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abortion, Contraception, Ethics, evidence based medicine, health insurance

An OB/GYN’s opinion on the Supreme Court, Hobby Lobby, and contraception

The Supreme Court, in a 5-4 decision, sided with Hobby Lobby (and much of the religious right in the United States) and ruled that a closely held private corporation does not have to provide insurance coverage for certain birth control methods. Justice Alito, speaking for the majority wrote:

“The owners of the businesses have religious objections to abortion, and according to their religious beliefs the four contraceptive methods at issue are abortifacients. If the owners comply with the HHS mandate, they believe they will be facilitating abortions…It is not for us to say that their religious beliefs are mistaken or insubstantial.”

As an OB/GYN I see six disastrous consequences of this decision:

1) The idea that religious beliefs of some are more important that the religious beliefs of others. Any woman wanting to use one of the 4 methods of contraception listed obviously doesn’t share the same beliefs as the closely held corporation who employs her. Why are her beliefs less important? Why can her place of employment push their religious beliefs (because a place of employment now has the rights of an individual) into the exam room? The First Amendment rights of women seeking health care are less important that the First Amendment rights of a corporation. Thank you Justice Alito for putting us in our place.

2) Legislating a belief over science. The 4 methods of contraception that Hobby Lobby takes issue with are Plan B, Ella, and the two IUDs, ParaGard and Mirena. We call these methods contraceptives not abortifacients because in science, unlike the Supreme Court, we like facts and facts tell us that these methods do not cause abortion (which is by definition the disruption of a pregnancy that is already implanted, no matter how early). But even if we take the evangelical definition of pregnancy (the wandering fertilized egg) we know for sure Plan B has no effect because it is biochemically impossible for a progestin in that dose (or probably any dose) to prevent pregnancy by any definition, scientific or otherwise. The bulk of the medical evidence suggests that the two IUDs in the United States do not prevent a fertilized egg from implanting and the same goes for Ella. We can’t say with 100% accuracy because there is no easily accessible test to tell us that a fertilized egg is wandering aimlessly around the upper reproductive tract and so the information comes from indirect methods like studying the mechanisms of action in lab and animal models and studies that have looked at the time of the cycle that the method is used. Science is fact and apparently facts don’t matter to the Supreme Court. Good to know.

3) A slippery slope for other contraceptives. If you believe the untruth that Plan B (a progestin) causes abortion (by any definition, evangelical or scientific) then all hormonal contraceptives should be excluded for sexually active women as they all contain progestins. Quick start pill taking (starting the birth control pill the day you get them versus waiting for your period) is very common and improves compliance, however, if you share the magical belief that progestins could prevent a fertilized egg from implanting then all oral contraceptives have to go, otherwise every time a woman starts her pills mid cycle a baby might die (never mind the possibility of escape ovulation). Hey, if you want to pervert science you can go down any rabbit hole.

4) A slippery slope for other medical practices that infringe on religious beliefs. Vaccinations, psychiatric care, blood transfusions, and infertility care are all opposed by some religions. While Alito wrote that this decision is “very specific” meaning that it only applies to these four contraceptives in this specific situation, it is somewhat naive (or obtuse or insulting, depending on your perspective) to not consider that other groups might also have”sincerely held religious beliefs.” Justice Ginsberg voiced concerns about these broader implications in her dissent, after all there is real money to be saved in carving out health care based on what a religion allows. Since case-law is integral to the US legal system what is to stop a closely held corporation owned by a Jehovah’s Witness from suing to exclude transfusions and organ transplants? If the court were to say “no” to a Jehovah’s Witness corporation (as Alito’s statement implies) they would be saying that only evangelical Christian beliefs are important and only a woman’s reproduction deserves to be controlled.

5) That contraception isn’t really health care. This legislation fuels the belief that contraceptives are, to paraphrase that wordsmith Rush Limbaugh, “slut pills.” It perpetuates the idea that sex is wrong or only for procreation, when sex is a normal part of life and people who have active sex lives tend to be healthier and live longer. In addition, the benefits of contraception in the health and longevity for women is undisputed. According to the World Health Organization “Women’s and adolescents’ right to contraceptive information and services is grounded in basic human rights. Paying for contraception is no different from paying for vaccinations, diabetes care, or an appendectomy.

6) Restricting access to IUDs increases the risk of unplanned pregnancies and thus paradoxically the rate of abortion. As an IUD costs about $900 (or as Ginsburg pointed out, about a month’s salary for a minimum wage worker). IUDs are by far the most effective method of contraception and they have been shown to reduce the rate of abortions.  Fewer IUDs means more methods with higher failure rates.

The message from the five male justices of the Supreme Court who felt it was within their purview to opine on women’s health care yet ignore medical facts (which I hope was presented as evidence) is chilling. The religious beliefs of privately held corporations are definitely not insubstantial, but the rights of women most definitely are.

 

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Discussion

225 thoughts on “An OB/GYN’s opinion on the Supreme Court, Hobby Lobby, and contraception

  1. Thank you. I’ve been in a white hot lather of fury and despair since Monday morning when I read the ruling. While I had half way expected this result, I had a persistent little voice saying “They can’t POSSIBLY — can they?” Because it is crazy, because it is so damaging, because it helps nobody except some penny pinchers dressed in religious garb.

    Posted by syrbal-labrys | July 1, 2014, 1:36 pm
  2. Brava. There are so MANY issues of fact and law that the Court got wrong on this one; I’m delighted to see so many collected in one place.

    Posted by Lex | July 1, 2014, 6:01 pm
  3. Can a company now ban Viagra if the employee is unmarried if they do not believe in sex outside of marriage?

    Posted by Jeff Livingston MD | July 1, 2014, 7:23 pm
    • Can a company make it policy that the only employees who qualify for paid maternity leave are those who are married?

      Posted by Dee | July 1, 2014, 11:32 pm
      • Do these same companies make sure that their employees are tithing? What about all the other biblically based rules for living?

        Posted by Jan Mazeau | July 2, 2014, 4:56 pm
    • They will never ban viagra because then how would the judges sleep with their teenage mistresses they just bought with their corporate bribe money?

      Posted by armystrong305 | July 3, 2014, 3:31 pm
    • they can not BAN Viagra but they do not have to pay for it

      Posted by Frank Stein | July 7, 2014, 12:30 pm
    • This is an idiotic statement. No one is banning anything. Not paying for something is not the same as banning it. I’m not buying you a Big Mac, therefore I have apparently denied you access to Big Macs.

      Posted by Alex | July 9, 2014, 7:48 am
      • Bravo, Alex. You hit the nail on the head. This is not about women’s healthcare, as most opponents of the decision like to promote. It is about the fact that liberals have, for once, been denied their “entitlement” to whatever they want someone else to pay for. The government has NO business telling any company or any individual what they must provide or not provide. Employees of Hobby Lobby earn an above average wage and had benefits (healthcare and other) before the ACA was enacted. They were satisfied with that. Anyone who was not was welcome to seek employment elsewhere. No one forced them to accept the wage or the healthcare package that was in place. Now, a few discontents, all, I would render to bet, who are not employees of Hobby Lobby, want to raise a stink about the decision.

        Posted by Randall | July 14, 2014, 7:32 am
      • The part that baffles me is the argument that contraceptives are a healthcare essential, rather than a convenience/luxury good which are already highly affordable (condoms, VCFs, and birth control pills). The only methods of birth control which are not affordable tend to be the most extreme forms (typically surgical in nature). The problem is that many things which did not exist prior to the last century, whether it be elective medicines or technology, have gone from being luxury to human rights in less than the span of a generation.

        Posted by Alex | July 14, 2014, 8:58 am
  4. Thank you for this. Yet again, a court has shown that it simply doesn’t understand anything where the word “science” is included; and rather than trying to understand, it simply ignores it.

    It’s interesting that the majority opinion was delivered by five men; the minority opinion was delivered by three women, and one male. Draw your own conclusions, I’d say.

    Surely, the most basic problem is the failure of clear, logical thinking. The court is saying that though you and I have equal rights in relation to religious beliefs, actually my rights trump yours. That’s a rephrasing of Napoleon’s dictum (in George Orwell’s Animal Farm): All animals are equal, but some are more equal than others.

    It’s also another example of the old saying, “Hard cases make bad law”. And the law is bad, for the reasons given in the minority opinion, particularly those around blood transfusion, vaccines etc. Despite the majority opinion trying to “ring-fence” the judgement, I’d guess that this will be challenged at some time.

    And it’s also an inherent problem, where the court seems to be required to give a binary response—a yes/no alternative; actually, I’d have thought that this sort of problem cannot be determined in this way.

    Posted by korhomme | July 2, 2014, 12:41 am
    • You throw the word “science” around like it is something sacred. Not too many years ago, “science” was sure that “Lucy” was one of the earliest humans discovered. That turned out to be totally false. The same was true of “Brontasuarus.” They even had full scale replicas of what brontasuarus looked like. Science had that wrong, too. Don’t try to push your agenda in the name of science. Your “science” has been wrong before and it will be wrong again. The Supreme Court decision was a not about “science” or “women’s healthcare.” It was about freedom from government intrusion. Where in the world did anyone get the idea that government has or should ever have the right to force a company or an individual to do something they were morally opposed to? I have yet to hear any employee of Hobby Lobby voice their opposition or discontent with the decision. It is only a small number of “progressives (translation: liberal marxists) who seem to be compelled to voice their opposition to something that does not even affect them. You simply can’t stand the thought that you can’t have anything and everything and have it paid for by someone else.

      Posted by Randall | July 14, 2014, 7:47 am
  5. Reblogged this on Reading, Drinking and Dancing with a Chaser of Snark and commented:
    Know the facts.

    Posted by Michelle | July 2, 2014, 3:27 am
  6. Thanks for this Jen. It’s even made the news here in Oz, and it is horrifying.

    Companies were originally developed as separate legal persons (the least messy way to create new life, according to my company law lecturer) to protect their shareholders from the mistakes and misjudgements of the company; now they are taking on the ‘beliefs’ of those shareholders.

    I wonder if the precedent could come back to bite those shareholders one day, as if the corporation is so closely identified with them, maybe they will no longer be able to hid behind it to protect personal assets.

    Posted by Iorek | July 2, 2014, 4:11 am
  7. If only the Supreme Court had read your blog before their decision. They may be Supreme Court Justices but they are far from knowledgeable on every topic.The scariest part of this is the slippery slope aspect. Opening the door just a crack opens up far too many possibilities.

    Posted by Phil Taylor | July 2, 2014, 4:17 am
  8. Thank you for this. Following from Canada and was totally confused by why pro-lifers were against contraception. I understand now – and am still horrified by the decision. That slope is indeed very slippery…

    Posted by Liisa | July 2, 2014, 7:10 am
    • There’s already new cases waiting to be seen by SCOTUS – where employers with ‘sincere’ religious ‘beliefs’ don’t want to have to pay for ‘contraceptive counseling’ – they’re wanting to prevent women from having ANY choice for contraceptives for themselves.

      Posted by Darwy | July 2, 2014, 7:44 am
      • So? This isn’t a free ride, Darwy. You can do anything you want to your body, but I don’t have to pay for it and neither does Hobby Lobby. Get over it.

        Posted by alfrancis99 | July 15, 2014, 4:37 pm
      • You aren’t paying for it – medical benefits are PART OF MY PAY.

        Get over yourself.

        Posted by Darwy | July 15, 2014, 5:17 pm
      • Except that medical insurance is part of my PAY. Those are MY benefits that are part of my wages. You don’t get the right to determine how I use MY benefits from MY wages.

        Get over yourself.

        Posted by Darwy | July 21, 2014, 6:49 am
      • I guess this is where we just have to disagree. Health insurance isn’t a free ride to anything you want. What if you feel you’re a woman in a man’s body? Should your health insurance be forced to cover a sex change? What if you don’t like the size of your breasts and want implants to make you feel better about yourself? Should health insurance be forced to pay for it?

        I don’t think so.

        You’ve been give 16 of 20 choices to use for birth control. That’s ample to prevent any unwanted pregnancies. Should health insurance now cover the cost of condoms? Hardly. 26 choices should give even the most fertile person the coverage they need.

        It’s akin to saying, “I want green eyes, so my vision provider should have to cover green contacts instead of clear.” It’s a ridiculous and hollow argument.

        If you view your benefits package as part of your compensation, then choose a company that provides the exact benefits you want. It’s very, very easy to do.

        Posted by alfrancis99 | July 31, 2014, 6:32 am
      • Responding to Alfrancis99:
        People don’t choose birth control methods on a whim. There are medical reasons why some methods are more suitable for some people than others. The existence of many options is not an answer for those women for whom the medically recommended method is not among them.

