Mental, emotional exclusion part of second day of abortion ban testimony
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Witnesses for the Indiana Attorney General’s Office on Thursday pushed back on claims that the state’s abortion ban harms women’s physical and mental health.
It was the second day of a bench trial in which abortion providers are seeking to broaden exemptions under Indiana’s near total abortion ban. The Attorney General’s Office, which represents the defendants in the case, called two expert witnesses Thursday.
The ACLU of Indiana — which filed the lawsuit on behalf of IU Health OB-GYN Amy Caldwell, Indiana’s Planned Parenthood, Women’s Med Group and All-Options Pregnancy Resource Center — is seeking to widen medical exemptions under Senate Enrolled Act 1 and strike down a requirement that stripped abortion clinics of their licenses to perform the procedures.
Facial and as-applied challenges
The plaintiffs already lost a facial challenge to the law, in which they claimed it was unconstitutional in its entirety. Now they are pursuing an ‘as applied’ challenge focusing on specific context..
But the state countered the suit doesn’t address a specific pregnant person’s situation, rather asserting the law should not be enforced against any pregnant Hoosiers in the future. While plaintiff witnesses testified that there were several situations where they were not able to provide abortions, the complaint does not name any specific patients or incidents.
Dr. Steven Ralston, a witness for the plaintiffs, said during his testimony Wednesday, the law will force physicians to delay care for many hours in order to seek clarification on how to comply with the law.
However, IU Riley Children’s Health Chief Physician Executive Dr. Elaine Cox, a witness for the defense, said in her testimony that IU Health provides various resources and procedures for providers who are unsure if their patient meets the law’s exceptions to receive an abortion. One way providers can seek clarification is through IU Health’s Reproductive Health Rapid Response Team — a team of physicians, legal experts and ethicists who can advise how providers should comply with the law.
The defense also asked Cox to read parts of several IU Health documents, including policies outlining how providers should handle potential abortion complications and filing appropriate documents.
During her testimony, Cox stated that abortion clinics are not as well-equipped to deal with potential complications as hospitals. She said that while many clinics have knowledgeable staff and physicians, hospitals have a wider range of physicians and emergency equipment in case of complications.
Additionally, Cox said she is not aware of any criminal investigations into IU Health physicians for performing abortions that have occurred after SEA 1 went into effect. She said she is aware of one licensing investigation regarding a physician’s potential violation of HIPAA but not related to performing the abortion itself.
Exclusion of mental and emotional conditions
The law allows abortions when necessary to prevent death or a “serious health risk” to the mother. But that exception does not extend to patients with mental health conditions who may require abortions either to protect their own mental health or continue taking necessary medication.
Dr. Leena Mittal, a Boston-based women’s psychiatrist and the plaintiffs’ final witness, said abortion is considered part of a “range of care” for mental health conditions. She testified that mental health conditions can evolve to become life threatening to the pregnant person. Mittal also said some serious mental health conditions — including postpartum psychosis and depression — can emerge after a patient gives birth.
When the state asked her if she would recommend abortion to treat “lesser” mental health conditions, such as minor depressive symptoms, Mittal emphasized that more context would be needed to decide if abortion was a reasonable treatment. Still, she said even minor depressive symptoms could still evolve to become life threatening.
However, Dr. Aaron Kheriaty, a California psychiatrist and witness for the defense, rebutted some of Mittal’s statements during his testimony. Kheriaty is the director of the Bioethics and American Democracy program for the Ethics and Public Policy Center, an institution dedicated to applying Judeo-Christian moral traditions to contemporary issues. For instance, Kheriaty said that, in his experience, symptoms associated with specific mental health conditions do not significantly vary between pregnant and non-pregnant women.
Kheriaty also said there is no empirical evidence to support any claims that receiving an abortion can improve mental health outcomes. Instead, he said his experience and clinical research — some of which he cited during testimony — show some patients can experience negative mental health outcomes after receiving an abortion, though he cautioned that the litigants should not generalize all women’s experiences.
“Even if the abortion was decades before, the grief, the tears, the feelings of regret right there can manifest,” he said about his experience speaking with patients who received abortions.
During cross examination, he said he has never referred a patient for an abortion and has not published any scientific articles on abortion.
During the first day of the bench trial, the ACLU called three plaintiff witnesses — Caldwell, Ralston and All-Options Pregnancy Executive Director Jennifer Parker Dockray. The witnesses testified that an exception allowing a person to receive an abortion only if the procedure is necessary to prevent death or a “serious health risk” to the pregnant person’s life was vague and narrow, leading to some patients not receiving care and a chilling-effect for doctors.
The plaintiff witnesses also described how a requirement that terminated licenses for abortion clinics and only allows the procedure to occur in a hospital or ambulatory surgical center restricted Hoosiers from accessing care.
The Indiana Capital Chronicle is an independent, not-for-profit news organization that covers state government, policy and elections.