million has been invested in
- 51:34the creation of these baby boxes.
- 51:38And I wonder if any of those funds
- 51:42could also That generosity could
- 51:44also perhaps start to extend also
- 51:47to somebody who might be really
- 51:51needing medical care and having it
- 51:54in an anonymous or confidential way.
- 52:01Thank you for a really important talk.
- 52:04I guess what I'm wondering about
- 52:07is when a facility agrees to have
- 52:09a baby box are they not under the
- 52:13same regulations like American with
- 52:15Disabilities Act right about how we
- 52:18access buildings is very regulated and
- 52:20so are there are there no existing
- 52:22laws I I use that one for example
- 52:25that are applicable to this box that's
- 52:27attached to the side of a building Is
- 52:30is there a way to ensure greater safety
- 52:34for for the babies through other
- 52:37policies that already exist.
- 52:39the ADA was the one I
- 52:40thought of right away. Yeah.
- 52:42Through through other mechanisms.
- 52:44That's a great idea.
- 52:46I I know that there are legislators
- 52:50who have refused the installation
- 52:52of baby boxes in their town or
- 52:56in their state because they
- 52:58are exactly worried about
- 53:02these boxes not falling under
- 53:05any other kind of regulations.
- 53:07They're a very unique contraption and
- 53:11there's a lot of concern about what could
- 53:17potentially happen and and so other
- 53:22states are really excited about them.
- 53:25I've I've met with some legislators from
- 53:29Texas who I think excited is the wrong word,
- 53:31but maybe relieved by them as an option.
- 53:34And you know there there are,
- 53:37there's been a rash of younger women in
- 53:41certain Texas communities that have sadly
- 53:45been giving birth and don't know what to do.
- 53:48And when they know that there's a baby box,
- 53:51it does give them relief.
- 53:53It does give them a way out.
- 53:55It does give them an Ave.
- 53:57that in especially in Texas they don't have.
- 54:01But again I'm I'm worried for their safety.
- 54:04And so there there does it's it's
- 54:09the the regulations are all at
- 54:11the state level in this case.
- 54:13And I know some legislators in different
- 54:16states are trying to work together
- 54:19to think about how can we really
- 54:23put some protections around them.
- 54:26Yeah.
- 54:28So I've been told we have a lot of
- 54:30Zoom participants, at least 24.
- 54:32I think this is the best attended
- 54:35talk we've had all year, Lori.
- 54:37So anyone who's on Zoom who'd like
- 54:39to ask a question or raise a comment,
- 54:42please feel free to put it in the chat.
- 54:44And in the meantime,
- 54:46we have a comment right there
- 54:49in the Q&A. Let's
- 54:53see, looking there's nothing there.
- 54:55There's it's not a question chat. Oh no. OK,
- 55:01Laurie, thanks for a great talk.
- 55:05I found it very troubling because of the
- 55:10ample evidence of decreasing societal
- 55:15care there. There's simply more examples
- 55:20of of what seems to be a spiral of
- 55:23decreasing care in our society and as
- 55:25a doctor even some of the statistics
- 55:27you gave are are shocking to me.
- 55:29The image of the baby box I can't get
- 55:32out of my head as it looks like an
- 55:34after hours bank deposit receptacle.
- 55:38However, the psychology is brilliant because
- 55:40it seems to subtract the element of shame,
- 55:43which I'm sure was part of the design,
- 55:46and I wonder whether the placement
- 55:48of these boxes is carefully
- 55:50constructed to avoid passers by.
- 55:53I would imagine that they are I I'm
- 55:58also curious about the safety aspects
- 56:00and wonder whether there is an alarm
- 56:03that is tripped and a volunteer
- 56:06comes to take the baby immediately.
- 56:10However, the concept of an anonymous
- 56:12birth is mind bending to me only
- 56:15because of its simplicity and because
- 56:19I would imagine that statistically
- 56:21there are a higher percentage of high
- 56:25risk births associated with many of
- 56:29these children that are given up.
