Well first: Hi! I'm a new follower. My name is Franki and a friend recently introduced me to your book. I am really enjoying it so far. I am a mom of three, a former doula and am currently wrapping up a degree in Marriage and Family Therapy with a lot of extra training in perinatal mental health care. All this to say, I love these topic, am excited to engage them, and am glad you are doing so!
In the poll I noted that I am pro-life and also don't think we will see a lot of prosecution in states with abortion bans. That said, I am still hesitant about abortion ban law. In some ways I agree with both you and Martha. I do just think the current bans presently lack clarity that creates institutional and systemic risk for hospitals and for physicians. The threat of criminal penalties in addition to the intense politicization of this topic (which is maybe singular except in end of life care?) creates an atmosphere of fear for individual acting physicians. In situations where decisions are time-sensitive and outcomes are unpredictable, which is really anything related to birth, I think the threat of prosecution itself is what leads to the pauses, the delays, or the transfers. That moment of pause can lead to physical and psychological harm to mothers, babies, and families.
I'm not an expert on this and honestly could be very wrong, but I do think that after EMTALA was passed, CMS provided information on what counts as an "emergency medical care" which stabilized enforcement. I do think that clarity supersedes the lack of state clarity of the topic, which I think is why I lean towards your side of seeing few criminal cases. However, I think the nature of penalties for EMTALA violations are civil fines and loss of medicare funding for institutions, both of which are covered by insurance policies. In contrast, state abortion bans impose a felony/misdemeanor penalty for an individual physician, which is typically not covered by insurance. That difference in who bears the risk fundamentally changes how individual physicians respond to uncertainty and that is what gives me pause about the laws.
Thanks Leah! I do think this process is helpful to clarify disagreement.
I also want to clarify that I’m actively working to lose this bet by overturning bans and fighting against the prosecution of doctors and supporting their ability to provide care. As Katha raised, even without charges there are horrific impacts on women and doctors because of these laws.
So if only 25 doctors, or 15 or 5 are prosecuted, Leah, you win? Or if they are charged but the charges are eventually dropped, after putting them through Hell and destroying their careers, you win? Or if they are neither convicted or charged, but fired,sending a message to other doctors, you win? There is something so blithe and heartless about this bet. Women have ALREADY died or been terribly injured because they've been denied medical care. How many before you take in what is happening in this country? When abortion was illegal in Ireland, SOME women, I'm told, got life-saving care regardless, but Savita Halappanavar was allowed to die of sepsis because her fetus still had a heartbeat. And the "Pro-lifers" never admitted that the law had anything to do with it.
I think we disagree about the purpose of betting here, since you see it as heartless. We put a low dollar amount on the bet because the point isn't to make money, but to clarify where our anticipations about the shape of the future differ, and to have a reason to check in about what actually happened + what we should learn from being right or wrong.
I make bets to clarify disagreements on non-abortion related topics. I'm almost certainly losing one on AI-related unemployment to Lyman Stone at the end of the year. Taking different sides of the bet on that topic doesn't mean either of us are rooting for the side we took or will celebrate being right, but that we disagree about what's happening next and want to get better at thinking about our diagreement.
Do you think it's helpful to clearly express how your expectations of the future differ as long as there's no money at stake?
Part of what bets do that I value is force you to come up with a prediction precise enough that you could both appeal to a neutral arbiter to resolve it. (Versus "I expect things to get worse" which is fuzzy enough that it's hard to resolve).
Yes, it's the money at stake that rubs me the wrong way. It seems like two smart people, each acting in good faith, could take care to be precise without needing to make a game of it.
I usually stake a nominal amount on these kinds of bets, because it gives a clear way the bet gets "closed" and requires you to get back in touch if you've fallen out of it, versus a gentleman's bet where there's no pressure to meet and settle back up.
I appreciate your logic, and I know you put thought into what you do. To me, the whole idea of a bet/game just seems more lighthearted than the subject permits.
For what it’s worth, the idea of “betting on beliefs” is much broader than this topic, and I’m a fan of making it a more normal thing to do not because of anything having to do with abortion in particular.