        And please don’t go on a tangent on something you appear to be terribly under- or mis- informed about, such as issues relating to transgender people. People don’t seek gender transition in any form on a whim either. These are serious treatments for serious problems.

        Posted by Anat | July 31, 2014, 6:49 am
  9. Great you collected all the ignored facts that form basis of this decision. I hope that writing up a good article helped alleviate some of depression the tweets did not alleviate.
    Rich Hartmann

    Posted by Rich Hartmann | July 2, 2014, 9:30 am
  10. Reblogged this on T. L. Ryder and commented:
    This clear-headed, direct opinion from an OB/GYN should be read by everybody, IMO.

    Posted by tlryder | July 2, 2014, 1:26 pm
  11. Thanks for writing this great post. It makes me sad to think of the door this opened to companies to deny health care.

    Posted by Erlene | July 2, 2014, 3:18 pm
  12. I remember Eckards a drug store in Florida. They told their employees who to vote for and how to think. If they were against certain pills they would push others. A slippery slope to say the least.

    Posted by awax1217 | July 2, 2014, 3:31 pm
  13. Congratulations on being Freshly Pressed.

    Posted by wakingofthebear | July 2, 2014, 3:35 pm
  14. Why are employers paying for contraception etc. in America? In Australia so many people have private health insurance…..our system is better and so is self-employment if some bosses even tell you how to vote and think (RE: awax217)

    Posted by habibilamour | July 2, 2014, 4:11 pm
  15. Abortion is a disaster. Its better than killing a life that to consider contraception as first priority to stop unwanted pregnancy.

    Posted by parisa53 | July 2, 2014, 4:15 pm
  16. What a giant step backwards. It’s just contraception. So sad and ..chilling, creepy.

    Posted by Jean | July 2, 2014, 4:22 pm
  17. It is misogyny pure and simple. Those who have purchased the 5 on the bench who ruled in their favor, and we pretty much know who they are, have chipped away another piece of the barriers in their way toward their end: how much control can they get? They have been at this since the 1940s and The John Birch Society. Women mean nothing to them. Only concubines for pleasure and maids to care for them. There is no love. There is no emotion. There is only malice for our very existence. When will this end? Like I keep hearing, “Don’t get mad. Vote.” That’s how we change things. And a little reminder women should heed now more than ever, that little thing about a woman scorned? They ain’t seen nothin’ yet…

    Posted by ktremont | July 2, 2014, 4:34 pm
  18. Now I know that nothing that I will say is going to be treated with any creditability. I am after all a middle class American male from the Midwest. However, there are a few things I would like to say in response to this. The first of which being, this is well thought out, and well executed. The Supreme Court’s ruling does not restrict these birth control measures, it restricts the government’s right to force someone to pay for something that they are against. I could understand this argument if women were forced to work for hobby lobby, or it applied to most businesses. This was a narrow ruling, with a focused scope.
    The problem here is the assumption that the woman has to work for Hobby Lobby. If Hobby Lobby does not offer the benefits that woman wants, she can always go work somewhere else.

    Number 4, Reading the actual reading from the supreme court can calm these fears as the court ruled that this decision applies only to the contraception mandate, not other insurance mandates such as those involving vaccines. I would like to present an alternative picture to this ruling, and I ask that you please read it with an open mind. We live in a nation of laws. Laws that limit the government’s power, and protect us from having the viewpoints of others forced down our throats. I am a limited government conservative. I do not think the government has the right to tell anyone how to live their life. This ruling from the Supreme Court does just that. It prevents a family from having to do something that violates their deeply held religious views. I am not trying to debate the merit of their beliefs, I am just saying that defending liberty and limiting excessive government is not a bad thing. It does not make these methods of birth control illegal, it just simply enforced the laws of this country. Specifically in this case, the 1993 Religious Freedom Restoration Act, signed into law by Bill Clinton. I am all for a nation where the government is bound by law, and is prevented from trampling my rights.
    Now of course there is the issue of birth control. I know it is a hot button issue, and I can respect that. So the ruling restricted the government’s power to force a family to purchase something that violates their religious views. Thankfully it does not limit the birth control methods in question. Thus, women are able to stop working for hobby lobby, and instead go to work for a company that provides the benefits that they want. This puts hobby lobby at a disadvantage, trained, quality employees are leaving and going to the competition. Companies that provide the benefits that employees want will prosper, while companies that do not, will struggle dealing with unqualified uninterested employees. Hobby Lobby will be left with the option of adapt or die.
    It has been a pleasure reading your post Ma’am.

    Posted by progressivewatch | July 2, 2014, 4:43 pm
    • I keep wondering why women need anything paid for by the government when they are capable of buying what they want when they want no matter what? I have considered females more able than most men to see and get what they want come hell or high water! Just stay out of their way or pay the price fellas.

      Posted by talaverabeads | July 2, 2014, 5:30 pm
      • So should women pay out of pocket for delivery too? Contraception is an essential part of a woman’s health care. It should be covered by health insurance just like other medications that are important to maintaining one’s health.

        Posted by Anat | July 5, 2014, 12:37 pm
    • As to your first point, I would like to say that it’s not always true that someone “always has the option of working somewhere else”. I am currently out of work, trying to balance my bills, and going to school, and happen to live in an area that is so hard hit by the recession that I am desperate for work – I have to eat and have no desire to be homeless. If Hobby Lobby called me I would take the job in an instant because I simply don’t have another option. Does that mean I am alright with them insisting their religios rights trump mine? No. I am very much a believer in their rights ending where mine begin.

      I don’t think you quite understand the point number four is making. The point is that if Hobby Lobby can hold their religions beliefs – against contraception – over their employees, then any business owned by Seventh Day Adventists, who have deeply help religious convictions against blood transfusions, could make a case that they have a right to bar their employees from having those, or any business owned by Waldorf followers, who have deeply held religions beliefs against mental illness can bar their employees from getting medicine for mental illness. Their beliefs are just as valid and just as deeply held convictions as those who own Hobby Lobby, so if HL can get an exemption based on religious beliefs, there is absolutely no legal reason why the examples I just gave should not also be able to get exemptions.

      Should the government dictate how people should live? No. But the job of the government is to protect the rights of those who can’t. Hobby Lobby is not powerless; they have plenty of money. Their minimum wage workers do not have power, and far less money. So the government should never have granted HL the ability to block contraception.

      Posted by sweetpea616 | July 2, 2014, 11:01 pm
      • Why should your rights trump their rights?
        Also out of work? Apply in red states like Texas and others who are seeking qualified candidates all the time. Texas still produces 3 out of every 5 jobs created in the US.

        Your rights to choose where you work are where your rights end. You enter into a contract when you accept work from any company. You agree to work for x price and y benefits. They agree to provide those. You can still get the other 4 methods you just have to pay out of pocket.

        Hobby lobby pays almost 2x minimum wage and already offered insurance better than required by the new law. The exception? 4 methods of birth control they see as wrong. They had this same exact policy before the law and not a soul complained.

        So when asking about rights ask yourself why your rights trump theirs? And ask yourself why you feel you can unilaterally change a contract of employment based on your perceived slight of rights.

        Posted by Michelle Styles | July 3, 2014, 7:47 am
      • The ruling does not give a company the right to bar their employees from receiving these products. It does not open the flood gates, it was a narrow ruling on the issue of 4 methods of birth control. The ruling actually stated that.

        Basically you are saying that the green family has to give up its beliefs. Their beliefs are just as valid. The issue here is that they are the ones paying for it.

        They make more than the minimum wage you know. They make 93% above the minimum wage.

        One persons liberty does not trump another’s. The ruling does not say “you can’t have birth control”, it just says that “the government can’t force you to buy birth control”.

        Posted by progressivewatch | July 3, 2014, 2:49 pm
      • but again, I know that I have little to no creditability in your eyes. So I will let a Doctor explain the situation.

        Posted by progressivewatch | July 3, 2014, 3:12 pm
      • I should add that the court did not grant the green family the ability to block birth control, The court protected their right to not have to buy it. The courts do not grant anything, they merely protect.

        Posted by progressivewatch | July 3, 2014, 3:17 pm
      • HL is NOT blocking contraception. It’s idiotic to claim they are. They’re paying for 80% of the available FDA approved methods of contraception on the market. Not paying for something is not the same as blocking access. There is not a dude from Hobby Lobby hanging around outside the Walgreens with a velvet rope to keep out women trying to buy morning after pills. Also, Hobby Lobby pays significantly higher hourly wages than most other retailers. Folks can use that extra money they make to buy whatever contraceptives they want. Or they can just use one of the many types of contraception that their plan WILL pay for.

        Posted by Alex | July 9, 2014, 7:55 am
  19. Sad to me that Hobby Lobby is getting so much PR on such bad decision they have made.

    Posted by segmation | July 2, 2014, 4:55 pm
  20. Reblogged this on The Daily Blabber and commented:
    I will be busy or away for the next few days so I thought I would reblog a blog or two in meanwhile. I like the OB/GYNs take on Hobby Lobby’s stand on insurance & birth control. If you have a comment please comment on Dr Gunter’s feed as I will be disabling comments on mines. Thanks!

    Posted by The Daily Blabber | July 2, 2014, 4:59 pm
  21. This might sound like a stupid question, but why can’t American women pay for their own contraception like everywhere else?

    Posted by Just wondering | July 2, 2014, 5:49 pm
    • Because “everywhere else” women don’t pay for their own contraception. It’s provided, free or close to free, in many cases by the national healthcare service of many nations.

      Posted by Melanie | July 3, 2014, 8:30 am
      • How strange. I guess my first-world western country must be in the minority. I didn’t know that. I still can’t see why you are all so upset at having to pay for something yourself: it is only 4 of 16 options from what other commenters here have said. That leaves a lot of freebies. No wonder our country thinks your health care system is strange.

        Posted by JUST WONDERING | July 5, 2014, 9:03 pm
  22. Oh, HELL yeah. Well done.

    Would you please do a lecture circuit with a megaphone outside every fundamentalist church and Republican watering hole until the lunacy dissipates? I’ll bring the chocolate chip cookies and scotch.

    Posted by allthoughtswork | July 2, 2014, 6:10 pm
  23. Basically none of this matters. What matters is: employees of hobby lobby have the right to work somewhere else. No one is forcing them to do anything. Assuming that contraceptives should be given to them by right is effectively forcing the company to do something that should be entirely up to owner discretion. Apparently, the people who think the decision is bad or wrong want the world handed to them on a stick with extra toppings. Don’t impose the bill for your wants and needs on someone else. If you can’t afford contraceptives on your own, don’t have sex or don’t work at hobby lobby.

    Posted by amwestbrook | July 2, 2014, 6:58 pm
    • I had to re-write this many times to be respectful so I hope I achieved that.

      Your ‘go work elsewhere’ comment is the sort of thing people used to say to victims of workplace sexual harassment, pay inequity, and racism. It is ignorant to assume that retail employees can just leave when it turns out they work for religious nuts that want to control them.

      To your point about ‘imposing the bill for wants and needs': My understanding is that employers must contribute/sponsor a plan for their employees who also contribute (via paycheque) to the premiums – I am from Canada where we all have health coverage (and pay for it!) but additional plans are handled this way.

      Posted by christineespeer | July 2, 2014, 8:21 pm
      • I appreciate the respect and I hope I return it to you.
        When someone is being physically or emotionally harmed, yes, measures should be taken to help them, but in this case, no one is actually being harmed, regardless of how they may feel. Its a matter of hypothetical employees trying to control their employer and force them to provide something the employer simply doesn’t want to provide. Here’s the great thing about a job: it’s a relationship where one party provides a service and the other provides compensation, and the terms of that relationship have to be agreed upon. If the terms change, either party can leave.

        And ‘religious nuts who want to control them’ is hardly the way to describe Hobby Lobby. They provide excellent pay and workplace environment for their employees. If they are forcing employees to stay and work against their will, I’m sure we would all have heard by now.

        Yes, the premium is shared, thus the whole issue. Hobby Lobby isn’t saying employees can’t get contraceptives from their own separate insurance plan, they’re saying they don’t want to foot the bill for half of it.

        Posted by amwestbrook | July 2, 2014, 8:38 pm
    • The case was not brought by the employees against Hobby Lobby, it was brought by Hobby Lobby against the government because the government said you must provide coverage for these twenty contraceptives or pay a fine as part of the Affordable Care Act. It’s like minimum wage, the government is setting minimum health care standards that companies of a certain size must provide or pay fines.

