Ethical Dimensions of Infant Abandonment Laws in a Post-Roe America

Transcript

• 00:00OK, great. Hello and welcome
• 00:02to the Program for Biomedical
• 00:04Ethics evening seminar series.
• 00:05For those in Zoom, we're working
• 00:07on getting the video started,
• 00:09but in the meantime,
• 00:10you can all hear my voice.
• 00:12Just a quick introduction,
• 00:13I'm for those, I don't know,
• 00:15I'm Jennifer Miller.
• 00:15I'm the Co Director of the Program
• 00:17for Biomedical Ethics with Mark Mature
• 00:19and our wonderful leadership team and
• 00:21Associate Professor here in Internal
• 00:24Medicine and Biomedical Informatics.
• 00:25Tonight we have a fantastic speaker,
• 00:29our own Laurie Bruce.
• 00:31Laurie Bruce is the Associate
• 00:33Director and a bioethicist in the
• 00:36Interdisciplinary Center for Bioethics
• 00:38here at Yale and affiliated faculty
• 00:40at the Solomon Center for Health
• 00:42Law and Policy at Yale Law School.
• 00:44She's also an adjunct faculty member
• 00:47in the Bioethics Program at ICON
• 00:48School of Medicine at Mount Sinai,
• 00:50where she teaches courses on
• 00:53ethical policy making methods.
• 00:55Lori's also the founder of the
• 00:57Community Bioethics Forum here
• 00:59at Yale School of Medicine and
• 01:01on the leadership team at HOPE,
• 01:02a Psychedelic Ethics Institute at
• 01:04Oxford Center for Practical Ethics.
• 01:06She's a contributing editor for
• 01:08the Hastings Center Report and the
• 01:11Associate editor for Disability
• 01:13Inclusion and technology for
• 01:14the Journal of Human Technology
• 01:17Relations here at Yale.
• 01:18She also directs Yale Summer
• 01:20Institute in Bioethics.
• 01:21Serves on one of our IR BS and on both
• 01:26the Pediatric and Adult Ethics committees,
• 01:28the latter of which she chaired or
• 01:31she Co directed for three years.
• 01:34Her work has been published
• 01:35widely in journals including the
• 01:37Hastings Center Report,
• 01:38The American Journal of Bioethics
• 01:40and the Journal of Medical Ethics.
• 01:42And her scholarship has been
• 01:43covered by the popular media,
• 01:44some of which you might have heard,
• 01:46including the New York Times.
• 01:49Today, we have the great pleasure of
• 01:52hearing Lori Bruce talk about ethical
• 01:54dimensions of infant abandonment
• 01:55laws in a post row America.
• 01:58Thank you, Lori, and welcome.
• 02:08Hi everyone. Thanks so much for being here.
• 02:13Can you all hear me? OK, Great. OK.
• 02:17Thanks, Jen, for the warm welcome
• 02:20and I'm delighted to be here.
• 02:23So today we're going to talk about infant
• 02:26abandonment laws in post row America.
• 02:31I'll talk for about 45 minutes. Yeah.
• 02:33OK And then we'll open it up for some Q&A.
• 02:36Today we're going to discuss the
• 02:38ethical tensions related to infant
• 02:41abandonment within the United States.
• 02:43We'll talk about some recent trends,
• 02:45including the increasing,
• 02:47exponentially increasing numbers of
• 02:49infant abandonment baby boxes here in
• 02:52the US and we'll also touch upon some
• 02:55legislative improvements based on global
• 02:57best practices to increase the well-being
• 03:01and health of not only the infants,
• 03:04but the birth parents.
• 03:07So why are we talking about
• 03:10infant abandonment today?
• 03:11So I've examined these laws for many years
• 03:14and in our current political climate,
• 03:17we have this confluence of factors
• 03:19which leads to an increased
• 03:21need for these safety net laws.
• 03:23But this topic is also a good example of
• 03:25how policy making could benefit from a
• 03:28little bit more structure and process.
• 03:30And so we're going to use this topic
• 03:33as a bit of an example to kind of
• 03:35show how the fields of bioethics and
• 03:38policy analysis could merge together
• 03:40and help us to not only better
• 03:43serve stakeholders who are impacted
• 03:46by health law and health policy,
• 03:48but also to increase Community Trust
• 03:51in these kinds of dire topics.
• 03:54And so the methods I'll discuss
• 03:56today are easily applicable not
• 03:58just within public policy,
• 03:59but also within institutional
• 04:01policy settings such as IR, BS,
• 04:04hospital policy and other kinds
• 04:08of healthcare organizations.
• 04:11So parents are not permitted
• 04:14to abandon an infant,
• 04:16but some parents are unable to care for them,
• 04:19and so each state has a legal means
• 04:23of surrendering an unwanted infant.
• 04:26Texas was the first state to
• 04:28pass a safe haven law.
• 04:30That was back in 2000,
• 04:32and other states quickly followed
• 04:34within the next eight or nine years.
• 04:37And these laws always have
• 04:40strong bipartisan support.
• 04:41And since their passage,
• 04:454707 infants have been surrendered
• 04:49through these laws and another
• 04:541700 have been abandoned outside
• 04:56of the mechanisms of the law.
• 05:00And about 55% of those when found
• 05:04sadly had already passed away.
• 05:06And that's since 1999 two thousand.
• 05:10So our numbers are likely under
• 05:12reported because it's hard to track
• 05:15and because states aren't required
• 05:17to categorize or track them.
• 05:22So infant abandonment and neonioside
• 05:24have always been a part of
• 05:27society and getting this feedback.
• 05:33All right, let's Yeah,
• 05:35it's still coming. It's me.
• 05:42Are we OK now? OK, we're good.
• 05:45All right, so, so unwanted pregnancies
• 05:48happen to people of all religions,
• 05:51socio economic levels and races and
• 05:54at risk Parents face intolerable
• 05:57social or economic consequences
• 05:59to just for being pregnant or
• 06:03sometimes for having another child.
• 06:05And so that's why these laws were
• 06:08created and they offer a fast track
• 06:12adoption to a pre approved family
• 06:14that's been very heavily screened
• 06:17and it triggers the rapid cessation
• 06:19of the birth parents rights.
• 06:22Families want safe haven babies.
• 06:25This rapid cessation of the birth
• 06:29families rights create an environment
• 06:31such that the adoptive families feel
• 06:34that these babies are, you know,
• 06:36less risky or these adoptions are
• 06:38less risky or less complicated
• 06:40than a traditional adoption.
• 06:42But there are a lot of gotcha
• 06:44clauses in these laws.
• 06:45And so the surrendering parent,
• 06:47for instance,
• 06:48is not entitled often to legal immunity
• 06:51unless they follow the letter of the law.
• 06:54And some of the clauses,
• 06:56for instance,
• 06:56are that the infant can't suffer any harm.
• 07:00And that seems reasonable until
• 07:02we think about the conditions
• 07:05under which these births happen.
• 07:08And when a birthing parents is trying
• 07:11to hide A pregnancy or is unable to
• 07:14have that disclosed in their medical chart,
• 07:17they're not going to be giving
• 07:19birth in a hospital.
• 07:20It's going to be somewhere private
• 07:23where they have no assistance.
• 07:25And so it's really tricky to sometimes
• 07:29know what harm means in the law.
• 07:31And so a lot of families are
• 07:33scared away by these laws.
• 07:36And in certain states,
• 07:38such as Texas,
• 07:40even if someone follows the absolute
• 07:42letter of the law and transitions the
• 07:47baby in the specific location within
• 07:51the certain amount of within the
• 07:54specific time frame and all of the
• 07:56other components of that state's law,
• 08:00in places like Texas,
• 08:02there's still no guarantee
• 08:03of immunity from prosecution.
• 08:05So when these laws are closely examined,
• 08:09they're often called impulsive responses.
• 08:11They're called empirically doubtful
• 08:13of dubious efficacy and akin to a
• 08:17mere Band-Aid of on top of some
• 08:22policies that make things really
• 08:25difficult for families in this case.
• 08:27And so there's a good amount of
• 08:30literature on how to implement policies
• 08:32to reduce the numbers of unwanted
• 08:35births and unwanted pregnancies,
• 08:37literature that's not often read by the
• 08:40legislators who are writing safe haven laws.
• 08:43These laws are state based and
• 08:45many states only have a part time
• 08:48legislative window and these are
• 08:50short windows to design law which
• 08:52promote hastily written policies.
• 08:54Like here in Connecticut we have a very
• 08:56short window and when that legislative
• 08:58window opens people just have to try
• 09:00and pass something really quickly in
• 09:02the in the amount of time they have
• 09:05garnering support from stakeholders and
• 09:08not able to kind of have a very thoughtful,
• 09:11slow process.
• 09:11So, but what we do know is that
• 09:14there are all sorts of things that
• 09:17can reduce unwanted births including
• 09:20access to reproductive education,
• 09:22access to contraception and abortion
• 09:25and affordable prenatal support.
• 09:28But in many places in the US right now,
• 09:31the current conditions don't permit many,
• 09:35if any,
• 09:36of of these important policies.
• 09:39And in fact,
• 09:40more than 19,000,000 women here
• 09:42in the US of reproductive age
• 09:44are in need of publicly funded
• 09:46contraceptive contraception.
• 09:48But they're living in what's
• 09:50called a contraceptive desert.
• 09:54So another gotcha clause of safe
• 09:57haven laws relate to the tox screen.
• 10:00The public often believes that the
• 10:02surrendered child is going to go to
• 10:05one of the pre approved happy homes
• 10:06that often makes the appearance on TV.
