High-Risk Pregnancy After Roe: Dr. David Hackney on the Impossible Choices Doctors Face

After doves, a lot of these same systems that help prevent medical error can also cause problems because if everyone is able to express concern, if everyone's able to stop the line, then there's a potential for things just not to move forward.

You know, no doctor functions independently.

And especially for us in OBGYN, we need anesthesia, we need nursing, you know, there's so many other people.

Um, and then if you're staring at criminal penalties, you know, sometimes we know of colleagues who have had to proceed with a case to save the patient's life.

But like every single person in the chain of command, they had to just be like, I promise you're not going to jail.

I promise you're not going to jail.

I promise you're not going to jail.

Hello and welcome to the Dr. Kristen Lyerle show.

I'm Dr. Kristen Lyerle and you guys my guest today is my friend and colleague Dr. David Hackney.

Dr. Hackney is a professor of reproductive biology at Case Western.

He's the division chief of maternal fetal medicine.

That means he's a high-risk pregnancy doctor.

He was also the section chair in Ohio for the American College of Obstetricians and Gynecologists, my professional association, our professional association.

He was doing that work the day Ro fell, which means that he and I were literally living parallel versions of the same earthquake in different states, both very interesting, him and Ohio, me and Wisconsin.

And we were doing different versions of the same kind of advocacy work together.

going all the way back really to COVID.

So David has a new book out.

It's called Impossible Choices, a Physician's Guidance on High Risk Pregnancy in a World Without Row.

And I want to be up front.

This is not a boring policy book.

This one will definitely, you're not going to fall asleep reading it.

It's built out of real cases.

preeclampsia, ruptured membranes, fetal anomalies, cancer during pregnancies, all of these tragedies that you don't think happen to that many people, but actually they really do.

This is real life stuff, real impossible choices that people, patients,

physicians are being forced to make right now in real time in band states.

So we're gonna get into the book and we're also gonna get a little personal since we know each other about what it actually costs physicians to speak out and about the fight that David and I have both been in for a long time now, well before any of this.

So Dr. David Hackney, welcome to the show.

Thanks, thanks.

It is so...

fun to be here with you after everything that we've been through in the post-Dobbs era.

I remember doing an interview, a New York Times interview with you soon after Dobbs.

There we were with Lulu Garcia Navarro.

Yes, yes, I was totally stressed.

She actually helped a lot because I had had the piece in the

the New York Times.

And after that, I just started to get the saddest email.

And it's probably the case for yourself to, you know, sort of working in the public in this space.

You tend to sometimes get emails from patients who want to tell their own stories and it had their own, you know, cases of fetal loss.

So after my essay in the New York Times, I started to get all of this email, but

you remember what things were like for us in the immediate aftermath of DOBS.

It was complete craziness and stress and these new laws and trying to figure things out.

So I couldn't respond to the emails.

So I kept taking these long personal emails and putting them in this folder where I would plan to try to reply to them one day.

So I said to Lulu Garcia Javaya,

this story while we were sitting in the waiting room and she told me it's fine not to reply to those emails they're not expecting you

to reply because it's actually therapeutic for them to write the email itself.

You know, that the process of just explaining what you went through and typing it down and then sending it off to someone who you know is going to read it and understand is therapeutic for that person.

And she said, you know, as a national reporter who reports on a lot of heavy topics, I get

emails from the public about you know all sorts of personal things all the time and I also felt the early stress to reply to them all and then I realized I couldn't but then I realized that wasn't the point that it's it's sort of she gave me like permission to not stress as much about this growing folder of emails I was getting some of which were incredibly personal and paragraphs long.

But you're used to hearing those stories because that's what we do as doctors.

We're in the exam room.

We're talking with our patients about maybe they're amazing joyful things.

Maybe they're deeply devastating things and we're trying to talk them and their families through these really hard times.

And it's not just one visit, but it tends to be episodes of visits and life-changing decisions that we are making together.

So no wonder you felt that way because that's how you practice.

Yes, yes.

I mean, you're also in the field and in the public eye.

Yes.

Okay, let's go back to when the dubs decision happened because you and I were both in our own kitchens when it came down and you had to work that night.

