Alabama says embryos in a lab are children. What are the implications?
The Alabama Supreme Court has opened a new front in the legal debate over when human life begins. Embryos created and stored in a medical facility should be considered children under the state law governing harmful death, the court ruled.
Friday's ruling was cheered by anti-abortion activists nationwide, who have long argued that life begins at conception. They were very happy that a court included fertilization outside the womb in that definition for the first time. But the decision's strongest and most immediate impact will be on fertility patients trying to conceive, not women seeking to terminate their pregnancies.
The Alabama ruling invites states to issue tough new rules for the fertility industry, which could sharply limit the number of embryos created during a cycle of medical treatments and affect the future of millions of stored frozen embryos. A consensus even offered roadmaps for such statutes. That could have a chilling effect on anyone wanting to have children through in vitro fertilization, whether single, part of a same-sex or heterosexual couple.
What did the statement say?
The statement is actually a bit narrow. The cases involved three couples who sued the Center for Reproductive Medicine, a fertility clinic in Mobile, for unintentionally destroying their embryos. The plaintiffs argued that they were entitled to damages under Alabama's Wrongful Death of a Minor Act of 1872. Two lower state courts disagreed, saying the embryos were neither humans nor children. The state Supreme Court overturned those rulings, saying the embryos fell squarely within Alabama's definition of minors and the negligence lawsuits could proceed. The case now heads back to State District Court for further proceedings.
What did the statement say? not participation?
The decision is silent on the fate of other frozen embryos in Alabama because that issue was not before the courts. The ruling only addresses the conditions under which plaintiffs can bring a negligence lawsuit against a fertility clinic for embryo destruction. However, it could ultimately have major consequences for patients and healthcare providers in Alabama.
On Wednesday, the University of Alabama at Birmingham IVF clinic announced it would temporarily close to explore the implications of the court ruling for its patients and caregivers. One fear is that the clinic, doctors and even patients could face new liability issues surrounding the handling of embryos.
What does this mean for fertility patients and clinics?
“The honest answer is that we don't know for sure,” says Dr. Paula Amato, president of the American Association for Reproductive Medicine, an organization that lobbies on behalf of fertility experts and patients. “But the ruling is very worrying.”
Freezing embryos is a widespread practice. During a standard cycle of in vitro fertilization, a woman uses hormones to maximize her egg production. A doctor then retrieves as many eggs as possible and injects them with sperm in the clinic's laboratory, with the aim of creating viable embryos for implantation.
That process will often result in numerous embryos. Due to the dangers associated with multiple births through IVF, protocols now urge doctors to implant only one embryo at a time. But success at implantation is hardly guaranteed, which is why doctors typically freeze the remaining embryos for subsequent attempts.
But if laws prevent providers in Alabama from freezing embryos, patients could face the medically challenging and financially draining prospect of many more cycles, said Dr. Amato. Success rates would most likely drop. “It will disproportionately affect lower-income people, people of color and people in LGBT communities,” she said.
In short, according to federal data, Infertility affects 9 percent of men and 11 percent of women of childbearing age in the United States.
The ruling may therefore limit the ways in which reproductive medicine is practiced in Alabama. “The ruling potentially criminalizes or imposes stiff civil penalties on the standard procedures we perform every day,” said Dr. Amato.
Has the Alabama court proposed protocols for frozen embryos?
No. The court was clear that it could not regulate fertility clinics and the practice of reproductive medicine. But in a unanimous opinion, Chief Justice Tom Parker strongly urged the Alabama Legislature to investigate the matter. He said other countries, including Italy, New Zealand and Australia, were limiting the number of embryos that could be both created and implanted, and suggested states look to them for regulatory templates.
Will this case go to the US Supreme Court?
Not in the short term, legal experts predicted. The clinic would have to appeal the decision, a move that could be risky, said Katherine L. Kraschel, an expert in the field of reproductive law at Northeastern University School of Law. In light of the United States Supreme Court's 2022 Dobbs ruling, which overturned the nation's right to abortion, the clinic's chances of even getting to the Supreme Court's door would be slim, “because the case depends on the interpretation of the state Supreme Court.” of its own state statute.”
Lawyers for the clinic did not return requests for comment.
Moreover, the case in Alabama is far from over. The state Supreme Court ordered the parties to return to district court to litigate the case in light of the new ruling, including the suggestion that other legal avenues be explored. One of the issues raised was whether a clinic's standard contract with fertility patients, which typically allows providers to donate or destroy embryos at a later date, could limit the clinic's liability in this case.
Does all this have any effect on abortion?
In recent years, anti-abortion groups have pushed for fetuses to be given “personality” status, which would entitle them to legal protections. In expanding that umbrella to include lab-grown embryos, the Alabama Supreme Court used reasoning echoed in the U.S. Supreme Court's 2022 abortion ruling: that fetuses deserve a court's shield under the Equal Protection Clause of the 14th amendment.
“The Supreme Court is making an effort to view the fetus as a vulnerable, unprotected minority that courts must intervene and protect, whether that is by upholding anti-abortion restrictions or by making progress toward accepting and recognizing the fetus as a person. ,” said Melissa Murray, an expert in reproductive law at New York University School of Law.
Americans United for Life, the nation's oldest anti-abortion organization, was particularly encouraged by Alabama's embrace of that issue.
“The Alabama Supreme Court held that the text of the Wrongful Death of a Minor Act is clear and applies to all preborn children, including plaintiffs' embryonic preborn children. In doing so, the Court rightly recognized the legal status of embryos as human persons.” Danielle Pimentel, The organization's policy advisor said this in a statement. “This decision is a step in the right direction to ensure that all newborn children are equally protected by the law.”
Dr. Amato said she found it ironic that anti-abortion groups supported statements that could severely restrict IVF
“IVF is about family building,” she said. “It should be seen by the red states as a pro-life activity.”