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Health

How abortion ban exceptions muddy ethical care for pregnant patients

"How imminent must death be?"

woman in a doctor's office getting an ultrasound

Obstetricians are facing impossible dilemmas with abortion care in some states.

When the Dobbs decision overturned Roe v. Wade in the summer of 2022, experts warned that there would be medical consequences. Politicians have made abortion a black-and-white issue when it's a vast ocean of gray, and doctors are now stuck in dilemma after dilemma in states like Tennessee, which enacted some of the strictest abortion laws in the nation in the wake of Dobbs.

In Tennessee, it is now a Class C felony to perform an abortion. Exceptions are made for rape and incest, ectopic pregnancy, molar pregnancy, and if "the abortion was necessary to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman."

But as OB-GYN Sarah Osmundson explained on Radio Atlantic, that last exception is "very gray." Working as a maternal-fetal specialist at Vanderbilt University Medical Center, Osmundson serves on the abortion committee that decides whether a doctor has the green light to perform an abortion to save a mother's life or bodily function. In an interview with Hanna Rosin, Dr. Osmundson shared how making those calls can feel like an impossible task as providers walk the line between ethical care and the threat of legal action.

Osmundson explained that it's unclear what the exceptions to the law even mean because there's no predictable line for when a patient will cross over into imminent death or permanent injury. "It is a continuum of risk," she said. "Where is the cut point that we have to decide some aspect of risk is too high?"

Some cases are cut-and-dried, she said, but others present a conundrum for those who are tasked with assessing whether the risk to a mother's life or health is high enough to warrant an abortion. There are no clear thresholds, especially since risk assessment isn't an exact science.

She offered an example of a patient who has diabetes combined with an autoimmune condition, but they're both currently well managed, on top of kidney disease.

"You know, these are the kind of cases where we’re really trying to guess at: What is their risk of death or serious morbidity?" she said. "And even when I see these patients in the office, like, I can’t sit down with them and say, Your risk is X percent. I don’t have data to drive that individual case. Maybe their risk of serious problems in pregnancy is like 5 percent."

Osmundson pointed out that some patients choose not to screen for chromosomal abnormalities with an amniocentesis because there's a 0.1% risk of complication and they decide it's not worth the risk. "So we don’t do certain things because of very low risk. How am I to say that a risk of 5 percent is too low of a risk?" she asked.

Dr. Lisa Harris, an OB-GYN and professor at the University of Michigan, posed a similar questions to NPR shortly after the Dobbs decision was announced.

"How imminent must death be?" Harris asked. "There are many conditions that people have that when they become pregnant, they're OK in early pregnancy, but as pregnancy progresses, it puts enormous stress on all of the body's organ systems – the heart, the lungs, the kidneys. So they may be fine right now – there's no life-threatening emergency now – but three or four or five months from now, they may have life-threatening consequences."

Osmundson gave a specific example along those lines that posed a problem for some doctors on her committee. A woman was 14 weeks pregnant with a fetus that had no skull, which meant it had no chance of survival but an increased risk of excessive amniotic fluid, which could threaten the mother's life. Osmundson thought the case warranted an abortion, but others on the committee wouldn't commit, with one saying they weren't "brave enough."

The doctors were concerned about the way the decision would be scrutinized and the potential legal consequences if someone brought the case to court. Dr. Louise King, an OB-GYN at Boston's Brigham and Women's Hospital, had warned of this scenario when Roe v. Wade was overturned.

"Laws will exist that ask [physicians] to deprioritize the person in front of them and to act in a way that is medically harmful," King told NPR. "And the penalty for not doing so will be loss of license, money loss, potentially even criminal sanctions."

The reality Osmundson described in the Radio Atlantic interview demonstrates how prescient that warning truly was.

"I feel like I’m making a decision thinking about: How would our attorney general interpret this? How would the optics appear? And it makes me feel really uncomfortable, as a physician, that I’m considering care for the optics, rather than for what is right and best for the patient," she said.

Legal abortion ban exceptions like "to prevent the death of the pregnant woman or to prevent serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman" may sound straightforward to the average person, in the reality of medicine, it's not. Doctors aren't magicians or oracles, they don't have a crystal ball that tells them if a patient is going to live or die or be irreparably harmed—they make their best guesses based on their deep well of knowledge and experience, which lawyers and politicians deciding on legal boundaries don't have. Abortion restrictions and exceptions like Tennessee's force doctors to think as lawyers and lawyers to think as doctors when they don't have the training for it, all while people's lives hang in the balance.