• 10:08We've all seen these stories on
• 10:10the news and they're they're
• 10:12positioned as as really warm,
• 10:14happy kind of news stories, right.
• 10:17But they don't know that there's a
• 10:19whole process behind the scenes when
• 10:22a baby is potentially going to go
• 10:25down the safe haven policy track.
• 10:27And so if an infant has been
• 10:30presented as a safe haven baby but
• 10:32is positive for their talk screen,
• 10:35they are not eligible for
• 10:37safe haven in most states.
• 10:39Instead,
• 10:39they are moved into the foster care system,
• 10:42which has a very different approach.
• 10:45And often those those little ones are not
• 10:50getting assigned to their permanent home
• 10:52until right around the one year mark,
• 10:55which puts children,
• 10:56as we know,
• 10:57at risk for a lot of social
• 11:00and behavioral challenges.
• 11:01So we see disparities in placement.
• 11:04We're also seeing in this post Dobs world
• 11:09increases in unplanned and unwanted births.
• 11:12And we're also seeing the profile
• 11:14of the traditional parent who the
• 11:17parent who would more like be
• 11:19more likely to surrender a child
• 11:21is no longer an extreme outlier.
• 11:26And there's lots of data,
• 11:27that data that I could talk about today.
• 11:29But part of what I'll just kind of
• 11:31quickly go through is that there is
• 11:33the national Safe Haven hotline and
• 11:36there's been a very steep rise in
• 11:38the number of calls to this hotline.
• 11:40And that's a very strong predictor
• 11:42of the increased numbers of children
• 11:45who will be abandoned in 2000.
• 11:50In 2021, they had they were getting
• 11:53right around 500 calls a year and that
• 11:56was their pretty consistent number.
• 11:58But starting in 2022,
• 12:00those calls have doubled and they
• 12:02haven't and they've been consistently
• 12:04right around the 1000 mark per year.
• 12:07Also, we know that there are a number.
• 12:08There's a rise in the number
• 12:10of births in restricted states.
• 12:12Approximately 32,000 additional annual
• 12:16births are resulting from abortion bans.
• 12:20That number does seem high,
• 12:23but I I have seen it in a number
• 12:25of studies but it's still it still
• 12:27seems quite high to me.
• 12:29We also know that there's a rise
• 12:31in the number of rape related
• 12:33pregnancies in restricted states.
• 12:35Nearly 65,000 survivors of rape within
• 12:38the US could not get an abortion in
• 12:41their States and stops been passed.
• 12:46So if we assume that you know that we,
• 12:49we know that the rape related pregnancy
• 12:51rate is usually right around 5%.
• 12:53So that's about 3200 births and stabs
• 12:57just from sexual assaults alone.
• 13:02We're also seeing a rise in a new phenomenon,
• 13:04but in some European countries like Finland,
• 13:09there's this idea of a baby box.
• 13:12Every pregnant person receives a baby box,
• 13:15and it's a starter kit.
• 13:17It gives you infant essentials,
• 13:19It helps give all babies
• 13:21an equal start in life,
• 13:23and it helps to reduce infant
• 13:25mortality rates from sits.
• 13:26But baby boxes in the United
• 13:29States look different.
• 13:31Baby boxes here mean something
• 13:33different because there are now
• 13:35these privately funded baby boxes
• 13:36that are modern versions of the
• 13:39medieval abandonment wheels that are
• 13:40being installed in so many states
• 13:43that some say they're actually
• 13:45shaping a national infrastructure.
• 13:49They do not have any kind of testing
• 13:52protocol that has been approved by the FDA.
• 13:55It's just the testing that the
• 13:59designer is doing on their own.
• 14:01And there have already been 37
• 14:04survivor surrenders to these boxes.
• 14:06And here's what they look like.
• 14:09There are 186 of these boxes in the
• 14:13United States right now and just
• 14:15six months ago when I was giving
• 14:17another talk on this subject,
• 14:19there were 138.
• 14:20So it gives you a sense as to how they're,
• 14:23they're really exponentially
• 14:24growing right now.
• 14:26And then the local groups who are usually
• 14:31local churches that raise the funding
• 14:34through PIE sales and through local,
• 14:36local events, they,
• 14:38they raise the funds for these
• 14:41boxes and then they reach out to
• 14:43their legislators and they say,
• 14:44look, you know,
• 14:45we want safe haven laws to be
• 14:48updated to include these boxes.
• 14:50And indeed that's been happening.
• 14:53And I think it's,
• 14:55you know,
• 14:56part of the story here is that the
• 14:58groups that are pushing for that
• 15:00kind of a change to the law may
• 15:03not necessarily be representative
• 15:05of a state's constituents.
• 15:08So some of the states where these
• 15:10laws are being updated to permit
• 15:12these baby boxes include Arkansas
• 15:16and Pennsylvania and Virginia and
• 15:19Ohio and Indiana and and Louisiana.
• 15:23There are over 100 baby boxes for
• 15:27abandonment in Indiana alone.
• 15:30And to put it in perspective,
• 15:31there are 104 Dunkin' Donuts in Indiana.
• 15:35So they're just about as many places
• 15:37to surrender an infant as there
• 15:39are places to get a cup of Joe.
• 15:42And
• 15:44and and other states certainly don't
• 15:47have the numbers that Indiana does
• 15:51because Indiana is where the founder
• 15:54of these boxes resides and has worked
• 15:57with a number of church groups.
• 15:58But we are seeing numbers
• 16:00in many other states rise.
• 16:02There used to be a national calendar,
• 16:05but it's not up right now.
• 16:07So it's really interesting to learn about
• 16:12how these boxes have been rolled out.
• 16:15They're around 20,000 apiece,
• 16:18and so that totals around 3.7 million.
• 16:23Indiana plans to install more,
• 16:26having recently approved an additional
• 16:281,000,000 in baby box funds.
• 16:31But we also know that 19% of single
• 16:33moms in Indiana live in poverty.
• 16:36We know that many don't have access
• 16:39to birth control or abortion.
• 16:41We know that half of all pregnancies
• 16:44in Indiana are unwanted or unplanned,
• 16:47and there's no access to anonymous
• 16:50labor or delivery.
• 16:51And so these circumstances
• 16:53are perhaps not accidental,
• 16:55but the result of current laws and
• 16:57policies and reflective of parent
• 17:00circumstances across the country.
• 17:02Some suggest that these baby box funds
• 17:05could instead have financed accessible
• 17:07birth control or perhaps childcare,
• 17:09so that the parents could then
• 17:12keep the babies and seek employment
• 17:15and become self-sufficient.
• 17:17Some say that the scaled up use of
• 17:20baby boxes is a sign that people are
• 17:22increasingly placed into unwanted childbirth.
• 17:25And others are saying that perhaps
• 17:27there are an indicator of mistrust
• 17:30between communities and state sponsored
• 17:32services because perhaps due to bias
• 17:35or judgment people don't always feel
• 17:37safe at the other safe surrender sites
• 17:39like the fire station and hospitals.
• 17:43And so baby box policies are
• 17:47fast tracking these children to
• 17:50pre approved economically secure
• 17:52families while the birth parents
• 17:54rights are rapidly terminated.
• 17:57So some say that perhaps these
• 17:59baby boxes show that while we may
• 18:02care a lot about the babies,
• 18:04we might not be extending this care to the
• 18:07birth parents or to struggling families.
• 18:10The media is full of stories that
• 18:13celebrate the surrendering parents
• 18:15as being heroic or selfless.
• 18:17But the stories don't mention how the
• 18:20birth parent might be hemorrhaging
• 18:22or developing complications from
• 18:24having birthed alone without access
• 18:27to medical care or trauma counseling
• 18:30out of fear for being discovered.
• 18:33And so some of my community members,
• 18:38who have analyzed a number of different
• 18:41policies with me and provided community
• 18:43feedback on a number of health policies,
• 18:47have mentioned how these women are
• 18:49not just incubators to complete
• 18:51other people's families.
• 18:53And so we know that because
• 18:55of the rollback of Roe,
• 18:57economists anticipate 3040,
• 18:59some even as high as 50,000 additional
• 19:03unplanned or unwanted births annually.
• 19:06So this means that current U.S.
• 19:09policy is contributing to 10s
• 19:11of thousands of family families
• 19:14that are experiencing grief and
• 19:16anxiety and sometimes trauma.
• 19:22So it begs the question of who's
• 19:24worthy for these government resources,
• 19:27something that I talk about
• 19:28in a number of articles.
• 19:32And so when we consider the idea
• 19:35of an ethical policy making,
• 19:37we perhaps want to consider
• 19:40whose values matter,
• 19:41whose interests matter and what what
• 19:44values are guiding our policy design
• 19:47and whether or not our policy design
• 19:50is even actualizing our policies goals.
• 19:54And what are the goals of safe haven anyhow?
• 19:56And so you know, when we write
• 19:59institutional policy and public policy,
• 20:01we often talk to our colleagues who
• 20:03are in who are in similar positions,
• 20:05and then we replicate those policies.
• 20:07And sometimes that can work,
• 20:09but sometimes, like in this case,
• 20:11a copy and paste approach
• 20:13isn't benefiting those who are.
• 20:17Being impacted by the policy.
• 20:19And so in my bioethics work,
• 20:21I've increasingly leveraged my policy
• 20:23analysis background to kind of
• 20:25bring the world's of policy analysis
• 20:28and bioethics closer together.