I can't even imagine what it was like for you as a high-risk pregnancy doctor to be on call that night knowing that the entire world had changed because of this Supreme Court judgment.

What was it like?

You know, one of the things that I always look back on is that I should have been totally ready and I should have been totally prepared.

And I think a lot of us

Across the country that day were caught off-guard when in retrospect we shouldn't have been caught off-guard You know specifically the Dobs decision had leaked beforehand in my state the Attorney General had said that as soon as the Dobs decision would come out that they were going to Reinforce the law which had been under a hold so you know I should have been ready.

I should have like read the law.

We should have

come up with, not just at where I work, but throughout the state and my leadership role, we should have come out with protocols, been already talking to lawyers.

And I will always feel a bit bad about that.

But it also wasn't just me when I talked to colleagues from around the country.

Everyone was suddenly scrambling on the day of the Dobs decision.

And in retrospect, they're

we should not have been scrambling.

I mean, the decision threw us all into chaos and the specter of criminal jeopardy, but we knew it was coming.

I think in many ways, we had as a field, or perhaps even a country, a strange level of denial.

Again, despite it, I think we just couldn't believe that that row had fallen and that it had actually happened.

And I think we thought there'd be some sort of like,

buffer period or there'd be some additional layer of appeal but many many of us all throughout the country all of a sudden on that day were staring down criminal jeopardies that we never thought we would see and scrambling to figure out these laws a lot of which were poorly written vague used affirmative defenses but I was

you know under the law at that exact moment as were many of us.

Right.

I mean here in Wisconsin we had a law from 1849 that was almost

as

the state itself that banned almost all abortion care so we had people sitting in the waiting room at Planned Parenthood who were sent home and all we could do was

try to find other places for them to go, try to find funds for them to get to where they need to.

The whole thing was such a disaster.

You're right, as a leader in a state that was vulnerable, that was going to change when this happened, we were caught flat-footed and our patients suffered as a result.

You mentioned...

affirmative defense and you talk about this in your book and I think that this is a term that we hear a lot and you define it really well.

What does affirmative defense mean and why is it so bad?

Affirmative defense and I always like to say here that I'm not a lawyer although I perhaps play on my TV as they say but

It is broadly a defense that you can evoke, but in choosing to evoke an affirmative defense, the burden of proof shifts from the government to yourself.

So classic affirmative defenses would be entrapment or self-defense or saying that you committed an act under an unsound mind, insanity, quote unquote.

So these are defenses which you are allowed to invoke, but in doing so you shift the burden of proof.

So let's say I'm accused of some act and my alibi is that I didn't do the act at all.

My alibi is that I was in a different city.

I could not have done the act.

Then the burden of proof falls upon the government to prove that I did the act.

But let's say instead I say, yes, I did the act that I'm accused of, but I was entrapped or I did the act under self-defense.

These are an affirmative defense, and I can evoke it.

But in doing so, the burden of proof then shifts to me.

So now I have the burden to prove that it was entrapment, or that I did the act under self-defense.

So when legislators write abortion bans, they can either list exceptions, which have a whole universe of problems themselves.

And we never want to present exceptions as being positive.

But they can either

have exceptions or they can put things under an affirmative defense.

So our ban that we fell under in Ohio had five medical conditions, which were explicit exceptions.

Then they had a handful of conditions in which abortion was not allowed, including rape.

or children.

But then everything else fell under an affirmative defense.

And this included heart disease, kidney disease, cancer.

So if we provided abortion care for the universe of different health problems that were under an affirmative defense, then we faced the burden of proof.

The burden of proof for us was to prove that it was needed for whatever this was.

a lot of different states used affirmative defense.

There were some states initially that had everything under affirmative defense and I think a lot of people use the word exception, you know, sort of in

the more general but not necessarily legal use of that word.

You know, those studies states like Texas has an exception for health or Idaho has an exception.

Technically, you know, throughout the country, there's lots of things where there's no exceptions at all, where everything falls under an affirmative defense.

Mm-hmm.

Yeah, I think North Dakota is one of those states.