I think the case for an informal practice of betting on beliefs is very similar to the case for the methodological norm in science of pre-registration, where scientists have to announce in advance of looking at their data exactly what hypotheses they’ll test and what analyses they’ll perform. What this is meant to rule out is the old practice of first collecting data, and then coming up with a hypothesis that’s supported by the data, and presenting it as what they were hoping to test in the first place.
We humans are very good at constructing narratives that portray ourselves in a flattering light, where we have been right all along. But that tendency makes it hard to identify when we got something wrong, and so it makes it hard to learn from our mistakes. Pre-registration is a way of checking this tendency in science, and betting on beliefs is a way of checking it in other contexts.
In my circles, betting is for serious intellectual calibration, very much in contrast to lighthearted vague speculation. It's a rationalist tool to prevent exaggeration, not a game. Daniel makes a good comparison to pre-registering hypotheses.
However, I do also see a fair amount of pre-registered predictions expressed as a confidence percentage without money attached. E.g. "I predict a 30% chance that more than 30 doctors will be charged, etc." You can do this without exchanging money and even without someone else taking the other side of the bet. Usually that's more for calibrating your predictive abilities in general than on one question, though. In that case you might write down a set of lots of predictions so that when you get data back, you can calibrate your confidence level for likely events differently from your confidence level about unlikely events. You can try it with pre-written questions here:
I think you might be asking the wrong question. A better one would be, will women die or suffer serious injury because doctors are afraid to provide genuine emergency care? Healthcare should be about the patients, not the doctors. Obviously charges filed against doctors who DO provide emergency care would be cause for the kind of fear that would prevent others from doing the same, but a question that focuses on doctors rather than patients is looking at the question backwards.
I believe abortion bans are a moral good. I also believe there are plenty of doctors who care more about legalities and perceived legalities than patients, who may make bad choices out of fear, even if charges filed against other doctors are for egregious misconduct (not covered by your bet) than for an emergency judgment call. The key is clarity, education, and transparency about what the laws actually say, for the sake of all involved.
I think that's a different question than the one that Martha and I differ on—It was really helpful to clarify that one reason Martha disagrees with me about these laws is because she believes pro-life legislatures are falsely reassuring doctors while planning to wait and then prosecute them in the near future.
I'd have a lot more trouble setting up a bet on the chilling effect around emergency care, because it would require access to information that would be very hard to get, while charges and arrests wind up public. Bets can also be a useful tool to point to what we're going have trouble learning, even when we make a good faith effort to investigate.
Is it good policy to create a situation where a doctor must wonder if acting in a patient's best interest will lead to their arrest and possible incarceration? Good clinical judgement is hard enough without adding possible jail time and career suicide to the equation. The idea that these laws are ok if 'only' 30 docs will be punished for possibly saving a life seems like a bad bet.
There’s a case playing out right now in Eureka, CA on the other side of the spectrum: a state branding itself “a pro-choice haven”. The allegation against St John’s Hospital is their policies denied emergency abortion care - lots of players weighing in on this one.
Well, Katha, you have made Leah's day, recognition from a world renowned feminist on abortion! However, Leah has gone on to simply not hear what you and a few others have said. Leah, you are a professional facilitator who works with people who disagree on a range of issue, yet in response to Katha and others on the matter of what they see as a crass, unsensitive use of a bet, you moved immediately and repeatedly to defend the betting. Defending never helps fix even a benigh misunderstandingI think there was things you could have learned if you used your professional skills. Take a deep beath and just listen with a goal of figuring out where you might have gone wrong; where in such a charged issue, with deep polarization betting was not helpful to anyone. Perhaps an apology is in order.
Leah, I am in the midst of a round of covid and want to give you a full response so this is just a short clarifiation and before tonight I will answer more thoroughly. First I was referencing your responses to all those who posted concerned about and critical of the "betting" bit, not especially on Katha's question and remarks. Secondly, my suggestion about an apology was that, if, indeed, you see that using the mechanism of betting in the specific instance of something as serious as reproduction that clearly struck those who spoke up as in some way hurtful deserved an apology to them and perhaps others who were silent. With those two points, I am going to rest but I will post more later with a better analysis of the problem as I see it.
