Abortion Restrictions Threaten All Reproductive Health Care Clinicians

The Supreme Court's decision on Dobbs vJackson will have an impact on reproductive health care provision for years to come, not only where abortion care is now restricted but across the country. As of January 2023,14 states have outlawed or severely restricted abortion.1 Morbidity and mortality around the time of labor is already on the rise nationally, from 658 in 2018 to 861 in 20202-particularly in places where abortion is restricted and labor care is increasingly sparse because of loss of the workforce after the COVID-19 pandemic.3 It is important to understand how the criminalization of abortion providers will affect all other forms of reproductive health care moving forward.In states where abortion care is currently severely limited, clinicians who provide abortion care face criminalization that can include insurmountable legal fees, loss of their medical license, and even imprisonment. Abortion restrictions create a duality in which providers feel they must serve as agents of the state-reporting any suspicious pregnancy-related issues-or have their license called into question, all while trying to best help their patients. Since these laws took effect, we are already seeing delays in health care services for patients needing early pregnancy care management-for abortion as well as miscarriage management and ectopic pregnancies.4 Health care providers may be called on to increase surveillance and report signs of abortion that can violate their protection of HIPAA (the Health Insurance Portability and Accountability Act) rights, while also facing malpractice claims if they, by delaying or denying early pregnancy care management, are providing what medical evidence shows to be substandard care.

REDUCING FAMILY SEPARATIONS IN NEW YORK CITY: THE COVID-19 EXPERIMENT AND A CALL FOR CHANGE

Child welfare agencies and family courts have long removed children from allegedly abusive or neglectful parents as an ultimate means of ensuring a child's safety. The theory that high numbers of removals are necessary to keep children safe, however, had never been tested-there was no mechanism or political will to do so until the onset of the COVID-19 pandemic in March 2020. With the near-complete shutdown of New York City, the child welfare apparatus had no choice but to remove fewer children from their homes. Catastrophe did not ensue. Rather, the numbers tell a different story. Children remained safe across a range of metrics, avoided the trauma of removal from their homes during a global pandemic, and experienced sustained safety as the City began to reopen. This Piece argues that New York's child welfare system must learn from COVID-19 and significantly curtail its drastic measure of removing children from their families, which can cause substantial, often irreparable trauma to children. It uses the COVID-19 pandemic as a case study to demonstrate the safety and soundness of reserving removals (also known as remands) for only the most extreme circumstances. This Piece focuses on the dramatic reduction of removals specifically during the pandemic;examines the traumatic, racially biased, and overused practice of family separation from a child's perspective;and calls for specific reforms within the existing system to reduce remands while protecting children's safety.

The Electrical Contractors Case: Irish Supreme Court Illuminates Collective Bargaining and Delegated Legislation

As Europe begins to emerge from the Covid‐19 pandemic, two trends are clear: one, labour market reform is urgently needed, to cope with new economic and technological realities;and two, big government is back. The recent decision of the Irish Supreme Court in Náisiúnta Leichtreach Contraitheoir Éireann v Labour Court illuminates the relationship between collective bargaining and the regulatory state. In potentially one of the most important decisions in Irish labour law in decades, the Court rejected a constitutional challenge to legislation aimed at empowering social partners to regulate economic sectors through collective bargaining. This article situates that decision within recent scholarship on the ‘labour constitution' model of labour law, under which the social partners should participate in economic governance. It also highlights the relevance of the decision for the ‘Social Europe' agenda and the political economy of both national constitutional law and the EU internal market.

A PROPHYLACTIC APPROACH TO COMPACT CONSTITUTIONALITY

From COVID-19 to climate change, immigration to health insurance, firearms control to electoral reform: state politicians have sought to address all these hot-button issues by joining forces with other states. The U.S. Constitution, however, forbids states to "enter into any Agreement or Compact" with each other "without the Consent of Congress," a requirement that proponents of much interstate action, especially around controversial topics, would hope to circumvent. The Supreme Court lets them do just that. By interpreting "any Agreement or Compact" so narrowly that it is difficult to see what besides otherwise unlawful coordination qualifies, the Court has essentially read the Compact Clause out of existence. Scholars have offered substitute standards. But those efforts serve to corroborate the analytical point on which current caselaw rests: that the infinite variety of ways in which states can collaborate makes separating constitutionally suspect from safe agreements impossible. This Article presents a prophylactic path forward focused not on what "any Agreement or Compact" means, but on how "the Consent of Congress" works. It argues that Congress should encourage possible-compact reporting by establishing a system where submission plus silence can equal consent. This approach is prophylactic because it avoids difficult constitutional questions by preventing debatable constitutional violations. And it does so while preserving much of the state-favoring functionality of the current system. The Article contends that this approach makes theoretical sense given situations supporting regulatory safe harbors and juridical and political sense given court and congressional precedent. It also argues that the proposed approach facilitates balancing the efficiency, democracy, and community values underlying regional-governance mechanisms better than the current system does.