It makes it very very hard to practice medicine and you mentioned exceptions and I think for a lot of people they think well exceptions should be easy because there are only so many reasons why you would need an abortion but that is absolutely not the case and you write about Nancy Davis in Louisiana

Talk a

little bit

about her story and how it demonstrates that a list of exceptions just doesn't cut it.

So as you said the fundamental problem with exceptions is that there are hundreds if not thousands of human disease diseases.

You know of course we go to medical school and you study you know there there's so many

diseases, so many potential birth effects, so many genetic conditions.

There's thick books, stacks of cards that we memorize in medical school for a year.

So you're never going to be able to come up with a meaningful list.

And sometimes legislators or other people will say, OK, can you draw up a list?

But there's no list.

And to take a step back,

you know, drawing up such a list is a fundamental assault to autonomy in the first place.

You know, because something that's always very important to keep track of when we're talking about abortion for high-risk patients or, you know, the patients that I see as a maternal fetal medicine doctor is that we always have to make sure that we're also standing up for abortion for the healthiest person on earth who just doesn't want to become pregnant.

You know, I often think about

you know, sort of hypothetical example where you had like two patients in two different rooms and one had some severe life limiting fetal, congenital anomaly and the other one was just a completely healthy 20 year old for whom it was just not the right time in their life for them to be pre-pregnant, you know.

I don't think you can actually prioritize one of those patients over the other.

In fact, you can make a argument on behalf of the completely healthy 20-year-old that the impact on the totality of their life and decades to the decades to come may actually be greater.

But to get back to the subject of exception, so the state of Louisiana initially came up with, I believe it was a list of like 25...

birth defects in fetal anomalies that they would allow for abortion and then since again you can't cover everything it had a category 26 which was a more open-ended like life-limiting fetal anomalies or something along those lines and again here we have you know who comes up with that list of 25 you know people who are the people who decide which patients are going to have rights and which patients are not but

The patient ended up with a pregnancy where the fetus had a cramia.

Acrania is a severe birth defect of the fetal skull.

It's not compatible with life.

But again, there's so many birth defects.

There's hundreds.

You study them for years in maternal field medicine.

So Acrania wasn't one of the 25 ones on the list.

And so she ended up not being able to receive abortion services in the state.

If I recall correctly, she was able to travel out of state.

She was one of the very early...

cases and, you know, this sad story of the patient with the Ukrainian who had to travel out of state, hit the news media early on.

It's worth pointing out that there are a ton of states right now that's still as amazing as it is and something that we should never ignore ourselves to.

There's so many states right now that continue to have no exceptions for fetal birth.

defects and their continued to be patients who are having to continue pregnancies against their will.

And that's just, you know, you don't want that to become the normal.

You don't want us to ignore ourselves to that ever.

I always think about these state legislators who are writing, making these lists, are also the same people like your former state legislator who had tried to introduce some legislation that if you had neck topic pregnancy, a pregnancy that was located somewhere other than a viable part of the uterus, that all you had to do was just move it into the uterus and it would be fine.

And the crazy thing is like he had written this bill, he had been approached about writing it, it had support, it is not possible.

These folks who are writing this legislation and making these lists don't understand how medicine works, what our jobs are like, and most importantly, what patients go through.

Yeah, no, that's totally true.

Becker was his name.

There's quote in the book, I mean not remember the exact quote, but he was interviewed by the news media afterwards because the whole ectopic re-implantation thing turned into a laughing stock.

That was that was one of my first

tweets back in the pre Elon Musk Twitter that that went viral, you know So one sent me the PDF and I knew he was involved and I knew he had talked about ectopic re-implantation before so I searched the PDF for ectopic and there the language was so I sent out the tweet with some snarky comment about how we're all going to jail because you can't You can't do that.

But yeah, anyhow, he was

Interviewed by the news media.

I mean, I'm not going to remember the exact quote off the top of my head, but it was not there were there were like, why did you put that in the bill?

Because that bill was like a 700 plus page bill, which, you know, the topic re-implantation was what got the most attention, you know, was in the national media sort of turned him into, you know, a bit of a laughing stock.