Leah, let me start at the end. what might be appropriate in aplogizing, what for: There are three or four readers who found some of what you said insensitive, troubling, betting as too lighthearted for the subject, an underlying sense that the betting model might be a good technique for testing out conflicting opinions, but not on this issue. I am among that group. They were offended, particularly at what seemed to be a lack of recognition of women's suffering at such a time. For me, if I were perceived by anyone in that light, I would attempt to hear that and to apologize for hurting those who found the remarks troubling. I would feel no need to go deeper. I made a mistake, never thought anyone would react that way to what for me was first and formost an interest in providing people with a model for resolving differences (that back fired). A bit deeper, never once did you make reference to the issue in contention, you missed in my opinion the sensitivity towards women in desperate situations who should not be the object of your example but the subjects of their lives. Martha, in. contrast makes at least two references to this. First when she speaks of working to contribute to alleviating the risks for them and then again more directly to what they go through when they face these situations. I will stop here. I'd be happy bto say more in conversation if it would be helpful
Hi Frances, I appreciated you drawing this out at greater length, and I hope you feel better in time for a full and joyful Christmas.
I still do disagree about whether it's appropriate to engage in further conversation, instead of immediately apologizing when someone says they are offended.
For one thing, when I am in the wrong, I am still rarely able to give a sincere, full apology without some conversation first. I can mouth the words, "I'm sorry" but I need to actually be able to understand the other person (and be sure they didn't misunderstand me) to get to actual contrition. Especially on the internet, that usually takes further conversation, since my interlocutor and I don't have a deep, preexisting relationship where I can intuit how we differ.
I think you and I (and Martha, and Katha, and Audrey) are all united in wanting to take this question seriously, and the disagreement is about what best helps us reason and act here. I am making the case that formalizing disagreements (through bets and other tools) helps us reason seriously together and pin down what we believe and what contradictory evidence should cause us to reconsider our confidence.
Betting is not necessarily rooting for a particular outcome or trivializing the result. Bets (and larger prediction markets) are a tool for making our expectations legible to each other with the hope that it will allow us to act more prudently.
Here, I think it's very helpful to note that the pro-life and pro-choice readers (as measured by the poll) have very different expectations about how these laws will play out, and that, therefore, when we talk to each other about what it means to endorse these laws, we're expecting different results.
Politics is pop culture, pop culture valorizes public dissent, this is the way to achieve honor and respect among your progressive peers, and there are more than 3000 progressive doctors in the United States.
If there were any meaningful culture in the United States, aside from pop culture and politics, there would be some other way to achieve cultural credibility. The main limiting factor, if Leah wins the bet, will not have been laws, but finding some alternative and safer means to win the notoriety and respect of your peers.
But working against that will be up-and-comer political actors in the attorney general's office of various states looking to at least charge doctors to win public credibility. As the public shifts right, this will be a predictable attempt. So which is the greatest force here? Personal notoriety? Personal safety? Public notoriety?
You did not say convicted. You only said charged. I might have swung your way if you had said convicted.
I know a semi-retired doctor whose theory and practice is controversial, though not around abortion or anything political. Her outlook is that because of her age and solo medical practice, she can help patients her way without fear of getting fired or held back in her career by the disapproval of other doctors (and she is not so controversial as to be at risk of losing her license).
She keeps at it because she (believes she) is genuinely helping patients; her friends don't know or care about her area of expertise because it's obscure and not politicized.
But for almost-retired OBs who also have the silver lining of winning the approval of their friends and family by going out with a bang if they skirt the edge of abortion laws - yes, I think there are enough of those in the country that a few will be emboldened.
Not as many as will be chilled by uncertainty and risk, though. I think that effect will be much larger.
There are many more confused and risk-averse doctors around than principled and brave doctors.