Public Defense after the Pandemic

[...]a significant number of backlogged cases are murder cases. According to a recent public defense workload study conducted by ABA SCLAID and consulting firm Crowe in Indiana, public defenders require, on average, 232 hours for a noncapital murder case in which the individual is not facing life without parole and 311 hours in a case in which the individual is facing life without parole. [...]the ability to adequately build or defend a case decreases as time goes past, meaning backlogs impact not only the timing of justice, but the quality of justice. According to the Prison Policy Initiative, even before the pandemic extended jail stays, "[s]omeone in jail is more than three times as likely to die of suicide as someone in the general U.S. population."

FREE EXERCISE PARTISANSHIP

This Article presents new data demonstrating that, in contrast to earlier periods, recent judicial decision-making in free exercise cases tracks political affiliation to a significant degree. The trend toward increased free exercise partisanship is starkly manifested by free exercise cases borne out of the COVID-19 pandemic: a survey of federal court decisions pertaining to free exercise challenges to prohibitions of religious gatherings during the pandemic reveals that 0% of Democratic-appointed judges sided with religious plaintiffs, the majority (66%) of Republican-appointed judges sided with religious plaintiffs, and 82% of Trump-appointed judges sided with religious plaintiffs. But while religious challenges to COVID-19 lockdown orders have thrown free exercise partisanship into sharp relief, the trend of increased partisanship in free exercise jurisprudence actually predates the onset of the pandemic. This Article makes several contributions. One is empirical: it offers an original dataset that tracks every free exercise case from 2016 (the endpoint of previous surveys of free exercise cases) until 2021. Another is historical: it tells the story of how free exercise became politically controversial. A third is doctrinal: it reveals the deep ambiguity at the heart of free exercise doctrine, which this Article argues has enabled the rise in free exercise partisanship. A final one is jurisprudential: it shows the relationship between doctrinal clarity and partisanship, which has implications for constitutional law writ large.

Out of the Margins? Race, Racism, and Colonialism in Canadian Communication Studies

The current conjuncture is marked by a multitude of global crises that include the COVID-19 pandemic;global warming;conflicts in Ukraine, Afghanistan, and Palestine;growing global poverty and food scarcity;the exponential increase of forcibly displaced people;the escalating use of incarceration to manage migrants, including children;land conflicts with Indigenous peoples;and the persecution and genocide of religious, ethnic, and sexual minorities around the globe, from the Rohingya to the Uyghurs. In Canada, we nessed the of hundreds of unmarked graves of Indigenous children forced to attend residential schools;court rulings in favour of pipelines that violated the constitutional rights of Indigenous peoples;the global mobilization of Black Lives Matters;the escalation of anti-Asian racism;the heightened Islamophobia that resulted in the killing of members of the Afzaal Salman family;attacks on mosques and synagogues;and the ongoing criminalization, incarceration, and violent police murders of Black, Indigenous, and people of colour across the country. The recent occupation of Ottawa and other cities and towns highlights the rise of right-wing extremism that, along with the failure of the state to act swiftly to protect the rule of law, brings up the intersection of misogyny, racism, colonialism, anti-Semitism, Islamophobia, and populism (Karim, 2000;Mirrlees, 2021;Neville & Langlois, 2021). Drawing on their experiences working with the Community Media Advocacy Centre (CMAC) as scholar-activists, King and Odartey-Wellington argue that the canon of Canadian communications scholarship must be expanded to include Canada's history of colonialism and discrimination against ra- cialized people.