- 56:34I have to say that in addition to
- 56:37some of the elements that you brought
- 56:39up about
- 56:42the
- 56:46associations of lack of safety,
- 56:49walking through an ER door and so on,
- 56:52it seems to me the biggest obstacle
- 56:54is our pair system. I cannot imagine
- 57:00an anonymous birth system that
- 57:04functions in a society which
- 57:06demands proof of identification and
- 57:09insurance almost immediately upon
- 57:12receiving care in an emergency room,
- 57:14and I wonder whether you can comment on that.
- 57:18I I think this is yet another example of
- 57:22how our lack of a universal healthcare
- 57:26option does create so much complexity
- 57:30and poorer health for everyone involved.
- 57:34I have spoken with legislators about the
- 57:38idea of anonymous or confidential birth
- 57:46funding is is always a problem. And
- 57:53some legislators that I've spoken
- 57:55with said that it would actually
- 57:58be a horrible idea 'cause it could
- 58:01potentially encourage women to use
- 58:03safe haven so that they wouldn't have
- 58:06to pay for their labor and delivery,
- 58:09which I can't imagine happening.
- 58:13But it gives us a little bit of insight,
- 58:16not into all legislators,
- 58:18but into many of the there's
- 58:21a lot of conflation.
- 58:22There's a lot of assumptions
- 58:25about certain outliers of women
- 58:29who may indeed feel they have no
- 58:33other option except for something
- 58:35that considers absolutely morally
- 58:37reprehensible to the rest of us.
- 58:40And and yet that might be considered
- 58:46to be kind of like the average
- 58:48safe haven parent, right. And so.
- 58:50So there's there's a lot to unpack there.
- 58:53And you had also talked about
- 58:57decreased shame with the boxes
- 59:01I and and just the idea of
- 59:03anonymity. The boxes are are
- 59:08are installed to avoid local
- 59:10video cameras as much as possible.
- 59:12They are often around a corner so that
- 59:17someone can pull up out of sight.
- 59:21There are alarms on the boxes.
- 59:24There's there's supposed to be
- 59:25one alarm that goes off when it's
- 59:28opened and another when it's closed.
- 59:31And they're also only supposed to be
- 59:34in areas where there's 24/7 support and
- 59:36there are video cameras on it as well.
- 59:40But there's there's a lot of unknowns.
- 59:42You know, there are baby boxes in
- 59:46very hot areas of our country where
- 59:48we worry about the AC working.
- 59:50Indiana gets cold in the winter.
- 59:53You know, there's there's all sorts
- 59:55of things that could potentially
- 59:56happen in these cases that make
- 59:58a lot of people in the space.
- 01:00:00Really worried for the outcomes.
- 01:00:04Thanks for your reflections
- 01:00:09Lori. Thank you for wonderful talk.
- 01:00:11I have a question that's ultimate
- 01:00:14ultimately about the values informed model,
- 01:00:16but I'll I'll set it up by telling
- 01:00:20a caricature like story free Dobbs.
- 01:00:23Safe haven laws are a right wing
- 01:00:27pro-life thing and they're being
- 01:00:29pushed as a way to prevent abortions.
- 01:00:32There as a there a thing that you can
- 01:00:34say to women who are facing unwanted
- 01:00:37pregnancies saying we can you can
- 01:00:39avoid having abortion if you can
- 01:00:40only carry your pregnancy to term.
- 01:00:42You can rid yourself of the need to
- 01:00:44care for the child in this immediate
- 01:00:47safe haven facilitated kind of way.
- 01:00:49Post OPS, a whole bunch of lefties
- 01:00:53join the bandwagon for safe haven
- 01:00:56laws because they're very concerned
- 01:00:58about the trauma of having to have
- 01:01:01a child that you didn't want to
- 01:01:02have and about the health condition
- 01:01:04of the mom and of the family.