But, you know, it's important to remember that that was one line in a 700 page.

bill which defined abortion murder, you know, jail time, all of these like terrible, terrible things, you know, and which probably took an extremely long time to work on.

You know, I would have to imagine that himself and multiple AIDS.

I mean, you know, it, it's a lot of work to put together a 700 page, you know,

potentially comprehensive bill, the whole thing was sunk by those couple of lines.

But when he was asked, he was basically, oh, like someone told me about this, or I heard about this once.

And I'm like, is that the threshold to write laws?

I mean, us

as

doctors, yes, yes, no, totally.

Well, I think about this as when we're in training,

Once a week, we have a session that we call M&M, where it's morbidity and mortality, where we break down cases and we look for things that we could have done better, because we're always trying to do better.

We're bringing in evidence.

We're bringing in studies.

We're having an active debate.

And when we talk to media or when we are trying to get a point across, we like to bring all the receipts with us, because that's how we're trained to do it.

and politicians are totally different.

They just say whatever they think is going to get your attention.

And if they get your attention, they're like, sweet.

They don't care about the receipts.

They don't care about the data.

They don't care where the information came from, the irresponsible people this is.

And that is a huge difference between how they communicate and how we communicate and what makes it so hard for us as physicians to translate this way that we have been taught to communicate into a way that is attention

getting, but still honest and trustworthy in this world that is loaded with misinformation.

Yeah.

And, you know, when I first started to write the book, I really, you know, I never planned on writing a book before.

And to be honest, before I wrote the book, I hadn't really written a whole lot.

I mean, I'd written essays and op-eds and things along those lines.

So.

At first I was like, how do I write a book?

I'm not a writer, you know.

I haven't done this before and it's a strange thing having a book contract because you're, you know, you've sort of said I can write a book and then you have the contract and then you find yourself sitting in front of a computer and you're like, oh no, I have to write a book, you know.

So at first I was like,

Do I use high vocabulary words?

Do I come up with flowing sentence structure?

But then I think I sort of realized that writing is best when it's more simple and when it's more clear.

You know, people respond to writing that is straightforward.

People respond more to writing that uses straightforward words that people can understand.

But then I was like, you know, this.

actually isn't that different than what we do as doctors in our jobs.

You know, because we have a patient in our office and, you know, especially in high-risk obstetrics, let's say there's something very complicated going on.

But I have to explain it to them.

And so what do I do when I explain it to them?

I try to avoid medical jargon.

I take these complicated concepts and I try to make them as straightforward as I can.

So then when I started to write the book, I said, okay, I'm going to try to get outside of my own head.

I'm going to not try to think of myself as like a writer, you know, I'm going to think of myself as a doctor.

But instead of explaining things that are complicated to a patient in the office, I'm going to take these concepts such as exceptions, you know, affirmative defense, all of the other.

terrible things which have occurred within our health care system after Dobbs.

I'm going to try to explain them in as simple and straightforward and clear.

You want your writing to be as clear as you can, clear of a manner as I can, and hopefully that was what I did with the book.

Because we want to understand.

And one story that I think is really hard for people to understand, we get it as doctors, but cases like Amber Thurman and Portia Engubmesi.

Both died because they were waiting for DNCs that they should have received promptly, but they didn't get it.

And you are really careful in the book not to speculate on exactly what happened behind closed doors in their specific cases.

This is a tough one to talk about because it seems straightforward.

Why is the caution that you've used necessary and does it kind of also serve as its own indictment in these situations?

Yeah, those are complicated cases, you know, both because you know, obviously they are real people who died and as you said

We don't know everything that went on, you know, and we may never, I think it would benefit the healthcare system if there could really, you know, similar to a MFM or when we do quality reviews and medicine, if we could really get the blow by blow of what happened behind the scenes, you know, as you will know, healthcare systems are very complicated, have lots of moving parts and.

One of the things that's tricky is we've started to flatten out our healthcare systems so that instead of just one doctor at the very, very top who's totally in charge of everything, you have multiple layers where people are allowed to speak up, people are able to stop the line, people are able to express concerns, all of which are good.

This is one of our primary tools to prevent medical error.

