PAs in Idaho and Montana

[June11]

Hello all! I was wanting to hear perspective from PAs working in Idaho and Montana in terms of quality of life, the PA profession, and salary. I can’t seem to find any information on this and being from another state, I can only rely on what’s in job postings. Thank you!

[Reality Check 2]

Beyond everything else, learn about the political leanings and your safety as a medical professional regarding reproductive medicine and rights.

Understand the leadership of these states and how they lean - it will have an enormous impact on HOW you practice, what you can accomplish, your personal safety and sanity.

Recent judicial decisions in many states and at the Supreme Court level are impacting the very basics of medicine.

Practice somewhere people are apt to follow science, logic and humanity.

It is not just the PA laws 

[CAAdmission]

18 hours ago, Reality Check 2 said:

Beyond everything else, learn about the political leanings and your safety as a medical professional regarding reproductive medicine and rights.

[ANESMCR]

On 9/16/2022 at 3:19 PM, JadePA said:

Hello all! I was wanting to hear perspective from PAs working in Idaho and Montana in terms of quality of life, the PA profession, and salary. I can’t seem to find any information on this and being from another state, I can only rely on what’s in job postings. Thank you!

It’s slim pick-in’s and meh salary unless you’re well established with good connections. Lots of urgent care. Better salaries and job listings in WY and NM.

[TeddyRucpin]

22 hours ago, Reality Check 2 said:

Beyond everything else, learn about the political leanings and your safety as a medical professional regarding reproductive medicine and rights.

Understand the leadership of these states and how they lean - it will have an enormous impact on HOW you practice, what you can accomplish, your personal safety and sanity.

Recent judicial decisions in many states and at the Supreme Court level are impacting the very basics of medicine.

Practice somewhere people are apt to follow science, logic and humanity.

It is not just the PA laws 

How about salary, where they stand on OTP, and job opportunities? This is what I'd like to hear more about, not state politics.

Edited September 20, 2022 by TeddyRucpin

[Reality Check 2]

They do not promote OTP, salaries are not good, cost of living in parts of Montana and Idaho are excessive and access to care is limited, no specialists. 

It follows the politics.

[Ty2PA]

37 minutes ago, Reality Check 2 said:

They do not promote OTP, salaries are not good

Hmmm, I don't think you know much about Idaho. As in, maybe nothing at all about Idaho?

Idaho is a pretty progressive OTP state. No collaboration/supervision necessary at all if you work for a health system which has a credentialing system in place (so, basically any hospital system in the state). For private practice, a 1.5 page collaborative practice agreement with the clinic suffices - no need to "file" it with any state agency, nor anything like it, just a collab agreement with no specific physician kept at the practice level. No specific physician relationship needed if the clinic has multiple physicians. After two years of practice in any state, PAs can own their own clinics in Idaho. So, altogether, Idaho's PA laws probably rank in the top 10 of the country for OTA adoption. Still has some improvements to make, but beats out most of the country (hats off to you WY, ND, and UT).

Salaries of PAs in Idaho are higher than national averages, but not by much. Derm PAs can make a killing, rural EM PAs do well. FM PAs working in cities will be right around the national averages, or a shade higher in many markets, compared to the AAPA salary reported averages I've reviewed. There are jobs out there for PAs in most markets as well.

Rent/real estate is allover the place. Super high way up north and down south in Boise. Eastern Idaho and central have better real estate prices, but it's still pricey (think $379k for a 3bed/2bath, or $1500/mo rent). Food prices are average compared to the inland northwest (way cheaper than western washington/any major city), gas and other expenses are commensurate to the surrounding regions.

Altogether, it's a great place to live. The north is beautiful and green with crystal clear lakes; the south is more deserty and dry. You have to like all 4 seasons. 

 

**Edit** Forgot to mention the access and specialties. Idaho is definitely a "rural" state by most definitions. There are still several 50,000+ regions in the state, so not "major metro" besides Boise, but big enough to have the usual array of specialties, and PAs working in many different specialties (basically, every specialty has a place in several markets throughout the state). Yes, we have lots of low-access rural areas. I have made rural health an area of significant study of mine, including graduate course work and related studies. Basically every surrounding state has a great deal of rural regions similar to Idaho, including Oregon, WA and California. Personally, I like the support WA gives to its rural regions better than Idaho, so there is room for improvement there for sure. However, if you read about the problems of rural hospital closures allover the country, you'll note that Idaho/Montana/WA/OR all have had practically zero rural hospital closures, which is significant. Many are struggling financially, but they've been able to stay afloat. So, there's some support in place.