- 01:01:06OK, so now you're in the state legislature
- 01:01:09of Illinois and you want to do a values
- 01:01:14informed model of a good safe haven law,
- 01:01:17but the values people are
- 01:01:18bringing to the table are really,
- 01:01:20really different.
- 01:01:22So who, whose values do you use?
- 01:01:25And, you know,
- 01:01:26you talk about the value of inclusivity,
- 01:01:27but we've got people here who who
- 01:01:30are imagining these laws as having
- 01:01:33really different kinds of functions,
- 01:01:35completely agree.
- 01:01:39So safe haven laws have always had
- 01:01:42very strong bipartisan support,
- 01:01:44partly because they don't deserve,
- 01:01:46they don't require any funding and
- 01:01:49because everybody wants to save babies.
- 01:01:54But, you know, it is absolutely
- 01:01:57true that, you know, Amy Coney,
- 01:01:59Barrett and others who have been speaking
- 01:02:01about this have been saying, well,
- 01:02:03wouldn't this be a solution to abortion?
- 01:02:06We don't need abortion if
- 01:02:09birthing parents can just wait a
- 01:02:12couple months and then just stick
- 01:02:14it in a box and then check and then
- 01:02:17you can go make your bank deposit,
- 01:02:19as Ron was alluding to. Right.
- 01:02:22So yeah, so there's there's complexity here.
- 01:02:26And you know what?
- 01:02:28When I talk about my values
- 01:02:31informed logic model,
- 01:02:33when I talk about inclusivity,
- 01:02:35what I mean is to ensure that
- 01:02:39we're including all stakeholders.
- 01:02:41So we're not just including the the
- 01:02:44louder squeaky wheels of any policy,
- 01:02:46but to really think about
- 01:02:49who's being impacted by these
- 01:02:51policies and speak with them.
- 01:02:55I have received pushback in a
- 01:02:56number of states when I say,
- 01:02:58well, let's let's reach out to
- 01:02:59the local Rape Crisis centers.
- 01:03:01I did Rape Crisis counseling for many
- 01:03:04years before going into bioethics and
- 01:03:08and that really helps me to see a lot
- 01:03:11of the holes in the medical system.
- 01:03:14But so you know but and so when I
- 01:03:17suggest things like let's work with
- 01:03:19our local local Rape Crisis center,
- 01:03:21let's reach out to women who and
- 01:03:24families who might be really in this
- 01:03:27precarious position and need to do that.
- 01:03:30And I think it's just sometimes
- 01:03:32kind of a a foreign concept to a
- 01:03:34lot of folks who are really trying
- 01:03:36to push through policy fast.
- 01:03:38And so the idea is probably not to
- 01:03:43have legislators and policymakers
- 01:03:45cave too much to the the Laurie
- 01:03:49Bruce model doing things,
- 01:03:50the Laurie Bruce, you know, ideal world.
- 01:03:53But but to think about how policymakers
- 01:03:56work and how legislation works.
- 01:03:59And I I talk to my students a lot in my,
- 01:04:03in the courses that I teach on ethical
- 01:04:05policy making about Kingden's three streams.
- 01:04:08And Kingden is this policy analyst who says,
- 01:04:12you know,
- 01:04:12you can't just create policy when
- 01:04:14you want to create policy.
- 01:04:15You can be the smartest person
- 01:04:16and have all of the answers,
- 01:04:17but it's not necessarily going to happen.
- 01:04:19In order to create policy,
- 01:04:21you have to wait for the policy
- 01:04:23window to open.
- 01:04:24And in order for the policy window to open,
- 01:04:26three things have to occur.
- 01:04:29You have to have problem and that means
- 01:04:33society or and the general public has
- 01:04:36decided that there is a real problem,
- 01:04:38you have to have a solution and
- 01:04:41then you have to have momentum.
- 01:04:43So there needs to be enough people
- 01:04:45interested in an issue and then
- 01:04:48you need to be able to be prepared.