But after doves, a lot of these same systems that help prevent medical error can also cause problems because if everyone is able to express concern, if everyone's able to stop the line, then there's a potential for things just not to move forward.

You know, no doctor functions independently.

And especially for us in OBGYN, we need anesthesia, we need nursing, you know, there's so many other people.

And then if you're staring at criminal penalties, you know, sometimes we know of colleagues who have had to proceed with a case to save the patient's life.

But like every single person in the chain of command, they had to just be like, I promise you're not going to jail.

I promise you're not going to jail.

I promise you're not going to jail.

And if a patient is infected or if they're bleeding, those delays could result in death.

So one of my goals in the book was to try to peel back the curtain as much as I could for patients in terms of how doctors think and how health care systems work.

You know, one of the books that I read early on that helped the direction thinking of my book was Dr. Daniel Offery's How Doctors Feel.

one of the, not to speak on behalf of the book, I guess, but there's a certain hypothesis that the public benefits from understanding how doctors think, you know, that if the public understands us as human beings and the fallacies that we can fall into, you know, the potential for us to be emotionally swayed that we're not just, you know, clinical decision making.

robots or things along those lines, then that will help the public and that will help the public navigate the healthcare system.

So what I try to do is describe in the book, you know,

What are the things that could stop things from moving forward?

What are the potential pitfalls that doctors could fall into facing criminal jeopardy?

What if a doctor feels shame?

And what if a doctor is not being straightforward with the patient because they have a sense of shame?

Or the doctor isn't being straightforward with the patient because they just can't believe what's going on.

And that hopefully by having patients understand the emotional aspect of doctors and

that they would then be able to advocate better for their own health.

Because patients do, sadly, need to advocate for themselves right now with everything's going on.

And they need things to be direct.

If a patient is not receiving an abortion, they need to say, why not?

What would be the scenario in which it would be provided?

Am I going to get worse?

Should I leave?

Yeah, but they're disempowered and they don't know what their options are so that's why they look to us But we are people with as you said emotions and feelings and opinions and fear and all of those things factor into how we take care of our patients and in fact in one part of your book you talk about Micro performances which are seemingly small inconsequential decisions that doctors make about which version of the truth to tell which

audience.

This started long before Dobs, right?

Like doctors are making decisions about how much to tell and how little to tell or what version to tell, but those are all trade-offs.

And then Dobs happens and we realize that it's kind of like a slippery slope and because we haven't been talking

Not forcefully, but you know openly about abortion and the consequences we find ourselves stuck in this situation with our hands tied

Yeah, and I'm sure you also know many people who would not talk about abortion before adopts, you know There were lots of people who performed abortion supported abortion rights and you know, you certainly don't cast any

you know, shade.

And definitely there are historic safety concerns also, you know.

But all of a sudden, Dobbs changed everything in our field.

And of course, it's sort of sad that we needed something like Dobbs, you know, but so many of the people, and I'm sure you know so many people too, who

wouldn't, you know, support an abortion, but wouldn't talk about it, you know, with like family and friends or wouldn't publicly talk about it, you know.

I sort of got involved in a lot of this early on because the American College of Ubi Joanne wanted someone to write a op-ed.

And a whole bunch of people at the time didn't want their name going on it.

And I was like,

Fine, sure.

I'll write it and then put my name on it, you know, and things along those lines.

It wasn't many ways to sad wake up call.

And if you look at our state of Ohio, we had our ballot initiative in 2023.

We were able to add reproductive freedoms to the state constitution.

And then we've been without abortion ban ever since then.

That was everyone came together.

It was a wonderful movement.

We had the campaign.

And that's all good, except I do say to myself, we could have done that in 2021.

You know, we could have done that in 2019, right?

Because like we have ballot initiatives.

There's a mechanism to move ballot initiatives forward, you know, like.

why did why did we suffer under several months under the abortion ban when we couldn't be retrospect on this any any time you know but sometimes it does take a crisis to realize what's actually important you know and sometimes it takes a crisis to propel people to be brave

very much and i'll tell you that when i ran for state assembly in 2020 so before dobs

I didn't really talk about abortion in my campaign.

I live in Northeast Wisconsin.

Heavy Catholic influence here.