      Hobby Lobby decided based on their beliefs and not science that some of the contraceptives were offensive, but some of those contraceptives might be the best choice for a woman, there were reasons that doctors put them on the list. Mirena is an amazing and wonderful contraceptive in my opinion and taking such a long term and cost effective contraceptive away from people is a bad thing, especially if you want to avoid abortions. TMI warning: I haven’t had a period in twelve years because of my IUD, how is that an abortificant?

      Posted by Tribi | July 3, 2014, 6:39 am
      • I understand who brought the case. Everyone keeps talking about how its not fair to employees, so that’s what I’m talking about.
        And the question is not about “science” or whether certain contraceptives are a good idea or not. The question is this: should the government be able to dictate the terms of an employment agreement that it effectively has nothing to do with? I’m not going to argue about the healthcare bill, because that’s the same issue on a larger scale, but at least the government has drawn a line for where their intrusion will stop.

        Posted by amwestbrook | July 3, 2014, 8:52 am
      • Replying to AMWESTBROOK:

        Of course the government should be able to dictate at least some terms of employment agreements. The government can dictate that workers are not required to work in unsafe conditions, for instance. If the system is that it is the employer’s duty to provide health insurance then the government determines what the minimum requirements are for such health insurance to be sufficient.

        Posted by Anat | July 5, 2014, 12:44 pm
  24. Jen, that was great! There’s one thing I would change though and that’s how you describe the Plan B issue. I hope you’ll excuse my presumption, but this is how I would tell it. With Plan B forget the archaic word abortifacient. Think Egg or No Egg. You have sex, the condom breaks. You, both, freak. Are you ovulating now or in the next 48 hours or however long sperm stay effective? You don’t know, no one knows. Ovulation is changeable and arbitrary and like weather, not physics. So you take plan B. As Dr. G says, a progesterone, a regulatory hormone that, once pregnant tends to the womb lining. After condom breakage you’re taking it because: ovulation itself is this bizarre Rube Goldberg contraption and turns out progesterone which is super low when ovulation occurs, if high, will stop it in its tracks. Its like if I want a glass of freezing cold water and I turn on the hot tap I’m not going to get that nice cold water. If you turn on the progesterone tap when ovulation is about to happen you’re not going to get ovulation. To prevent pregnancy you want to stop ovulation.

    The Hobby Lobby zealots want you to not know that. So that they can say Plan B is an abortion. And scare people. Let’s not let them. (Also abortions are great and legal and moral. But not part of the Plan B story.)

    Posted by Conn Suits | July 2, 2014, 7:06 pm
    • Justice Alito said, “the requirement that the two companies provide contraception coverage imposed a substantial burden on their religious liberty”. That is, the company, the corporation has a burden placed on its religious liberty. Now you may think that the company is the same as the owners, managers or directors. But a company is, legally, a separate entity from the owners, it is a “non-real person”. Though this is a bit of legal fiction, the concept was invaluable for the development of the limited liability company. But so say that a piece of legal fiction can have religious liberty is nonsense. Does a company really have “personhood”?

      Posted by korhomme | July 3, 2014, 7:41 am
  25. Reblogged this on ohyesjulesdid and commented:
    Dr. Gunter hits a home run in summing up the very arguments I have been making for months now. This is a very succinct and to the point explanation why the SCOTUS ruling in the Hobby Lobby case is so “chilling” and wrong.

    Posted by ohyesjulesdid | July 2, 2014, 7:22 pm
  26. Sympathies from across the 49th parallel. I don’t think I’ve ever seen an individual in Canada who couldn’t get oral contraceptives under a private insurance plan (drug coverage in Canada is typically covered by either a private insurance plan paid for by the employer, or provincial governments for those who can’t access private plans).

    It’s disheartening to hear that your Supreme Court has the power to be willfully stupid, thus allowing them to ignore the fact that the science concretely shows that Plan B is not capable of causing abortions. I hope that someone comes up with a decent plan to remedy the situation soon.

    Posted by Ryan R. Persaud | July 2, 2014, 8:27 pm
  27. This debate is foreign to me, why would employers pay for a personal medical expense such as contraception unless the employee were in the sex industry ?

    I can understand the fuss about the ruling and its implications but not sure how employers got to the point of being responsible in the first place. Only in America I guess.

    Posted by brunnication | July 2, 2014, 10:05 pm
    • The issue isn’t that the employer must directly play for a contraceptive. Rather, the employer must provide employees with an options for health insurance or pay a fine, and the insurance must cover certain items considered preventative health care, including contraception. Since some of the premiums paid for that insurance would come from the employer’s pockets, they are paying indirectly for anything the insurance covers. They insist this is making them cooperate in the purchase of the contraceptives in question.

      Posted by Becky | July 3, 2014, 7:20 am
      • So the question is why is contraception on the list in the first place, sex and pregnacy are not diseases as far as I can tell. Condoms and birth control dosent cost that much, why invite employers into the bedroom ? Surely thats always going to end in tears !

        Posted by brunnication | July 3, 2014, 2:45 pm
    • That’s like asking why an employer’s health insurance should cover cancer if their employees don’t work with carcinogens. Or why an employer’s health insurance should cover anything, really. I mean, should employers cover dental if their employees aren’t taste testing foods? Should an employer have to pay for an insurance plan that will cover trauma from car accidents if their employee doesn’t need to drive around town as part of their job?

      My favorite part about your logic is it completely ignores the multitude of conditions and drugs that will continue to be covered by private insurance plans despite having nothing to do with the employee’s job. You can bet that private insurance will pay for Viagra, whether those men work in the sex industry or not.

      I do agree that this debate could only happen in America, because every other industrialized nation with private insurance plans on this planet is busy scratching their heads at this ridiculous ruling.

      Posted by Ryan R. Persaud | July 3, 2014, 9:45 am
      • But sex is a lesiure activity not a disease. Getting pregnant is not a work related issue. My point is you seen to believe the employer SHOULD be involved in personal choices and then complain when they make the wrong descisions.

        The car insurance is also no, if you arent working why should an employer be responsible ? Thats why you take out personal insurance…wait sorry personal responsibility doesnt that occur in the kand if the free ?

        Posted by brunnication | July 3, 2014, 2:40 pm
      • So you’re basically opposed to employer provided health insurance, is what I’m gathering. That’s the only logical conclusion to your argument.

        Posted by Ryan R. Persaud | July 3, 2014, 2:52 pm
      • Not at all but like most political debates the important question is being undermined by the very people that it affects. The argument here is encouraging employers to have the right to dictate terms in employees private lives, and employees are jumping off the cliff like lemmings demanding the concept !

        I would think a co-payment would have saved all the court costs and retained the boundary fence between personal and working lives !

        Posted by brunnication | July 3, 2014, 3:05 pm
      • Sorry, how could a co-payment have saved the court costs? A co-payment is when the user of a health insurance plan pays for part of their health care coverage, while insurance pays for the other part. Having co-payments certainly wouldn’t help to maintain barriers between work and personal lives. This issue has nothing to do with co-payments.

        Getting pregnant *is* a work related issue, and it’s the reason that many employers choose to cover contraception. Why would I want to pay to train a new employee when another employee gets pregnant out-of-the-blue and needs maternity leave? What if they get pregnant by accident and choose to keep the child in the middle of an important project or busy season? Yeah, no thanks, I’d rather provide my employees with birth control so they can plan these life-altering events.

        What employers should be forced to do is provide either (1) health insurance coverage that conforms to national standards, or (2) they should be forced to give their employees the option between a custom health insurance plan (such as the one the Hobby Lobby wants) or the annual cost of the custom health insurance coverage in cash so that employees may purchase coverage that meets their needs. Of course, that requires a level of cooperation between employers, employees, and government that seems to be very elusive down there.

        Posted by Ryan R. Persaud | July 3, 2014, 4:57 pm
  28. Reblogged this on I'm Getting Where?.

    Posted by irridessak | July 2, 2014, 10:40 pm
  29. Reblogged this on Jess in Mannheim and commented:
    I think my blog could be enhanced by the occasional reblog of things that I find well-written, interesting or humorous. Plus, it saves me from having to do the writing myself!

    Today we have an article about the US Supreme Court ruling that has all my liberal friends up in arms. I find this article presents a clear and easy-to-understand defense of the liberal position. I have been reading from the opposition as well, although I haven’t gotten around to the judgment itself.

    Posted by krysjez | July 3, 2014, 12:26 am
  30. So what your saying is that a employees religious belief is more important than the employers…

    Posted by Noelle Campbell | July 3, 2014, 3:42 am
    • No, she is saying that actual facts are more important than religious beliefs which are known to be false. Scotus specifically noted in the ruling that they did not consider whether the beliefs were true or nor, which is pretty shocking.

      Posted by Greg Smith | July 10, 2014, 5:38 am
      • Since the fact is any employee can still get provider/business paid for birth control (just not 4 specific kinda that destroy an egg), I’d say she is saying that the facts don’t really matter. Only HER beliefs matter.

        Posted by Noelle Campbell | July 12, 2014, 7:40 pm
    • Ahem. Emergency contraception works by delaying ovulation. No fertilized eggs get destroyed. IUDs work by killing sperm and unfertilized eggs. No fertilized eggs destroyed.

      IUDs are the most effective forms of reversible contraception. Better than the methods Hobby Lobby were willing to cover. The Paragard is especially important for those women for whom hormonal birth control is not recommended. And emergency birth control is a back-up for those women who suspect their method had failed them. And you know what happens when women can’t get suitable or good-enough birth control? More demand for abortions.

      Posted by Anat | July 12, 2014, 7:58 pm
      • So? That doesn’t change the fact that birth control WAS covered. If I don’t like the coffee that is served at work, I don’t make them buy the coffee I like, I go and get it. You know why? I’m a woman and not a big effin baby that needs everyone to take care of me.

        Posted by Noelle Campbell | July 13, 2014, 2:47 pm
  31. I look forward to when obgyn’s are required to do my prenatal care for free , sans insurance, because I believe they should.

    Posted by Noelle Campbell | July 3, 2014, 3:45 am
    • So you withdraw your argument that HL’s behavior had anything to do with objection to the destruction of fertilized eggs?

      Yes, some forms of birth control were covered, but there are women who *need* different forms. It isn’t about personal taste, it is a medical need. The whole point of medical insurance is that people shouldn’t be skimping on medical care or using inadequate medical services because they can’t afford good care. Good medical care should be something everyone can use as needed, and that includes birth control that is appropriate for each person’s situation, as recommended by a relevant medical practitioner.

      Posted by Anat | July 13, 2014, 4:15 pm
      • No, I’m just glad that I can force you to pay for the things you don’t want to support. Like when you have to pay for my attendance at church. Thank you for volunteering.

        Posted by Noelle Campbell | July 17, 2014, 4:04 pm
    • Of course we are all paying for things we don’t want to support. It is called taxes, and it is the price we pay for living in a civilized society. I doubt there is a single citizen who wants to support every single item covered by taxes, but we pay for the ones we don’t want and others pay for things we want and they don’t.

      Health insurance is part of the employee’s compensation for their work. It is not more the employer’s money than the employee’s salary – once it leaves the hands of the employer it belongs to the employee. Just like the law can define what is allowable in the terms of salary (minimum wage laws) the law can define what is acceptable in the way of employer-provided health insurance. Not covering contraception as part of the health insurance should be the same as paying less than minimum wage. And the decision on what should be covered follows the recommendations of medical societies, people who have the relevant expertise to determine what is or isn’t a medical treatment that should be easily and universally available.

      Also, for some reason the conservative justices think it is OK to force employers to provide coverage for some medical treatments they object to for religious reasons (blood transfusions, to which Jehovah Witnesses object). So there doesn’t seem to be a consistent position that people (or corporations) cannot be forced to provide coverage for treatments that go against their beliefs.

      Posted by Anat | July 17, 2014, 9:53 pm
      • Yeah and we all love paying taxes and know for sure that the IRS and the federal government would never do anything unethical with our money.

        Posted by Noelle Campbell | July 26, 2014, 3:12 am
    • And??? Yes, I love paying taxes, despite the fact that way too much of the money goes towards things I disagree with. Because that’s how civilization works.

      Posted by Anat | July 26, 2014, 11:19 am
      • Civilization also falls and fails (every time, btw, not a single “civilization” has not come to an end in a matter of centuries) – and we should examine WHY it fails.

        Posted by Noelle Campbell | July 31, 2014, 4:58 pm
  32. Reblogged this on AlternativeMedicineFreedom and commented:
    From the mouth of a Physician specializing in women’s reproductive health!