• 20:29And so when I'm working with
• 20:32legislators or hospitals,
• 20:33I tend to use a logic model that
• 20:36helps us to step back and define
• 20:39and engage with our stakeholders
• 20:41and really consider what a policy's
• 20:43short and long term goals are.
• 20:45So the root of all policy analysis
• 20:48methods are to think about what
• 20:50does a policy do so that we can get
• 20:53something out of the policy right?
• 20:55So if I'm writing a policy to try to
• 20:58decrease children from using vaping pens,
• 21:00we would say OK,
• 21:02we want to create an age limit or
• 21:04create some kind of carrots and sticks
• 21:07to get the results that we want,
• 21:10which is less children vaping.
• 21:12So similarly here,
• 21:15in any kind of logic bottle,
• 21:16we want to not only think about
• 21:18the DO and the get,
• 21:19but I encourage us to also consider
• 21:24what values are the ones that should
• 21:27be shaping any specific policy,
• 21:29and therefore who ought we include
• 21:32to achieve those values.
• 21:34And these aren't usually explicit
• 21:37questions and institutional policy making.
• 21:39But I find that this method
• 21:42is often quite helpful.
• 21:44And we're not thinking about the
• 21:46values of any individual in the room,
• 21:49but we're thinking about what values
• 21:51should undergird any specific policy.
• 21:56So I find that a critical addendum
• 21:58to this work is to document the
• 22:01assumptions that are underlying
• 22:03any policy that you are developing.
• 22:05And even though it's those
• 22:07are fairly documented.
• 22:09And it might even seem a little
• 22:10silly to take the time and say
• 22:12what are what are we assuming when
• 22:14we're writing these policies?
• 22:16Documenting our assumptions
• 22:18helps us to examine whether our
• 22:20inherent beliefs are on track
• 22:25and so placing a value on
• 22:28collaboration and inclusion over time.
• 22:30I've engaged with multidisciplinary
• 22:32stakeholders across the US about these laws.
• 22:35I've spoken with many community members,
• 22:37including my Community Bioethics Forum,
• 22:40high school students including a
• 22:42wonderful bioethics class at the
• 22:44River School led by Julian Willard,
• 22:45and I'm also on a national task
• 22:47force that's writing best practice
• 22:49guidelines for these laws.
• 22:53And I've written a bunch of op eds
• 22:57across the US and most often choosing
• 22:59to co-author with other scholars and
• 23:02advocates specifically from those regions.
• 23:04Because even though this
• 23:06is a very global issue,
• 23:08it's also about dynamics at the micro level.
• 23:11It's about communities,
• 23:13and it requires small community
• 23:16discussions about shame,
• 23:17about desperation and about
• 23:19what meaningful help could
• 23:20really look like to people who
• 23:22are placed in this position.
• 23:26And so there are just a number of articles
• 23:29that we've issued in all over the US,
• 23:35which have prompted articles
• 23:37in Sweden and Australia and New
• 23:40Zealand and all over the place.
• 23:42And through this work,
• 23:43I've examined what a broad what a
• 23:45broader community would really want
• 23:47us to value in safe haven laws,
• 23:49and what folks really wish we
• 23:51would do through these laws.
• 23:53And so using an ethical
• 23:54policy making approach,
• 23:55we would also be encouraged to examine how
• 23:59others would approach infant abandonment.
• 24:02And so I've also conducted a
• 24:05global policy review and find that
• 24:07we could really gain value from
• 24:11examining what Austria has done,
• 24:13what Japan has done,
• 24:15and what France did before
• 24:18abortion was legal,
• 24:20because that echoes some of our
• 24:23current conditions in Austria.
• 24:25Their rate of neonatacides was the
• 24:27highest across all of Western Europe
• 24:29and they were really bothered by this.
• 24:31And so they spent a lot of time trying
• 24:34to figure out how to get the rate down.
• 24:36And they found that anonymous child,
• 24:40anonymous delivery and coupled with
• 24:45a marketing campaign to let everyone
• 24:48know about this option really
• 24:51helped to have their rate plummet.
• 24:54And then it became one of the
• 24:56lowest in all of Europe and in
• 24:58Japan and in France as well,
• 25:00they have offered confidential
• 25:02or anonymous labor and delivery,
• 25:04allowing someone to come to the
• 25:06hospital and not making them give
• 25:08their name and just saying that they
• 25:11need to have a delivery without
• 25:14disclosing any personal information.
• 25:16So we've found that that has been
• 25:21globally a very successful policy
• 25:23that the US has not really considered,
• 25:27at least at this point.
• 25:28And so when we examine all of the
• 25:31community responses that I've gotten
• 25:33from my op Eds and from my work
• 25:36across the US and with a number of
• 25:39different collaborative engagements,
• 25:41we found that hospitals don't always
• 25:44feel safe to many people in the
• 25:46US They've said, you know,
• 25:49everyone's designed these policies
• 25:51around the hospital being the
• 25:53main site of surrender.
• 25:55But many of us don't feel
• 25:57safe walking into an ER.
• 25:59It certainly doesn't feel anonymous
• 26:01to a lot of people when there are
• 26:04cameras and neighbors all around.
• 26:06And also for many people,
• 26:08they've said that even the act of
• 26:11walking through the ER doors seems
• 26:14to them to be a traumatic event.
• 26:17They've had loved ones pass away,
• 26:18or they faced bias,
• 26:20or they've had a whole host of
• 26:23experiences that to them don't
• 26:25create a feeling of safety.
• 26:26So policy makers and legislators always say,
• 26:30well, you know,
• 26:31of course everyone feels safe
• 26:32in the hospital,
• 26:32but that's actually not
• 26:34the case for many people.
• 26:36Others have said, you know,
• 26:37it's a safe haven for whom, right?
• 26:39Why are we only prioritizing
• 26:41the babies after they're born?
• 26:43Can't we also think about that
• 26:45developing fetus who needs to
• 26:47have prenatal care but can't get
• 26:49it because the woman has to give
• 26:52her name in order to receive
• 26:53services? So I can't go into all of the
• 26:58details, but another point that I think is
• 27:04perhaps especially relevant relates to
• 27:07how these laws make assumptions about
• 27:10the moral fitness of the people who
• 27:12are having to surrender their baby.
• 27:14Because a certain percentage of
• 27:16people in this position would indeed
• 27:18commit neonatacide if they did
• 27:20not have the option of safe haven.
• 27:22But that is a subset of all of these parents,
• 27:26especially under current
• 27:27political conditions.
• 27:29And so many community members
• 27:32have said to me,
• 27:33let's think about it more in terms
• 27:35of what's going on for someone as
• 27:37opposed to what's wrong with them.
• 27:39And I am borrowing the words
• 27:41of Uche Anani and Liz Lanfier,
• 27:44who have written some wonderful articles
• 27:47about how to integrate the idea of
• 27:50trauma informed principles that focus
• 27:53on collaboration and inclusivity and
• 27:56not only clinical ethics consultations,
• 27:58but also within the policy setting.
• 28:00So those are some of the
• 28:02things that we've learned.
• 28:06And we've also learned that parents
• 28:08have been denied safe haven.
• 28:10Sometimes clinicians don't want
• 28:12to encourage others to abandon
• 28:15their baby so they might hide the
• 28:17safe haven signs, for instance.
• 28:19And there are many stories
• 28:21we've heard about how
• 28:25the policies in practice aren't
• 28:27working the way they were anticipated.
• 28:31So community members, if,
• 28:35if we look at kind of summarizing
• 28:37their feedback, they said, yes,
• 28:39of course we need to be more collaborative.
• 28:41We need to be more inclusive in these laws.
• 28:43But we also of course need to
• 28:45think about what how we can really
• 28:49actualize more equitable care.
• 28:50And we need to also think about the
• 28:52safety and health of the birthing parent.
• 28:54We need to think about emotional and
• 28:57physical safety of the surrendering parent.
• 28:59And they, you know,
• 29:02working together with them.
• 29:04We've come up with some options,
• 29:05which not only include anonymous
• 29:07labor and delivery and prenatal care,
• 29:09but the idea of working with the
• 29:13911 system so that someone could.
• 29:15You know, it's it's hard for someone,
• 29:17especially if someone already
• 29:19has other children,
• 29:20it's hard for them to get to an ER
• 29:24knowing that they're going to have
• 29:26to meet with the nurse face to face.
• 29:28Neighbors might be all around.
• 29:30And so the idea of being able to call
• 29:33911 at any time that's convenient
• 29:36for someone and meet that person in
• 29:39a location that feels safe to them
• 29:41might be a way to really decrease
• 29:44the numbers of unsafe abandonments
• 29:46in this country.
• 29:47Another idea too is to think about
• 29:50the use of community Health Workers.
• 29:53These are people who share the
• 29:55same lived experience and cultural
• 29:57background as those they are serving.
• 29:59They are a wonderful third party
• 30:01that has had multiple success
• 30:04stories in this country.
• 30:05They were more traditionally used for
• 30:09just within the public health realm,
• 30:10but even here locally,
• 30:12we've started using more community health
• 30:15workers in a variety of ways and had
• 30:17have had really wonderful successes.
• 30:21And so the goals of this policy are not
• 30:25just to have less unsafe abandonments,
• 30:28but perhaps also to provide basic
• 30:30medical care for the birthing
• 30:32parent with a longer term goal of
• 30:35increased trust within medicine.
• 30:40And so those kinds of themes are
• 30:42echoed by a recent piece that
• 30:44Jen Herbst and I wrote about,
• 30:46which talks more generally about
• 30:48extending trauma informed principles
• 30:50to hospital system policy.