Edited September 20, 2022 by Ty2PA
Added comment about specialties and access

[TeddyRucpin]

36 minutes ago, Reality Check 2 said:

They do not promote OTP, salaries are not good, cost of living in parts of Montana and Idaho are excessive and access to care is limited, no specialists. 

It follows the politics.

 

1 minute ago, Ty2PA said:

Hmmm, I don't think you know much about Idaho. As in, maybe nothing at all about Idaho?

Idaho is a pretty progressive OTP state. No collaboration/supervision necessary at all if you work for a health system which has a credentialing system in place (so, basically any hospital system in the state). For private practice, a 1.5 page collaborative practice agreement with the clinic suffices - no need to "file" it with any state agency, nor anything like it, just a collab agreement with no specific physician kept at the practice level. No specific physician relationship needed if the clinic has multiple physicians. After two years of practice in any state, PAs can own their own clinics in Idaho. So, altogether, Idaho's PA laws probably rank in the top 10 of the country for OTA adoption. Still has some improvements to make, but beats out most of the country (hats off to you WY, ND, and UT).

Salaries of PAs in Idaho are higher than national averages, but not by much. Derm PAs can make a killing, rural EM PAs do well. FM PAs working in cities will be right around the national averages, or a shade higher in many markets, compared to the AAPA salary reported averages I've reviewed. There are jobs out there for PAs in most markets as well.

Rent/real estate is allover the place. Super high way up north and down south in Boise. Eastern Idaho and central have better real estate prices, but it's still pricey (think $379k for a 3bed/2bath, or $1500/mo rent). Food prices are average compared to the inland northwest (way cheaper than western washington/any major city), gas and other expenses are commensurate to the surrounding regions.

Altogether, it's a great place to live. The north is beautiful and green with crystal clear lakes; the south is more deserty and dry. You have to like all 4 seasons. 

I was going to say, I remember AAPA articles on practice improvement laws in Idaho over the past few years. Thanks for the details; this is what I was looking to hear. 

[CAAdmission]

12 hours ago, Reality Check 2 said:

They do not promote OTP, salaries are not good, cost of living in parts of Montana and Idaho are excessive and access to care is limited, no specialists. 

It follows the politics.

OP - in case you were wondering, you should also avoid Detroit, San Francisco, LA and NYC. Rampant drugs, high taxes and violent crime with a prohibitive cost of living. Lots of specialists, but most are jerks. 

I think it follows the politics.

Edited September 20, 2022 by CAAdmission

[ANESMCR]

The mountain west is also heavily NP dominated, for what that’s worth anymore. The more you job search and interview in the area, the more you’ll find out. Quality of life is great, or at least it used to be. There are nice spots of PA strength to find. Missoula, Bozeman, Billings. 
 

Not that anyone’s advice matters because Jade will never comment again after the thread gets sufficiently trolled. 

Edited September 21, 2022 by ANESMCR

[moose1]

Perspective from the Bozeman/Missoula area- There is a new phenomenon in the past few years here we call the Yellowstone effect. So many people watched that show and decided to move to MT on a whim. I have a friend who is a realtor who sits by the phone after new episodes air and he finds random properties to sell to people sight unseen. I think it's unethical but that's the environment we live in. Long story short a TON of PAs, NPs, and MDs have moved to the bigger towns in MT in the last year and a half. The job market here has absolutely dropped out, I know two NPs who went back to doing the RN thing because they made more money with substantially less work. The travel nursing situation in Montana is insane right now, I know RNs making 1K+ per shift while the locums PAs are making $800 for the same hours worked. The market here is saturated, I'm looking at moving to AK when I graduate because there still is bargaining power there. For example, there is an urgent care in Bozeman that was looking for an experienced 5+ year PA and offering 110K + RVU bonus. The median home price here is now 800K. I don't get how that pencils, but they have no problem filling these jobs. I also know of several docs who had their salaries cut by 10-20% in the last two years, this is partially due to covid but the increase in the number of providers is contributing too. 

 

Best of luck with your move, I hope you beat the odds and find something worthwhile. 

[June11]

Thank you everyone! I currently reside in Oregon and this thread definitely puts things into perspective. I really appreciate everyone’s time and comments! 

[nicuPAC]

I work at one of the hospitals in Boise. Moved from the East coast. 50% salary increase coming out here, but cost of living is much higher. 

This place sucks- don’t move here 

[Reality Check 2]

Food for thought...............

Idaho hospital to stop labor and delivery services citing "political climate" and doctor shortages - CBS News

 

[rev ronin]

23 hours ago, Reality Check 2 said:

Food for thought...............