    Posted by emery myers | July 3, 2014, 4:33 am
  33. Reblogged this on The Southern Yankee and commented:
    I really appreciate Dr. Gunter’s perspective on the SCOTUS Hobby Lobby decision.

    Thanks for reading…

    The Southern Yankee

    Posted by celatime | July 3, 2014, 4:58 am
  34. The idea that contraceptives are an inalienable, constitutional right to be paid for by others still doesn’t sit well with me. The lack of respect and understanding for those who believe life begins at conception saddens me. The Facebook and Twitter deluge of knee jerk, insensitive remarks about the “religious right” leave me without appetite. Then… this.

    I am heartened to read this. Here are FACTS written plain without snide judgement of those who might hold other beliefs. This is far and away the BEST set of arguments to side with the dissenting judges. There has been so little kind discourse about this since Monday. I only hope more essays like these are shared and discussed.

    Posted by Britt | July 3, 2014, 5:21 am
  35. Well said. Canada is standing with its mouth open, uncomprehending what happened this week in the American courts.

    Posted by flourishandknot | July 3, 2014, 6:14 am
  36. It is very interesting to read this blog and some of the comments. Everyone seems to have forgotten about one very important person! His name is GOD and he is the Father of not only your soul but also the soul of every aborted and abandoned child. The only love that most people know today is intercourse because it is known as “making love.” Intercourse has become recreation and we have one giant orgy going on in this country. Adultery is at the root of our nation’s ills. As long as we continue with this mindset, our country will continue to deteriorate and dysfunction and chaos will spread. I will be publishing a book called “The Step-Father’s Step-Son – A Story for Women” this year. It will explain your Father’s plan for His family and your role as a fertile woman.

    Posted by barbaramcox | July 3, 2014, 6:40 am
  37. That’s funny : ) “A slippery slope for other contraceptives.” (rim shot).

    Posted by Denny Sinnoh | July 3, 2014, 9:21 am
  38. wonderful post – well thought out and well presented arguments. The fact that we still have regular arguments in politics about womens’ rights to their own bodies is frustrating and terrible. the ‘slut pills’ i started taking when i was eleven are what kept my ovarian cysts from coming back (the cysts my doctor were concerned would do damage to my ovaries and prevent me from having children in future). Now, they keep me from unwanted pregnancies. Neither of these reasons for being on birth control are things anyone else but me gets to decide are worthy or unworthy of being considered ‘healthcare’.

    Posted by lexy3587 | July 3, 2014, 10:14 am
  39. Reblogged this on Apps Lotus's Blog.

    Posted by appslotus | July 3, 2014, 10:48 am
  40. The truly frustrating thing, is that many women actually need the pill to control other issues with their reproductive system. The pill is often prescribed for a whole host of other reasons, like irregular, painful periods, or endometriosis, and to help prevent some of the scarring that might occur so women can have babies later. Why can’t they see past their own stereotypes?

    Posted by Heather | July 3, 2014, 1:05 pm
    • Great point of any health care treatment. Birth control medications or devices may have other reasons for prescribing the medication. All of this is very private and personal information between a woman and her health care provider. There are many medications that may have been introduced certain conditions but over time their use was found in other conditions. Drugs to treat a GI condition was found useful in Atrial fibrillation treatment is but one example. Viagra was originally being studied for cardiac conditions but the study showed it was useful for treating erectile dysfunction.

      Posted by Rich Hartmann | July 3, 2014, 1:59 pm
    • The women you speak of where birth control pills, etc. are used for actual health issues are the only ones for which the insurance should pay—for all the others, sex is a choice and therefore taking contraception to prevent pregnancy, whether women or men, is a choice and not a health requirement.

      Posted by molonlabe1776 | July 3, 2014, 2:05 pm
      • Preventing pregnancy is an actual health issue. Pregnancy often has adverse health impacts and preventing it when not desired is an important part of managing the health care of all those capable of getting pregnant.

        Having sex is a normal part of life.

        Posted by Anat | July 5, 2014, 12:51 pm
  41. What’s even more disturbing is they don’t want the insurance to pay for consultation on the “objectionable” methods.
    So what happens if the other companies that object to 100 % of contraception get their way, I know as a female my physicians have always asked about it, and if it was working, which would mean ZERO doctor’s appointments would be covered for women, or doctors will have to stop asking.
    Both scenarios are a nightmare for women’s health.

    Posted by Bobbi | July 3, 2014, 1:11 pm
  42. There is NO true debate here. Bottom-line: Contraception, whether pills or devices for men or women is NOT part of HEALTH CARE. There may be a very small percentage out there that contraceptive pills are used for some health issue and for those, I am willing to accept that, but for the vast majority, taking/using a contraceptive to prevent pregnancy whether man or woman is a choice. What has happened to logic and thinking in reality in this country? Having sex, unless someone changed the law, is an adult choice, therefore contraception or not is also an adult choice. The part that disturbs me is that the Supreme Court and the Justices that serve there do not state this logic and strike the entire requirement for contraception, except in that small percentage that may actually be health related, from the fascist authoritarian ACA.

    Posted by molonlabe1776 | July 3, 2014, 2:03 pm
  43. There is NO true debate here. Bottom-line: Contraception, whether pills or devices for men or women is NOT part of HEALTH CARE. There may be a very small percentage out there that contraceptive pills are used for some health issue and for those, I am willing to accept that, but for the vast majority, taking/using a contraceptive to prevent pregnancy whether man or woman is a choice. What has happened to logic and thinking in reality in this country? Having sex, unless someone changed the law, is an adult choice, therefore contraception or not is also an adult choice. The part that disturbs me is that the Supreme Court and the Justices that serve there do not state this logic and strike the entire requirement for contraception, except in that small percentage that may actually be health related, from the fascist authoritarian ACA.

    Posted by molonlabe1776 | July 3, 2014, 2:03 pm
    • I’m not sure why you think “adult choices” and “healthcare” are mutually exclusive, because they often go hand-in-hand. You do know that contraception is used to prevent pregnancy, one of the most demanding conditions on any healthcare system? And that hormonal contraceptives are drugs with real risks and benefits? Healthcare is a huge field, and contraceptives definitely fall within its scope.

      Posted by Ryan R. Persaud | July 3, 2014, 5:05 pm
      • Yes, sex is a choice, unless it is being committed as a crime against someone’s will, it is not required and in many cases, especially outside of a committed, supportive relationship such as marriage, for women it may be an unwise risk, such as sexually transmitted diseases (contraceptives that women mainly use do not provide any prevention to these).
        Explain to me what disease that preventing a pregnancy (the vast majority of what contraceptives are used for) is preventing? Are you actually saying that pregnancy is a disease?

        Posted by molonlabe1776 | July 3, 2014, 6:59 pm
      • I definitely did not say that pregnancy is a disease, but you’d have to be daft to think that pregnancy is less dangerous than a common sexually transmitted infection (such as gonorrhea or chlamydia, which usually be treated with a simple course of antibiotics). Women and their neonates are very vulnerable, especially at the time of delivery.

        The American College of Obstetricians and Gynecologists also points out that pregnancy is *more* dangerous than contraception (https://www.acog.org/About-ACOG/News-Room/News-Releases/2013/Half-of-Women-Unaware-that-Pregnancy-Is-More-Dangerous-Than-Contraception).

        So, no, pregnancy is not a disease, but that doesn’t mean that it’s free of complications or risk. Just because it’s a natural process doesn’t mean that it’s a safe one.

        Posted by Ryan R. Persaud | July 3, 2014, 7:34 pm
      • could not reply to actual thread.

        This is what is wrong
        “Getting pregnant *is* a work related issue, and it’s the reason that many employers choose to cover contraception. Why would I want to pay to train a new employee when another employee gets pregnant out-of-the-blue and needs maternity leave? What if they get pregnant by accident and choose to keep the child in the middle of an important project or busy season? Yeah, no thanks, I’d rather provide my employees with birth control so they can plan these life-altering events.”

        This concept of employers exercising such control over their employees, whilst clearly desired by employers, is against basic international human rights.

        Employers should be required to contribute to health insurance policies, in the abscence of a base government scheme, but these policies should be owned and defined by the employee. extra benefits should be paid by the employee and this for woman can include contraceptives. HOW IS THIS SO DIFFICULT ?
        #onlyinamerica

        Posted by brunnication | July 4, 2014, 4:13 pm
    • melonlabe1776 mentioned in a later post that a sexual relationship requires a strong commitment such as “marriage”. I think that the word “marriage” may be the problem here. People seem to think that as long as they are not married through a minster, lawyer, and a piece of paper, promiscuous intercourse is permitted. Also, in order to illustrate just how problematic that the word is, homosexuals now think that they can marry also. All of this can be done through laws written by lawyers – they are the only ones that can destroy a family the way that we do in this country through divorce and let people of the same sex marry declare themselves to be a “FAMILY”. I also want to make it perfectly clear that I am not against homosexuals in any way. I believe that homosexuality is a symptom of something that is very wrong in our culture. Christ came, lived, and died 2000 years ago and spoke out against the very same things that we are doing today! The funny thing is that absolutely nothing changed! We are doing the same things still today.

      What if God’s definition of “Marriage” is intercourse? Intercourse is a commitment between two consenting adults – one male and one female. It is two bodies becoming ONE. Intercourse is one covenant that a lawyer cannot break. It either happened or it didn’t happen. GOD is the one that knows everything. You can’t hide from him ever – not now or after you die and go before your final judgment. He knows about everyone with whom we have had intercourse. And if this is true, it is adultery to have intercourse with any other person except your first spouse without their permission. Also, if a man divorces his first spouse and marries another woman, the man commits adultery. If a man marries a divorced woman, he commits adultery. Christ also said “Let no man separate what God has joined together.” Any step-parent that separates the family is commiting adultery also.

      Jesus said that he is the Son of man. Mary is the female man that gave life to Jesus without a man’s sperm. So, we can rest assured that Christ was warning us not to let any female man or male man separate what God has joined together.

      Posted by Barbara M. Cox | July 4, 2014, 7:11 pm
      • You’re preaching to the wrong choir here lady. Your comments illustrate everything wrong with ultra-conservative. evangelicals.

        Posted by Vanessa Ray | July 5, 2014, 1:14 pm
  44. Ask any geneticist—human life begins at conception, therefore, ending a human life after conception is by definition an abortion. The pills objected to by Hobby Lobby are only the ones that eliminate the human being that has been conceived that would otherwise naturally develop and be born(barring any natural impediment or mishap to the mother). This is different from contraception, which defined means preventing contraception. Words have meaning–words and accurate definitions are required for logical thinking.

    Posted by molonlabe1776 | July 3, 2014, 2:14 pm
    • As a biologist I can tell you this is a red herring. Human life started somewhere in the last 5 million years or so, after our ancestors split away from the ancestors of the other chimpanzee species and has been around since then. Human zygotes form from human gametes – human cells from human cells.

      Genetics doesn’t help you – a human embryo can split in two (before or after implantation) to give rise to identical twins. When did the life of each twin begin?

      Abortion is the termination of pregnancy, it is a medical term. As such, doctors get to define what it applies to.

      Posted by Anat | July 4, 2014, 5:21 pm
    • Ask any scientist – and he or she will tell you that life begins at implantation, because a fertilized egg cannot sustain itself or its life without implantation.

      Furthermore, between 50-80% of fertilized eggs fail to implant naturally.

      Plan B and Ella do NOTHING to a fertilized egg. They operate by DELAYING ovulation – which allows time for the sperm to DIE prior to reaching the egg.

      Posted by Darwy | July 15, 2014, 5:26 pm
  45. This is not the right way to exercise religious freedom. You can’t just infringe upon someone else’s rights and call that democracy.

    Posted by rejectreality101 | July 3, 2014, 2:20 pm
  46. Why in the world is this question even relevant to employer/employee relationships? What does this have to do with running a business? That this debate is even happening is nonsensical.

    Posted by walt walker | July 3, 2014, 4:46 pm
  47. Agree. I can only hope someone sues, because, among other things, this ruling flies in the face of separation of church and state.

    Posted by Sonia Lal | July 3, 2014, 6:37 pm
  48. I am going to repost this and see if it will be allowed to be posted this time….
    Ask any geneticist—human life begins at conception, therefore, ending a human life after conception is by definition an abortion. The pills objected to by Hobby Lobby are only the ones that eliminate the human being that has been conceived that would otherwise naturally develop and be born(barring any natural impediment or mishap to the mother). This is different from contraception, which defined means preventing contraception. Words have meaning–words and accurate definitions are required for logical thinking.