• 30:54And as mentioned,
• 30:56we have a strategic working group
• 31:00that has that consists of lots of
• 31:04folks working on the front lines of
• 31:09families and infants in crisis
• 31:11and people working in adoption
• 31:13law and in foster care systems.
• 31:15And they've been working hard to
• 31:19better ensure safety for these
• 31:21families and are now together.
• 31:24We're now proposing streamlined
• 31:26and more uniform legislation at
• 31:30the state level and perhaps even
• 31:31a a federal legislation that will
• 31:33help to resolve a lot of the
• 31:36inconsistencies we are seeing across
• 31:37the state when it comes to these laws.
• 31:41One of the one of the biggest
• 31:45sticky points with these laws
• 31:48relates to how individuals have to
• 31:50deliver outside of the hospital.
• 31:53And so one of the points that
• 31:55we're also pushing for is to be
• 31:57allowed to relinquish relinquish
• 31:59in the hospital right after birth.
• 32:02Some even when it was first
• 32:03rolled out here in Connecticut.
• 32:05The law has since been updated
• 32:07and was updated very quickly,
• 32:09which was a testament to how
• 32:10speedy things can be here.
• 32:12But initially,
• 32:13if a woman had given birth and
• 32:16needed to surrender that infant,
• 32:19they would have to wheel her around
• 32:21the hospital and bring her to the ER so
• 32:24that she would be eligible for the law.
• 32:26So we were glad to see that
• 32:30law quickly updated.
• 32:31And of course,
• 32:32good ethics relies on good data.
• 32:35And so another,
• 32:37the component that our task force is
• 32:41pushing for is to require tracking
• 32:44of numbers and to require some
• 32:46federal fund funding to help get
• 32:49those numbers reported and tracked
• 32:51so that we can get a better sense
• 32:54as to the conditions under which
• 32:57these abandonments are happening.
• 32:59We are starting to see changes.
• 33:02Legislators are beginning to question
• 33:04the design of safe haven laws as the
• 33:08numbers are rising across the nation.
• 33:11They're beginning to think about what
• 33:14location is safe to a surrendering parent.
• 33:19And I really find this to
• 33:21be a very local there,
• 33:24that there's a very local answer.
• 33:25What might be safe,
• 33:27what might feel safe to someone in
• 33:29Arkansas might be really different to what
• 33:32someone might feel safe here in New Haven.
• 33:35And they're all sorts of different people
• 33:37who feel safe in different places,
• 33:39right?
• 33:40So it really does require
• 33:43not just community feedback,
• 33:45but feedback from diverse communities
• 33:48in in places across the United States.
• 33:52Another factor about these laws
• 33:55relates to the surrender window.
• 33:57When they were first created,
• 33:59there was no window and so families
• 34:03across the US were actually going to
• 34:06the few states that had these laws.
• 34:12And the the states that had no
• 34:14limitation found that there were
• 34:16many older children with severe
• 34:18disabilities that were being surrendered,
• 34:21which points to another problem
• 34:23of course in our system. But
• 34:29I think
• 34:32another point that we might want to
• 34:34consider is just this way of kind of
• 34:38summarizing trauma informed care from
• 34:40the Islamfir and Uche Anani and thinking
• 34:43about how hospitals can really work
• 34:45with policy makers on finding ways to
• 34:48roll these policies out in a way that
• 34:50is more empathic and more inclusive.
• 34:57And so there are many policy analysis
• 34:59methods that can be really helpful
• 35:02not only for infant safe haven laws,
• 35:04but for a wide range of policies.
• 35:09We've we've used it a bit here when
• 35:12we were looking at ethical discharge
• 35:15policies and some other policy solutions
• 35:18here on the adult Ethics Committee.
• 35:21And today, I've just touched upon
• 35:22a couple of those, but I'm always
• 35:24happy to talk more about those.
• 35:26And so we know of course that we
• 35:28need to push for full spectrum
• 35:31reproductive care in this country.
• 35:33But in its absence,
• 35:35I think examining the effective laws
• 35:38in countries before they had access to
• 35:41abortion can be really helpful to us.
• 35:44Next steps include continuing to work
• 35:47with our strategic working group,
• 35:49pushing out more op Eds across the
• 35:53US to help shine a light on the
• 35:56dimensions of the baby boxes as well
• 35:58as the dimensions of the local laws,
• 36:01and working in partnership with legislators.
• 36:06So I whenever I give a talk on Safe Haven,
• 36:11I always put up our national
• 36:13the national hotline number.
• 36:15This is Heather Berner.
• 36:18She's the executive director of
• 36:19the National Safe Haven Alliance.
• 36:21She is the one who's running
• 36:23the national task force.
• 36:25And her organization has a specific focus
• 36:29on family preservation and providing
• 36:35all sorts of resources and connecting
• 36:37people to all sorts of resources and
• 36:40safe options that can be available
• 36:41to someone at the very end of their
• 36:44pregnancy or when they have a newborn. So
• 36:50in closing, of course I have to
• 36:53give a pitch for my summer program.
• 36:56In addition to other work I do,
• 36:58I direct our summer institute in
• 37:01bioethics and this year we will have
• 37:05a our foundations program which is an
• 37:08intro to bioethics which I typically
• 37:11squish into four really intense days.
• 37:13But we're finding that a number
• 37:16of folks want longer time with
• 37:19the curriculum at a slower pace.
• 37:21So this year we'll be offering
• 37:24foundations remotely again,
• 37:25but we're going to be offering
• 37:27it slowly over a two week period
• 37:30and you are all welcome to join.
• 37:33In addition to our foundations program,
• 37:36we will also be having six weeks of in
• 37:39person programming and it'll be near our bio,
• 37:43our bioethics center by Science
• 37:45Hill and it's a very global program.
• 37:48It's a very multidisciplinary program
• 37:51and it's it covers a lot of ground
• 37:54in a very short amount of time.
• 37:56So I'm always happy to talk to people
• 37:59about my bioethics programs and with
• 38:02that I will open things up to questions.
• 38:07And I'm supposed to to remind everyone
• 38:10if you need the CE number that I
• 38:12have displayed it here in Redfont
• 38:14for those of you who should not be
• 38:16forgetting to to write the number down.
• 38:21OK. Well, thanks everyone for your time.
• 38:31Thank you, Lori.
• 38:33That was an incredibly important rich,
• 38:35thought and action provoking talk.
• 38:39Very lucky to have heard it
• 38:41and to have you here at Yale.
• 38:43So we have about 50 minutes.
• 38:47Sorry, 50 minutes for Q&A.
• 38:50Would anyone like to jump
• 38:52in and ask a question?
• 38:54Great, Sarah.
• 39:03Thank you, Lori, for that incredible
• 39:06and really informative talk.
• 39:08I feel like I have so many questions
• 39:10but the one that I really had to stifle,
• 39:13not just blurting out in the middle of your
• 39:15talk because I was so shocked by it was
• 39:17why did you. Can you explain sort of some
• 39:20of the rationale for why infants with a
• 39:24positive tox screen who seem like would
• 39:25be the ones in most need of a stable
• 39:28home right away are somehow
• 39:32not allowed to be adopted and
• 39:34put into the foster system?
• 39:35Which again I'm sure as you know
• 39:38much better than I and probably
• 39:39most people in this room is
• 39:40is fraught with issues. It it just
• 39:44it boggles the mind that it's like
• 39:46your a system is sort of
• 39:49intentionally doubly disadvantaging
• 39:50these these for kids and and why
• 39:54is that and and
• 39:56I I don't know I'm I'm just trying to wrap
• 39:58my head around it and and I and I can't
• 40:01yeah yeah thank you for bringing that
• 40:03up and it is this double disadvantage
• 40:06and I I'm like how you frame that
• 40:10in truth it's very likely an unintended
• 40:14consequence There's never been
• 40:16an intention of any state to say.
• 40:21Here's a child who needs more support.
• 40:23Let's not give him to the best families.
• 40:27But what does happen is that families
• 40:32create these processes for parents
• 40:34to be eligible for safe haven.
• 40:38They are screened heavily.
• 40:39In some states there is.
• 40:44There are families who know
• 40:45that they're next on the list,
• 40:46and so they'll get the crib.
• 40:48They'll get all ready for their
• 40:51safe haven baby because they they
• 40:54know that they're next on the list.
• 40:57And yet what's happened is,
• 40:59you know, when you create policy,
• 41:01there are just a lot of unintended
• 41:04consequences sometimes.
• 41:05But I would also argue that that
• 41:07would make sense in the first
• 41:08year of a policy being around.
• 41:10But one something has been defined
• 41:12as an unintended consequence.
• 41:14It will no longer be an unintended
• 41:16consequence if we choose not to take action,
• 41:19to have some sort of path to resolution.
• 41:22I do know that some states have been
• 41:26considering whether there might be a change,
• 41:29and there's a lot of variation
• 41:31across the states.
• 41:32California has one of the most robust
• 41:35responses to safe haven babies and
• 41:38a lot of support for these families,
• 41:40a lot of counseling for everyone involved.
• 41:45And so there there are efforts to
• 41:48think about, starting to address,
• 41:49address it, but without public pressure.
• 41:51I'm not sure if many states are
• 41:55really actively doing much about it,
• 41:58but I really do view it as something
• 42:01that hadn't been intended,
• 42:02but indeed is occurring,
• 42:04Which is why I always find it
• 42:08so helpful to bring in community
• 42:11members and stakeholders who may
• 42:13not be traditionally involved.
• 42:15These laws are often written by reaching
• 42:20out to hospital lobbying associations,
• 42:24hospital leadership,
• 42:27leadership at the fire stations
• 42:29and the police departments,
• 42:31which is good,
• 42:32and all of those people should be
• 42:34heavily involved.