It was just something that we didn't think would be helpful.

I wasn't afraid to.

I just didn't think it was beneficial.

When I ran for Congress in 2024, it was all I talked about

because it was after jobs.

It

completely changed the environment.

But it made a lot of us step up and understand that we had to use our voices, including a lot of patients who otherwise didn't want to share their stories.

And maybe they didn't want to share their stories.

afterwards either, but they felt compelled to do that.

But there are a lot of people who do want to share their stories, and media wants to hear these stories.

But in the book, you talk about a story about CNN being stonewalled by universities and hospitals.

And specifically, MD Anderson oncologists were not available.

UT Southwestern researchers could only speak as private individuals.

We've seen this all across our profession.

afraid to speak out because they are part of a bigger hospital system or university system that they felt or were muzzled.

Have you seen that chill lift at all in the years since, or do you think it's gotten harder?

The years since.

I think it's probably been about the same.

What's tricky is there's always formal power and informal power.

We are all as free people allowed to speak out.

What we always have to do is carefully follow the media policy of our employer and always make sure that we're clear that we're not speaking on behalf of anyone.

Right now sitting here in this chair, I'm not speaking on behalf of anyone.

So we should all be able to speak out as basically a free speech thing.

But that doesn't mean that you may have problems in the realm of informal power.

You don't know if you're going to speak out and then maybe you don't get selected to the committee that you want to be on a couple of months later.

You know, there's so many things in medicine.

Maybe you don't get your Block time or maybe the people are less friendly to you and the OR and things and things along those lines, you know, so that there are many reasons to financially not speak out in the realm of of informal power and I also, you know Colleagues who are working in restrictive states.

I have tremendous

respect for and they need to do the things that they need to do for patient care you know and also everyone makes their own decisions in terms of their own risks you know I don't face the same risks that other people do also you know you know

demographically, I'm a white male, you know, I don't get the same online harassment that other people do.

I'm also in, I'm a well established doctor too.

So I will 100% never throw shade, you know, to anyone who does not feel safe, or does not feel comfortable speaking out, you know, either, you know, and the people who don't feel comfortable speaking out, but are quietly doing the scenes behind the work, including lots of people who will

quietly go meet with people in power behind closed doors.

There's lots of ways to advocate that doesn't all have to be being out in public or writing op-eds or things along those lines.

Sometimes just continuing to care for the patients in your restrictive state who need care is their own way of fighting back.

It's very true, and that can be the hardest job.

And you do tell a story in the book about a retired pediatric oncologist who you met on a tour.

This person lived through the HIV-contaminated blood supply that was killing the children that he'd saved, and he eventually just left the field.

And you use this story to ask yourself whether physicians are ever released from an obligation once they've chosen to enter a valley.

Like so many of our colleagues are living in this valley right now.

Where did you land on that question for yourself?

Oh, that's a good question.

I think if it's a question about the metaphor itself, it was originally a different metaphor.

I think it was like a boat or something along those lines.

But yeah, that whole chapter brings up the question of duty.

And often doctors say, I have to do this because of my oath or my moral code.

Or I can't do this because of my oath or the moral code.

Or we feel a sense as though.

you know, once we started down a path, we are morally obliged to always sort of follow down that path, which isn't really true, you know, because we are

We are free.

Most doctors have never actually taken the Hippocratic oath.

The public doesn't think that we all have.

I've never taken the Hippocratic oath.

Yes, yes.

Most doctors have not.

In fact, I find that the Hippocratic oath is more often used to attack us.

Someone outside of medicine says, you're violating your Hippocratic this or that.

And I always feel like saying,

The Hippocratic Oath is like over 2,000 years old.

A doctor don't actually take it.

I

didn't take that

out.

Any more.

Yes, yes.

We did not take the Hippocratic Oath.

But I feel sometimes the moral sense of duty is perhaps a little bit like sartrean bad faith in a way that doesn't actually give us due credit.

If a doctor does the right thing, if a doctor

works long hours if a doctor faces criminal jeopardy, advocates on behalf of their patients.

You know, they shouldn't necessarily turn around and say, I did this because I had to do this because I took an oath.