- 01:04:51And he's Kingdom is this kind of,
- 01:04:54you know,
- 01:04:54very
- 01:04:57academic kind of guy.
- 01:04:58But he talks about surfing.
- 01:04:59If you can imagine this distinguished
- 01:05:01professor talking about surfing.
- 01:05:03But you have to have,
- 01:05:05you have to be ready for the moment,
- 01:05:06just like a surfer is
- 01:05:08ready for the next wave.
- 01:05:09And so that means that you know,
- 01:05:11as much as there is this Laurie
- 01:05:13Bruce model of defining values
- 01:05:15and working with local people.
- 01:05:16You have to be very organized
- 01:05:18and you have to have all of your
- 01:05:21people in a in yours and your
- 01:05:23stakeholders ready and organized
- 01:05:25So that when you so that we would
- 01:05:27have a solution to propose when it
- 01:05:30finally became important enough
- 01:05:32to everybody in the nation or
- 01:05:35whatever area you're talking in.
- 01:05:37And so I have been working and
- 01:05:39studying these laws for many,
- 01:05:40many years and now the policy
- 01:05:42window is actually starting to open.
- 01:05:43And so we have all of these
- 01:05:46multidisciplinary stakeholders and
- 01:05:47we have all of this feedback from
- 01:05:49all of these op eds across the US.
- 01:05:51And so really that I think is the
- 01:05:55way of getting back to this really
- 01:05:57integral question that I'm always
- 01:05:59hammering with my students as well
- 01:06:01as in terms of whose values matter,
- 01:06:03whose ethics matter.
- 01:06:04So that's my long winded way of
- 01:06:07talking about how we really need to.
- 01:06:10We as bioethicists and anyone
- 01:06:12who wants to be influential in
- 01:06:16the policy making arena,
- 01:06:17needs to understand how policy makers
- 01:06:20work and how we can serve them.
- 01:06:22You know,
- 01:06:23they're not going to want to
- 01:06:24read my Hastings Center report.
- 01:06:25They're going to want a bulleted
- 01:06:27list of items.
- 01:06:27They're going to want to text
- 01:06:29me whenever and say, hey Lori,
- 01:06:31I need you to give me this.
- 01:06:32And you have to be responsive and you
- 01:06:34have to build those relationships
- 01:06:36with your local legislators.
- 01:06:37And that's something that I talk
- 01:06:39about with my students a lot
- 01:06:40in terms of you know,
- 01:06:41how does policy making work so that
- 01:06:44we can learn to be receptive and
- 01:06:47available and helpful within the
- 01:06:49their their time limitations and
- 01:06:51their and their other limitations.
- 01:06:59So we've heard a lot about policy
- 01:07:02making and kind of the higher
- 01:07:05levels of this whole process.
- 01:07:07I was kind of wondering from a
- 01:07:10more pragmatic EMS perspective,
- 01:07:12is there any thought to develop
- 01:07:16a policy how first responders,
- 01:07:19especially on ambulances,
- 01:07:21are supposed to handle situations
- 01:07:23when they find out that birthing
- 01:07:27parents are intending to abandon them?
- 01:07:30How that would work in terms
- 01:07:32of duty of care towards the
- 01:07:35birthing parent and the baby?
- 01:07:37Or if that should be at that
- 01:07:40point separated one's intend
- 01:07:42to surrender the the child,
- 01:07:46or if it would influence
- 01:07:50the legal obligations if intention
- 01:07:53to abandon or surrender has been
- 01:07:56established before the birth.
- 01:08:00That last part when you were talking about
- 01:08:03legal aspects of surrender? What basically
- 01:08:07if if legally speaking something,
- 01:08:10if there's a different legal process in
- 01:08:13terms of responsibility and duty of care,
- 01:08:16if it has been established before the baby
- 01:08:19is born that the birthing parents intends
- 01:08:22to surrender the baby once it is born.