• 42:35I would argue we'd also want to think
• 42:38about folks who are really in the trenches,
• 42:40who might have a deeper sense as to
• 42:44what a family or pregnant person might
• 42:48need when they're really in that position.
• 42:51And then that would help to curtail
• 42:54things like this when it happens.
• 42:56Sure.
• 43:03Hi. I was hoping you could talk
• 43:05a little bit about the surrender
• 43:07windows. Like, what are the
• 43:09ethical considerations that hold
• 43:10us back from having that be,
• 43:11like multiple years? Or like,
• 43:13just what are people thinking about
• 43:14when you make it seven days or 30 days?
• 43:17Yeah, that's a that's a great question.
• 43:20So the question related to surrender
• 43:23windows and what do we consider when,
• 43:26when we're deciding what any state would
• 43:31decide on for their surrender window?
• 43:36State laws differ and they should
• 43:39differ because of many reasons,
• 43:42including geography, right.
• 43:44So certain states are going to
• 43:47have different kinds of challenges
• 43:49because they may face tsunami threats
• 43:52or tornado threats or hurricane
• 43:53threats and others may not, right.
• 43:55So, So there's always going to be a
• 43:56lot of variation across state law.
• 43:58And and in this case,
• 44:00we see that certain states like
• 44:03Alaska would need a longer window
• 44:06because of geographic constraints.
• 44:09So that's one factor when
• 44:12considering the optimal window.
• 44:14What lots of people talk about with
• 44:17respect to infant abandonment is
• 44:19this critical 24 hour window and the
• 44:23the greatest threat to any baby is
• 44:27within the 1st 24 hours of their life.
• 44:31That is when they are most at
• 44:33risk for neonatacide.
• 44:34If you can get the baby past
• 44:36that first 24 hour window,
• 44:38the rate of likelihood of them being a
• 44:42victim of of infanticide dramatically drops.
• 44:46So that's another factor that
• 44:48people think about and they say,
• 44:50OK, well,
• 44:51maybe it really shouldn't be that
• 44:53much longer past that one day.
• 44:55But it's really hard for people
• 44:59to know about their state's laws.
• 45:02And lots of people here in Connecticut say,
• 45:05of course,
• 45:06you just bring the baby to the fire station.
• 45:08It's actually impermissible to drop a
• 45:10baby off in Connecticut at a fire station.
• 45:13And so then that family would be would be
• 45:18susceptible to being prosecuted in New York.
• 45:21I think it's fine to drop
• 45:22off at a fire station,
• 45:23but here there's a good reason
• 45:26for that in that fire stations
• 45:30aren't always staffed 24/7.
• 45:31And so the idea here was to
• 45:34create a simple policy that
• 45:36everybody could remember and keep
• 45:38it as simple as possible.
• 45:40However,
• 45:40sometimes a simple policy
• 45:42isn't the one that's going to
• 45:46really work or or or be amenable to a
• 45:50range of people who are actually going
• 45:52to be impacted by it. And so there.
• 45:55So they're just a number of factors
• 45:57that can go into that number.
• 45:59But most states are,
• 46:03many states are at 48 hours,
• 46:05some are at 72, some are at two weeks,
• 46:07very few are at around 30 days.
• 46:10And I think the idea really is
• 46:12to allow someone to have enough
• 46:14time to kind of gather their wits.
• 46:16I mean, especially if you're giving birth
• 46:20and in your apartment without any help,
• 46:23it's going to be really hard within
• 46:2748 or 72 hours to to be able to know
• 46:30what to do and and how how to approach
• 46:33that and how to get yourself to an ER.
• 46:36Which is why I think the EMT or the
• 46:39community health worker who could
• 46:41actually meet someone wherever
• 46:42they are physically located and
• 46:44come to their apartment,
• 46:46could really be very helpful regardless
• 46:48of whatever that window of time might be.
• 46:58Thanks, Lori. I I wonder if you could
• 47:01unpack the experience of the baby boxes.
• 47:04I mean it it seems like A at least
• 47:07a reasonable component of a system.
• 47:09Do you have a can you tell us a
• 47:11little more about are they working
• 47:13or do they tend to work even in
• 47:16places where they where we might not
• 47:19think that they would work so well?
• 47:20What's happening in Indiana
• 47:23with all those baby boxes?
• 47:26Are they or they're being utilized
• 47:28or are families feeling well served?
• 47:31What can you tell us?
• 47:33I I know it's probably impossible
• 47:35to get that kind of follow up data,
• 47:37but I'm just wondering what
• 47:38what you can tell us.
• 47:40Yeah,
• 47:40it's it's a great question, Jack.
• 47:43So the the woman who has single handedly
• 47:49LED this initiative of baby boxes
• 47:53was abandoned herself at birth and
• 47:57she many years later was on vacation
• 48:01in Africa and she saw a foundling
• 48:05wheel and she said what is this?
• 48:07And she learned how unwanted
• 48:10infants can be abandoned.
• 48:12And she thought that that sounded like
• 48:16a really viable solution to something
• 48:21that she had always considered to be
• 48:24really pivotal to her life story.
• 48:27And she's from Indiana.
• 48:29And so she went back and she started
• 48:32creating them herself with her husband.
• 48:34And so it's the two of them
• 48:36that build these boxes.
• 48:37And
• 48:41in in any policy, you want to think about
• 48:45what is the do and what is the get,
• 48:47You know what what what are the
• 48:48what are the goals of the policy.
• 48:50And if the goal of a policy is purely
• 48:54to reduce the numbers of unsafely
• 48:57abandoned babies in our current climate,
• 49:01where there is distrust in the
• 49:03medical system and people don't feel
• 49:05safe at the other surrender sites,
• 49:08that can indeed fulfill the mission of
• 49:11a policy that's seeking to reduce the
• 49:14numbers of unsafely abandoned infants.
• 49:16And so these boxes have been used.
• 49:20The FDA has declined to consider
• 49:23them a medical device.
• 49:25And so while they are tested,
• 49:30they are tested by someone who's
• 49:32not an engineer,
• 49:33who saw a box in Africa and and decided
• 49:39to create a more modern version of it.
• 49:42They are installed.
• 49:43They are supposed to be installed only
• 49:46in places where there's 24/7 support.
• 49:49They've been criticized for perhaps
• 49:53not having tougher language that
• 49:57requires essential staff to be
• 50:00very on top of regular checks.
• 50:04They are intended to be
• 50:08temperature controlled.
• 50:09Many people are worried that an alarm
• 50:12might not go off because someone
• 50:14might not find an infant in time,
• 50:16especially because while there is testing,
• 50:21it isn't according to any sort of testing
• 50:26standard that's ever been developed.
• 50:29And so
• 50:32every time an infant is
• 50:34abandoned in one of these boxes,
• 50:37the local news rushes over and they
• 50:40interview the family who is now deemed
• 50:43complete by their by their new baby.
• 50:47And so those news stories always
• 50:50are very quick to lift up and
• 50:54praise the surrendering parent.
• 50:57But that's the only mention of that parent.
• 51:01And I worry a lot about the numbers and the,
• 51:08you know, in five years and 10 years,
• 51:11how many families are going to have
• 51:14this as part of their legacy and
• 51:18what's happening to these birthing
• 51:21parents who have no medical care?
• 51:25And so I wouldn't.
• 51:27And we know that you know that
• 51:30$3.72 million has been invested in
• 51:34the creation of these baby boxes.
• 51:38And I wonder if any of those funds
• 51:42could also That generosity could
• 51:44also perhaps start to extend also
• 51:47to somebody who might be really
• 51:51needing medical care and having it
• 51:54in an anonymous or confidential way.
• 52:01Thank you for a really important talk.
• 52:04I guess what I'm wondering about
• 52:07is when a facility agrees to have
• 52:09a baby box are they not under the
• 52:13same regulations like American with
• 52:15Disabilities Act right about how we
• 52:18access buildings is very regulated and
• 52:20so are there are there no existing
• 52:22laws I I use that one for example
• 52:25that are applicable to this box that's
• 52:27attached to the side of a building Is
• 52:30is there a way to ensure greater safety
• 52:34for for the babies through other
• 52:37policies that already exist.
• 52:39the ADA was the one I
• 52:40thought of right away. Yeah.
• 52:42Through through other mechanisms.
• 52:44That's a great idea.
• 52:46I I know that there are legislators
• 52:50who have refused the installation
• 52:52of baby boxes in their town or
• 52:56in their state because they
• 52:58are exactly worried about
• 53:02these boxes not falling under
• 53:05any other kind of regulations.
• 53:07They're a very unique contraption and
• 53:11there's a lot of concern about what could
• 53:17potentially happen and and so other
• 53:22states are really excited about them.
• 53:25I've I've met with some legislators from
• 53:29Texas who I think excited is the wrong word,
• 53:31but maybe relieved by them as an option.
• 53:34And you know there there are,
• 53:37there's been a rash of younger women in
• 53:41certain Texas communities that have sadly
• 53:45been giving birth and don't know what to do.
• 53:48And when they know that there's a baby box,
• 53:51it does give them relief.
• 53:53It does give them a way out.
• 53:55It does give them an Ave.
• 53:57that in especially in Texas they don't have.
• 54:01But again I'm I'm worried for their safety.
• 54:04And so there there does it's it's
• 54:09the the regulations are all at
• 54:11the state level in this case.
• 54:13And I know some legislators in different
• 54:16states are trying to work together
• 54:19to think about how can we really
• 54:23put some protections around them.
