Thoughts on Sebelius v. Hobby Lobby Stores, Inc., Pt. 1

**This will be the first of two parts on my thinking regarding the Sebelius v. Hobby Lobby Stores, Inc. case currently in the Supreme Court. Part 1 will detail my personal interests in this case. Part 2 will detail my legal and medical reasoning for my predicted outcome. Please feel free to read only one or the other.

Growing up in a red state near a blue city, I am exposed frequently to people of different backgrounds. I have met people ranging from avid supporters and contributors of the Tea Party to Trotskyist International Socialist supporters within my hometown alone. Nashville, with its many diverse issues in Second Amendment rights, immigration, education, death penalty, and First Amendment rights, frequently provides evidence of the wildly political American South.

As you walk around the city, it’s easy to see that Nashville boasts an incredible amount of bars, gas stations, and churches for a city of its size (the common joke is that everyone is looking for a way out). But it’s difficult to ignore the sheer number of hospitals looming throughout the city. With Skyline, Centennial, Saint Thomas, and Baptist clustered together, the concentration of healthcare services is impressive. Of course, Vanderbilt Medical Center and its affiliates dominate the city.

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Monroe Carell Jr. Children’s Hospital at Vanderbilt at night

Unfortunately, I had to spend some time in high school within these buildings. When I was fifteen, I began having sharp pains in the right side of my abdomen. I started visiting several specialists with my mother, and my physicians remained puzzled. Nothing was showing up on scans, X-rays, etc., but it was obvious that I was having pains. The doctors prescribed a “wait and see” approach with levonorgestral and ethinyl estradiol. The pains would come in cycles – some weeks were better than others, so really, there wasn’t too much that they could do.

My condition worsened my junior year. One morning, I woke up in the worst pain that I have experienced in my life. Being the normal, Type-A student, I tried to go about getting ready: brushing my hair, putting on some make up, and getting into the kilt (well, maybe that part isn’t so normal). I remember my mom calling up to me on the second floor and asking how I was doing that morning, and I responded that I was “a bit nauseous” but fine. She left to go to work, and I was alone.

A few minutes later, I was sweating on my bathroom floor. I reached up to grab my phone on the counter, and my vision kept “going white.” I stayed on the floor for a few minutes, and I was then able to call my mom. She told me to wait it out a bit and see how I felt. I was usually able to wait out waves of pain, so this was normal. However, my conditioned worsened. I called my grandmother, who worked as an anesthesiologist at one of the Nashville hospitals, as I began to become violently ill. Fortunately, my family was able to take me to my pediatrician who completed an exam in my less-than-perfect state. She recommended that I immediately go to Vanderbilt to have them check my possibly ruptured appendix.

A few hours and morphine naps later, the physicians still had not found a diagnosis. My appendix was not showing anything abnormal. The next morning, I was feeling better, and the doctors discharged me. Levonorgestral and ethinyl estradiol, levonorgestral and ethinyl estradiol, and repeat.

During my senior year, I grew tired of “waiting and seeing.” I wanted a laproscopic procedure (where a surgeon will make a small incision in the abdomen to insert a small camera to check out what’s going on inside). Before I went under the anesthesia, a surgeon told me that if I woke up with two incisions, then they had probably found the problem. If I woke up with only one, then that would likely mean that they would continue testing.

I woke up with two incisions. Almost three years later, I had a diagnosis.

I have a condition called endometriosis (see the hyperlink for Mayo’s description of this condition). In short, endometriosis causes the tissue that normally lines the inside of a uterus to grow on the outside. This causes the tissue to become trapped and irritated, possibly forming adhesions. Abnormal tissue then can bind organs together or cause cysts to form. It’s treated with levonorgestral and ethinyl estradiol, and if I have significant pain, I can just go in for a quick laproscopic surgery. My case was unique because the pain was so intense due to my young age and time to diagnose (usually, this condition affects women over 30, but no one is too young to face symptoms). On a typical day, I am pain-free and can go about my usual activities with ease.

Maybe you noticed throughout that I used the term “levonorgestral and ethinyl estradiol.” I’m sure that many of my female readers recognize this phrase. These are the progesterone and estrogen combinations of the common birth control pill. I treat my condition primarily with birth control.

I will not be working explicitly on issues of reproductive rights or accessibility to contraception this summer, but I am closely following the Sebelius v. Hobby Lobby Stores, Inc. case. The issue of this case primarily surrounds questions regarding the 1993 Religious Freedom Restoration Act (RFRA). RFRA asserts that the government “shall not substantially burden a person’s exercise of religion” unless that burden is the least restrictive means to further a “compelling” government interest. Thus, the question remains: can a for-profit, nonreligious corporation, such as Hobby Lobby, deny its employees the health coverage of contraceptives if the owners have religious objections?

When I read about issues in contraceptive coverage, I can’t help but to feel a bit anxious. Throughout high school, I was confident that my physicians would be able to take care of me, but there was always a small bit of lingering doubt and frustration. To me, this isn’t some thought piece on Sandra Fluke. This isn’t the Senate debating President Obama’s policies.

To me, this is my daily life. This is me reaching for a pill every night before I go to bed. To me, this is an eighteen year old girl taking off her make up, washing her face, and hoping that tomorrow morning she doesn’t wake up in the worst pain of her life.

Perhaps some will think that I am misguided in writing this. Maybe politicians really are just springing to provide me the care that I need.

Yet, when people tell me that my contraception “serves no medical purpose,” they aren’t looking to just start a debate. They are jeopardizing medication I need to go about living with the best quality of life. They are looking to restrict access to an evidenced-based-medical practice that helps me get the best education, have the best relationships, and get the most benefit from my daily life.

I’ve grown up in a city with bustling healthcare, many diverse political beliefs, and several cultural values. I think that a lot of this debate centers around the nature of preventing pregnancy (which is a whole different political blog entirely), and politicians will cut the medical research out of the debate.

By refusing to acknowledge the medical benefits of contraceptives, we ignore the millions of women who may face polycystic ovary syndrome (PCOS), endometriosis, amenorrhea resulting from radiation or chemotherapy, or anemia. Contraception, in addition, helps lower the risk of getting endometrial and ovarian cancer alike.

There is an important political debate that must surround reproductive rights for women. However, we must remember that accessibility to medical care should not be compromised.

We must not forget the millions of women who face these difficult medical conditions daily.

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