- 01:08:26Sure. Kind of wondering what is the the
- 01:08:30legal reasoning or is there any thought
- 01:08:33given to how that would work? Sure,
- 01:08:37some people while pregnant
- 01:08:43do learn about safe haven.
- 01:08:48Many don't. But some are organized
- 01:08:51and learn about the safe haven
- 01:08:54laws and intend to safe haven
- 01:08:58their baby. And in those cases
- 01:09:05the baby may not be safe haven because
- 01:09:08of all of the letters of the law,
- 01:09:10all the details of the law including
- 01:09:12that talk screen that we talked
- 01:09:15about and and the harm clause.
- 01:09:17But even if a parent does
- 01:09:21decide or intends to surrender,
- 01:09:24they don't have to surrender until a
- 01:09:29certain window within each state's law.
- 01:09:34And from an EMS perspective,
- 01:09:37I think you know the the the,
- 01:09:40the core of any EMS call is to stabilize
- 01:09:45and to build trust and rapport.
- 01:09:48And so we would not only want to do
- 01:09:52our best to ensure that infant who
- 01:09:55may possibly have been delivered
- 01:09:57in an apartment building or in a
- 01:10:00public restroom sometimes is getting
- 01:10:02all of the medical care they need,
- 01:10:04but to also try to build a little
- 01:10:07bit of rapport with the person
- 01:10:10who just went through labor and
- 01:10:14try to see what kinds of medical
- 01:10:17care they'd be up for receiving.
- 01:10:20But doing that really grounded
- 01:10:24in honesty and transparency,
- 01:10:27because these are often folks who cannot
- 01:10:31have that on their medical record and
- 01:10:35open notes is great until it's not.
- 01:10:39And this is the kind of
- 01:10:44notes in a chart that could put
- 01:10:46someone at a great deal of risk if,
- 01:10:49for instance, their partner or
- 01:10:52spouse didn't know of the pregnancy.
- 01:10:55That happens sometimes.
- 01:10:57Or, you know, all sorts of
- 01:11:00reasons why people often may
- 01:11:02need to hide their pregnancy.
- 01:11:04So I would say that the duty of
- 01:11:07the EMS responder would be to
- 01:11:10really understand what the laws
- 01:11:13are in their state with respect to
- 01:11:17surrender to focus on stabilization
- 01:11:20for the infant And to be absolutely
- 01:11:25honest when it comes to telling
- 01:11:29that birthing parent what how,
- 01:11:33which services could potentially be
- 01:11:35offered within the realm of their
- 01:11:38comfort based upon confidentiality clauses
- 01:11:41at any given hospital or institution.
- 01:11:44Do any of our students have questions,
- 01:11:47We've heard more from the the
- 01:11:50faculty and we have handed.
- 01:11:52Great.
- 01:11:55Hi, thank you for your talk today.
- 01:11:57I just had a quick question.
- 01:11:59You mentioned earlier that one of the
- 01:12:01biggest backlashes that you've gotten
- 01:12:03from legislators was on the financial
- 01:12:05side of like you know where is the
- 01:12:07money gonna come from And $3.72 million
- 01:12:10is like a very impressive figure to
- 01:12:13like for like this entire project.
- 01:12:15But obviously when you're trying to serve a
- 01:12:18population of 165,000,000 women in America,
- 01:12:20there's going to even if like
- 01:12:220.01% of them are going to need the
- 01:12:24services within the 10 year window.
- 01:12:26You're it's not enough capital.
- 01:12:28It's especially considering like
- 01:12:29everything from like medical services
- 01:12:31to you know like actually like
- 01:12:35implementing these baby boxes and
- 01:12:36also like you know taking care of them
- 01:12:38for however long that they may need.
- 01:12:40So where like obviously like there's
- 01:12:43like two different kinds of like
- 01:12:45capital that you could raise one from
- 01:12:46the government and other from private
- 01:12:48equity or like non profit investors.