The ambiguity in risk thresholds also makes these legal questions impossible to navigate. As Osmundson pointed out, a 5% risk is actually quite high, especially when it's your own life on the line. That's a hard enough choice for a person to make for themselves, much less a choice we should expect a doctor to make for someone based on political decisions and legal judgments made by people with no experience in the intricacies of medicine.

The challenges are even causing some doctors to leave states where they feel they can't care for patients properly. Kylie Cooper, MD was a maternal-fetal specialist who moved from Idaho to Minnesota in the wake of the Dobbs decision.

“My husband and I would talk about this every day. It was consuming us,” she told the AAMC. “What if I lost my license? What would happen to our kids if I went to jail? What about my guilt if I didn’t help a sick patient to my fullest ability? It was a nightmare. I didn’t feel I could remain a health care provider in a place where I couldn’t help a patient sitting right in front of me. It was unbearable.”

And for many, it doesn't seem to be a matter of making the law clearer. There are simply too many factors on an individual patient basis for more clarity in the law to even be possible, much less helpful, while also preserving a doctor's ethical standards of care.

So what's the answer?

The simplest answer is medical privacy—the protection that was provided by Roe. v. Wade—which was argued for and passed by the majority of Republican-nominated Supreme Court Justices, by the way—for doctors and patients together to decide on healthcare decisions without government interference. We were warned by doctors of what would happen when abortion laws were left fully up to each state, and now we're seeing those consequences play out in state after state.

After going through various challenging scenarios, Osmundson summed up the crux of the issue with two questions that every person ought to consider: "Do you want your cancer doctor to be considering the opinion of an attorney general when they’re making recommendations about your cancer care? Why would you want those kind of external things involved in your care during pregnancy?"

Listen to Dr. Osmundson's enlightening Radio Atlantic interview here.

Mel Robbins making a TED Talk.

Towards the end of The Beatles’ illustrious but brief career, Paul McCartney wrote “Let it Be,” a song about finding peace by letting events take their natural course. It was a sentiment that seemed to mirror the feeling of resignation the band had with its imminent demise.

The bittersweet song has had an appeal that has lasted generations, and that may be because it reflects an essential psychological concept: the locus of control. “It’s about understanding where our influence ends and accepting that some things are beyond our control,” Jennifer Chappell Marsh, a marriage and family therapist, told The Huffington Post. “We can’t control others, so instead, we should focus on our own actions and responses.”

This idea of giving up control (or the illusion of it) when it does us no good was perfectly distilled into two words that everyone can understand: "Let Them." This is officially known as the “Let Them” theory. Podcast host, author, motivational speaker and former lawyer Mel Robbins explained this theory perfectly in a vial Instagram video posted in May 2023.

“I just heard about this thing called the ‘Let Them Theory,’ I freaking love this,” Robbins starts the video.

“If your friends are not inviting you out to brunch this weekend, let them. If the person that you're really attracted to is not interested in a commitment, let them. If your kids do not want to get up and go to that thing with you this week, let them.” Robbins says in the clip. “So much time and energy is wasted on forcing other people to match our expectations.”

“If they’re not showing up how you want them to show up, do not try to force them to change; let them be themselves because they are revealing who they are to you. Just let them – and then you get to choose what you do next,” she continued.

The phrase is a great one to keep in your mental health tool kit because it’s a reminder that, for the most part, we can’t control other people. And if we can, is it worth wasting the emotional energy? Especially when we can allow people to behave as they wish and then we can react to them however we choose?

@melrobbins

Stop wasting energy on trying to get other people to meet YOUR expectations. Instead, try using the “Let Them Theory.” 💥 Listen now on the #melrobbinspodcast!! “The “Let Them Theory”: A Life Changing Mindset Hack That 15 Million People Can’t Stop Talking About” 🔗 in bio #melrobbins #letthemtheory #letgo #lettinggo #podcast #podcastepisode

How you respond to their behavior can significantly impact how they treat you in the future.

It’s also incredibly freeing to relieve yourself of the responsibility of changing people or feeling responsible for their actions. As the old Polish proverb goes, “Not my circus, not my monkeys.”

“Yes! It’s much like a concept propelled by the book ‘The Subtle Art of Not Giving a F**k.’ Save your energy and set your boundaries accordingly. It’s realizing that we only have “control” over ourselves and it’s so freeing,” one viewer wrote.