Work and illness: a disputed relationship (20th-century Spain)

El concepto de accidente de trabajo, y aún más el de enfermedad profesional, no designan realidades que se impongan invariablemente por su sola denominación. El reconocimiento de un "nexo" entre trabajo y enfermedades ha sido en todas partes mucho más tímido y dificultoso que el de los accidentes propiamente dichos. Con el objetivo puesto en los riesgos de enfermar "con ocasión o por consecuencia del trabajo", una muestra de un millar de sentencias judiciales, repartidas entre 1936 y 1983, comprueba el peso de inercias estructurales y se detiene en los signos de inflexión, en función de la evolución de la legislación de referencia, pero también de sus interpretaciones por los tribunales y de su contexto. Como expresión normalizada de hechos sociales (los riesgos del trabajo para la salud de quienes lo realizan), el "riesgo profesional" es un objeto en construcción, en un proceso más contradictorio que lineal.Alternate :The concepts of occupational accident, and especially of professional illness, do not express concrete realities that are self-evident by name alone. The recognition of a "link" between work and illnesses has always been a much more gradual, more problematic process than that linking work and accidents in the strict sense of the word. In this article, we focus on the risks of becoming ill"on the occasion of or as a consequence of work" In a review of a sample group of around 1,000 court sentences between 1936 and 1983, we analyse the influence of structural inertias, highlighting in particular the signs of change, in line with the evolution of legislation and the way it was interpreted by the courts. The changing social contextis also taken into account. As a normalized expression of social facts (the occupational health risks to which workers are exposed), the concept of "occupational hazard" is still very much under construction, in a process that is contradictory and far from linear.

Criminal Liability Nuances of Medical Negligence During the COVID-19 Pandemic

Under normal circumstances, the medical negligence of doctors in most European (continental) states is assessed within the limits of criminal liability under the criminal laws of each state, without exception in the case of COVID-19 or another pandemic. The author raises the question of whether doctors, in the performance of their duties and in the provision of treatment services during the COVID-19 pandemic, deserve any relief from their liability due to errors or negligence in the performance of their duties that have resulted in the consequences of damage to health or life loss of patients. The article provides an analysis of the special laws created for such situations and adopted in Poland and Italy while presenting the shortcomings and advantages of such legal regulation and distinguishing the discussion issues raised by legal scholars and practitioners of the abovementioned states. The author criticises the attempt to adopt a similar legal act in Lithuania and at the same time proposes to discuss the possibility of changing the existing legal regulation and setting limits on the criminal liability of doctors during the COVID-19 pandemic.

IN RE COVID-RELATED RESTRICTIONS ON RELIGIOUS SERVICES Consol. C.A. No. 2021-1036-JTL

For starters, he claims that this court lacks subject matter jurisdiction over the plaintiffs' claims. The Governor argues that it is not reasonably conceivable that the plaintiffs face a threat of imminent irreparable harm given that he lifted the Challenged Restrictions more than two years ago, has no intention of re- imposing them, and has entered into a settlement agreement that resolved a federal lawsuit brought by another religious leader in which he agreed to limitations on his ability to impose restrictions on houses of worship. The Delaware cases that impose that requirement have ported it over from the tests that a plaintiff must meet when seeking interim forms of injunctive relief, such as a temporary restraining order or a preliminary injunction. [...]when a plaintiff seeks to ground equitable jurisdiction on the potential need for a permanent injunction, the pled facts must support a reasonable apprehension that the defendant will act in a manner that will necessitate the injunction's issuance.

Combating Domestic Violence amidst Social Isolation and Covid-19

This paper explores the situation faced by women in the family atmosphere during the pandemic-imposed lockdown and the inability on the part of the State and its machinery to provide access to instant remedies against domestic violence as envisaged under the Protection of Women from Domestic Violence (PWDV) Act, 2005. The concept of parens patriae (parent of people) has proved to be in existence only nominally during the contingency. Many of the well framed statutory protective mechanisms including the constitutional machinery of the Judiciary have failed to provide a helping hand to the tortured women everywhere. The social isolation strategy adopted to tackle the Covid-19 epidemic has accelerated the age-old shadow of domestic violence. A doctrinal study is undertaken to analyse the existing legislative and judicial measures against domestic violence, especially in the context of rising domestic violence during the pandemic. The objective of the paper is to identify the victimisation faced by women during the pandemic and the difficulties they face in accessing the redressal mechanisms stipulated under the PWDV Act. To reach the victims of domestic violence, and to free and save them from the clutches of respondents1 with the help of legislations is not sufficient. To deal with such an unexpected new normal scenario, it is necessary to find an alternative mechanism whereby an instant remedy, more than which is perceived under the PWDV Act, could be provided to victims of domestic violence. The methodology adopted for this paper is basically doctrinal. The legal framework at the national and international levels to curb the menace of domestic violence is brought in for the structuring of rights and obligations. An analysis of the present Covid-19 pandemic based on the reports available offline and online is also undertaken. Judicial decisions form the building bricks for the establishment of constitutional rights and its affirmation. Hence a systematic analysis of Supreme Court decisions is also undertaken to complete the research paper.