- 01:12:49And I was wondering like what is
- 01:12:52the current outlook on like the
- 01:12:54solutions in terms of like how you're
- 01:12:56how this organization,
- 01:12:57how this task force that you are leading
- 01:12:59with like a bunch of other influential
- 01:13:02people is planning to address that.
- 01:13:05Yeah, dismally
- 01:13:09it's pretty and in terms of any we
- 01:13:13will the the argument for funding for
- 01:13:18gathering statistics is likely, but it's
- 01:13:26very unlikely that we would have funding
- 01:13:32for anonymous childbirth labor and delivery.
- 01:13:37However, with that said,
- 01:13:39this is going back to the Kingdom
- 01:13:42model and and and momentum.
- 01:13:44There is a feeling by legislators on
- 01:13:49both sides of the aisle that we really
- 01:13:53need to do something because they're
- 01:13:55all of these stories right now of of
- 01:13:59pregnant people who are undergoing
- 01:14:01a lot of trauma and legislators
- 01:14:04are being pushed to do something.
- 01:14:06And so if there were ever a time when
- 01:14:10we could borrow a policy from Austria
- 01:14:13or Japan or post abortion France,
- 01:14:16this would be the time because
- 01:14:19legislators are really being pushed,
- 01:14:21you know, they're being squeezed.
- 01:14:23So I would say that I'm hopeful in
- 01:14:27the first round with the task force.
- 01:14:30I don't think it's going to make the cut,
- 01:14:32but I personally have been lobbying
- 01:14:34for it hard.
- 01:14:36And we can also talk about the
- 01:14:38costs of not implementing it.
- 01:14:40Sometimes,
- 01:14:40if you can help lay it out to legislators,
- 01:14:45the costs of not having
- 01:14:48such a policy offered
- 01:14:53and the impact to the child and the mother,
- 01:14:55because it's better for the child too.
- 01:14:58And so if we, if we really
- 01:14:59do care about these infants,
- 01:15:01we should care about them as they're being
- 01:15:04born instead of just after they're born.
- 01:15:07And it's we, we know it's much
- 01:15:10safer to give birth in a hospital.
- 01:15:13So it's not just about the woman,
- 01:15:15it's also about that baby.
- 01:15:17And when these laws are passed, you know,
- 01:15:22it takes work to to pass any law.
- 01:15:24But legislators always say if
- 01:15:26one an infant can be saved,
- 01:15:28it would be worth all of the
- 01:15:30hassle of writing this law and
- 01:15:32getting it through the door right.
- 01:15:33And so similarly,
- 01:15:35we can kind of go back to that and echo
- 01:15:39that same theme that really rallied
- 01:15:41them and that is important to them.
- 01:15:43So.
- 01:15:44So again,
- 01:15:46it's really trying to find a way through
- 01:15:51it in a way that that can be heard.
- 01:15:56So fingers crossed
- 01:16:01I'll take a moderator's privilege.
- 01:16:02While you all think of
- 01:16:04your brilliant questions.
- 01:16:05Have are there any shining examples of
- 01:16:09community healthcare workers supporting A
- 01:16:12birthing parent going through this process?
- 01:16:15I I wish I had a story of a CHW
- 01:16:20helping someone in this example.
- 01:16:24To date, CHWS or community health
- 01:16:26workers have not been used in this way.
- 01:16:29But there are many other examples of how
- 01:16:33CHWS have been very effective in the
- 01:16:38hospital setting and in public health arena.
- 01:16:43During COVID the Yale New Haven Health
- 01:16:46System hired a bunch of CHWS and they
- 01:16:50engaged in very slow conversations with
- 01:16:55families all over the New Haven area to
- 01:16:59help sit with people who were nervous
- 01:17:02about getting the vaccine and and just
- 01:17:05engaged in slow conversations and had
- 01:17:07the luxury of being able to engage in
- 01:17:10slow conversations and and that was
- 01:17:12very effective and since then we still
- 01:17:15have CHWS here and they are wonderful
- 01:17:20people who and and you can actually
- 01:17:23put a note in epic and request a CHW
- 01:17:26you might not know that and they can
- 01:17:29meet a patient or family at their house.