“Let It Be” brought Paul McCartney solace as he dealt with losing his band in a very public breakup. The same state of mind can help all of us, whether it’s dealing with parents living in the past, friends who change and you don’t feel like you know them anymore, or someone who cuts you off in traffic because they’re in a huge rush to go who knows where.

The moment someone gets on your nerves and you feel a jolt of anxiety run up your back, take a big breath and say, “Let them.”

let them theory, let it be, paul mccartney, the beatles, exhalethe beatles wave GIFGiphy

This article originally appeared last year.

A man and two women having a fun conversation.

There’s no one alive who doesn’t feel some anxiety about making small talk with other people. The difference is that some confront their fears because they know the incredible benefits that it can mean for their social life, romantic prospects, and careers, while some shy away and miss out on many opportunities.

Many people who avoid small talk believe those who excel at it are naturally charismatic or have been blessed with the “gift of gab.” However, many great conversationalists honed their skills and have a set of rules, techniques, and strategies they use when speaking to people, just like how people who do improvisational comedy or acting have a set of rules to follow to put everyone on the same page. Confident, sociable people may make engaging with others look effortless, but that’s because they have a strategy.

conversation, fun office, men and woman, funny conversation, jokes, levityA group of coworkers having a laugh.via Canva/Photos

What is the 30-second rule?

New York Times bestselling author and founder of the Maxwell Institute, John C. Maxwell, had a rule whenever he started a conversation: “Within the first 30 seconds of a conversation, say something encouraging to a person.” This can work in any social or professional situation, for example:

At work:

“Wendy, I heard you did great on yesterday’s conference call.”

“Frank, I hear the clients really love working with you.”

At a party:

“Mohammed, I really loved those pictures you posted on Instagram on your trip to Mexico.”

“Sang, are we going to get some of your incredible barbecue today?”

On a date:

“Thanks for choosing such a great restaurant, it has such a nice ambiance.”

“I really like the way your necklace brings out your eyes.”

date, conversation, laughs, jokes, salads, dinner, restaurant, cafeA man and woman joking on a date.via Canva/Photos

Whether you are complimenting, relaying positive information about the person, or encouraging them, the key is to pump them up and make them feel good about themselves. The 30-second rule fits nicely into Maxwell’s overall view of relationships: “Those who add to us, draw us to them. Those who subtract, cause us to withdraw,” he said.

The key to giving the other person encouragement is to do so genuinely. If you aren’t genuine with your compliments or words of encouragement, your words can have the opposite effect and make the other person feel like you are being condescending.

How does encouragement make people feel?

encouragement, poeple in blue shirts, luaghs, my bad, smiles, supportive peopleA man making a joke with other people in blue shirts.via Canva/Photos

Studies have shown that when people hear words of encouragement, they feel good and have a burst of energy. Psychologist Henry H. Goddard studied tired children and found that they had a burst of energy when he said something encouraging to them. But when he said something negative, they became even more tired.

Ultimately, a direct connection exists between being likeable and being genuinely interested in other people. William King said, “A gossip is one who talks to you about other people. A bore is one who talks to you about himself. And a brilliant conversationalist is one who talks to you about yourself.”

Every time you start a new conversation with someone, take the opportunity to share some words of encouragement with the other person, and you’ll be on your way to being seen as a brilliant conversationalist.

A woman holding back her laughter.

One of the biggest topics in parenting these days is the mental and physical drain that comes with being the default parent in a family. The default parent is the one who is first in line when it comes to taking responsibility for parenting duties, whether that means making doctor’s appointments, ensuring the homework is done, or making sure the child has enough socks to make it through the week.

Being the default parent can lead to fatigue and burnout, and the parent can experience incredible anxiety when their attention turns away from the household or family. The situation is even worse when the default parent’s partner only does the bare minimum. Unfortunately, in American society, fathers are often the parents who do just enough to get by and are praised for it.

The notion that men don’t have to pull their equal weight in American family life is so ingrained that when Emma Hughes, a travel nanny with over one year of experience in childcare and family support, visited Sweden for two weeks, she experienced extreme culture shock.


"I've been in Sweden now and I think I've been ruined for American men," the 24-year-old said in a viral Instagram video. "Specifically raising a child with an American man in America, because these Scandinavian dads? Chef's kiss …"

"I'm actually embarrassed to talk about this because all of the observations that I've made have really revealed to me how deeply ingrained [expletive] dads have become like in my brain, and it's just like the default,” she continued.