GOVERNMENT DISMISSAL AUTHORITY OF FALSE CLAIMS ACT QUI TAM CLAIMS: AN ANALYSIS OF THE CURRENT POLITICAL AND JUDICIAL DEBATE

Dating back to the Civil War, the False Claims Act (FCA) is a powerful weapon that the U.S. government (government) wields to combat fraud. In particular, the FCA contains "qui tam" provisions wherein a whistleblower, known as a "relator," may bring claims in the government's name and retain a portion of any resultant recoveries. While the FCA allows the government to dismiss a qui tam claim notwithstanding the objections of relator, there is a four-way circuit split on the appropriate standard of review for such motions to dismiss. From 2003 through 2020, the split was only between the Ninth Circuit's Sequoia standard, which requires the government to demonstrate the dismissal is rationally related to a valid governmental objective, and the D.C. Circuit's Swift standard, which confers nearly unfettered deference to the government. The year 2020 ushered in a new era of judicial debate with the Seventh Circuit creating a third standard based on the Federal Rules of Civil Procedure and the First Circuit promulgating an entirely different standard-one that requires the government to provide reasons for dismissal. The First Circuit standard also requires dismissal to be granted unless there is a constitutional infirmity or evidence of fraud. This circuit split was thrust into the spotlight in 2018 when Michael Granston, Director of the Department of Justice (DoJ) Commercial Litigation Branch, Fraud Section, promulgated guidance instructing DoJ attorneys to consider dismissing qui tam cases to curb meritless qui tam cases, conserve government resources, and prevent unfavorable precedents. Senator Charles "Chuck" Grassley (R-Iowa), a life-long whistleblower champion, has publicly criticized these dismissals as pretextual and antithetical to the spirit of the FCA. In October 2021, Senator Grassley proposed an FCA amendment that essentially codifies the Sequoia standard. Shortly before this article was sent to the publisher, the Supreme Court granted certiorari to address this question. This article examines the historical context of the qui tam provisions that ultimately gave rise to the circuit split as well as the DOJ's recent use of its dismissal authority. It further evaluates Senator Grassley's proposed FCA amendment and argues that it does not substantively settle key nuanced issues that continue to drive judicial disagreement. In light of the evolution to a four-way circuit split and the recent increase in judicial divergence, this article argues that the government's dismissal authority is well-suited for Supreme Court intervention. Finally, this article examines why the dismissal authority particularly matters now. With a newly emerging circuit split on whether a denied government motion to dismiss can be appealed and the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) introducing significant opportunities to commit fraud against the government, it is imperative that all FCA litigants have clarity on the contours of the government's dismissal authority.

Improving our chances of a healthier future

What should we do now to improve health in the future? For women with gestational diabetes, adherence to five healthy lifestyle habits over a quarter century of follow-up was associated with a 90% lower risk of developing type 2 diabetes, when compared with women who had none of these habits (doi:10.1136/bmj-2022-070312).1 Gestational diabetes is a strong marker of future illness, associated with a meaningful increase in later cardiovascular and cerebrovascular disease. Some though not all of the risk is due to the subsequent development of diabetes (doi:10.1136/bmj-2022-070244).2 Quite obviously, then, women with gestational diabetes are especially likely to benefit from public health measures aimed at helping them implement healthy habits.

For emergency CS, a labour epidural should be removed and a spinal anaesthetic used instead