    Posted by molonlabe1776 | July 3, 2014, 7:00 pm
    • Geneticist’s do not believe life begins at conception. I challenge you to find an article written by the board of Medical Genetics that supports your claim.

      Posted by Dr. Jen Gunter | July 3, 2014, 7:09 pm
      • Do you really think that any “board” can or should answer that question? It apears that we are worshipping men and not God. I think that it is time that we stopped waiting for answers from the Supreme Court and others. We must trust in God and make the right decisions for ourselves, our life partners, and our generations. We are supposed to keep our generations perfect! In this country we keep our generations perfect by excluding family members through divorce, abandonment, adoption, abortion, etc. God is concerned about His WHOLE FAMILY and not just the part that we currently think of as family!

        Posted by barbaramcox | July 5, 2014, 6:20 am
      • @BarbaraMCox your right to your religion ends at YOUR body. Keep your religion OUT OF MINE.

        Posted by Darwy | July 15, 2014, 5:26 pm
    • Plan B and other oral contraceptives cannot induce an abortion. Plan B is taken after having unprotected sex, but it does not affect fertilized eggs — if the woman is pregnant, taking Plan B won’t stop the pregnancy.

      So, no, the pills objected to by the Hobby Lobby are not the ones that “eliminate the human being that has been conceived that would otherwise naturally develop and be born,” and the pills are *not* different than contraception, because the pills that the Hobby Lobby objected to can only prevent conception.

      To clarify, the United States has not approved the use of any abortifacient agents, such as RU-486. None of the agents contested by the Hobby Lobby are capable of terminating an ongoing pregnancy — they merely prevent conception.

      Posted by Ryan R. Persaud | July 3, 2014, 7:45 pm
  49. The Author has clearly not read the actual opinion of the court; otherwise, She would have seen a number of Her arguments are incorrect.
    First, the opening emphasis on J. Alito’s quote excludes context which shows, at this point, J. Alito was referring to whether or not the beliefs in question are the result of “line drawing”, which the court has long held is left entirely to the party raising a free exercise claim.

    Alleged disastrous consequence #1 (ADC1) ignores the fact the Religious Freedom Restoration Act (RFRA) focuses primarily on the beliefs of the Person(s) burdened by federal government action and relegates the beliefs of all other Persons, Male or Female, to the compelling interest test portion of the act. In this case, the “First Amendment rights of women seeking health care” are perceived as being treated as “less important” because they, like the First Amendment rights of any other Person are not the rights being burdened by the federal government. Consequently, the court was doing exactly what the law instructs it to do in this case.

    ADC2 ignores the large body of judicial rulings which say, “What ever a Person says is Their belief, however accurate or inaccurate or implausible, is Their belief and the courts have no authority to say otherwise.” While, as an OB/GYN, You clearly use the traditional clinical definition of abortion, the Objectors in this case use what One might call a “colloquial definition of abortion” which includes the destruction of the fertilized egg from the moment of fertilization to implantation as well as the traditional clinical definition. For legal purposes, the definition the Objectors say They use is the only one which matters.

    ADC3 seeks to “redraw” said “line” for Objectors, a practice the court has also said is legally impermissible on multiple occasions. The most famous case of attempted redrawing is Thomas v. Review Board of the Indiana Employment Division, where state Officials attempted to argue, “Well if Thomas believes ‘A’, He should believe ‘B’ as well.” The Supreme Court at the time, 1980, rejected such redrawing outright.

    ADC4 ignores the fact RFRA requires cases be analyzed on a case by case basis. The court even highlighted RFRA’s “one by one” requirement, suggesting the Author did not actually read the ruling because this notation is quite prominent and hard for any reasonable Individual to miss. Consequently, the court was doing exactly what the law instructs it to do in this case.

    ADC4 also leverages an inaccurate stereotype of Jehovah’s Witnesses. Jehovah’s Witnesses are not (1) required to abstain from blood transfusions or organ transplants nor (2) required to withhold financial support for Others seeking to avail Themselves of such medical treatments. Instead, Jehovah’s Witnesses are asked to study scripture for Themselves and to draw Their conclusions. While a number of Jehovah’s Witnesses do suggest People avoid, say, blood transfusions, belief in eschewing such treatment is not a requirement.

    ADC4, however, even if the prior paragraph were not true ignores the key test of RFRA: in order for a substantial burden on religious exercise to be legal permissible, the federal government must show the burden is the least restrictive means of advancing a compelling government interest, as applied to the Person burdened. If a feasible alternative cannot be constructed which still advances that interest, the burden is permissible. Only if a feasible alternative CAN be constructed which still advances that interest, however, is the burden then on the government to utilize that less restrictive method if it wants to advance such an interest. Therefore, RFRA provides a limiting principle to prevent the supposed “slippery slope” and the court was doing exactly what the law instructs it to do in this case.

    ADC5 confuses judicial rulings with laws and with legislation, raising the question of the Author’s competency with respect to legal analysis in the first place. However, I digress. ADC5 further ignores the fact the court actually stated it was not disputing the governments interest is compelling in this case, only whether or not the government used the least restrictive means of advancing that interest. This ignorance on the Author’s part strongly suggests the Author did not read the ruling because, as was noted with respect to ADC4, had the Author actually read the ruling there is no reasonable way the Author could have missed this fact. The only other alternative I can think of is the Author is being deliberately deceitful but I am not prepared to levy that accusation at this point in time.

    ADC6 also indicates a failure to comprehend the court’s refusal to dispute the government has a compelling interest and, for the same reasons as ADC5, strongly suggests the Author either did not read the actual opinion of the court or is being dishonest.

    The closing paragraph is extremely telling. The Author says, “The message from the five male justices of the Supreme Court who felt it was within their purview to opine on women’s health care yet ignore medical facts (which I hope was presented as evidence) is chilling.” The “which I hope was presented as evidence” portion says to Me the Author, in addition to not having read the ruling, probably did not listen to oral arguments. I am having a hard time understanding, if this issue is as important to theAuthor as this post suggests, how the Author could not have found time to listen to oral arguments; if this case really is that important, I would think One would make time to listen to the arguments.

    Posted by MyNameIsNotRelevant | July 3, 2014, 9:46 pm
    • “ADC2 ignores the large body of judicial rulings which say, “What ever a Person says is Their belief, however accurate or inaccurate or implausible, is Their belief and the courts have no authority to say otherwise.””

      But surely the courts need to be able to determine if what someone claims is their belief is really what they claim it to be, and not simply animus?

      This part however makes more sense:

      “While, as an OB/GYN, You clearly use the traditional clinical definition of abortion, the Objectors in this case use what One might call a “colloquial definition of abortion” which includes the destruction of the fertilized egg from the moment of fertilization to implantation as well as the traditional clinical definition. For legal purposes, the definition the Objectors say They use is the only one which matters.”

      The question remains, what is the effect of these forms of contraception on the “destruction of the fertilized egg”?

      Posted by thelyniezian | July 4, 2014, 5:31 pm
  50. II won’t shop Hobby Lobby, it’s against my religion. But does this ruling mean that if I worked for a Muslim owned company I would have to wear a Burka? Would it be legal to kill me if I dishonored my family?

    Posted by Constance Tippett | July 4, 2014, 7:56 am
  51. Thanks, Dr. Gunter, for a scientific evaluation of this Supreme Court decision. It was 144 years after the founding of this country before women gained the right to vote. How many years before we gain control over our own bodies?

    Posted by mimiatleisure | July 4, 2014, 8:12 am
  52. Thank you for your informative opinion. I could rant on this for hours but I will just say you are correct about how many slippery slopes this will create . The fundamentalist right rails at how there freedom is being taken But this decision is the most dangerous attack on our freedom in the history of this country

    Posted by auburngraydesigns | July 4, 2014, 9:57 am
  53. Get over yourself. Did you bitch and moan about this in 1993 when Bill Clinton originally signed this into law? Oh but wait, your just an OB/GYN and didn’t spend years and years dedicated to the study of law and ended up sitting on the Supreme Court. I’ll trust their legal decisions over your medical opinion which by the way has nothing to do with what the Supreme Court ruled. I don’t believe the argument should even be about Hobby Lobby. The argument should be that NO ONE SHOULD BE FORCED TO BUY HEALTH CARE! Never mind that single males are being forced to pay for medical care that includes coverage for birth control and abortions. What makes that right?

    Posted by J Roycroft | July 4, 2014, 12:52 pm
    • Well I don’t know about the author or anyone else, but if you’re basing that on the idea no-one should be forced to enter a contract with another private party unconditionally and against their will, I’d be with you- but what about if the government itself provides healthcare using taxpayer’s money? (This is what we have over here and few object.) Paying tax is pretty much universally regarded as a social obligation for at least some things, (unless you’e an anarchist opposed to such systems of power altogether) and that includes things which people might object to morally (like certain questionable wars).

      Posted by thelyniezian | July 4, 2014, 5:26 pm
      • Until our “moocher’ class was swayed by the promises made by Barrack Obama, referred to here as our dear Ruler, the idea of citizens being forced to buy health insurance was unimaginable. It goes against our Constitution and our rights as a nation of free people. Until this “Obamacare” was forced upon us we all had choices as to what types of coverage and even whether we could outright pay cash for health services. No more. I have chosen to not participate and refuse to sign with any healthcare offered. So now I am considered a criminal and will be punished because I have chosen to violate federal law. Because Obamacare is tied in with our Internal Revenue Service, the IRS has been appointed as the collector of fines implemented on those who refuse to sign up. So now when tax filing time comes the government will take money from me by force, as a fine, to pay a portion of every other persons healthcare that could not otherwise afford it. It’s much too complicated to breakdown here. The bottom line, American citizens have lost their rights when it comes to freedom of choice. For example, a single male is forced, by law now to purchase health care that includes care for drug addictions, birth control and abortions. What makes that right? In America healthcare was never considered a “right.’ It has always been a privilege to those that could afford to choose a plan that fit their own personal needs. There has always been a safety net for those that could never afford any healthcare. Our existing welfare system and taxes took care of that. Not good enough for our new Ruler who despises the very idea of capitalism and the United States Constitution as it was originally written.A man who uses Executive orders to violate Constitutional law in an effort to push his own political agendas. This is not a case of the government providing health care using tax payers money. It is in fact a matter of our government forcing taxpayers to purchase a very expensive plan or pay a fine if they do not. This on top of the existing welfare taxes we already pay. I’ll end this long winded comment by saying that, like so many other Americans who still love this country we are sickened by the weak, pathetic people in this great nation who insist on robbing Peter to pay Paul in the name of political correctness. Over half of our voters now vote for a living, meaning they vote for the person that promises more free stuff taken by force from the very people who provide the jobs to people that actually want to work and be free and independent. This is not the America I grew up with. It is now a nation of liberal candy asses and deadbeats in search of a free ride and giving out excuses by blaming everyone but themselves for all of their own failures in life. Barack Obama is intentionally trying to destroy the very fabric of this great nation. We are fastly becoming a nation of lazy beggars and moochers.

        Posted by J Roycroft | July 4, 2014, 7:02 pm
      • I think part of the problem with the old system was that the “safety net” did not cover everyone- there have been reported cases wherepeople did not qualify for government health benefits, but could not afford the insurance to cover what amounted to life-saving treatment. Whilst I now understand that hospitals have no right to refuse emergency treatment to those who can’t pay, they still try to recover the costs and this ends up being more expensive than either the insurance companies or the government are able to use their leverage to negotiate a price for, and when they can’t pay those costs, everyone else has to pick up the tab. And unless you go to the ER, no luck. This was the best that could be negotiated in an effort to solve the problem. (People have died as a result of the failtures of the old system, and surely individual freedoms must be weighed in the balance against the moral responsibility not to see people dead?) It is all too easy to blame “moochers” in search of a “free ride”, though many of these people may in fact work hard for a living (or would if they could) yet are still disadvantaged.

        However, I would agree that being forced to pay what is essentially a private entity for things one does not need or want. If certain things are truly a right, it is the business of government to ensure those rights are upheld (doesn’t the 9th Amendment provide for rights not enumerated in the Constitution?), not private entities.

        Posted by thelyniezian | July 28, 2014, 12:25 pm
      • Not being an authority on the definitions of the Constitution, I most certainly won’t try to explain the meaning behind the 8th Amendment. It’s the one Amendment that most experts can’t even define or agree on.