The notion that fathers only have to do the bare minimum was so ingrained in Hughes’ psyche that she couldn’t understand seeing so many involved fathers in Sweden.

sweden, swedish dad, swedish fathers, soccer, swedish childA dad playing soccer with his child.via Canva/Photos

"When I see more dads pushing their strollers in the park on a Saturday morning than moms, what does my brain think … That's weird, there is something abnormal about that,” Hughes said. “When I see dads at the grocery store with their kids. When I see dads out at restaurants or in public. It is so deeply telling of a lot of subconscious stuff that I have going on in my brain after working with so many families."

She said that even the best dads she's worked with in America would be considered the "Scandinavian bare minimum." She applauded one Swedish father who purchased a new size of diapers for his baby without being told to do so by his partner.

swedes, swedish couple, scandanavia, swedish flag, happy swedesA couple holding up the Swedish flag.via Canva/Photos

"Like I watched a Swedish dad go to the grocery store and come home with like four bags of groceries and in that trip he had bought size two diapers for a baby that had previously been wearing size one and was ready to move into size two but that conversation had not happened between the mom and the dad,” she said.

Given Swedish dads' dedication towards their parenting responsibilities, it’s fair to assume that their partners are much happier and stress-free than those in the States. But what about their kids? Researchers at the United Nations who studied “child well-being in rich countries” found that Swedish fathers also ranked high by their children. The survey asked children in 28 countries if it was easy to talk to their dads, and while 67% of children in the study said their parents were easy to talk to, Swedish fathers scored higher at 72.4%. Meanwhile, the U.S ranked 25, out of 28, at just 59.7%.

sweden, swedish dad, swedish fathers, swedish child, dad reading note, A Swedish dad reading a note. via Canva/Photos

Ultimately, Hughes makes an important point that Scandinavian men have set a high bar for being fathers and that American men need to step up. The positive sign is that in America, the discussion around default parenting has been getting louder and louder, and hopefully, that will prompt more American men and women to set higher expectations so that one day, American men can catch Sweden’s.

Celebrity

Actor Christian Bale helps build foster 'village' to keep siblings in foster care together

"This will be one of the things that I'll be most proud of when I draw my last breath."

CBS Sunday Mornings/YouTube

Christian Bale builds foster home to keep siblings together called Together California.

Actor Christian Bale has found a calling beyond Hollywood. TheBatman star, 51, opened up about his mission to keep siblings in foster care together through Together California, a foster home community under construction in Palmdale, California.

In an interview withCBS Sunday Morning, Bale shared how he became passionate about helping children in foster care, and more about the home's construction process. Citing research that nearly 75 percent of siblings in foster care are separated, Bale explained how terrible it made him feel.

"And so you imagine the trauma of that, you know? But added trauma to being taken from your parents, and then you lose your siblings, you know, that's just something that we shouldn't be doing," he told CBS Sunday Morning correspondent Tracy Smith.

- YouTubewww.youtube.com

Bale did not grow up in foster care or have any personal ties to it. "I don't think you have to have any connection to foster care in your past. It's just about the basic understanding that as a society, how can we not take care of our children?" he said. "So I don't think it requires a connection. It just requires having a heart."

However, becoming a father 17 years ago to his daughter Emmeline with his wife Sibi Blažić (he also has a son, Joseph), changed his perspective. Bale began to look into foster care, and connected with a man in Chicago named Tim McCormick, who had run foster care homes for decades.

The duo created Together California, a unique model for foster homes. Siblings will stay together in individual houses around a central garden, and will be cared for by trained foster parents whose only job will be to look after them. It is a $22 million project, which "includes 12 homes, transitional housing, and a community center, aiming to provide stability and support for vulnerable children."

The home is being designed by architects AC Martin. They broke ground on the project in February 2024. "I love designing. I love architecture," Bale added. "So I adore the whole design process. And so actually seeing it really–coming to happen is just very, very exciting."

While Together California is still under construction, the goal is to welcome the first foster children early next year. With additional funding being raised (actor Leonardo DiCaprio is an investor), Bale is chomping at the bit to see it officially opened after 17 years in the making. "Ignorance is bliss. If I'd have known it would be 17 years [to open], I still would have done it," he says.