• 54:26Yeah.
• 54:28So I've been told we have a lot of
• 54:30Zoom participants, at least 24.
• 54:32I think this is the best attended
• 54:35talk we've had all year, Lori.
• 54:37So anyone who's on Zoom who'd like
• 54:39to ask a question or raise a comment,
• 54:42please feel free to put it in the chat.
• 54:44And in the meantime,
• 54:46we have a comment right there
• 54:49in the Q&A. Let's
• 54:53see, looking there's nothing there.
• 54:55There's it's not a question chat. Oh no. OK,
• 55:01Laurie, thanks for a great talk.
• 55:05I found it very troubling because of the
• 55:10ample evidence of decreasing societal
• 55:15care there. There's simply more examples
• 55:20of of what seems to be a spiral of
• 55:23decreasing care in our society and as
• 55:25a doctor even some of the statistics
• 55:27you gave are are shocking to me.
• 55:29The image of the baby box I can't get
• 55:32out of my head as it looks like an
• 55:34after hours bank deposit receptacle.
• 55:38However, the psychology is brilliant because
• 55:40it seems to subtract the element of shame,
• 55:43which I'm sure was part of the design,
• 55:46and I wonder whether the placement
• 55:48of these boxes is carefully
• 55:50constructed to avoid passers by.
• 55:53I would imagine that they are I I'm
• 55:58also curious about the safety aspects
• 56:00and wonder whether there is an alarm
• 56:03that is tripped and a volunteer
• 56:06comes to take the baby immediately.
• 56:10However, the concept of an anonymous
• 56:12birth is mind bending to me only
• 56:15because of its simplicity and because
• 56:19I would imagine that statistically
• 56:21there are a higher percentage of high
• 56:25risk births associated with many of
• 56:29these children that are given up.
• 56:34I have to say that in addition to
• 56:37some of the elements that you brought
• 56:39up about
• 56:42the
• 56:46associations of lack of safety,
• 56:49walking through an ER door and so on,
• 56:52it seems to me the biggest obstacle
• 56:54is our pair system. I cannot imagine
• 57:00an anonymous birth system that
• 57:04functions in a society which
• 57:06demands proof of identification and
• 57:09insurance almost immediately upon
• 57:12receiving care in an emergency room,
• 57:14and I wonder whether you can comment on that.
• 57:18I I think this is yet another example of
• 57:22how our lack of a universal healthcare
• 57:26option does create so much complexity
• 57:30and poorer health for everyone involved.
• 57:34I have spoken with legislators about the
• 57:38idea of anonymous or confidential birth
• 57:46funding is is always a problem. And
• 57:53some legislators that I've spoken
• 57:55with said that it would actually
• 57:58be a horrible idea 'cause it could
• 58:01potentially encourage women to use
• 58:03safe haven so that they wouldn't have
• 58:06to pay for their labor and delivery,
• 58:09which I can't imagine happening.
• 58:13But it gives us a little bit of insight,
• 58:16not into all legislators,
• 58:18but into many of the there's
• 58:21a lot of conflation.
• 58:22There's a lot of assumptions
• 58:25about certain outliers of women
• 58:29who may indeed feel they have no
• 58:33other option except for something
• 58:35that considers absolutely morally
• 58:37reprehensible to the rest of us.
• 58:40And and yet that might be considered
• 58:46to be kind of like the average
• 58:48safe haven parent, right. And so.
• 58:50So there's there's a lot to unpack there.
• 58:53And you had also talked about
• 58:57decreased shame with the boxes
• 59:01I and and just the idea of
• 59:03anonymity. The boxes are are
• 59:08are installed to avoid local
• 59:10video cameras as much as possible.
• 59:12They are often around a corner so that
• 59:17someone can pull up out of sight.
• 59:21There are alarms on the boxes.
• 59:24There's there's supposed to be
• 59:25one alarm that goes off when it's
• 59:28opened and another when it's closed.
• 59:31And they're also only supposed to be
• 59:34in areas where there's 24/7 support and
• 59:36there are video cameras on it as well.
• 59:40But there's there's a lot of unknowns.
• 59:42You know, there are baby boxes in
• 59:46very hot areas of our country where
• 59:48we worry about the AC working.
• 59:50Indiana gets cold in the winter.
• 59:53You know, there's there's all sorts
• 59:55of things that could potentially
• 59:56happen in these cases that make
• 59:58a lot of people in the space.
• 01:00:00Really worried for the outcomes.
• 01:00:04Thanks for your reflections
• 01:00:09Lori. Thank you for wonderful talk.
• 01:00:11I have a question that's ultimate
• 01:00:14ultimately about the values informed model,
• 01:00:16but I'll I'll set it up by telling
• 01:00:20a caricature like story free Dobbs.
• 01:00:23Safe haven laws are a right wing
• 01:00:27pro-life thing and they're being
• 01:00:29pushed as a way to prevent abortions.
• 01:00:32There as a there a thing that you can
• 01:00:34say to women who are facing unwanted
• 01:00:37pregnancies saying we can you can
• 01:00:39avoid having abortion if you can
• 01:00:40only carry your pregnancy to term.
• 01:00:42You can rid yourself of the need to
• 01:00:44care for the child in this immediate
• 01:00:47safe haven facilitated kind of way.
• 01:00:49Post OPS, a whole bunch of lefties
• 01:00:53join the bandwagon for safe haven
• 01:00:56laws because they're very concerned
• 01:00:58about the trauma of having to have
• 01:01:01a child that you didn't want to
• 01:01:02have and about the health condition
• 01:01:04of the mom and of the family.
• 01:01:06OK, so now you're in the state legislature
• 01:01:09of Illinois and you want to do a values
• 01:01:14informed model of a good safe haven law,
• 01:01:17but the values people are
• 01:01:18bringing to the table are really,
• 01:01:20really different.
• 01:01:22So who, whose values do you use?
• 01:01:25And, you know,
• 01:01:26you talk about the value of inclusivity,
• 01:01:27but we've got people here who who
• 01:01:30are imagining these laws as having
• 01:01:33really different kinds of functions,
• 01:01:35completely agree.
• 01:01:39So safe haven laws have always had
• 01:01:42very strong bipartisan support,
• 01:01:44partly because they don't deserve,
• 01:01:46they don't require any funding and
• 01:01:49because everybody wants to save babies.
• 01:01:54But, you know, it is absolutely
• 01:01:57true that, you know, Amy Coney,
• 01:01:59Barrett and others who have been speaking
• 01:02:01about this have been saying, well,
• 01:02:03wouldn't this be a solution to abortion?
• 01:02:06We don't need abortion if
• 01:02:09birthing parents can just wait a
• 01:02:12couple months and then just stick
• 01:02:14it in a box and then check and then
• 01:02:17you can go make your bank deposit,
• 01:02:19as Ron was alluding to. Right.
• 01:02:22So yeah, so there's there's complexity here.
• 01:02:26And you know what?
• 01:02:28When I talk about my values
• 01:02:31informed logic model,
• 01:02:33when I talk about inclusivity,
• 01:02:35what I mean is to ensure that
• 01:02:39we're including all stakeholders.
• 01:02:41So we're not just including the the
• 01:02:44louder squeaky wheels of any policy,
• 01:02:46but to really think about
• 01:02:49who's being impacted by these
• 01:02:51policies and speak with them.
• 01:02:55I have received pushback in a
• 01:02:56number of states when I say,
• 01:02:58well, let's let's reach out to
• 01:02:59the local Rape Crisis centers.
• 01:03:01I did Rape Crisis counseling for many
• 01:03:04years before going into bioethics and
• 01:03:08and that really helps me to see a lot
• 01:03:11of the holes in the medical system.
• 01:03:14But so you know but and so when I
• 01:03:17suggest things like let's work with
• 01:03:19our local local Rape Crisis center,
• 01:03:21let's reach out to women who and
• 01:03:24families who might be really in this
• 01:03:27precarious position and need to do that.
• 01:03:30And I think it's just sometimes
• 01:03:32kind of a a foreign concept to a
• 01:03:34lot of folks who are really trying
• 01:03:36to push through policy fast.
• 01:03:38And so the idea is probably not to
• 01:03:43have legislators and policymakers
• 01:03:45cave too much to the the Laurie
• 01:03:49Bruce model doing things,
• 01:03:50the Laurie Bruce, you know, ideal world.
• 01:03:53But but to think about how policymakers
• 01:03:56work and how legislation works.
• 01:03:59And I I talk to my students a lot in my,
• 01:04:03in the courses that I teach on ethical
• 01:04:05policy making about Kingden's three streams.
• 01:04:08And Kingden is this policy analyst who says,
• 01:04:12you know,
• 01:04:12you can't just create policy when
• 01:04:14you want to create policy.
• 01:04:15You can be the smartest person
• 01:04:16and have all of the answers,
• 01:04:17but it's not necessarily going to happen.
• 01:04:19In order to create policy,
• 01:04:21you have to wait for the policy
• 01:04:23window to open.
• 01:04:24And in order for the policy window to open,
• 01:04:26three things have to occur.
• 01:04:29You have to have problem and that means
• 01:04:33society or and the general public has
• 01:04:36decided that there is a real problem,
• 01:04:38you have to have a solution and
• 01:04:41then you have to have momentum.
• 01:04:43So there needs to be enough people
• 01:04:45interested in an issue and then
• 01:04:48you need to be able to be prepared.
• 01:04:51And he's Kingdom is this kind of,
• 01:04:54you know,
• 01:04:54very
• 01:04:57academic kind of guy.