Especially with OBs, being principled will have already selected many of them out of practice long before retirement age, since modern hospital policy around birth is so harmful. It already optimizes for minimizing hospital liability at the expense of women's and babies' experiences and long-term wellbeing.
I agree with a lot of this, but my question is, what if the law never needs to be enforced in the way the bet tracks? Suppose penalties are severe but the exception language is loose, hospitals know they’ll be on their own if something goes wrong, and no one wants to be the first test case. Legal reviews are added, decisions delayed, maybe “borderline” cases get transferred/ deferred. Nothing visibly dramatic happens, and no prosecutions follow, but practice has still shifted in a predictable direction.
In that situation, a bet keyed to arrests would still appear reassuring, even though the effect people were worried about manifested through risk avoidant behaviors rather than enforcement. Maybe the relevant "harm" or "constraint" is not "doctor goes to jail," but “doctor does not provide care at the earlier medically indicated moment because the institution is afraid of being targeted."
That’d be one of my concerns about using discrete outcomes as the primary diagnostic, would love to hear more thoughts.
My observation is that OBs and L&D departments, as a group, already lean strongly toward avoiding liability or complexity for providers and hospitals, at the expense of mothers' and babies' experiences, wishes, and long-term physical and mental health. This is evident from trends in C-sections, VBACs, inductions, continuous monitoring (the NYT recently did an expose on that), etc.
So don't think many OBs or hospital admins will stick their necks out to do anything that they sense would risk liability when it comes to abortion either.
I expect this will mean that charged doctors will be few (I would guess under 30) and yet the chilling effect on providing edge case treatments that might possibly be viewed as abortion will be high.
I can't help but find it distasteful as well. I identify as neither pro life nor pro choice so I didn't take your poll. I feel very conflicted on this issue of abortion, and this is after twenty years of working in maternal health, seeing all the actual complexities. But I have to say based on 6 years on my state's Maternal Mortality Review Team: it is often only evident in retrospect when a mother's life was endangered by a pregnancy. Perhaps the two of you would also like to do an over/under on maternal deaths in these states as well? Texas has an atrocious maternal mortality rate.
If it's true that it is often only evident in retrospect when a mother's life was endangered by a pregnancy, that is unfortunate, because it means that neither abortion nor induction can be recommended in time to help in those cases.
I'm guessing many of those life-threatening circumstances that don't get predicted beforehand are birth complications like hemorrhage or sepsis from C-sections?
Yes, that is one possible scenario. A lot of women do not come to pregnancy in a state of good health (mental and/or physical) and cesarean overuse does contribute to maternal death.
I'm also thinking about hypothetical cases like, a person with a BMI of 60 who has both preexisting diabetes and heart disease, a person who has severe depression with a history of many suicide attempts or drug overdoses, or a person with a history of several C-sections who is therefore is at risk for death due to somewhat unpredictable events like placental abruption, uterine rupture, or hemorrhage.
In cases like this, it is not surprising or unpredictable that the mother died, or that the pregnancy worsened her health further. Even though most people agree that abortion is morally permissible to save the mother's life, most of these cases would not have met any conservative state government's test of "this situation is life-threatening enough to permit abortion."
I find it so hard to take states with strict anti-abortion laws at their word when they say they care about life, because their attention to issues like cesarean overuse, maternity care deserts, and high infant/maternal morbidity and mortality rates is entirely lacking.
It’s a different question, and I agree I wouldn’t want to bet on it. But I think it’s also the true metric of the laws—do they protect patients, both women and children, rather than do they protect doctors?
Well first: Hi! I'm a new follower. My name is Franki and a friend recently introduced me to your book. I am really enjoying it so far. I am a mom of three, a former doula and am currently wrapping up a degree in Marriage and Family Therapy with a lot of extra training in perinatal mental health care. All this to say, I love these topic, am excited to engage them, and am glad you are doing so!