Idaho hospital to stop labor and delivery services citing "political climate" and doctor shortages - CBS News

Doctors don't leave practice because laws prohibit killing unborn babies: murderers do.

Remember, folks, the PA Oath is scientifically explicit and particular on this matter:

"I pledge to perform the following duties with honesty, integrity, and dedication, remembering always that my primary responsibility is to the health, safety, welfare, and dignity of all human beings:" (emphasis mine)

They could have said "persons" which would have been equivocal, or "legal persons" which would have clearly excluded the unborn, but the PA Oath applies to every human being, including the aged, dying, helpless, suffering, incarcerated, differently abled, or unborn.

[Reality Check 2]

Never mind.............. my point is totally lost.

Doctors and medical professionals don't need inappropriate religious legalities hovering over their judgment and relationships with their patients. 

State laws taking away women's rights ARE affecting where people will practice - end of my statement and my opinion.

Have your own opinion. The exodus of providers is real and will continue.

Edited March 22, 2023 by Reality Check 2

[rev ronin]

1 minute ago, Reality Check 2 said:

Never mind.............. my point is totally lost.

Doctors and medical professionals don't need inappropriate religious legalities hovering over their judgment and relationships with their patients. 

State laws taking away women's rights ARE affecting where people will practice - end of my statement and my opinion.

Have your own opinion. The exodus of providers is real and will continue.

No, your point is understood... in fact, it's better understood than you understand it.

The fact that you think that religion is the only plausible reason someone might think killing tiny humans obligatorily dependent on their mothers is not OK demonstrates a profound intellectual poverty.

The eugenicist elimination of children with Down's across Europe?
The misogynist systematic elimination of literally one hundred million unborn girls across India and China, leading to skewed gender ratios--and hence socially destablizing two nuclear-armed societies--on a scale never before known?
Naah, neither of those could possibly be an issue absent a religious underpinning.

Here's a thought: if a right can be "invented" by a court and then removed by another court, it was never really a right to begin with. Why are folks talking about slavery reparations? Because even when owning another human being was legal it never was right.

Hippocratic medical professionals stand up for the rights of those unable to march for themselves and voice the concerns of those without voices. To the extent that some medical associations have forgotten that, they've absented themselves from the profession of medicine.  The fact that the people of the State of Idaho, through their elected representatives, are reimposing some Hippocratic constraints on killing speaks well for them and poorly of the medical community.

[SedRate]

Thought provoking, heavy stuff here. 

What about those women with deadly, genetic or transferable diseases or high risk factors for complications who then learn they're pregnant despite protective measures? Should they be required to carry through with it or is it ok to abort an unborn fetus in that circumstance? For those women who abort/miscarry for maternal reasons, why is that considered natural and not murder? Is it because they didn't make the conscious decision to abort? What about those women who don't want children and learn they're pregnant despite 99.9% preventive measures? Should they not be allowed to engage in sex because of the 0.1% risk of being forced carry to term and endure the consequences of pregnancy? (Pregnancy is not a benign event on a woman's body.) Should they be forced to accept their fate and raise a child they never wanted? That poor child... I guess it's better than being murdered, right?

What's the definition of "human being?" Is the human being who is deemed brain dead and then offered for organ donation actually being mutilated and murdered during procurement? Or is that different than an unborn embryo?

Just trying to better understand the nuances of all this and the ethics of both sides -- abortion and preservation of "life." Which brings up another thing: which life should be preserved if preserving one life might mean the death of the other?

[CAAdmission]

3 hours ago, SedRate said:

Should they not be allowed to engage in sex because of the 0.1% risk of being forced carry to term and endure the consequences of pregnancy?

Not to be a prude, but sexual activity has degenerated into cheap recreation. People need to recognize that it can have extremely serious consequences. That's a reason it is best enjoyed in a stable, committed, long-term relationship. 

[rev ronin]

 

2 hours ago, SedRate said:

Just trying to better understand the nuances of all this and the ethics of both sides -- abortion and preservation of "life." Which brings up another thing: which life should be preserved if preserving one life might mean the death of the other?

So, let's start with the ending to understand the beginning: Either you're not seriously asking that question, or you haven't thought much about it. Seriously--this isn't remotely hard: Pre-viability, you save the mom, because if you can't save mom you can't save baby. Post-viability, you deliver the baby and try to save both. In no circumstance does one ever need to intentionally cause fetal demise in order to save mom's life: pre-viability delivery leaves an intact fetal corpse for celebration and burial.

 

3 hours ago, SedRate said:

Thought provoking, heavy stuff here. 

What about those women with deadly, genetic or transferable diseases or high risk factors for complications who then learn they're pregnant despite protective measures? Should they be required to carry through with it or is it ok to abort an unborn fetus in that circumstance?