        Posted by J Roycroft | July 28, 2014, 12:37 pm
  54. To those who think there is a difference between using hormonal contraception for mitigating or treating conditions such as PCO, acne, or painful menses and using it for contraception: Pregnancy has a major impact on a woman’s health, and more often than not, for the worse – whether in the short term or the long term, from ‘morning’ sickness (that is known to be in some cases debilitating) to increased risk of diabetes and hypertension. Controlling whether and when a woman gets pregnant is a health decision and providing women with the means to do so is as much a part of healthcare as any preventive medicine, from vaccines to aspirin.

    Posted by Anat | July 4, 2014, 1:19 pm
    • its important to stay on topic, this debate is not about whether contraception should or shouldn’t be covered by health insurance – thats a different minefield. This is about whether an Employer should pay the premium for a personal medical issue.

      Posted by brunnication | July 4, 2014, 3:38 pm
      • The employer is paying for health insurance. The purpose of the mandate was to make sure health insurance included contraception. Upthread people were arguing that contraception as such is not health care and thus shouldn’t be included in health insurance coverage, or at least its inclusion should be a matter of choice for the one paying for the insurance. Oh, I see you were one of them. Seriously, yes, pregnancy is a potentially unhealthy state or the precursor for an unhealthy state for most women who have ever been pregnant.

        Posted by Anat | July 4, 2014, 5:05 pm
      • Not sure I understand you last bit, are you saying women should be stopped from getting pregnant because its a health risk ?

        No my view is only that employers should not have to pay for personal issues, they are healthcare and I have no issue with their use.

        It is scary that an employer should have any say whatsoever in this personal activity. The next step will be employers having the right to proscribe protected sex !

        Posted by brunnication | July 4, 2014, 5:32 pm
      • Replying here, because there isn’t a link on your other response:

        Upthread you asked: “So the question is why is contraception on the list in the first place, sex and pregnacy are not diseases as far as I can tell. ”

        To which I reply that yes, pregnancy is a health risk. See also: http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/PregComplications.htm and http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/SevereMaternalMorbidity.html for more information.

        Therefore the means to prevent pregnancy should be an essential part of health insurance. If we had health insurance provided by the government or some other single payer then they’d be the one paying. As it is, given that the US system relies on employers to provide health insurance they are the ones who should be required to provide a plan that includes coverage for various forms of contraception. And should have no say in what is or isn’t on the list of forms of contraception. The ones who should have the say on the contents of the list should be medical professionals.

        Posted by Anat | July 5, 2014, 12:31 pm
      • If you read my comments properly you will understand my view is solely about the employer paying. Where they pay in full they have rights to uphold, make it a personal policy with a shared premium contribution and tge problem disappears.
        Only in America can you do these things so backward.

        Posted by brunnication | July 5, 2014, 2:18 pm
      • Since there usually is a copay for medications your objection would be moot then?

        Posted by Anat | July 5, 2014, 2:23 pm
      • No. The ownership policy itself infers the rights that are being argued. It so obvious.
        The world has moved away from Master and Servant scenarios, pensions are the easiest example, employers used to dictate investment.

        Posted by brunnication | July 5, 2014, 3:01 pm
      • And traditional pensions were safer for retirees than 401 plans.

        Contraception is no more a personal medical issue than any other common preventive treatment.

        The law should be able to define a basic standard, informed by medical professionals, of procedures and medications, that should be included in employer-provided health insurance, and employers should shut up and pay if they want to legally employ people. Beyond the basics, employers should be able to choose what else to include.

        (Yes, single payer would have been better)

        Posted by Anat | July 5, 2014, 3:32 pm
      • As I said you need to ask why the employer has the right to question the coverage

        Posted by brunnication | July 5, 2014, 4:10 pm
      • .. So you are saying bend over and just take it because. That was the end of the sentenace btw as you havent explained why the policy owner has no rights.

        Very boring when the facts are explained and the true cause is ignored.

        Posted by brunnication | July 5, 2014, 4:35 pm
      • Because the relevant experts determined that some items were basics, to which everyone should have affordable access, and without which the plan is deemed inadequate.

        Posted by Anat | July 5, 2014, 8:15 pm
      • Again ignoring my point. Boring

        Posted by brunnication | July 5, 2014, 8:30 pm
      • Because I don’t consider it relevant.

        Posted by Anat | July 5, 2014, 8:46 pm
      • Or I am right and you have no actual answer to my point, whuch incidentally is the point of the judgement !

        Posted by brunnication | July 5, 2014, 8:54 pm
      • There are all kinds of things employers are not allowed to do to their employees (see for example job safety regulations). I don’t see why providing inadequate health insurance can’t be one of those.

        Posted by Anat | July 6, 2014, 8:02 am
      • I don’t see why your government can’t have a base national health system like the majority if the western world but thats fairly typical of the US in most things.

        Posted by brunnication | July 6, 2014, 5:09 pm
      • As I said several times already, a single payer system would have been much better. However someone convinced Americans that a system of social services that works is icky socialism, and we can’t have that.

        Posted by Anat | July 6, 2014, 7:14 pm
      • And you think dictating that an employer should pay blindly with no rights to argue is anything less than communism ?
        Its not about healthcare or contraception at all !

        Posted by brunnication | July 6, 2014, 7:20 pm
      • All freedoms have their limits. One works with the system that exists.

        Posted by Anat | July 6, 2014, 7:25 pm
      • Haha but this has been prescribed today not 50 years ago, its backward even by US standards.

        Posted by brunnication | July 6, 2014, 8:32 pm
  55. Before I start, I will offer a few points as disclaimer:

    1. I am (at least nominally) a fearly theologically (as opposed to politically) conservative evangelical Christian, and very much a “pro-lifer” of the “human life begins at conception” position, but not necessarily in agreement with the American “Religious Right” on many points.

    2. I am a layperson, not a medical expert or lawyer. So I will happily defer to those with expertise in those fields unless it seems entirely unreasonable to do so.

    3. Yes, I am a man, for those who consider that makes me ineligible to even enter a discussion on women’s reproductive matters, or makes me automatically biased.

    4. I am also British; take from that what you will.

    5. I do tend to ramble a bit and for reasons of style address the author indirectly, in the third person when making general comments like this; please forgive me if this causes problems.

    6. I also know full well my views are controversial, and may offend some (that’s inevitable). Whilst I’m open to discssion and correction, I tend to stand by them.

    And with all that having been said, the thing that strikes me as most worrying about this case is that it is based on beleifs which are almost certainly at odds with reality. It is one thing to argue about the role of the creator in abiogenesis and the evolution of life, quite another when dealing with present reality that can usually (within physical and ethical limitations) be directly tested by experiment. And given the information provided by the blog’s author that these contraceptives don’t necessarily cause abortions (something I didn’t know until now, assuming otherwise), then their case is based on a false premise. Surely if you want to claim your right to free exercise of religion is being infringed, the burden of proof should be upon you to a. demonstrate that it is actually in accordance with the beliefs and teachings you claim to espouse, and b. makes some sense. Christianity places a high value on the truth, and building your case on falsehood marks you out to be either a liar or deluded, which is sin and not in accordance with practicing your religion. It is all well and good for American legal preecedent to say that beleifs are beliefs irrespective of rationality and the courts have no business saying what it should be, as one commentator has pointed out, but surely that rests on the understanding that what you believe is not dependent upon personal whim alone. And I say this as someone who beleives accomodating the right to religious freedom is paramount in ways which would have most secularists and “progressive” types tearing their proverbial hair out in rage. It would make more sense in my view, if the owners of Hobby Lobby were hardline Catholics opposed to all forms of contracpetion on principle, though I reject this view personally and note it opens up a different, much bigger can of worms. At least such a position would be consistent and not rely on what is either misinformation or outright lies, as it’s a value judgement not dependent upon certain scientific facts.

    Although it might be said that the technical definition of abortion as used in science in medical practice is really beside the point here- the moral objection of strict “pro-lifers” is to anything that might kill even a fertilised egg, not whether it’s technically abortion or not at such an early stage. Of course, then again, it matters that a given form of contraception doesn’t affect a fertilised egg (in terms of it being implanted in the uterus or not).

    I’m somewhat skeptical about the relationship between contraception and other forms of health care, however. Whilst the author may be very right to point out that having an active sex life may provide health benefits, experience and common sense suggest to me those benefits are marginal. Contraception only provides major and obvious health benefits if your chosen lifestyle involves sex (mine for one does not), whereas vaccinations, blood transfusions, and many forms of medcation have much more obvious, non lifestyle-choice-related health benefits which may be literally the difference between life and death. I also understand that the forms of contraception in question don’t do much to stop STDs, only unwanted pregnancies, which limits their staatus as a health benefit. Whilst the making of lifestyle choices regarding sex is clearly a right, must it be assumed that it is a right to expect third parties to facilitate that, if their rights to free exercide of religion (including acting according to conscience), as clearly enumerated in your Constitution, are infringed? With this borne in mind, I can at least suggest that the case for requiring the provision of other forms of health care which some religions may object to, is much stronger than it is for requiring cotraceptives in any or all forms to be provided.

    I’m also a little skeptical of those who jump to conclusions and say that the underlying motive (of either those who run Hobby Lobby, or the jusdges who rules in favour) must automatically be motivated by misogyny. It’s possible, but could this not simply be a matter of political points-scoring against Obama or trying to make a point about religious rights, whilst conveniently ignoring the wider issues? From what I’ve read elsewhere, the company was allegedly quite willing to cover these forms of contraception in its employee heath insurance before the whole “Obamacare” controversy, and if so it’s hardly simply a matter of conscience based on religious moral standpoints.

    Posted by thelyniezian | July 4, 2014, 5:01 pm
    • Thankyou for this thoughtful response.

      It does appear that what was argued before the Court for HL does not reflect the reality of how some of these contraceptives work, and that the other side was unable to convince the Court of the true position.

      I take issue though with your concern about the relationship between contraception and general health. At least some of the four drugs objected to are prescribed not only for contraception, but to manage other health issues such as bad periods or a disordered menstrual cycle, and often for women who have either completed their families or who, because of their health issues, happen to be sub-fertile anyway. Some of these women are also celibate. So in depriving women of subsidisation for the cost of those treatments, their general health is put at risk or their health is not optimised. It is here the risk comes in for things like blood transfusion and vaccination, both of which are offensive to certain religious groups.

      Rather than misogyny it’s more likely that lack of imagination and empathy could be driving the decision of the majority-until you’ve had a 10 day period that forces you to the toilet hourly as it floods out of you and makes you ache from your bellybutton to your knees for a fortnight each month, it is hard to appreciate just how much quality of life a tiny pill or implant can offer.

      Posted by Iorek | July 4, 2014, 8:36 pm
      • I had considered the use of contraceptive drugs to aid general health, though failed to mention it. My thought is that when they are used in that way they occupy a similar general function to other prescription drugs, and are not really part of the moral objection. Of course, if the ruling really absolves the company of having to provide these drugs, then why is it not being given the due weight of consideration it deserves?

        I suppose it is true that it is difficult to truly appreciate the importance of something you can never experience, which explains the gender divide in the way the judges voted. Good point.

        Posted by thelyniezian | July 5, 2014, 5:09 am
    • People whose lifestyle doesn’t ever include sex are rare. 99% of women in the US use some form of contraception at some point in their lives. To pretend that contraception is some kind of special need of some odd sub-population is disingenuous. And since pregnancy and childbirth are health risk their prevention is an important health benefit to many women.

      Posted by Anat | July 6, 2014, 7:44 pm
      • You’re kind of missing my point. It doesn’t matter to my point what proportion of people are having sex or to those that are not. The point is that in the main, it is something that it is possible to choose to do or not do, and is enough that a few people do not have sexual intercourse with a partner and yet go on to lead full and satisfying lives. Therefore, it might be argued, it’s not quite in the same league as other forms of healthcare.

        Perhaps a better counter-argument would be the possibility of a woman being raped and getting pregnant as a result (which I am sure we will both agree is something we don’t want to happen, but it does). This would undermine such an assertion of choice.

        Posted by thelyniezian | July 8, 2014, 6:56 am
    • More people live satisfying lives without smoking than without sex, yet both treatment of the downstream effects of smoking and smoking cessation treatments are part of health care. Same goes for alcohol consumption. And treatment of injuries acquired in exercise and common sports.

      Posted by Anat | July 8, 2014, 9:00 am
      • True, though I wonder if that argument would sway the hardcore opponents of “Obamacare” even less- i.e. why should they subsidize treatment for the consequences of people damaging their own health?

        The main point I am trying to make is to address the “slippery slope” argument, that this ruling will set a precedent for other employers to object on religious grounds to other types of treatment. As I understand these cases reqire there be a “compelling state interest” before religious freedom can be overruled. There is a much more obvious “compelling state interest” in requiring access to immediate life-saving treatment, or any sort of treatment for existing health problems than preventative measures which are essentially optional. (I am not talking about those contraceptive drugs used to treat other health problems, obviously).