In the poll I noted that I am pro-life and also don't think we will see a lot of prosecution in states with abortion bans. That said, I am still hesitant about abortion ban law. In some ways I agree with both you and Martha. I do just think the current bans presently lack clarity that creates institutional and systemic risk for hospitals and for physicians. The threat of criminal penalties in addition to the intense politicization of this topic (which is maybe singular except in end of life care?) creates an atmosphere of fear for individual acting physicians. In situations where decisions are time-sensitive and outcomes are unpredictable, which is really anything related to birth, I think the threat of prosecution itself is what leads to the pauses, the delays, or the transfers. That moment of pause can lead to physical and psychological harm to mothers, babies, and families.
I'm not an expert on this and honestly could be very wrong, but I do think that after EMTALA was passed, CMS provided information on what counts as an "emergency medical care" which stabilized enforcement. I do think that clarity supersedes the lack of state clarity of the topic, which I think is why I lean towards your side of seeing few criminal cases. However, I think the nature of penalties for EMTALA violations are civil fines and loss of medicare funding for institutions, both of which are covered by insurance policies. In contrast, state abortion bans impose a felony/misdemeanor penalty for an individual physician, which is typically not covered by insurance. That difference in who bears the risk fundamentally changes how individual physicians respond to uncertainty and that is what gives me pause about the laws.
Thanks Leah! I do think this process is helpful to clarify disagreement.
I also want to clarify that I’m actively working to lose this bet by overturning bans and fighting against the prosecution of doctors and supporting their ability to provide care. As Katha raised, even without charges there are horrific impacts on women and doctors because of these laws.
So if only 25 doctors, or 15 or 5 are prosecuted, Leah, you win? Or if they are charged but the charges are eventually dropped, after putting them through Hell and destroying their careers, you win? Or if they are neither convicted or charged, but fired,sending a message to other doctors, you win? There is something so blithe and heartless about this bet. Women have ALREADY died or been terribly injured because they've been denied medical care. How many before you take in what is happening in this country? When abortion was illegal in Ireland, SOME women, I'm told, got life-saving care regardless, but Savita Halappanavar was allowed to die of sepsis because her fetus still had a heartbeat. And the "Pro-lifers" never admitted that the law had anything to do with it.
I think we disagree about the purpose of betting here, since you see it as heartless. We put a low dollar amount on the bet because the point isn't to make money, but to clarify where our anticipations about the shape of the future differ, and to have a reason to check in about what actually happened + what we should learn from being right or wrong.
I make bets to clarify disagreements on non-abortion related topics. I'm almost certainly losing one on AI-related unemployment to Lyman Stone at the end of the year. Taking different sides of the bet on that topic doesn't mean either of us are rooting for the side we took or will celebrate being right, but that we disagree about what's happening next and want to get better at thinking about our diagreement.
I also find this a very insensitive way to express different expectations. This isn’t a game. I am sorry to see it.
Do you think it's helpful to clearly express how your expectations of the future differ as long as there's no money at stake?
Part of what bets do that I value is force you to come up with a prediction precise enough that you could both appeal to a neutral arbiter to resolve it. (Versus "I expect things to get worse" which is fuzzy enough that it's hard to resolve).
Yes, it's the money at stake that rubs me the wrong way. It seems like two smart people, each acting in good faith, could take care to be precise without needing to make a game of it.
I usually stake a nominal amount on these kinds of bets, because it gives a clear way the bet gets "closed" and requires you to get back in touch if you've fallen out of it, versus a gentleman's bet where there's no pressure to meet and settle back up.
I appreciate your logic, and I know you put thought into what you do. To me, the whole idea of a bet/game just seems more lighthearted than the subject permits.
For what it’s worth, the idea of “betting on beliefs” is much broader than this topic, and I’m a fan of making it a more normal thing to do not because of anything having to do with abortion in particular.
I think the case for an informal practice of betting on beliefs is very similar to the case for the methodological norm in science of pre-registration, where scientists have to announce in advance of looking at their data exactly what hypotheses they’ll test and what analyses they’ll perform. What this is meant to rule out is the old practice of first collecting data, and then coming up with a hypothesis that’s supported by the data, and presenting it as what they were hoping to test in the first place.