Planning, Preparation and Pre-emption are three key concepts in the practice of anaesthesia. In obstetric anaesthesia specifically, these three ‘P’s are particularly relevant as parturients are commonly present the Delivery Suite for a period of time prior to requesting or requiring anaesthetic intervention. One frequently encountered example of implementing Planning, Preparation and Pre-emption by the obstetric anaesthesiologist is the recommendation of starting epidural analgesia during labour. Unless contraindicated, this is suggested or advisable in parturients with modified WHO 3 and modified WHO 4 heart disease1, in women with maternal obesity2, in active COVID-19 infection3, in the presence of certain ophthalmic pathologies4, and in laboring women with pre-eclampsia5, among others. This is to ensure labour analgesia and patient comfort;to prevent deterioration of medical conditions due to the added physiological and psychological stresses of labour;to reduce the need for further anaesthetic intervention should anaesthesia be required for a surgical procedure;and to avoid general anaesthesia wherever possible, reducing the incidence of associated complications and protecting healthcare staff from aerosol-generating procedures.The main benefits of having an established Labour Epidural providing good epidural analgesia are: 1) the possibility of its conversion to an epidural anaesthetic in the case of an emergency Caesarean section, 2) the avoidance of disadvantages associated with removing the Epidural and using a Spinal, and 3) other considerations including cost, environmental impact, anaesthetist workload, and patient perspectives.1. Conversion to Epidural Anaesthesia for Emergency Caesarean SectionLumbar epidurals are regarded as the gold standard for labour analgesia6. The Obstetric Anaesthetists’ Association (OAA) in the United Kingdom estimates that only 5% of labour epidurals will not work well enough for a Caesarean section7, should it be required. In an Irish study, the rate of labour epidurals converted to spinal or general anaesthesia for Caesarean section was 9%8, the conversion rate from an Indian study was approximately 4%9, a Maltese study identified a rate of epidural conversion to spinal or general anaesthesia for Caesarean section as 0.85% and 1.5% respectively10, a Chinese publication showed a conversion rate to general anaesthesia of 3%11, while a systematic review in 2022 by authors from the United Kingdom and the United States of America including over 3000 patients showed an overall prevalence of inadequate epidural anaesthesia of around 30%12. It is however worth noting that this systematic review relates to elective caesarean section, and not emergencies, with the possibility that epidural analgesia was not established for a significant period of time prior to the procedure.Naturally, it is important to ensure that the epidural analgesia provided during labour is satisfactory to increase chances of success of epidural anaesthesia for emergency Caesarean section13. A number of risk factors have been identified as being associated with a failure of conversion from epidural analgesia to anaesthesia and recommendations for their mitigation14, in line with the spirit of Planning, Preparation and Pre-emption, have been made. The presence of an obstetric anaesthetist has also been mentioned as a relevant factor in this regard15.Furthermore, the time required for an epidural top up to a level adequate for surgical anaesthesia compares favourably with that required for a spinal, and in some cases, even with that required for a general anaesthetic. A 2018 retrospective cohort study showed that unadjusted median operating room-to-incision intervals were 6 minutes for general anaesthesia, 11 minutes for epidural top-up, and 13 minutes for spinal anaesthesia16. It is important to point out that when relating to clinical significance, general anaesthesia was associated with worse short term neonatal outcomes in this study, and that longer time intervals were not associated with worse neona al outcomes16. A 2007 retrospective audit from Australia showed mean decision-to-delivery times of 17 (±6) minutes for general anaesthesia, 19 (±9) minutes for epidural, and 26 (±9) minutes for spinal17. It has also been reported that established epidural analgesia may mitigate the increased anaesthesia and surgery time required in obese obstetric patients undergoing Caesarean section18.Finally, epidural anaesthesia for emergency Caesarean section has the benefit of being topped up as often as required to prolong the duration of the anaesthetic block. It also allows for manipulation of the time of onset of the anaesthetic, speeding it up by using lignocaine together with adjuvants such as opiates, bicarbonate, or adrenaline;or even providing a gentle onset of neuraxial anaesthetic blockade when required, for example, in patients with severe heart disease. One-shot spinal anaesthesia does not confer these benefits.Therefore, it can be said that in over 90% of cases where a functioning labour epidural analgesia is present, this can be satisfactorily used for emergency Caesarean section anaesthesia in a timely manner. This is very promising data which encourages the anaesthesiologist to utilize epidural top ups, instead of removing the labour epidural and attempting an alternative technique.2. Disadvantages associated with removing the Epidural and using a SpinalThe decision to remove a labour epidural for an emergency Caesarean section and opt for a spinal anaesthetic has its disadvantages. Firstly, as described above, the anaesthesiologist is losing an anaesthetic option which has a high chance of success and is negating some benefits related to Planning, Preparation and Pre-emption in obstetric anaesthesia. Secondly, the patient is being exposed to the potential complications associated with a second procedure, which may not have been justifiably necessary. In this case, there is always the possibility that a spinal anaesthetic is not possible to site due to patient anatomy, difficulty with appropriate positioning in an emergency situation, challenges resulting from the volume already present in the epidural space, and psychological stress due to the urgency felt by the multidisciplinary team, among others. This would result in the anaesthesiologist having to resort to general anaesthesia, which may further expose the patient to complications such as awareness, aspiration, and difficulty with airway manoeuvres.Additionally, there is controversy in the literature regarding the safety of spinal anaesthesia following pre-established epidural analgesia in obstetrics. A number of authors express concerns regarding the risk of high spinal or total spinal with the injection of local anaesthetic and adjuvants into the cerebrospinal fluid once this is already compressed by the contents of the epidural space14,19. This seems to be more of an issue if a recent epidural bolus would have just been administered, as compared to an epidural infusion only19–20. Case reports of these complications have been published21–22.3. Other considerationsWhen considering the choice between topping up a labour epidural or removing it and using a spinal for emergency Caesarean section, one should also factor in the issues of cost, environmental impact, anaesthesiologist workload, and patient perspectives.It can be argued that removing a