        Posted by thelyniezian | July 8, 2014, 2:55 pm
    • But there is a very strong societal interest for making as many as possible forms of birth control as broadly available as possible: Controlling one’s family size is essential for avoiding or being able to rise out of poverty. I’d call that compelling state interest. And for the Holly Hobby sector – controlling conception reduces demand for abortion. The real kind.

      Posted by Anat | July 8, 2014, 4:18 pm
      • @Anat: “But there is a very strong societal interest for making as many as possible forms of birth control as broadly available as possible…”

        I agree. (And that’s without getting into Malthusian arguments, which might be a bit dubious…) It is just that there is a much more *obvious* compelling state interest for protecting more immediate life-saving treatment.

        Posted by thelyniezian | July 28, 2014, 12:02 pm
    • I’m coming back here because of the whole ‘sex is a lifestyle choice’. I’m sure somewhere out there there are people living satisfying lives without leaving their homes. Therefore leaving one’s home is a lifestyle choice and covering care for road accidents and other injuries acquired outside one’s home shouldn’t be part of one’s health insurance.

      Also, there are people who live satisfying lives while eating some perfect diet, so any health problems acquired by deviating even a little bit from said perfect diet don’t need to be covered by insurance.

      This is stupid. While not everyone has sex, and not everyone leaves their home, and not everyone commutes by vehicular transportation, all these are normal activities and any medical concerns resulting from them belong in health insurance plans.

      Posted by Anat | July 11, 2014, 12:13 pm
      • @Anat: “I’m coming back here because of the whole ‘sex is a lifestyle choice’. I’m sure somewhere out there there are people living satisfying lives without leaving their homes. Therefore leaving one’s home is a lifestyle choice and covering care for road accidents and other injuries acquired outside one’s home shouldn’t be part of one’s health insurance.”

        Bit of a false equivalence here. It is unreasonable to expect most people not to leave their homes- many need to do so in order to work for their living, to buy food and other essentials, etc. I suppose it might just be possible if one is able to work at home via the internet, and buy all their groceries online (it’s possible nowadays) or are not self-supporting. I would imagine very few people are voluntary shut-ins as a lifestyle choice; even the ‘hikkikomori’ of Japan have some social or cultural reason for doing so.

        On the other hand, there is no imperative based personal survival for one to have sex; the human race as a whole will continue to propagate just fine if not everyone reproduces.

        Again, I am not saying that there is no room for them in health insurance plans. It’s just whether there is such a compelling reason for it to be provided that a private employer can choose not to pay for it if they have some strong moral objection, that they have no right to refuse and no alternative provision could be provided that covers contraception if needs be.

        Posted by thelyniezian | July 28, 2014, 12:12 pm
    • Are those forms of life-saving treatment not required to be covered by employer-provided health insurance?

      Posted by Anat | July 30, 2014, 8:05 pm
    • A life without leaving one’s home is limited, but not impossible. You’d have limited, but not zero, ways of making a living. A life without sex is limited, but not impossible. The limitation won’t be in ways of making a living (except for a small segment of society) but in ways to have functional family life. We are a social species, relegating to ‘unnecessary’ one of our most common social interactions is absurd.

      A healthy sex life is important for people’s overall well-being. Yes, you can survive without it, but then you can survive without exercising at all. And a healthy sex life is apparently life-extending, so from a medical POV should be seen in the same category as exercising and healthy eating. And unwanted pregnancy is something to be avoided just like sports injuries are.

      And then from the POV of health insurance – helping fund better contraception, or contraception for situations not addressed by other methods – saves the need to cover for pregnancies and childbirth, the much bigger expenses.

      Posted by Anat | July 30, 2014, 8:31 pm
  56. Another thought: why does “Obamacare” tend to rely on employer-based health insurance when it causes these sorts of issues? Would it not be more sensible for the Ameirican government to find some way for emplyees of businesses, who require forms of healthcare their employer would prefer to opt out of.

    Of course, as a Brit who has the NHS, i.e. government-provided healthcare funded by taxation, and takes it as a normal part of life here, I sometimes wonder why Americans have so many objections to similar provision at all, at least on the state level if not the federal level. Detractors say “it doesn’t work”, but in many ways it works better (in terms of cost) than the American system has historically, and whilst the systme is not perfect and has lead to the odd horrible scandal like the “Mid Staffs” case, it doesn’t reflect at all on the service as a whole; negligence can happen under any system. The point is, if something is so important a (postive) right, should it not be the responsibility of the state to provide it, as opposed to private entities whose (negative) rights may be infringed? After all, its one thing to provide for morally questionable things (like fighting questionable wars) out of taxpayer’s money, so simply because other taxpayers might object to cotraception, abortion or suchlike.

    (As a Christian, I don’t see any arguments which say government should ephatically *not* provide public healthcare in the Bible. This seems to be an argument from right-wing/libertarian politics alone, and even then seems pretty unique to the US in the developed world.)

    (Also, yes, I know I said I prefer to use the third person but said “your constitution”- as I assume most people reading will be American and was addressing them as a whole.)

    Posted by thelyniezian | July 4, 2014, 5:18 pm
    • The idea of a single-payer healthcare is something I wish we’d implement over here!! It would get rid of ridiculous rulings like this and save everyone a lot of time and money in the long run. I have absolutely no idea why the conservatives over here are so opposed to it {other than the fact that it would benefit poor people, and American conservatives are staunchly against that.}.

      Posted by Vanessa Ray | July 5, 2014, 1:35 pm
      • OTOH if we went single-payer whenever the Republicans were in power they’d exclude contraception they don’t like for everyone.

        Posted by Anat | July 13, 2014, 4:21 pm
  57. You obviously put a lot of thought and time into this writing, I wanted to say thank you.

    Religion too frequently obfuscate facts with emotion and tightly held beliefs unsupported not only by facts but by reasonable logic.

    Unfortunate it is, when that kind of thinking makes it’s way into public health policy, and yes, this time puts corporate rights ahead of the individual.

    Happy Fourth of July. Can I still say happy Independence Day?

    Posted by drtsneuromojo | July 4, 2014, 5:37 pm
  58. Your article is interesting and I don’t know what to say about most of it. However, your very argument stating “the religious beliefs of some are more important than the religious beliefs of others” is flawed.

    Your very statement tells me that you don’t respect religious beliefs. The Supreme Court has ruled that the religious beliefs of those PAYING for the service is more important than the religious beliefs of those who would receive the benefits.

    Also, an article I recently read disproves your statement that Plan B is no different from the daily birth control pill in that “A zygote is the beginning of a new human being” (i.e., an embryo).
    (Moore, Keith L. and Persaud, T.V.N., The Developing Human: Clinically Oriented Embryology, 7th ed.)

    The argument really starts and ends in how do we define new life.

    Posted by idiomsinlife | July 5, 2014, 6:47 am
    • Oh, and I forgot one important thing: The Constitution states that the Federal Gov’t shall make no law regarding the free exercise of religion.

      Posted by idiomsinlife | July 5, 2014, 6:49 am
      • As a person you’re entitled to exercise your religion.

        This is a CORPORATION which now is entitled to use the religious beliefs of its owners, and now those beliefs of the corporation TRUMP the rights of another person.

        That’s simply wrong.

        Posted by Darwy | July 15, 2014, 5:32 pm
      • First, corporations are people- that is a judgement the FEDERAL COURTS ruled on many years ago. Therefore, because Hobby Lobby is a closely held private company, the views of the owners are the views of the person called “Corporation”.

        Second, since when does the Left care about trumping the rights of others? This has been happening for a long time. More so now that our POTUS and FLOTUS are in office.

        Third, sorry this took so long to reply to, I am still new to wordpress…

        Posted by idiomsinlife | September 20, 2014, 4:32 am
      • Oh, and you totally ignored the fact that my point concerns who PAYS for the service. Not if they can or cannot receive the service.

        Posted by idiomsinlife | September 20, 2014, 4:36 am
    • Moore and Persaud are big in anti-abortion world, not really disinterested bystanders. Dr G deals with these issues in this post and the next.

      Posted by Iorek | July 5, 2014, 7:14 pm
  59. Reblogged this on Molly & Fred's Excellent Adventures and commented:
    All I can say is WOW… For now.

    Read the comments on Dr. Gunter’s post… And WOW… Interesting (and disturbing in some cases) to read people’s perspectives on this.

    This whole subject reminds me eerily of the book “The Handmaid’s Tale”…

    I will have more to say on this later. Really just marking my spot at this point.

    ~ Molly

    Posted by Miss Molly | July 5, 2014, 10:35 am
  60. It’s worth noting that the reason countries like Switzerland have such low abortion rates is because of comprehensive sex education and easy access to birth control. The sad thing about this ruling, is that it affects the poor the most {and I don’t believe that’s at all unintentional}.

    Posted by Vanessa Ray | July 5, 2014, 1:45 pm
  61. This week’s New Scientist, a UK magazine, has a short news article about the verdict; it’s titled “contraception confusion”.

    It starts: “Religion1, Science 0″.

    http://www.newscientist.com/article/mg22329761.800-science-ignored-in-us-birth-control-ruling.html#.U7h0zai5bEY

    Posted by korhomme | July 5, 2014, 3:00 pm
  62. I couldn’t agree more.

    Posted by therewillbeasummit | July 5, 2014, 5:01 pm
  63. First off, the Constitution states that the free exercise of religion is a fundamental right, nowhere in the Constitution says that someone else should pay for you healthcare. Secondly, the study you cited about active sex lives and longevity was conducted on mainly married couples. Thirdly, sex before and outside of marriage is morally wrong and can lead to more than unwanted pregnancy. These forms of contraception do not protect against Herpes, HIV, Hepatitis, or any other STD. The only form that gives any degree of protection (with a failure rate of 85%) are condoms and the last time I checked they were not covered by any insurance. You may be a doctor but you are using the same irrational, emotional argument. What we need is real personal responsibility and a return to a moral and self-controlled society. The media have painted the picture the Supreme Court has just outlawed all contraception but the truth is they have said there are limits to what other are forced to pay for.

    Posted by jowens72 | July 5, 2014, 7:48 pm
  64. Thank for this informative and straightforward analysis of the Supreme Court decision in the Hobby Lobby case. Both sides of the media and pundits in the debate tried to spin it for their own political uses. I had to do a Google search to try to find out which birth control methods were banned and why. Your article was by far the best: factual (including scientific AND Evangelical definitions of when conception begins) and how none of the 4 methods banned is capable of terminating an actual pregnancy, based on the SCIENCE.) This is what people really need to understand, without all the rhetoric. Thanks again for taking the time to write this and explore the potential for the decision to be cited in case law. A slippery slope, indeed.

    Posted by Sunny | July 5, 2014, 11:20 pm
  65. Thank you, very informative.

    Posted by dalecooper57 | July 6, 2014, 7:19 am
  66. What if a woman needs an actual abortifacient for medical reasons–say to expel a miscarried dead fetus? Will her insurance automatically cover it, or would she need to approach her employer to provide an exception?

    Posted by Rose Phillips | July 6, 2014, 10:28 am
  67. Congratulations on being freshly pressed! I, too, wrote about this topic and just feel utterly discouraged by SCOTUS outcome.

    Posted by Natasha | July 6, 2014, 7:11 pm
  68. Reblogged this on Pacific Northwest Life and commented:
    I skimmed through this but I loved the parts I did read deeper into. I am a HUGE advocate for preventative healthcare. This topic is definitely on that fine line between politics and religion although I support the desperation between church and state. I get that every person is entitled to their own thoughts, ideas and beliefs but I don’t believe that an employer should have this kind of control over their employees beliefs and/or needs.

    Another thing worth noting is that contraceptives are used for more than just birth control. I also liked how this blogger mentioned how not having that equal access to birth control has additional repercussions specifically unwanted pregnancies that are then aborted rather than prevented in the first place. I also think that individuals who are sexually active are not always prepared financially to raise a child and they shouldn’t be forced to. If a person becomes pregnant and they cannot afford it they are likely to remain on public assistance for their whole life. I’m a tax payer an you are likely a tax payer. I prefer knowing that my tax money is being spent on worthy cause. Public financial assistance is not infinite. I could have qualified for food stamps many many times but I refuse to apply and take assistance because I know it is limited and I can get by without it. I might now eat all organic or expensive meats like some people but I eat well and I budget my food based on my income. Someone else needs those food stamps more than myself. I could go on forever but I’ll save it for another post.