We humans are very good at constructing narratives that portray ourselves in a flattering light, where we have been right all along. But that tendency makes it hard to identify when we got something wrong, and so it makes it hard to learn from our mistakes. Pre-registration is a way of checking this tendency in science, and betting on beliefs is a way of checking it in other contexts.
In my circles, betting is for serious intellectual calibration, very much in contrast to lighthearted vague speculation. It's a rationalist tool to prevent exaggeration, not a game. Daniel makes a good comparison to pre-registering hypotheses.
However, I do also see a fair amount of pre-registered predictions expressed as a confidence percentage without money attached. E.g. "I predict a 30% chance that more than 30 doctors will be charged, etc." You can do this without exchanging money and even without someone else taking the other side of the bet. Usually that's more for calibrating your predictive abilities in general than on one question, though. In that case you might write down a set of lots of predictions so that when you get data back, you can calibrate your confidence level for likely events differently from your confidence level about unlikely events. You can try it with pre-written questions here:
https://www.clearerthinking.org/post/2019/10/16/practice-making-accurate-predictions-with-our-new-tool
I think you might be asking the wrong question. A better one would be, will women die or suffer serious injury because doctors are afraid to provide genuine emergency care? Healthcare should be about the patients, not the doctors. Obviously charges filed against doctors who DO provide emergency care would be cause for the kind of fear that would prevent others from doing the same, but a question that focuses on doctors rather than patients is looking at the question backwards.
I believe abortion bans are a moral good. I also believe there are plenty of doctors who care more about legalities and perceived legalities than patients, who may make bad choices out of fear, even if charges filed against other doctors are for egregious misconduct (not covered by your bet) than for an emergency judgment call. The key is clarity, education, and transparency about what the laws actually say, for the sake of all involved.
I think that's a different question than the one that Martha and I differ on—It was really helpful to clarify that one reason Martha disagrees with me about these laws is because she believes pro-life legislatures are falsely reassuring doctors while planning to wait and then prosecute them in the near future.
I'd have a lot more trouble setting up a bet on the chilling effect around emergency care, because it would require access to information that would be very hard to get, while charges and arrests wind up public. Bets can also be a useful tool to point to what we're going have trouble learning, even when we make a good faith effort to investigate.
My recent New Atlantis article covers some hospitals that have excelled at giving their doctors clarity and some that have failed: https://www.thenewatlantis.com/publications/who-decides-on-emergency-abortions-after-roe
Is it good policy to create a situation where a doctor must wonder if acting in a patient's best interest will lead to their arrest and possible incarceration? Good clinical judgement is hard enough without adding possible jail time and career suicide to the equation. The idea that these laws are ok if 'only' 30 docs will be punished for possibly saving a life seems like a bad bet.
There’s a case playing out right now in Eureka, CA on the other side of the spectrum: a state branding itself “a pro-choice haven”. The allegation against St John’s Hospital is their policies denied emergency abortion care - lots of players weighing in on this one.
https://www.ijpr.org/health-and-medicine/2025-12-12/humboldt-st-joseph-emergency-abortion-hearing
Well, Katha, you have made Leah's day, recognition from a world renowned feminist on abortion! However, Leah has gone on to simply not hear what you and a few others have said. Leah, you are a professional facilitator who works with people who disagree on a range of issue, yet in response to Katha and others on the matter of what they see as a crass, unsensitive use of a bet, you moved immediately and repeatedly to defend the betting. Defending never helps fix even a benigh misunderstandingI think there was things you could have learned if you used your professional skills. Take a deep beath and just listen with a goal of figuring out where you might have gone wrong; where in such a charged issue, with deep polarization betting was not helpful to anyone. Perhaps an apology is in order.
Frances, can you expand a little on where you think my attempt to explain became inappropriate?
I’m happy to apologize where appropriate but I’d need a clearer idea of what fault I committed.
I thought Katha asked a good faith question and I tried to respond in kind.