labour epidural and performing spinal anaesthesia is more costly than topping up the already-present epidural. A new sterile gown and gloves will need to be used by the anaesthesiologist, together with the opening of a new sterile pack for spinal anaesthesia. This will include consumables, such as the spinal needle, the cleaning solution and swabs;as well as the cost of cleaning, decontamination, and sterilization of any reusable items, which involves the cost of additional staff. The repeated use of personal protective equipment, utilization of consumables, and processes associated with cleaning, decontamination, and sterilization also carries an environmental impact. In a world where cost-efficiency is key, and minimization of environmental impact is important, these considerations cannot be ignored.Choosing to remove a labour epidural and use a spinal anaesthetic for an emergency Caesarean section may also have an effect on the anaesthesiologist in terms of stress and workload. Deciding to remove a working epidural analgesia catheter before even giving it a chance to work is eliminating a realistic anaesthetic option for an emergency procedure. This limits the tools available to the anaesthesiologist as it is not usually feasible for an epidural catheter to be re-inserted in an emergency. It also requires the anaesthesiologist to explain this additional procedure to the patient and gain informed consent in a challenging situation. This extra workload i.e., explaining, gaining informed consent, and inserting a spinal anaesthetic, may be stressful for the anaesthesiologist. Also, they are now required to perform a procedure in a time-pressured and high-stakes environment. Performance anxiety may also play a part if the anaesthesiologist is very keen to avoid a general anaesthetic, for example, if they feel the patient’s airway looks particularly difficult or the patient has pre-eclampsia and would therefore be at a higher risk of complications.Patient perspectives should also be considered. The author has found no published literature specifically relating to patient preference regarding epidural or spinal anaesthesia for emergency Caesarean section. However, it is reasonable to think that a patient who has a working labour epidural already has confidence in the technique and as a result, may feel more reassured with epidural anaesthesia for emergency Caesarean section as compared to alternatives.In summary, labour epidurals providing satisfactory analgesia shouldbe considered for a top up to provide epidural anaesthesia for emergency Caesarean sections. In fact, this is one of the main benefits of siting labour epidurals in patients who are at a higher risk for Caesarean section and is a strong feature of obstetric anaesthesia practice using the principles of Planning, Preparation and Pre-emption. In addition, there are disadvantages to the alternative of removing the labour epidural and using a spinal anaesthetic. Furthermore, there are cost, environmental, anaesthesiologist, and patient considerations that may support the choice of epidural anaesthesia over spinal.National Institute for Health and Care Excellence (Great Britain). Intrapartum care for women with existing medical conditions or obstetric complications and their babies. National Institute for Health and Care Excellence (NICE);2019.Denison FC, Aedla NR, Keag O, Hor K, Reynolds RM, Milne A, Diamond A, on behalf of the Royal College of Obstetricians and Gynaecologists. Care of Women with Obesity in Pregnancy. Green-top Guideline No. 72. BJOG 2018Bauer M, Bernstein K, Dinges E, et al. Obstetric anesthesia during the coronavirus disease 2019 pandemic. Anesthesia and Analgesia 2020 Apr 20.Digre KB. Neuro-ophthalmology and pregnancy: what does a neuro-ophthalmologist need to know? Journal of Neuro-Ophthalmology 2011 Dec 1;31(4):381–7.Siddiqui MM, Banayan JM, Hofer JE. Pre-eclampsia through the eyes of the obstetrician and anesthesiologist. International Journal of Obstetric Anesthesia 2019 Nov 1;40:140–8.Kumar, Nishant DA, DNB, MNAMS Epidural Technique in Obstetric Anesthesia, Anesthesia & Analgesia: March 2021 - Volume 132 - Issue 3 - p e40 doi: 10.1213/ANE.0000000000005359Obstetric Anaesthetists’ Association (OAA). Risk of having an epidural or spinal to reduce labour pain. March 2021. Accessible at: https://www.labourpains.com/Epidural-Information-CardSingh V, Lal S, Thomas J, Narayanan N. ESRA19–0621 Incidence of failed epidural anaesthesia for emergency cesarean section and conversion rate to spinal or general anaesthesia.Pandya ST, Mikkilineni J, Madapu M. Conversion of labour epidural analgesia to anaesthesia for emergency caesarean section: A retrospective audit. Journal of Obstetric Anaesthesia and Critical Care 2021 Jan 1;11(1):5.Abela GP, Thor ton B, Cortis PA, Calleja P. Evaluation of the obstetric anaesthesia procedures at mater dei hospital in 2019. Malta Medical Journal 2022 Jan 11;34(1):43–9.Shen C, Chen L, Yue C, Cheng J. Extending epidural analgesia for intrapartum cesarean section following epidural labor analgesia: a retrospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine 2022 Mar 19;35(6):1127–33.Patel R, Kua J, Sharawi N, et al. Inadequate neuraxial anaesthesia in patients undergoing elective caesarean section: a systematic review. Anaesthesia. 2022.Visser WA, Zwijnenburg RD. Management of neuraxial anaesthesia for intrapartum caesarean delivery based on the quality of epidural labour analgesia: A case series. European Journal of Anaesthesiology;EJA. 2019 Aug 1;36(8):615–7.Desai N, Carvalho B. Conversion of labour epidural analgesia to surgical anaesthesia for emergency intrapartum Caesarean section. BJA education. 2020 Jan;20(1):26.Bjornestad EE, Haney M. An obstetric anaesthetist: A key to successful conversion of epidural analgesia to surgical anaesthesia for caesarean delivery?. Acta Anaesthesiologica Scandinavica. 2020;64(2):142–4.Palmer E, Ciechanowicz S, Reeve A, et al. Operating room-to-incision interval and neonatal outcome in emergency caesarean section: a retrospective 5-year cohort study. Anaesthesia. 2018 Jul;73(7):825–31.Popham P, Buettner A, Mendola M. Anaesthesia for emergency caesarean section, 2000–2004, at the Royal Women’s Hospital, Melbourne. Anaesthesia and intensive care. 2007 Feb;35(1):74–9.Lawrence S, Malacova E, Reutens D, Sturgess DJ. Increased maternal body mass index is associated with prolonged anaesthetic and surgical times for caesarean delivery but is partially offset by clinician seniority and established epidural analgesia. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2021;61(3):394–402.Vaida S, Dalal P, Mets B. Spinal anesthesia for Cesarean delivery following pre-existing epidural labour analgesia. Canadian Journal of Anesthesia/Journal canadien d’anesthésie 2009 Dec;56(12):988–9.Dadarkar P, Philip J, Weidner C, et al. Spinal anesthesia for cesarean section following inadequate labor epidural analgesia: a retrospective audit. International journal of Obstetric Anesthesia. 2004;13(4):239–43.Siddik-Sayyid SM, Gellad PH, Aouad MT. Total spinal block after spinal anesthesia following ongoing epidural analgesia for cesarean delivery. Journal of Anesthesia 2012;26(2):312–3.Gupta A, Enlund G, Bengtsson M, et al. Spinal anaesthesia for caesarean section following epidural analgesia in labour: a relative contraindication. International Journal of Obstetric Anesthesia 1994 jul 1;3(3):153–6.

