Ethical Dimensions of Infant Abandonment Laws in a Post-Roe America

February 10, 2024

Information

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&amp;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&amp;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&amp;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.