Leah, I am in the midst of a round of covid and want to give you a full response so this is just a short clarifiation and before tonight I will answer more thoroughly. First I was referencing your responses to all those who posted concerned about and critical of the "betting" bit, not especially on Katha's question and remarks. Secondly, my suggestion about an apology was that, if, indeed, you see that using the mechanism of betting in the specific instance of something as serious as reproduction that clearly struck those who spoke up as in some way hurtful deserved an apology to them and perhaps others who were silent. With those two points, I am going to rest but I will post more later with a better analysis of the problem as I see it.
Leah, let me start at the end. what might be appropriate in aplogizing, what for: There are three or four readers who found some of what you said insensitive, troubling, betting as too lighthearted for the subject, an underlying sense that the betting model might be a good technique for testing out conflicting opinions, but not on this issue. I am among that group. They were offended, particularly at what seemed to be a lack of recognition of women's suffering at such a time. For me, if I were perceived by anyone in that light, I would attempt to hear that and to apologize for hurting those who found the remarks troubling. I would feel no need to go deeper. I made a mistake, never thought anyone would react that way to what for me was first and formost an interest in providing people with a model for resolving differences (that back fired). A bit deeper, never once did you make reference to the issue in contention, you missed in my opinion the sensitivity towards women in desperate situations who should not be the object of your example but the subjects of their lives. Martha, in. contrast makes at least two references to this. First when she speaks of working to contribute to alleviating the risks for them and then again more directly to what they go through when they face these situations. I will stop here. I'd be happy bto say more in conversation if it would be helpful
Hi Frances, I appreciated you drawing this out at greater length, and I hope you feel better in time for a full and joyful Christmas.
I still do disagree about whether it's appropriate to engage in further conversation, instead of immediately apologizing when someone says they are offended.
For one thing, when I am in the wrong, I am still rarely able to give a sincere, full apology without some conversation first. I can mouth the words, "I'm sorry" but I need to actually be able to understand the other person (and be sure they didn't misunderstand me) to get to actual contrition. Especially on the internet, that usually takes further conversation, since my interlocutor and I don't have a deep, preexisting relationship where I can intuit how we differ.
I appreciated being able to have exactly this kind of back and forth with Audrey here: https://www.otherfeminisms.com/p/the-future-of-abortion-ban-arrests/comment/189547509
I think you and I (and Martha, and Katha, and Audrey) are all united in wanting to take this question seriously, and the disagreement is about what best helps us reason and act here. I am making the case that formalizing disagreements (through bets and other tools) helps us reason seriously together and pin down what we believe and what contradictory evidence should cause us to reconsider our confidence.
Betting is not necessarily rooting for a particular outcome or trivializing the result. Bets (and larger prediction markets) are a tool for making our expectations legible to each other with the hope that it will allow us to act more prudently.
Here, I think it's very helpful to note that the pro-life and pro-choice readers (as measured by the poll) have very different expectations about how these laws will play out, and that, therefore, when we talk to each other about what it means to endorse these laws, we're expecting different results.
Appreciate your comments. Best
Politics is pop culture, pop culture valorizes public dissent, this is the way to achieve honor and respect among your progressive peers, and there are more than 3000 progressive doctors in the United States.
If there were any meaningful culture in the United States, aside from pop culture and politics, there would be some other way to achieve cultural credibility. The main limiting factor, if Leah wins the bet, will not have been laws, but finding some alternative and safer means to win the notoriety and respect of your peers.
But working against that will be up-and-comer political actors in the attorney general's office of various states looking to at least charge doctors to win public credibility. As the public shifts right, this will be a predictable attempt. So which is the greatest force here? Personal notoriety? Personal safety? Public notoriety?
You did not say convicted. You only said charged. I might have swung your way if you had said convicted.
Long time pro-lifer here.
I know a semi-retired doctor whose theory and practice is controversial, though not around abortion or anything political. Her outlook is that because of her age and solo medical practice, she can help patients her way without fear of getting fired or held back in her career by the disapproval of other doctors (and she is not so controversial as to be at risk of losing her license).
She keeps at it because she (believes she) is genuinely helping patients; her friends don't know or care about her area of expertise because it's obscure and not politicized.