So, you're asking hypothetical questions without specifics. I'd say that specifics are the only way to ever answer any nuanced ethical question. With that caveat, let me try to provide some specific answers.

Say mom is a Huntington's Chorea carrier, so baby has a 50/50 chance. That's anything but certain death, and life allows the potentially (but not necessarily) doomed person a chance--who knows, we might even have a gene therapy cure by the time the chorea would otherwise manifest.

3 hours ago, SedRate said:

For those women who abort/miscarry for maternal reasons, why is that considered natural and not murder? Is it because they didn't make the conscious decision to abort?

Again, is this seriously a question? Women have been charged for causing the deaths of their own babies through reckless criminal conduct (e.g., drunk driving crash), which is clearly a felony murder that would apply to anyone causing the death of an innocent bystander through their own criminal conduct. There was someone on Huddle the last time this came up arguing this, and it was consistently misconstruing the facts in every case cited. But no one with a working knowledge of embryology assigns agency to moms in the natural cause deaths of their unborn children any more than they do to the demise of infants from genetic or congenital abnormalities.

3 hours ago, SedRate said:

What about those women who don't want children and learn they're pregnant despite 99.9% preventive measures? Should they not be allowed to engage in sex because of the 0.1% risk of being forced carry to term and endure the consequences of pregnancy? (Pregnancy is not a benign event on a woman's body.) Should they be forced to accept their fate and raise a child they never wanted? That poor child... I guess it's better than being murdered, right?

The telos of sex is reproduction--Darwin will tell you that. That's why gametes are involved. The fact that it's pleasurable is not the purpose of sex. The fact that we spend a lot of time trying to minimize the chances of conception does not change the underlying purpose of sex. Consent to potentially procreative sex (penis in vagina, woman of ovulating age) is consent to the possibility of pregnancy. And, as that answer indicates, there are plenty of non-reproduction-capable ways of using human sexual organs pleasurably.

No one is ever "forced" to raise a child. For children without disabilities or maternal history of substance abuse, adoption at birth is a reasonable and widely available option. Failing that, every state I'm aware of has a 72 hour surrender law that allows moms to legally opt out of their baby's life.

3 hours ago, SedRate said:

What's the definition of "human being?" Is the human being who is deemed brain dead and then offered for organ donation actually being mutilated and murdered during procurement? Or is that different than an unborn embryo?

Human being? Homo sapiens. As far as brain death, there's law, case law, and ethics debates on that that would expand this answer far beyond reasonableness.

[SedRate]

54 minutes ago, CAAdmission said:

Not to be a prude, but sexual activity has degenerated into cheap recreation. People need to recognize that it can have extremely serious consequences. That's a reason it is best enjoyed in a stable, committed, long-term relationship. 

I agree. I find it interesting, though, that sexual activity is criticized in women of child-bearing age who don't want children yet non-fertile women perform it for non-procreation reasons without criticism. 

Further, it takes two to tango, and so I find it disheartening that women are having to bear this burden. 

[rev ronin]

5 minutes ago, SedRate said:

I agree. I find it interesting, though, that sexual activity is criticized in women of child-bearing age who don't want children yet non-fertile women perform it for non-procreation reasons without criticism. 

Further, it takes two to tango, and so I find it disheartening that women are having to bear this burden. 

Talk about a negative view of sex and procreation! Women, assisted by men's contributions, create new life from their own bodies, and then nurture that new life both pre- and post-delivery. The "burden" is one of the most awesome experiences available to human beings, and is entirely reserved for women.

[SedRate]

44 minutes ago, rev ronin said:

So, let's start with the ending to understand the beginning: Either you're not seriously asking that question, or you haven't thought much about it. Seriously--this isn't remotely hard: Pre-viability, you save the mom, because if you can't save mom you can't save baby. Post-viability, you deliver the baby and try to save both. In no circumstance does one ever need to intentionally cause fetal demise in order to save mom's life: pre-viability delivery leaves an intact fetal corpse for celebration and burial.

I've thought about it but have been thinking about it more given the reversal of some laws. I've also heard of some pretty interesting things like a trauma pt exanguinating and the team tried to also save the twins. Result: no one survived. I wish it were as easy as you make it out to sound. 

50 minutes ago, rev ronin said:

So, you're asking hypothetical questions without specifics. I'd say that specifics are the only way to ever answer any nuanced ethical question. With that caveat, let me try to provide some specific answers.

Say mom is a Huntington's Chorea carrier, so baby has a 50/50 chance. That's anything but certain death, and life allows the potentially (but not necessarily) doomed person a chance--who knows, we might even have a gene therapy cure by the time the chorea would otherwise manifest.

