Alabama's largest hospital paused Wednesday as providers and patients across the state scrambled to assess the impact of a court ruling that said frozen embryos are the legal equivalent of children.
The University of Alabama at Birmingham health system said in a statement that it must evaluate whether its patients or doctors could face criminal charges or punitive damages for undergoing IVF treatments. "We are saddened that this will impact our patients' attempt to have a baby through IVF," the statement from spokeswoman Savannah Koplon read.
Doctors and patients were gripped by a mixture of shock, anxiety and fear as they weighed how to proceed in the wake of the ruling by the all-Republican Alabama Supreme Court that put in question the future of IVF.
"Disbelief, denial, all the stages of grief. ... I was stunned," said Michael C. Allemand, MD, a reproductive endocrinologist at Alabama Fertility, which provides IVF services.
Allemand said they are having daily discussions about how to proceed. He said IVF is often the best treatment for patients who desperately want a child, and the ruling threatens doctors' ability to provide that care.
"The moments that our patients are wanting to have by growing their families -- Christmas mornings with grandparents, kindergarten, going in the first day of school, with little back-backs -- all that stuff is what this is about. Those are the real moments that this ruling could deprive patients of," he said.
Gabby and Spencer Goidel of Auburn, Alabama, turned to IVF after three miscarriages. The Alabama ruling came down on the same day Gabby began a 10-day series of daily injections ahead of egg retrieval, with the hopes of getting pregnant through IVF next month.
"When I saw this ruling, I got very angry and very hurt that it could potentially stop my cycle. People need to know this is affecting couples -- real-life couples who are trying to start families, who are just trying to live the quote, unquote American dream," Gabby Goidel, 26, said. She said her clinic is continuing to provide treatment for now but is reviewing the situation on a day-by-day basis.
Justices -- citing language in the Alabama Constitution that the state recognizes the "rights of the unborn child" -- said three couples could sue for wrongful death when their frozen embryos were destroyed in an accident at a storage facility.
"Unborn children are 'children' ... without exception based on developmental stage, physical location, or any other ancillary characteristics," Justice Jay Mitchell wrote in Friday's majority ruling. Mitchell said the court had previously ruled that a fetus killed when a woman is pregnant is covered under Alabama's Wrongful Death of a Minor Act and nothing excludes "extrauterine children from the Act's coverage."
Alabama Chief Justice Tom Parker, in a scripture-draped concurring opinion, wrote that, "even before birth, all human beings bear the image of God, and their lives cannot be destroyed without effacing his glory."
While the court case centered on whether embryos were covered under the wrongful death of a minor statute, some said treating the embryo as a child -- rather than property -- could have broader implications and call into question many of the practices of IVF.
"If this is now a person, will we be able to freeze embryos?" Barbara Collura, CEO of RESOLVE: The National Infertility Association, said.
The fertility clinic and hospital in the Alabama case could ask the court to reconsider the decision or ask the U.S. Supreme Court to review the matter if they believe there is a conflict with federal law.
The Alabama Supreme Court decision partly hinged on anti-abortion language added to the Alabama Constitution by voters in 2018, stating it is the "policy of this state to ensure the protection of the rights of the unborn child."
Eric Johnston, an anti-abortion activist and lawyer who helped draft the constitutional language, said the "purpose of that was more related to abortion."
He said it was intended to clarify that the Alabama Constitution does not protect the right to abortion and eventually laid the groundwork for Alabama to ban abortions when states regained control of abortion access. However, opponents of the constitutional amendment warned in 2018 that it was essentially a personhood measure that could give rights to fertilized eggs.
"Modern science has raised up this question about well is a fertilized egg that is frozen -- is that a person? And that's the ethical, medical, legal dilemma that we've got right now," Johnston said.
"It's a very complicated issue," he added.