FREE EXERCISE PARTISANSHIP

This Article presents new data demonstrating that, in contrast to earlier periods, recent judicial decision-making in free exercise cases tracks political affiliation to a significant degree. The trend toward increased free exercise partisanship is starkly manifested by free exercise cases borne out of the COVID-19 pandemic: a survey of federal court decisions pertaining to free exercise challenges to prohibitions of religious gatherings during the pandemic reveals that 0% of Democratic-appointed judges sided with religious plaintiffs, the majority (66%) of Republican-appointed judges sided with religious plaintiffs, and 82% of Trump-appointed judges sided with religious plaintiffs. But while religious challenges to COVID-19 lockdown orders have thrown free exercise partisanship into sharp relief, the trend of increased partisanship in free exercise jurisprudence actually predates the onset of the pandemic. This Article makes several contributions. One is empirical: it offers an original dataset that tracks every free exercise case from 2016 (the endpoint of previous surveys of free exercise cases) until 2021. Another is historical: it tells the story of how free exercise became politically controversial. A third is doctrinal: it reveals the deep ambiguity at the heart of free exercise doctrine, which this Article argues has enabled the rise in free exercise partisanship. A final one is jurisprudential: it shows the relationship between doctrinal clarity and partisanship, which has implications for constitutional law writ large.