- 01:17:32They can meet you for a cup of coffee.
- 01:17:36They can really help to provide space
- 01:17:41as a third party that might feel
- 01:17:45more safe or trusted or comfortable
- 01:17:48for many patients and families.
- 01:17:50And there,
- 01:17:53there have been a couple of clinics
- 01:17:56here in New Haven that have called
- 01:17:59upon community health workers to help
- 01:18:01so-called non compliant patients,
- 01:18:03right,
- 01:18:04who aren't following up.
- 01:18:07And when the very kind receptionists
- 01:18:11were calling and saying hi,
- 01:18:13just to review another reminder,
- 01:18:15you really need to get to your appointment,
- 01:18:17that wasn't effective for a number
- 01:18:19of communities here in New Haven.
- 01:18:22And so they called upon the CHWS here and
- 01:18:28through some authentic safe conversations,
- 01:18:32they've been able to help many,
- 01:18:33many patients turn from being non
- 01:18:36compliant to being back on schedule.
- 01:18:38So they are a wonderful testament to how
- 01:18:43we can provide more collaborative care.
- 01:18:48So under that system though,
- 01:18:49you would have to rely on the
- 01:18:51birthing person to call for a
- 01:18:53community health worker or would
- 01:18:55you have some kind of push?
- 01:18:57Yeah, that's a great question.
- 01:18:59You know, safe haven laws are only
- 01:19:01as effective as they are known.
- 01:19:05And we saw that in Austria,
- 01:19:07we saw that here in Connecticut.
- 01:19:09We've seen it in many places.
- 01:19:10When there is marketing
- 01:19:13and community education,
- 01:19:15then the safe haven laws
- 01:19:17are used much more often.
- 01:19:19And so my community members and our
- 01:19:23task force are all recommending that
- 01:19:26that the that information about
- 01:19:29safe havens be a part of public
- 01:19:33school health classes and be a part
- 01:19:36of other educational campaigns.
- 01:19:38Because once a certain community kind
- 01:19:41of ages out of needing those resources,
- 01:19:44that information isn't necessarily
- 01:19:46passed along.
- 01:19:47And so when Connecticut took the
- 01:19:50time and funding to put a bunch of
- 01:19:54billboards on buses and in other locations,
- 01:19:57it was really, really helpful.
- 01:19:58So we need to have more education.
- 01:20:01And if,
- 01:20:02as a part of that education,
- 01:20:04we're letting people know about
- 01:20:07community health workers who
- 01:20:08are from their communities and
- 01:20:11share their lived experiences,
- 01:20:13that would be a way to enable someone
- 01:20:16to make that phone call to the Safe
- 01:20:20Haven National Hotline or to link
- 01:20:22it through your 211 services here.
- 01:20:25And 911 is, of course, well,
- 01:20:27we have time for great.
- 01:20:29One or two more questions.
- 01:20:34Hi. Do you know if it's
- 01:20:35necessary for us to have new laws
- 01:20:38before health centers allow anonymous
- 01:20:40confidential births or could health
- 01:20:43centers do this by themselves and
- 01:20:45they just don't want to right now.
- 01:20:48I think there are a lot of people
- 01:20:51who really want to offer anonymous
- 01:20:53labor and delivery. I think there's
- 01:20:57a huge need for it that lots of
- 01:21:01folks are really pushing for. I think
- 01:21:08there are a host of factors that
- 01:21:10I don't understand in terms of
- 01:21:12billing codes and requirements for
- 01:21:14when a patient walks in the door.
- 01:21:17So I I, I'm not the expert in
- 01:21:21knowing how those tactical
- 01:21:23challenges could be addressed.
- 01:21:29Yeah,
- 01:21:32we
- 01:21:42have one last question.