That actually doesn't give the doctor in that scenario enough credit.

Doctors are humans and doctors are free.

And the doctor said, you know, I chose to do this as a free, as a free person, you know, because we could walk away.

You know, we don't have to face criminal jeopardy.

All of us could have died during the COVID pandemic.

You know, each time we showed to work, you know, and doctors died.

Many, many doctors died during the COVID pandemic.

And lots of doctors stopped working during the COVID pandemic.

We're not no oath.

you know, forces us to potentially face criminal jeopardy.

No oath forces us to face death from a virus.

So, you know, the fact that we are free to walk away is all the more meaningful than for the people who choose to stay.

It has been a hell of a couple of years for us, hasn't it?

Yes.

I mean, COVID and Dobs, I can't imagine.

Part of what I wanted, this wasn't goal number one, but maybe goal number four for the book or number five for the book is, I wanted to sort of be, I don't know if love letters, the right word, maybe not, but like, I wanted to like honor my colleagues in our field over the last couple of years.

I mean, I can't imagine any field in medicine going through the one, two punch of the COVID pandemic followed by Dobs.

And our field overall, you know, OB-GYNs, maternal field of medicine, doctors,

I will be forever proud of all of us.

I think I have to think that decades later when other doctors look back upon us in the past, we have stood up, we've spoken out, we've been lit against in lawsuits, we've spoken to the media, we've held to our morals.

Again, it's not goal number one.

Goal number one is hopefully to educate the public and help people navigate the health care system.

But definitively, one of my goals was to hopefully honor our field.

I love that so much because you and I have both put so much time and energy not just into taking care of patients but in translating that into our advocacy work and like really the media that I think you sued your state I sued my state I mean we've really got in deep on this because we knew we had to do more than just show up every day and we knew that it had to be us.

Yes yeah no no from the day of Dobbs you know we

So many of us stepped stepped forward and I think especially in the several weeks or months after dogs all many of us collectively were able to change the Tide I mean not not necessarily change the law, but the

narrative had to be grabbed very fast, you know, because narratives form or don't form, you know, the stories have to be told.

And, you know, I don't particularly like going in front of television cameras.

A lot of people didn't, a lot of people beforehand wouldn't even talk publicly about abortion.

But so many people stepped up in so many ways.

I mean, in retrospect, that was such an insane time.

But I think us as a field were able to grab

the narrative and pointed in the right direction very fast.

And I think if we look at the years since then, I think our field deserves a lot of credit for what we did in the early days, which I still feel informs much of the public view.

Yeah, I do too, and I'm really proud of that too.

So thank you for writing the book.

And

thank you for stepping up and being a leader in these really hard times.

You know people do look up to you, which is why I want to ask this question.

I only have two left, just so you know we're getting there.

What would you say to a physician who has stayed quiet so far?

Maybe they've been afraid of the public backlash or the informal power differential or just anything that's out there.

What would you actually say to a colleague one-on-one?

Well,

I would respect their choice to stay quiet.

We all make different choices.

We all assume different risks.

First off, I would say, remain a member of your professional group.

Our professional organizations right now have never been more important, especially with everything going on with the federal government, the CDC, the FDA.

Whatever your professional organization is, pay your dues.

There's a range of different things that you could do.

You don't have to be on a podcast.

You don't have to write a book.

But a lot of people doing the minimum is very different than a lot of people not doing anything at all.

And right now, the minimum is to pay your medical professionals society dues.

You know, whatever the group it is, American College of Obi-Wan, the American Academy of Pediatrics, on and on, because they are all also in a historic fight right now and are more critical than ever.

You know, with the changes in the FDA, the changes in the CDC, where do patients go?

You know, where does the public...

go to find critical stuff.

So if you have a doctor, especially in a restrictive state who may not have the safety protections that I do, and they're continuing to see patients, maybe they're speaking out behind closed doors.

Maybe they're talking to friends and family.

Maybe they're driving down to the state house and having coffee with someone behind closed doors.

and they pay their dues, then I respect that person, especially because patients need care, and that person could easily leave the state and leave the folks behind.

To be very clear, we both are involved with the American College of Obstetricians and Gynecologists, and we are not representing them, but we

love them.