WHEN PATIENTS ARE THEIR OWN DOCTORS: ROE V. WADE IN AN ERA OF SELF-MANAGED CARE

The Supreme Court in Roe v. Wade framed the abortion right as the right to make an abortion decision in consultation with a "responsible physician." Under this framing, doctors were cast into the role of medical "gatekeepers" to mediate patient access to abortion. In the ensuing years, the doctorpatient relationship has become the site of restrictive abortion regulations in many states. This Article argues that Roe's framing suffers from a foundational flaw: while the gatekeeper framing may have been appropriate in the Roe era when abortion was surgical and non-clinical abortions were potentially lethal, today, medication abortion-a two-drug non-surgical regimen that can safely and effectively terminate a pregnancy at home-renders the Court's gatekeeper framing obsolete and no longer reflects the technological or medical realities of abortion-related healthcare. This Article reasserts the constitutional right to abortion and argues that advances in medical technology call for a new framing for the right as one of direct access to abortion that is not dependent upon the provider-patient relationship. This framing is better suited to protect the breadth and depth of the abortion right because it reflects the new technological realities of the practice of abortion and the promise of abortion care outside of the medical gatekeeper model, which has been the focus of restrictive regulation and clinic harassment. It is a critical time to re-examine the gatekeeper framing of the abortion right considering the dramatic conservative shift in the Supreme Court that threatens Roe, and in the midst of a pandemic, which-in a complete reversal of the Roe period- renders in-person care by a provider potentially dangerous. In January, the Supreme Court's first abortion decision since President Trump's appointment of three justices, FDA v. American College of Obstetricians & Gynecologists ("ACOG"), doubled down on the medical gatekeeper model by reinstating an FDA requirement that medication abortion pills must be dispensed in person by a provider. Re-examining the historical, social, and technological assumptions that animate the current framing of the abortion right is vital to thinking of new ways to frame and expand abortion access. Today's online medical and pharmaceutical marketplaces reveal that the Court's confined vision of the abortion right was informed by the social and technological realities of its time-social and technological realities that no longer exist. If Roe's cramped vision of the abortion right has run its course, as I argue here, then the movement to protect access to abortion must include direct consumer access to abortion. Empirical evidence reveals widespread use of self-managed medication abortion in the face of abortion restrictions. The shuttering of clinics as "non-essential services" during the COVID-19 pandemic and the unnecessary increased risk of clinic-based care for procedures that can be safely managed at home only amplify the need for direct-to-consumer access to abortion care. As state legislatures seek to make it easier to prosecute individuals suspected of terminating their own pregnancies, it is a crucial moment to reconsider the constitutional foundation of the abortion right and the right to self-managed care as a matter of criminal and reproductive justice and public health.

Abortion Care Is Health Care: A Public Health of Consequence, September 2022

[...]although poor women saw a 26% decrease, women living at or above 200% of the poverty level saw a 36% decrease in abortions. [...]between 2011 and 2015, conservative state legislators enacted 288 restrictions on women seeking abortion care (e.g., 24-hour waiting periods, mandatory counseling, bans on abortions after the first trimester, and banning medication abortion) as well as on abortion care providers (most commonly referred to as "targeted regulation of abortion providers," or TRAP laws, that mandated a number of unnecessary and onerous burdens on providers;https://bit.ly/3NYKZLM). [...]it is possible that declines in overall fertility were related to the recession, particularly fertility among adolescents,2 women already living in poverty, and women who already had children.3 Second, use of long-acting reversible contraception increased from 6% in 2008 to 12% in 2012.4Third, women residing in Medicaid expansion states had greater access to contraception as part of their insurance coverage than did women in nonexpansion states. [...]expansion of access to comprehensive sexual and reproductive health care by expanding insurance coverage for these services is being proposed in several states.

The best response to US criminalisation of abortion is decriminalisation elsewhere

[...]with the US Supreme Court overturning Roe v Wade, sexual and reproductive rights are under threat globally.23 The US is polarised on abortion, but criminalising abortion, as many states in the US are now doing,4 is harmful and costs lives.5 It disproportionately affects the poorest, most marginalised, and most vulnerable. Despite many US states following the Supreme Court ruling, the Republican state of Kansas recently voted to allow abortion.7 In the UK, although the public and politicians are supportive of abortion, it remains a criminal act under certain circumstances.8 Only Northern Ireland in the UK has decriminalised abortion, but that sea change in law is not yet matched by provision of services. Risk of preterm birth, small for gestational age at birth, and stillbirth after covid-19 vaccination during pregnancy: population based retrospective cohort study.