- 01:21:43Hi, kind of going off that question,
- 01:21:45I've been sitting here kind of
- 01:21:47brainstorming this entire time,
- 01:21:48going from 300 questions.
- 01:21:50Are you aware of any models that
- 01:21:54kind of integrate community health
- 01:21:56workers and doulas to be able to
- 01:22:00do confidential home births and
- 01:22:03the safety of a maybe professional
- 01:22:06who's not a typically licensed
- 01:22:08medical professional but still
- 01:22:13very competent?
- 01:22:14I know thinking about maternal
- 01:22:19mortality in black women specifically,
- 01:22:23there's been a big shift to
- 01:22:25community health workers,
- 01:22:26doulas and home births for a similar reason.
- 01:22:31Not necessarily confidential,
- 01:22:32but there's a lot of conversation
- 01:22:36generating around that topic already.
- 01:22:39Are you aware of any of these models
- 01:22:42or do you know if it would even be
- 01:22:44something that could be considered.
- 01:22:46Yeah. You you raise,
- 01:22:47you raise a great point because
- 01:22:49I I am aware of this trend of
- 01:22:52many black women seeking out home
- 01:22:57births and private clinics to
- 01:22:59have the birth experience that's
- 01:23:01much more in line with what feels
- 01:23:05emotionally and physically safe to
- 01:23:07them and to optimize their outcomes
- 01:23:09because we're all aware of racial
- 01:23:13disparities and in childbirth and
- 01:23:15in the the six months afterwards.
- 01:23:19So I I would say that
- 01:23:23that is a great idea that would still
- 01:23:27probably meet the same hurdles in terms of
- 01:23:33requirements for documentation and billing.
- 01:23:37And so and yet I'm hopeful that there's
- 01:23:41something there that that there's
- 01:23:43a way to kind of navigate that and
- 01:23:46work with doulas and legislators
- 01:23:49and midwives who could potentially
- 01:23:53volunteer those services in a way
- 01:23:57that could potentially Createspace.
- 01:23:59What I'd like to see is rooms within
- 01:24:01hospitals that are just available for
- 01:24:05this purpose to be able to support
- 01:24:09a real in hospital setting.
- 01:24:12The tricky piece again is most safe
- 01:24:15haven laws have that harm clause.
- 01:24:17And I worry a lot about an infant in
- 01:24:23you know if someone does choose and
- 01:24:26is supported by the state to allow
- 01:24:29a midwife to deliver one of these
- 01:24:33babies in a home setting and if there
- 01:24:37is any risk of harm to the infant,
- 01:24:42then that birthing parent may still
- 01:24:47be at risk for prosecution.
- 01:24:48And so this goes back to how
- 01:24:52complicated it is to write meaningful
- 01:24:55law other and and you see this in
- 01:24:58other areas of safe haven as well.
- 01:25:01It's actually still a crime here in
- 01:25:05Connecticut to conceal a pregnancy that
- 01:25:09has never been stricken off the books.
- 01:25:12So, you know,
- 01:25:13would a prosecutor actually
- 01:25:15go after someone for that?
- 01:25:17I I I certainly hope not.
- 01:25:19But I I'm hopeful that that,
- 01:25:24you know,
- 01:25:24the ideas that you're bringing to light,
- 01:25:26you know,
- 01:25:27really do demonstrate the kind of
- 01:25:30originality and creativity and
- 01:25:32collaboration that are going to
- 01:25:34help us find a way through this
- 01:25:37really messy point in our history.
- 01:25:39So thank you for bringing that up.
- 01:25:40And maybe we should write some op Eds
- 01:25:43together and get the word out about
- 01:25:45how we can kind of push that through.
- 01:25:47So thank you,
- 01:25:48everybody for coming out tonight.
- 01:25:54Great. And thank you, Lori.
- 01:25:55It was one of the the best lectures
- 01:25:58of the year. Thanks so much.
- 01:26:01I get presents, so you could do.