Push for ‘personhood’ creates uncertainty for state businesses

Casting the human embryo into the Mississippi Constitution as a living person promises to bring “drastic change” to the way medicine is practiced in Mississippi, the president of the Mississippi State Medical Association predicts.

The unknowns are immense, but you could see physician defections to other states and a migration of patients to Tennessee, Arkansas and other border states, says family practitioner Dr. Tom Joiner, who will be guiding the association through May.

And you could see fewer startup practices, he adds. “This certainly wouldn’t be where you’d want to establish your business from day one” of the state officially designating an embryo as a human being.

“It is going to drastically change the way practice is done from day one,” Joiner says. “What‘s going to happen in Mississippi is not going to happen in Arkansas and Alabama.

“Is that going to drive that business to other states?”

One likely target of the amendment is Mississippi’s lone abortion provider, the Jackson Women’s Health Center at 2903 N. State St. in Fondren. Backers of the measure say it would outlaw abortion across the state, even in cases of rape or incest. The Centers for Disease Control reports that 2,932 abortions occurred in the state in 2007, the latest year for which figures are available.

No one has a fix on all of the many possible implications.

To start with, it is not clear how broadly Mississippi’s elected leaders, attorney general and district attorneys will interpret an amendment that states that life begins at fertilization. Since Mississippi would be the first state to make such a designation in its constitution, healthcare professionals have no enforcement examples to weigh.

So a time of waiting and worrying is ahead for physicians, fertility clinic operators and pharmacists.

The state medical association’s official position on Initiative 26 is that it has no position.

But that did not stop Joiner from sounding an alarm in an official statement approved by the medical association’s board and issued Oct. 2.

“Well intentioned physicians could be placed in a perilous position,” the statement read.

The association’s worry, the statement said, is that “even when acting in the best interest of both the mother and unborn, the medical judgment of well-intentioned physicians could be brought into question.”

In an interview, Joiner said OB-GYNs are the main physicians concerned “and you can understand why. This is going to affect the way each and every one of them practices.

“Can we save a mother” at the cost of the fetus? “How would the attorney general and prosecutors interpret that?”

Backers of the amendment say physicians should not worry they will be forced to change established medical practices.

But Joiner cautions, “This is going to be out of our hands once this thing passes. It is not going to be up to the doctor to make a determination.

“That’s a very serious thing when you go into surgery to save a woman’s life and there’s a prosecutor sitting out there who may beg to differ.”

Officials of the University if Mississippi Health Care reproductive endocrinology and infertility (REI) clinic say they hope to preserve patient access “to safe and reliable medical treatments for infertility.”

As one of three infertility practices in the state (all in Jackson), the center says it averaged 120-130 in-vitro fertilization (IVF) cycles per year from 2003 through 2008, which likely includes some repeat patients.

Overall, the clinic had 535 patient visits last year, said spokesman Jack Mazurak. That’s “a number that we expect to increase in 2012 with the recent recruitment of a second reproductive endocrinologist, a physician specializing in this field.”

The coalition pushing for the amendment, Yes to 26, says it does not want fertility clinics shut down and they should not expect to be prosecuted as long as they do not intentionally destroy human embryos.

That assurance aside, the National Infertility Association says clinics such as the one run by University of Mississippi have cause for worry. The Mississippi measure and those proposed for states such as Georgia and Ohio “may seriously impair the ability of citizens with infertility to obtain needed medical treatment,” the association said in a statement.

“The personhood amendment would produce so many legal uncertainties about the status of embryos,” the association said, that it anticipates “it would be difficult or impossible for reproductive endocrinologists to treat infertility patients using long-established assisted reproductive treatments.”

Often, the procedure does not require use of all embryos and unused ones are frozen. If any are destroyed in the process, that could be deemed the criminal taking of a life, the infertility association says, and adds it fears anything that puts an embryo at risk could be a violation.

Dr. Joiner, the state medical association president, said fertility science has advanced to the point that doctors can determine which of the embryos might have a defective genetic trait. Neither the couple seeking the treatment nor the physician giving it would want to implant those embryos, he said. “But under this law doing away with the other embryos would be interpreted as murder.”

Dr. Randall Hines, a reproductive endocrinologist who has an infertility clinic in Jackson, is bothered by what he sees as encroachment into something that for ages has been a matter between doctor and patient. “My biggest concern is we are changing our paradigm…. With passage of Initiative 26 the government will, in some form, make decisions for people about their healthcare. It‘s a concern for all of us.”

Hines said some of his contacts say not to worry. Legislators “will work that through the Legislature” to limit the burden on the medical sector, he says he has been told, though he notes he does not relish witnessing lawmakers making medical decisions.

But even if lawmakers were to somehow make it all better, the amendment would go into effect mid-December, 30 days after passage.

The Legislature doesn’t convene until after the New Year. “What happens to people in the meantime? There are way too many complexities.”

On the expense side, Hines figures he might need to keep a lawyer on speed dial. And his patients will probably need legal assistance before any procedures are preformed or before they make donations of embryos or receive donations of embryos. “Some things we do will become more expensive for the patient.“

Hines said he expects the ability of his practice to help people with genetic disorders could be lessened. “That simply would get more complicated and expensive.”

For instance, if you thawed a frozen embryo and found that embryo contained a lethal disorder “would anyone want that embryo transferred into the uterus?”

Meanwhile, the Mississippi Pharmaceutical Association says its board discussed the issue last week and decided it did not merit any action on the board’s part. If the state bans certain types of contraceptives, “we would return these just like we would any other drugs,” said Bill Mosby, association president and fourth generation owner of a Canton drug store.

“It hasn’t really been all that significant of an issue.”

Eugene O’Donnell, association executive director, says pharmacists may soon be cutting back on orders for contraceptives.

Both Mosby and O’Donnell say they would prefer the state left the decision on dispensing birth control drugs and devices to the pharmacies.

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