We're not representing them.

And we

recommend that you go to ACOG.org, ACOG.org to look for information and guidance.

Even as patients, you can find lots of information there.

And when there is such a vacuum federally because of the FDA and the CDC and all of the other things that are happening right now in our government, you can trust ACOG with that incredibly important health information.

So yay, Cog.

Okay,

one last

question.

If a reader is a patient in a banned state right now, a patient, what is the single most useful thing that they should take away from your book?

Not as legal advice, but as a way to walk into their doctor's office, better prepared.

Sure, yeah.

So I think it's important now more than ever.

to try to do all the preventative things that you can do to prevent problems, which of course is the same as patients in non-restrictive states is the same as before Dobbs.

And it's actually sort of unfortunate that after Dobbs, we're especially looking hard at trying to detect birth defects early, prevent birth defects, prevent viral infections and things along those lines.

But you know, sort of...

the bread and butter has to be extra eye dotted and T crossed and for our colleagues working in restrictive states, you know, all eyes need to be dotted and all T's need to be crossed, which again should be the case for all agents everywhere.

But I would say also be prepared to ask very direct questions and that the doctor should be able to provide very direct

answer is back.

You may have to be your own advocate, but also, unfortunately, you probably need to make a plan to leave the state.

You probably have to have some sort of plan where if there is a major birth defect and not identified or there is bleeding or something arises, where is the near state?

Where is the state that's not under a ban where you have family and how could you travel?

money set aside.

And unfortunately, these are questions which are much more complicated than medicine itself, but are sadly things that people have to at least give thought to.

There are so many good resources out there, money, travel, support, and your healthcare provider should be able to help you connect to those things.

So if you are not getting those answers, you got to find yourself a different healthcare provider.

Yeah.

Yeah.

Yeah.

Dr. David Agne, impossible choices.

Oh, and let's be very clear.

Your impossible choices is different than the other impossible choices,

which is a

children's

book.

That was released

on the same day.

How did that

happen?

I don't know.

Well, they're both through Penguin Random House.

Impossible choices is from MIT Press.

Penguin Random House has a large number of books which are coming out every day.

So I don't think they looked at what was coming out from us and what

is coming out in the children's realm.

But yes, that is a very important point.

There are two different books, both called impossible choices.

They were same title.

The subtitles are very different, both released at the same day.

The other is a wacky children's book.

So I'm hoping that none of the copies get switched.

Or maybe that'd be good.

Maybe people stressed out about abortion rights would enjoy a children's activity book.

And maybe children will learn something if they get the other one.

Maybe they do.

This is how you reach broader audiences.

Yes, yes, yes.

How can our listeners find you?

You're on socials.

How can they find you if they want to get in touch or if they want to follow you?

Yes, I'm on Blue Sky.

I have an Instagram account.

I am so bad at it.

I've

been seeing your posts though lately.

I will link.

I know, but oh Lord, I feel so.

I get confused every time I'm on the app.

I think I'm pressing the wrong buttons, but I am there.

I like Blue Sky a lot more.

It's the closest we have to the wonderful world, which is pre Elon Musk Twitter.

If you want to buy the book, I encourage people to go to bookshop.org.

Bookshop.org allows you to buy the book from a independent store.

So certainly, I'd be glad if people buy it on.

you know, Amazon also.

But if you want the convenience of a book that's delivered to your house, but you would rather support your local mom and pop bookstore rather than Jeff Bezos bookshop.org, you know, you go there, you put in the name of whatever bookshop you want, and then it still gets mail to your house, but they route it through the independent store.

Oh, that's really nice.

I didn't know if that was possible.

I always just walked down to my local bookshop.

You can do that, too.

If they don't have it, they have to order it.

Or you can, of course, read it for free through the library.

It's on the Libby app.

So if they don't have it in yours, hit the little bell thing, which will notify them that you want it, and then they may get a copy.

But of course, I would rather have people buy it, but the first goal is to have people read it.

Exactly.

Read it.

Dr. David Hackney, Impossible Choices.

Thank you for spending this time with us today.

Oh, yes, yes.

This was great.

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