And for Bale, it's much more than a passion project. "This is something that when, you know, I'm closing my eyes for the last time. I wanna look and say...think about, 'Did I do some good? Did I make any changes in the world that were useful?' And this will be one of the things that I'll be most proud of when I, you know, draw my last breath," he said.

In another video shared by CBS Sunday Morning on Instagram, Bale called the project, "Transformative, magical and soulful. And it's going to change children's lives completely."

Innovation

Welcome to the world of hyper-realistic silicone masks

The amazing disguises in "Mission Impossible" aren't as unrealistic as you think.

Canva Photos

Masks have gotten so good, 1 in 5 people can't even identify one.

In the Mission Impossible movies, you can never quite trust anything you see. That's because the films make liberal use of futuristic and wild fictional mask technology. At least, I thought it was fictional.

With a simple scan or photo of someone's face and a machine that fits in a briefcase, Ethan Hunt (Tom Cruise) and his team can 3D print a mask that's 100% indistinguishable from the real thing. Add in a little extra technology that helps the spies mimic others' voices and you've got the perfect disguise. Cruise can walk amongst the bad guys without fear, and his costars get the fun challenge of playing Tom Cruise playing themselves! It makes for incredible entertainment.

I've always loved the movies and understood that part of the viewing experience is learning to suspend my disbelief. The gadgets, stunts, and disguises are a lot of fun, but pretty out there.

And then I saw this video, and it opened the door to the new, and more than a little frightening, world of hyper-realistic silicone masks.

In the clip shared by Science Girl on X, a man tries on a lifelike mask in real time, sliding it over his head, and in just a moment and with one small wiggle of the nose, he's completely transformed. I thought for sure the whole thing had to be AI-assisted, but no. The clip originated from a mask manufacturer called FL Silicone Mask. They've got tons of demonstrations all over their Instagram page.

The final result of this mask in particular is a little unnerving, a little uncanny valley. There's something off with the way it looks but it's really hard to say what. The details are incredible, the eye-sockets seamless. The mouth can even move open and closed.

In passing, without looking for it, you'd probably never have any idea that this person was wearing a mask. Just see for yourself. It's no wonder the post clocked over 27 million views on social media.

Realistic masks like this one have actually been researched. Studies have shown that about one in five people can be fooled by someone in a realistic silicone mask.

A research study out of the Universities of York and Kyoto asked volunteers to look at photographs of people wearing a realistic mask, and photos of people not wearing a mask. They had to guess which was which, and an astonishing 20% of the selections turned out to be wrong. Considering this was a controlled environment where participants were actively looking to see if someone was wearing a disguise, it's even scarier to Imagine how easy it would be to get fooled in real life when you aren't on your guard.

- YouTubewww.youtube.com

The technology for hyper-realistic masks has grown by leaps in bounds in recent years. The fit and detail work on them is astonishing, so much so that it's becoming cause for concern.

While Tom Cruise uses his disguises to save the world, not everyone is so altruistic. Police forces all over the world are facing more and more challenges with criminals using creative camouflage.

The "Geezer Bandit" once terrorized San Diego banks for years, robbing them while disguised as an old man. He or she was never caught.

Realistic silicone masks are expensive, usually costing several thousand dollars, and good ones are hard to find. Mesh masks that can be worn under a hoodie are a lot more cost-effective and incredible at fooling security cameras from a distance. Worse yet, masks can be made in the likeness of almost any person, making identity theft a serious concern.

There might be a bright side to this bizarre technological advancement, though.

For years now, wigs have been helping people with various forms and causes of hair loss find their confidence again. It's a chance to blend in with the public and not feel othered by stares or field any questions. It allows people to just exist the same way anyone else does.

Masks haven't been able to do the same thing because, well, they've always looked like masks. But you have to wonder if the technology has finally reached a tipping point where they too could become a source of confidence and normalcy for people with facial deformities or disfigurations.

When mangled soldiers were returning from WWI by the hundreds, a British sculptor named Francis Derwent Wood opened up a shop that specialized in creating masks that would hide their scars. According to Forces News, "Wood's painted metal mask work was an attempt to give back to veterans the sense of self-worth and pride they once had in their appearance and help them 'fit in' back on civvy street."

Maybe these stunningly-accurate silicone creations could do that for a new generation of people who could use a little help feeling like themselves again. No one should ever feel like they have to wear a mask or hide their face. But if you're going to wear one, it might as well be the best quality you can find!