• 01:04:58But he talks about surfing.
• 01:04:59If you can imagine this distinguished
• 01:05:01professor talking about surfing.
• 01:05:03But you have to have,
• 01:05:05you have to be ready for the moment,
• 01:05:06just like a surfer is
• 01:05:08ready for the next wave.
• 01:05:09And so that means that you know,
• 01:05:11as much as there is this Laurie
• 01:05:13Bruce model of defining values
• 01:05:15and working with local people.
• 01:05:16You have to be very organized
• 01:05:18and you have to have all of your
• 01:05:21people in a in yours and your
• 01:05:23stakeholders ready and organized
• 01:05:25So that when you so that we would
• 01:05:27have a solution to propose when it
• 01:05:30finally became important enough
• 01:05:32to everybody in the nation or
• 01:05:35whatever area you're talking in.
• 01:05:37And so I have been working and
• 01:05:39studying these laws for many,
• 01:05:40many years and now the policy
• 01:05:42window is actually starting to open.
• 01:05:43And so we have all of these
• 01:05:46multidisciplinary stakeholders and
• 01:05:47we have all of this feedback from
• 01:05:49all of these op eds across the US.
• 01:05:51And so really that I think is the
• 01:05:55way of getting back to this really
• 01:05:57integral question that I'm always
• 01:05:59hammering with my students as well
• 01:06:01as in terms of whose values matter,
• 01:06:03whose ethics matter.
• 01:06:04So that's my long winded way of
• 01:06:07talking about how we really need to.
• 01:06:10We as bioethicists and anyone
• 01:06:12who wants to be influential in
• 01:06:16the policy making arena,
• 01:06:17needs to understand how policy makers
• 01:06:20work and how we can serve them.
• 01:06:22You know,
• 01:06:23they're not going to want to
• 01:06:24read my Hastings Center report.
• 01:06:25They're going to want a bulleted
• 01:06:27list of items.
• 01:06:27They're going to want to text
• 01:06:29me whenever and say, hey Lori,
• 01:06:31I need you to give me this.
• 01:06:32And you have to be responsive and you
• 01:06:34have to build those relationships
• 01:06:36with your local legislators.
• 01:06:37And that's something that I talk
• 01:06:39about with my students a lot
• 01:06:40in terms of you know,
• 01:06:41how does policy making work so that
• 01:06:44we can learn to be receptive and
• 01:06:47available and helpful within the
• 01:06:49their their time limitations and
• 01:06:51their and their other limitations.
• 01:06:59So we've heard a lot about policy
• 01:07:02making and kind of the higher
• 01:07:05levels of this whole process.
• 01:07:07I was kind of wondering from a
• 01:07:10more pragmatic EMS perspective,
• 01:07:12is there any thought to develop
• 01:07:16a policy how first responders,
• 01:07:19especially on ambulances,
• 01:07:21are supposed to handle situations
• 01:07:23when they find out that birthing
• 01:07:27parents are intending to abandon them?
• 01:07:30How that would work in terms
• 01:07:32of duty of care towards the
• 01:07:35birthing parent and the baby?
• 01:07:37Or if that should be at that
• 01:07:40point separated one's intend
• 01:07:42to surrender the the child,
• 01:07:46or if it would influence
• 01:07:50the legal obligations if intention
• 01:07:53to abandon or surrender has been
• 01:07:56established before the birth.
• 01:08:00That last part when you were talking about
• 01:08:03legal aspects of surrender? What basically
• 01:08:07if if legally speaking something,
• 01:08:10if there's a different legal process in
• 01:08:13terms of responsibility and duty of care,
• 01:08:16if it has been established before the baby
• 01:08:19is born that the birthing parents intends
• 01:08:22to surrender the baby once it is born.
• 01:08:26Sure. Kind of wondering what is the the
• 01:08:30legal reasoning or is there any thought
• 01:08:33given to how that would work? Sure,
• 01:08:37some people while pregnant
• 01:08:43do learn about safe haven.
• 01:08:48Many don't. But some are organized
• 01:08:51and learn about the safe haven
• 01:08:54laws and intend to safe haven
• 01:08:58their baby. And in those cases
• 01:09:05the baby may not be safe haven because
• 01:09:08of all of the letters of the law,
• 01:09:10all the details of the law including
• 01:09:12that talk screen that we talked
• 01:09:15about and and the harm clause.
• 01:09:17But even if a parent does
• 01:09:21decide or intends to surrender,
• 01:09:24they don't have to surrender until a
• 01:09:29certain window within each state's law.
• 01:09:34And from an EMS perspective,
• 01:09:37I think you know the the the,
• 01:09:40the core of any EMS call is to stabilize
• 01:09:45and to build trust and rapport.
• 01:09:48And so we would not only want to do
• 01:09:52our best to ensure that infant who
• 01:09:55may possibly have been delivered
• 01:09:57in an apartment building or in a
• 01:10:00public restroom sometimes is getting
• 01:10:02all of the medical care they need,
• 01:10:04but to also try to build a little
• 01:10:07bit of rapport with the person
• 01:10:10who just went through labor and
• 01:10:14try to see what kinds of medical
• 01:10:17care they'd be up for receiving.
• 01:10:20But doing that really grounded
• 01:10:24in honesty and transparency,
• 01:10:27because these are often folks who cannot
• 01:10:31have that on their medical record and
• 01:10:35open notes is great until it's not.
• 01:10:39And this is the kind of
• 01:10:44notes in a chart that could put
• 01:10:46someone at a great deal of risk if,
• 01:10:49for instance, their partner or
• 01:10:52spouse didn't know of the pregnancy.
• 01:10:55That happens sometimes.
• 01:10:57Or, you know, all sorts of
• 01:11:00reasons why people often may
• 01:11:02need to hide their pregnancy.
• 01:11:04So I would say that the duty of
• 01:11:07the EMS responder would be to
• 01:11:10really understand what the laws
• 01:11:13are in their state with respect to
• 01:11:17surrender to focus on stabilization
• 01:11:20for the infant And to be absolutely
• 01:11:25honest when it comes to telling
• 01:11:29that birthing parent what how,
• 01:11:33which services could potentially be
• 01:11:35offered within the realm of their
• 01:11:38comfort based upon confidentiality clauses
• 01:11:41at any given hospital or institution.
• 01:11:44Do any of our students have questions,
• 01:11:47We've heard more from the the
• 01:11:50faculty and we have handed.
• 01:11:52Great.
• 01:11:55Hi, thank you for your talk today.
• 01:11:57I just had a quick question.
• 01:11:59You mentioned earlier that one of the
• 01:12:01biggest backlashes that you've gotten
• 01:12:03from legislators was on the financial
• 01:12:05side of like you know where is the
• 01:12:07money gonna come from And $3.72 million
• 01:12:10is like a very impressive figure to
• 01:12:13like for like this entire project.
• 01:12:15But obviously when you're trying to serve a
• 01:12:18population of 165,000,000 women in America,
• 01:12:20there's going to even if like
• 01:12:220.01% of them are going to need the
• 01:12:24services within the 10 year window.
• 01:12:26You're it's not enough capital.
• 01:12:28It's especially considering like
• 01:12:29everything from like medical services
• 01:12:31to you know like actually like
• 01:12:35implementing these baby boxes and
• 01:12:36also like you know taking care of them
• 01:12:38for however long that they may need.
• 01:12:40So where like obviously like there's
• 01:12:43like two different kinds of like
• 01:12:45capital that you could raise one from
• 01:12:46the government and other from private
• 01:12:48equity or like non profit investors.
• 01:12:49And I was wondering like what is
• 01:12:52the current outlook on like the
• 01:12:54solutions in terms of like how you're
• 01:12:56how this organization,
• 01:12:57how this task force that you are leading
• 01:12:59with like a bunch of other influential
• 01:13:02people is planning to address that.
• 01:13:05Yeah, dismally
• 01:13:09it's pretty and in terms of any we
• 01:13:13will the the argument for funding for
• 01:13:18gathering statistics is likely, but it's
• 01:13:26very unlikely that we would have funding
• 01:13:32for anonymous childbirth labor and delivery.
• 01:13:37However, with that said,
• 01:13:39this is going back to the Kingdom
• 01:13:42model and and and momentum.
• 01:13:44There is a feeling by legislators on
• 01:13:49both sides of the aisle that we really
• 01:13:53need to do something because they're
• 01:13:55all of these stories right now of of
• 01:13:59pregnant people who are undergoing
• 01:14:01a lot of trauma and legislators
• 01:14:04are being pushed to do something.
• 01:14:06And so if there were ever a time when
• 01:14:10we could borrow a policy from Austria
• 01:14:13or Japan or post abortion France,
• 01:14:16this would be the time because
• 01:14:19legislators are really being pushed,
• 01:14:21you know, they're being squeezed.
• 01:14:23So I would say that I'm hopeful in
• 01:14:27the first round with the task force.
• 01:14:30I don't think it's going to make the cut,
• 01:14:32but I personally have been lobbying
• 01:14:34for it hard.
• 01:14:36And we can also talk about the
• 01:14:38costs of not implementing it.
• 01:14:40Sometimes,
• 01:14:40if you can help lay it out to legislators,
• 01:14:45the costs of not having
• 01:14:48such a policy offered
• 01:14:53and the impact to the child and the mother,
• 01:14:55because it's better for the child too.
• 01:14:58And so if we, if we really
• 01:14:59do care about these infants,
• 01:15:01we should care about them as they're being
• 01:15:04born instead of just after they're born.
• 01:15:07And it's we, we know it's much
• 01:15:10safer to give birth in a hospital.
