On June 24, 2022, the Supreme Court of the United States (SCOTUS) issued a decision in the Dobbs v. Jackson case, which reverses the 1973 ruling on the Roe v. Wade case and returns the question of the right to access abortion services to the States, among other issues. There have been a variety of discussions about this ruling and the effect on abortion services all over the media, on social media, in homes, in protests, and I suspect that will continue. Some organizations have made statements and taken positions on this issue, while others have remained silent.
At Project Life, we are focused on those of us in the Metastatic Breast Cancer (MBC) community and so this article will be focused on the impact on our community.
First of all, it's important to remember the Dobbs v. Jackson decision only removes the federal right to privacy and doesn't actually directly impact access to abortion services. While this may be strange legal semantics to most, it is important to understand that the decision means that each individual State now has more power to issue or update existing laws enacted before or after Roe. Depending on where a person able to carry a child lives, their experiences and access to care may be wildly different.
The extreme differences between States can mean life or death for cancer patients already facing the most difficult event in their lives.
Secondly, the federal right to privacy has created a body of law that affects nearly everyone. The Justices have already indicated that the decision in Dobbs will mean an examination of a variety of decisions and issues, including IVF, contraception, access to health information, protected classes, gay marriage, and others. In essence, removing that federal right to privacy could be viewed as the first domino in a long train of dominoes that will be falling in the future, all of them affecting cancer patients and limiting options.
The Dobbs decision creates and will create a plethora of issues for cancer patients in the present and the future, complicating an already complicated and difficult experience.
Let's start with the present ...
A cancer patient who finds themselves pregnant or is diagnosed while pregnant faces decisions and concerns roughly double that of the cancer patient who is not pregnant because there are two entities involved. Getting a diagnosis of breast cancer while pregnant (or indeed in the postpartum period as well) can be really difficult since there are already so many changes to the body and the breasts. There are also only a few cancer treatments that the placenta can filter, which then limits the choices available for treatment, additionally, there are few tests that don't affect the pregnancy, limiting the medical team's ability to see and treat metastases. Further, a pregnant person's immune system is already affected by the pregnancy, affecting the body's ability to respond to any invader.
Bottom line, a pregnancy complicates the diagnosis and treatment of breast cancer, affecting the life and health of both entities involved; these complications limit options and treatments available, which is a life or death issue.
An oncology doctor, who I respect and follow on social media, has identified the issues in a tweet that I think sums up these challenges well:
And so, in the present, cancer patients finding themselves pregnant at the time of diagnosis, during treatment, or beyond, will be faced with difficult decisions with options limited or expanded depending on where they live. Those people with money and resources will likely be able to travel for the treatment they desire, whereas those who do not will need more assistance or may seek out solutions that endanger their lives. The end result of these geographical and socioeconomic differences will almost certainly mean that the poor, the disabled, the black and brown, the disenfranchised, and those in most need of help, will be disproportionately negatively affected.
The disproportionate negative effect on the neediest in our population as well as our black and brown sisters is one of the outcomes of the Dobbs decision that concern us the most.
And now, let's turn to the future ...
Without sounding too alarmist, the indications thus far appear that SCOTUS will be examining other cases that flow from the federal right of privacy that has now disappeared. It is likely that individual States will do the same now that the constitutional foundation for those decisions has been dismantled. Issues that affect cancer patients directly include fertility preservation, surrogacy, IVF, access to health care information, LGBTQ rights, etc.
Since the landscape is still uncertain with regard to these issues, we recommend that MBC patients who are concerned about these issues do the following:
1. Ensure that your Powers of Attorney and Surrogate documents are updated and correct. These documents ensure that your selected person(s) are able to access health information and can make many different decisions on your behalf. It is possible that access to marriage for same sex couples may not control these decisions in the future. A legal document can address these concerns and sharing your specific preferences with those family members who might feel the need to intervene is also recommended.
2. If you are in the middle of fertility preservation or have eggs/embryos saved for the future, you should pull your contract with the storage company and be sure you are familiar with what is covered or not. It is possible that changing the location of storage may be important depending on where you live. Those storage companies likely have been looking into these issues or may have a plan in place, so asking questions at this point is key.
3. If surrogacy or other fertility options are being considered, a review of the laws and regulations in the applicable States involved would be important, and consulting with an attorney familiar with fertility and surrogacy regulations could be key.
4. Breathe. Gathering information is the only thing you can do right now to be able to make the best decision when that decision must be made.
5. Share. If any of these categories apply to you and you have found solutions, share that with your MBC friends. The value of our community is that we can support each other.
The final thing I will mention is that there are many different organizations and concerned professionals across the country who have known this decision was coming. Remedies have been discussed and may be more available than we realize at this point. Before taking individual action, check with local or State organizations that have created plans and consider volunteering or donating to those organizations. We are stronger together!
If you have questions or concerns about how the Dobbs decision or other legal issues affect your treatment, please don't hesitate to contact us at Project Life.
Abigail Johnston, Esquire
Director of Mentorship