But for almost-retired OBs who also have the silver lining of winning the approval of their friends and family by going out with a bang if they skirt the edge of abortion laws - yes, I think there are enough of those in the country that a few will be emboldened.
Not as many as will be chilled by uncertainty and risk, though. I think that effect will be much larger.
There are many more confused and risk-averse doctors around than principled and brave doctors.
Especially with OBs, being principled will have already selected many of them out of practice long before retirement age, since modern hospital policy around birth is so harmful. It already optimizes for minimizing hospital liability at the expense of women's and babies' experiences and long-term wellbeing.
I agree with a lot of this, but my question is, what if the law never needs to be enforced in the way the bet tracks? Suppose penalties are severe but the exception language is loose, hospitals know they’ll be on their own if something goes wrong, and no one wants to be the first test case. Legal reviews are added, decisions delayed, maybe “borderline” cases get transferred/ deferred. Nothing visibly dramatic happens, and no prosecutions follow, but practice has still shifted in a predictable direction.
In that situation, a bet keyed to arrests would still appear reassuring, even though the effect people were worried about manifested through risk avoidant behaviors rather than enforcement. Maybe the relevant "harm" or "constraint" is not "doctor goes to jail," but “doctor does not provide care at the earlier medically indicated moment because the institution is afraid of being targeted."
That’d be one of my concerns about using discrete outcomes as the primary diagnostic, would love to hear more thoughts.
My observation is that OBs and L&D departments, as a group, already lean strongly toward avoiding liability or complexity for providers and hospitals, at the expense of mothers' and babies' experiences, wishes, and long-term physical and mental health. This is evident from trends in C-sections, VBACs, inductions, continuous monitoring (the NYT recently did an expose on that), etc.
So don't think many OBs or hospital admins will stick their necks out to do anything that they sense would risk liability when it comes to abortion either.
I expect this will mean that charged doctors will be few (I would guess under 30) and yet the chilling effect on providing edge case treatments that might possibly be viewed as abortion will be high.
I can't help but find it distasteful as well. I identify as neither pro life nor pro choice so I didn't take your poll. I feel very conflicted on this issue of abortion, and this is after twenty years of working in maternal health, seeing all the actual complexities. But I have to say based on 6 years on my state's Maternal Mortality Review Team: it is often only evident in retrospect when a mother's life was endangered by a pregnancy. Perhaps the two of you would also like to do an over/under on maternal deaths in these states as well? Texas has an atrocious maternal mortality rate.
If it's true that it is often only evident in retrospect when a mother's life was endangered by a pregnancy, that is unfortunate, because it means that neither abortion nor induction can be recommended in time to help in those cases.
I'm guessing many of those life-threatening circumstances that don't get predicted beforehand are birth complications like hemorrhage or sepsis from C-sections?
Yes, that is one possible scenario. A lot of women do not come to pregnancy in a state of good health (mental and/or physical) and cesarean overuse does contribute to maternal death.
I'm also thinking about hypothetical cases like, a person with a BMI of 60 who has both preexisting diabetes and heart disease, a person who has severe depression with a history of many suicide attempts or drug overdoses, or a person with a history of several C-sections who is therefore is at risk for death due to somewhat unpredictable events like placental abruption, uterine rupture, or hemorrhage.
In cases like this, it is not surprising or unpredictable that the mother died, or that the pregnancy worsened her health further. Even though most people agree that abortion is morally permissible to save the mother's life, most of these cases would not have met any conservative state government's test of "this situation is life-threatening enough to permit abortion."
I find it so hard to take states with strict anti-abortion laws at their word when they say they care about life, because their attention to issues like cesarean overuse, maternity care deserts, and high infant/maternal morbidity and mortality rates is entirely lacking.
How sweet it is to be an MD jumping for criminal code books before protocols and guidelines
It’s a different question, and I agree I wouldn’t want to bet on it. But I think it’s also the true metric of the laws—do they protect patients, both women and children, rather than do they protect doctors?