    Posted by alishamwhite | July 6, 2014, 7:15 pm
  69. Whatever happened to responsibility for your actions? If someone doesn’t want any potential responsibility of having children, act responsibly. Contraception shouldn’t be an afterthought to counter lascivious behavior.

    Posted by Ted Luoma | July 6, 2014, 10:28 pm
    • There are several scenarios under which a responsible woman might need emergency contraception. Some examples are:

      – rape
      – failure of barrier method (broken condom)
      – missed/skipped pill
      – pill was taken but lost due to vomiting

      Posted by Anat | July 6, 2014, 11:07 pm
      • This is in response to your second post:
        And your point is? What has your family’s story got to do with your slut-shaming of women using emergency contraception? Women who recognize that their method of contraception has failed them or may have likely failed them and use emergency contraception as a back up are being responsible for their actions.

        Posted by Anat | July 6, 2014, 11:29 pm
    • Additionally, note that the 4 methods in question include the 2 IUDs. These are long acting methods, precisely for women who are planning their child-bearing over the long run.

      Posted by Anat | July 6, 2014, 11:12 pm
      • My wife and I had two children regardless of her faithfully taking the pill. There was no way we were ready for either of them, and our youngest showed markers for Down Syndrome on the ultrasound. We were going to have our baby even if she was born disabled. Fortunately, she was born healthy.

        The point is that we know where babies come from and we took measures. Apparently God had other plans for us.

        After our third child five years ago, I had a vasectomy which went horribly wrong. I have nerve damage and have chronic pain that leaves me unable to work.

        This isn’t strictly a choice issue or a medical issue. It is a moral issue as well.

        Posted by Ted Luoma | July 6, 2014, 11:23 pm
  70. I would think, as a doctor, you’d be more committed to facts than your blog suggests. Each of your points is riddled with falsehoods. I recognize they are popular talking points, but for your benefit, here is some logic for your points. First off, this case had nothing to with “religious beliefs of some are more important that the religious beliefs of others.” The argument is completely specious. The argument merely set Hobby Lobbies interests at the same as others. It identified that there is a law that prevents the government from blocking someone’s right to live their religion (or not participate in something that would violate their religion). It essentially puts everyone on an equal footing. Hobby Lobby not providing these BC methods does not infringe upon the employees rights to use them, while forcing HL to buy them would interfere with theirs. “Why can her place of employment push their religious beliefs (because a place of employment now has the rights of an individual) into the exam room?” – No, it took the employer out of the exam room.
    “Legislating a belief over science.” Well, I guess the Mayo Clinic and the Royal College of Obstetrics and Gynecology must not be respected medical organizations, because they have both published situations where they can act act as abortifacients. And you are relying on the definition of birth that the AMA modified after determining that emergency contraception should not interfere with an existing pregnancy. I can give you the list of science dictionaries that define conception as the fertilization, and the medical dictionaries that give both – fertilization or implantation – depending on your belief system.
    “A slippery slope for other contraceptives.” See the above. Like I said, I guess we can’t consider the Mayo and RCObGyn scientific. I guess that leads to a whole new group of rabbit holes.
    “A slippery slope for other medical practices that infringe on religious beliefs” – Sorry. Nothing in this case prevents any use of BC, or other treatments. It only allows people not to pay for government mandated procedures that violate its beliefs. You are welcome to pay for whatever you want to do. Many companies provide no sponsored health care. And many health plans exclude all sorts of issues – for example, every plan I’ve had has denied services for Autism. I know this because I have a 25 year old Autistic son and we’ve never had coverage for him. We’ve taken care of his needs through other sources.
    “That contraception isn’t really health care.” It isn’t really heathcare, now is it? I wouldn’t call it slut pills, or anything like that, but let’s face it, Birth Control makes no difference for someone who is not sexually active (I realize there are non-pregnancy related benefits for some methods).
    “Restricting access to IUDs increases the risk of unplanned pregnancies and thus paradoxically the rate of abortion.” That may be, but that’s not germane to the discussion. I don’t believe Hobby Lobby’s goal is to reduce abortion, but to not participate in the process (through support). Having an abortion to deal with an unplanned pregnancy is the choice of the individual – not Hobby Lobby’s. The individuals can make their own decision. Can’t Hobby Lobby make their own?

    Posted by Rick Chappell | July 6, 2014, 11:56 pm
  71. Thank you so much. I have been telling anyone who will listen in the past week why this matters so much to women. I am perimenopausal and I have always had trouble with hormone regulation. In recent years, this has meant continuous bleeding, sometimes with clots the size of my palm. I had a D&C that revealed uterine hyperplasia, and my OB-GYN said I should consider getting the Mirena, otherwise, I might end up needing an emergency hysterectomy. I was wary, so I adopted a wait-and-see, and what I saw was the symptoms returning. A second D&C a year or so later showed out-of-phase uterine lining and a polyp. I gave in and got the IUD.

    This is how medical decisions should be made – between doctor and patient. Not by a company owner who doesn’t know you, has never met you and will never have to deal with the health challenges you face.

    It’s not an exact comparison, but consider hemophilia, another disorder that causes uncontrollable bleeding and is experienced only by one sex, in this case, men. Do hemopiliac men working at Hobby Lobby have to face an uphill battle to get the hemophilia treatments they need? Or are they treated with dignity and respect, their medical decisions made by themselves and a qualified medical team?

    I’m so heartsick over this.

    Posted by femingen | July 7, 2014, 12:33 pm
  72. Great, succinct explanation of the world of trouble this decision could open up. It’s infuriating how reproductive care is viewed as some sideline to “real” healthcare. As someone who can no longer use hormonal birth control after a blood clot, I find it especially obnoxious to have corporations getting between women and their doctors in making the best birth control decisions, and putting effective contraception out of reach for employees based on non-scientific blather.

    Posted by Rebecca Griffin | July 7, 2014, 12:44 pm
  73. This is so old. If she wants one of the methods that cause a V.I.P. (voluntary interruption of pregnancy, aka abortion) she can use them, she will just have to pay for them herself because yes, they do cause an abortion by preventing a fertilized egg from implanting, or causing its expulsion. No one is denying her their use, the people running these corporations should not be forced to pay for them, though. You claim to be an O. B. If that is so, you know that abortion is almost never “a female health issue”. It is almost always an issue of convenience, pride, or fear of being caught having sex outside of marriage.

    Again, No one is denying the woman’s beliefs. The SCOTUS just protected the business owners rights. No woman was denied anything but having her abortion paid for.

    Oh, and how do I know what I am talking about? I am a woman, a wife, a mother, and a former OB nurse.

    It is time to stop all of the drama and face the fact that sex outside of marriage is not a right or a privilege, but very often a regretted mistake. Pregnancies resulting from same are called consequences. Old school? Yeah, but right.

    Posted by Lisa Ritchey | July 7, 2014, 3:35 pm
    • As an OB nurse surely you must understand the science behind the subject, that Plan B and ella impact implantation only and have no impact on a fertilized egg (not that preventing a fertilized eggs from implanting is any medical definition of abortion, it is the definition used by a narrow group of religious individuals in the U.S.). As you are an R.N. you must also know that the Mirena IUD has no impact on implantation and the mechanism of action for the Copper IUD also is unlikely to involve implantation. Just to clarify, it is biologically impossible based on science for Plan B, ella, and Mirena to impact implantation and it is biologically improbably for the Copper IUD to impact implantation.

      I “claim to be an OB”? An ad hominen attack is a sign that your argument has no merit. Why would you even write such a thing? Did you take the time to read my About Me page or are you just so used to untruths yourself that you think everyone else does it?

      Your stated understanding of why women seek abortion is quite far from the truth and thinking abortion isn’t a “health issue” is absurd.” Your idea that sex outside of marriage is wrong implies that you feel it is valid to impose your own religious and/or moral beliefs on others. Thinking that only single women get abortions or need contraception means you need to invest in some continuing education.

      Posted by Dr. Jen Gunter | July 8, 2014, 6:19 am
      • I stand by what I said.

        Posted by Lisa Ritchey | July 8, 2014, 10:13 am
      • Just to go slightly para-relevant for a moment: the Edinburgh zoo has a panda that has been artificially inseminated. But the zoo warns, a successful fertilization does not mean a successful pregnancy. Pandas can keep fertilized ova for quite some time before they implant, and it will be some time before a pregnancy can be confirmed.

        Fertilization isn’t pregnancy. (Anyway, when exactly is fertilization? When the sperm enters the cytoplasm of the ova? When the sperm passes through the nuclear membrane? Or when the sperm’s dna and the ovum’s dna combine? Really, so much hair-splitting for the lawyers.)

        And: married women can and do seek abortion. And sex is only confined to “marriage” in certain religiously-defined circumstances: to say that it is, is to invest marriage with some sort of magical property. Physicians don’t deal in magic.

        Posted by korhomme | July 8, 2014, 10:21 am
    • So what about sex inside of marriage – is that a privilege too? Is not having more children than one can afford or feel prepared to care for properly a privilege too? Among the methods Holly Hobby refused to cover were the 2 types of IUD. These are among the most effective non-surgical forms of birth control. Both require a high upfront cost but in the long term are much cheaper than most other methods. They are highly recommended for married women.

      Posted by Anat | July 8, 2014, 4:06 pm
  74. “Science is fact.”

    This is what non-scientists actually believe.

    Posted by squall | July 7, 2014, 10:32 pm
    • It has a far, far, far better record than religious belief. Ask Bill Cassidy about the ‘abstinence training’ he sincerely believes in, for instance.

      Posted by Greg Smith | July 10, 2014, 5:46 am
  75. My thing is, they don’t want people having abortions, but they don’t want people using contraception either. such idiots!

    Posted by SouthernGal | July 8, 2014, 8:34 pm
  76. This is just more proof that the government should have kept their business out of our business.

    Posted by ibjoee | July 8, 2014, 10:01 pm
  77. Nobody who argues that these “abortifacients” end a human life make any claims about the medical definition of pregnancy. The medical definition of pregnancy doesn’t come into their argument. And to wrongly state that “evangelicals” try to re-define the term “pregnancy” is either dishonest or shows a fundamental lack of understanding of the opposing viewpoint.

    The point made is that it ends a human life. And if fertilization has happened, then it is a human life. This is a scientific fact. Nobody is saying it is a “person”. Just the scientific fact: it is a human life. Whether or not the embryo has implanted in the uterus or not (thus making it a medically official “pregnancy”) is irrelevant to this fact.

    The argument made is that taking direct and purposeful action to end a human life, in whatever form, is unethical and immoral.

    Is that so hard to understand? You may not agree, but is it hard to understand?

    Posted by dan-O | July 9, 2014, 12:50 pm
  78. I wonder if Hobby Lobby provides coat hangers for their employees to hang up their coats.

    Posted by thorsaurus | July 11, 2014, 9:43 pm
  79. I completely agree. But on the flipside we as Americans have the freedom to choose who we work for. If we (people like myself) disagree with Hobby Lobby and their beliefs, or how they run their company then we can choose not to work there.

    Posted by PaytonE | July 13, 2014, 9:35 am
    • Ever since the economic downturn a large number of Americans don’t have much of a choice of whom to work for.

      Posted by Anat | July 13, 2014, 4:18 pm
      • I understand that as well, being a teenage single mother. That’s just one counter argument I’ve heard on the radio which is pretty valid.

        Posted by PaytonE | July 13, 2014, 4:35 pm
    • This might make more sense if all the affected employees had known in advance that this would happen. Hobby Lobby’s insurance covered contraception for years; it wasn’t until Obamacare that they noticed or cared or whatever about the fact that, by their own admission, they were baby-killers.

      So, yeah, these employees just had the rug pulled out from under them, but now they’re free to choose to become unemployed and then they can choose to live under a bridge. Yay freedom!

      Posted by scarshapedstar1 | July 15, 2014, 9:34 pm
      • I can understand how it’s unfair to the current employees, to add to that I didn’t know that they previously covered these contraceptives. However, to those out there looking for a job now know that Hobby Lobby doesn’t cover these contraceptives and they have the freedom and choice to not work there, shop there, associate with Hobby Lobby, etc.

        Posted by PaytonE | July 16, 2014, 6:50 pm
  80. Great post!

    Posted by allthenamesaretakensothisisreallyreallylong | July 16, 2014, 3:56 am
  81. Reblogged this on mythoughtlessmind and commented:
    Everything I’ve tried to explain to too many people. It is overwhelming how little people care until it directly affects them.

    Posted by mythoughtlessmind | July 17, 2014, 10:10 pm

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