• 01:15:13So it's not just about the woman,
• 01:15:15it's also about that baby.
• 01:15:17And when these laws are passed, you know,
• 01:15:22it takes work to to pass any law.
• 01:15:24But legislators always say if
• 01:15:26one an infant can be saved,
• 01:15:28it would be worth all of the
• 01:15:30hassle of writing this law and
• 01:15:32getting it through the door right.
• 01:15:33And so similarly,
• 01:15:35we can kind of go back to that and echo
• 01:15:39that same theme that really rallied
• 01:15:41them and that is important to them.
• 01:15:43So.
• 01:15:44So again,
• 01:15:46it's really trying to find a way through
• 01:15:51it in a way that that can be heard.
• 01:15:56So fingers crossed
• 01:16:01I'll take a moderator's privilege.
• 01:16:02While you all think of
• 01:16:04your brilliant questions.
• 01:16:05Have are there any shining examples of
• 01:16:09community healthcare workers supporting A
• 01:16:12birthing parent going through this process?
• 01:16:15I I wish I had a story of a CHW
• 01:16:20helping someone in this example.
• 01:16:24To date, CHWS or community health
• 01:16:26workers have not been used in this way.
• 01:16:29But there are many other examples of how
• 01:16:33CHWS have been very effective in the
• 01:16:38hospital setting and in public health arena.
• 01:16:43During COVID the Yale New Haven Health
• 01:16:46System hired a bunch of CHWS and they
• 01:16:50engaged in very slow conversations with
• 01:16:55families all over the New Haven area to
• 01:16:59help sit with people who were nervous
• 01:17:02about getting the vaccine and and just
• 01:17:05engaged in slow conversations and had
• 01:17:07the luxury of being able to engage in
• 01:17:10slow conversations and and that was
• 01:17:12very effective and since then we still
• 01:17:15have CHWS here and they are wonderful
• 01:17:20people who and and you can actually
• 01:17:23put a note in epic and request a CHW
• 01:17:26you might not know that and they can
• 01:17:29meet a patient or family at their house.
• 01:17:32They can meet you for a cup of coffee.
• 01:17:36They can really help to provide space
• 01:17:41as a third party that might feel
• 01:17:45more safe or trusted or comfortable
• 01:17:48for many patients and families.
• 01:17:50And there,
• 01:17:53there have been a couple of clinics
• 01:17:56here in New Haven that have called
• 01:17:59upon community health workers to help
• 01:18:01so-called non compliant patients,
• 01:18:03right,
• 01:18:04who aren't following up.
• 01:18:07And when the very kind receptionists
• 01:18:11were calling and saying hi,
• 01:18:13just to review another reminder,
• 01:18:15you really need to get to your appointment,
• 01:18:17that wasn't effective for a number
• 01:18:19of communities here in New Haven.
• 01:18:22And so they called upon the CHWS here and
• 01:18:28through some authentic safe conversations,
• 01:18:32they've been able to help many,
• 01:18:33many patients turn from being non
• 01:18:36compliant to being back on schedule.
• 01:18:38So they are a wonderful testament to how
• 01:18:43we can provide more collaborative care.
• 01:18:48So under that system though,
• 01:18:49you would have to rely on the
• 01:18:51birthing person to call for a
• 01:18:53community health worker or would
• 01:18:55you have some kind of push?
• 01:18:57Yeah, that's a great question.
• 01:18:59You know, safe haven laws are only
• 01:19:01as effective as they are known.
• 01:19:05And we saw that in Austria,
• 01:19:07we saw that here in Connecticut.
• 01:19:09We've seen it in many places.
• 01:19:10When there is marketing
• 01:19:13and community education,
• 01:19:15then the safe haven laws
• 01:19:17are used much more often.
• 01:19:19And so my community members and our
• 01:19:23task force are all recommending that
• 01:19:26that the that information about
• 01:19:29safe havens be a part of public
• 01:19:33school health classes and be a part
• 01:19:36of other educational campaigns.
• 01:19:38Because once a certain community kind
• 01:19:41of ages out of needing those resources,
• 01:19:44that information isn't necessarily
• 01:19:46passed along.
• 01:19:47And so when Connecticut took the
• 01:19:50time and funding to put a bunch of
• 01:19:54billboards on buses and in other locations,
• 01:19:57it was really, really helpful.
• 01:19:58So we need to have more education.
• 01:20:01And if,
• 01:20:02as a part of that education,
• 01:20:04we're letting people know about
• 01:20:07community health workers who
• 01:20:08are from their communities and
• 01:20:11share their lived experiences,
• 01:20:13that would be a way to enable someone
• 01:20:16to make that phone call to the Safe
• 01:20:20Haven National Hotline or to link
• 01:20:22it through your 211 services here.
• 01:20:25And 911 is, of course, well,
• 01:20:27we have time for great.
• 01:20:29One or two more questions.
• 01:20:34Hi. Do you know if it's
• 01:20:35necessary for us to have new laws
• 01:20:38before health centers allow anonymous
• 01:20:40confidential births or could health
• 01:20:43centers do this by themselves and
• 01:20:45they just don't want to right now.
• 01:20:48I think there are a lot of people
• 01:20:51who really want to offer anonymous
• 01:20:53labor and delivery. I think there's
• 01:20:57a huge need for it that lots of
• 01:21:01folks are really pushing for. I think
• 01:21:08there are a host of factors that
• 01:21:10I don't understand in terms of
• 01:21:12billing codes and requirements for
• 01:21:14when a patient walks in the door.
• 01:21:17So I I, I'm not the expert in
• 01:21:21knowing how those tactical
• 01:21:23challenges could be addressed.
• 01:21:29Yeah,
• 01:21:32we
• 01:21:42have one last question.
• 01:21:43Hi, kind of going off that question,
• 01:21:45I've been sitting here kind of
• 01:21:47brainstorming this entire time,
• 01:21:48going from 300 questions.
• 01:21:50Are you aware of any models that
• 01:21:54kind of integrate community health
• 01:21:56workers and doulas to be able to
• 01:22:00do confidential home births and
• 01:22:03the safety of a maybe professional
• 01:22:06who's not a typically licensed
• 01:22:08medical professional but still
• 01:22:13very competent?
• 01:22:14I know thinking about maternal
• 01:22:19mortality in black women specifically,
• 01:22:23there's been a big shift to
• 01:22:25community health workers,
• 01:22:26doulas and home births for a similar reason.
• 01:22:31Not necessarily confidential,
• 01:22:32but there's a lot of conversation
• 01:22:36generating around that topic already.
• 01:22:39Are you aware of any of these models
• 01:22:42or do you know if it would even be
• 01:22:44something that could be considered.
• 01:22:46Yeah. You you raise,
• 01:22:47you raise a great point because
• 01:22:49I I am aware of this trend of
• 01:22:52many black women seeking out home
• 01:22:57births and private clinics to
• 01:22:59have the birth experience that's
• 01:23:01much more in line with what feels
• 01:23:05emotionally and physically safe to
• 01:23:07them and to optimize their outcomes
• 01:23:09because we're all aware of racial
• 01:23:13disparities and in childbirth and
• 01:23:15in the the six months afterwards.
• 01:23:19So I I would say that
• 01:23:23that is a great idea that would still
• 01:23:27probably meet the same hurdles in terms of
• 01:23:33requirements for documentation and billing.
• 01:23:37And so and yet I'm hopeful that there's
• 01:23:41something there that that there's
• 01:23:43a way to kind of navigate that and
• 01:23:46work with doulas and legislators
• 01:23:49and midwives who could potentially
• 01:23:53volunteer those services in a way
• 01:23:57that could potentially Createspace.
• 01:23:59What I'd like to see is rooms within
• 01:24:01hospitals that are just available for
• 01:24:05this purpose to be able to support
• 01:24:09a real in hospital setting.
• 01:24:12The tricky piece again is most safe
• 01:24:15haven laws have that harm clause.
• 01:24:17And I worry a lot about an infant in
• 01:24:23you know if someone does choose and
• 01:24:26is supported by the state to allow
• 01:24:29a midwife to deliver one of these
• 01:24:33babies in a home setting and if there
• 01:24:37is any risk of harm to the infant,
• 01:24:42then that birthing parent may still
• 01:24:47be at risk for prosecution.
• 01:24:48And so this goes back to how
• 01:24:52complicated it is to write meaningful
• 01:24:55law other and and you see this in
• 01:24:58other areas of safe haven as well.
• 01:25:01It's actually still a crime here in
• 01:25:05Connecticut to conceal a pregnancy that
• 01:25:09has never been stricken off the books.
• 01:25:12So, you know,
• 01:25:13would a prosecutor actually
• 01:25:15go after someone for that?
• 01:25:17I I I certainly hope not.
• 01:25:19But I I'm hopeful that that,
• 01:25:24you know,
• 01:25:24the ideas that you're bringing to light,
• 01:25:26you know,
• 01:25:27really do demonstrate the kind of
• 01:25:30originality and creativity and
• 01:25:32collaboration that are going to
• 01:25:34help us find a way through this
• 01:25:37really messy point in our history.
• 01:25:39So thank you for bringing that up.
• 01:25:40And maybe we should write some op Eds
• 01:25:43together and get the word out about
• 01:25:45how we can kind of push that through.
• 01:25:47So thank you,
• 01:25:48everybody for coming out tonight.
• 01:25:54Great. And thank you, Lori.
• 01:25:55It was one of the the best lectures
• 01:25:58of the year. Thanks so much.
• 01:26:01I get presents, so you could do.