Fair, but laws aren't written for specifics. I was alluding to Huntington's, HIV, hepatitis, etc. 

52 minutes ago, rev ronin said:

Again, is this seriously a question? Women have been charged for causing the deaths of their own babies through reckless criminal conduct (e.g., drunk driving crash), which is clearly a felony murder that would apply to anyone causing the death of an innocent bystander through their own criminal conduct.

Please don't be condescending. I'm not intimately aware of all this. Clearly you have way more understanding of these nuances than I do so I appreciate your input. 

56 minutes ago, rev ronin said:

The telos of sex is reproduction--Darwin will tell you that. That's why gametes are involved. The fact that it's pleasurable is not the purpose of sex. The fact that we spend a lot of time trying to minimize the chances of conception does not change the underlying purpose of sex. Consent to potentially procreative sex (penis in vagina, woman of ovulating age) is consent to the possibility of pregnancy. And, as that answer indicates, there are plenty of non-reproduction-capable ways of using human sexual organs pleasurably.

No one is ever "forced" to raise a child. For children without disabilities or maternal history of substance abuse, adoption at birth is a reasonable and widely available option. Failing that, every state I'm aware of has a 72 hour surrender law that allows moms to legally opt out of their baby's life.

Then non-fertile individuals shouldn't engage in sex.

I understand the opportunity of adoption. But what about the effects of pregnancy on the mother in irder to carry. Or the ill-effects on fetal-alcohol children, or meth-positive babies. Should these ALWAYS be carried to term? Thankfully mortality in pregnancy is very low these days. 

1 hour ago, rev ronin said:

Human being? Homo sapiens. As far as brain death, there's law, case law, and ethics debates on that that would expand this answer far beyond reasonableness.

 

7 hours ago, rev ronin said:

"I pledge to perform the following duties with honesty, integrity, and dedication, remembering always that my primary responsibility is to the health, safety, welfare, and dignity of all human beings:" (emphasis mine)

They could have said "persons" which would have been equivocal, or "legal persons" which would have clearly excluded the unborn, but the PA Oath applies to every human being, including the aged, dying, helpless, suffering, incarcerated, differently abled, or unborn.

You mentioned human beings here and implied brain dead individuals as well, so I wanted to hear your thoughts on the definition. Agree that it would be a very involved discussion. 

[SedRate]

16 minutes ago, rev ronin said:

Talk about a negative view of sex and procreation! Women, assisted by men's contributions, create new life from their own bodies, and then nurture that new life both pre- and post-delivery. The "burden" is one of the most awesome experiences available to human beings, and is entirely reserved for women.

The burden of being forced to physically carry and grow something inside them that they don't want and tried to prevent. For most women, it's the best thing. For some, it's the worst. But I suppose we all take risks every day. And if sex is for procreation only, then why do non-fertile women engage? Obviously because they enjoy it, but if the point is to produce, then why can't child-bearing aged women do it for pleasure as well?

I'm glad to hear you have such a positive view on child birth and rearing. Sadly, not all individuals share that positive view.

[rev ronin]

1 hour ago, SedRate said:

The burden of being forced to physically carry and grow something inside them that they don't want and tried to prevent. For most women, it's the best thing. For some, it's the worst. But I suppose we all take risks every day. And if sex is for procreation only, then why do non-fertile women engage? Obviously because they enjoy it, but if the point is to produce, then why can't child-bearing aged women do it for pleasure as well?

I'm glad to hear you have such a positive view on child birth and rearing. Sadly, not all individuals share that positive view.

One of the few things that has been an unquestionably positive medical development has been improvements in childbirth safety. No one complained about sex and pregnancy before contraception, even though it killed more women, because they knew that intercourse necessarily involved procreation or the potential of procreation: It's the only way we make new baby humans, and if the average woman in a particular society doesn't have ~2.1-2.2 live children, population in that context is either going to expand or contract.  That replacement value number has itself dropped based on decreases in infant mortality.  However, introduce reasonably effective contraception, and we find people unhappy with the possibility of general but imperfect separation between sex and procreation.

The most disappointing thing about improvements in maternal mortality is that they are so unequally distributed.

1 hour ago, SedRate said:

I've thought about it but have been thinking about it more given the reversal of some laws. I've also heard of some pretty interesting things like a trauma pt exanguinating and the team tried to also save the twins. Result: no one survived. I wish it were as easy as you make it out to sound.

Not sure what was going on in the incident you reference, but perimortem C-section is supposed to help mom first, baby second. Just because they appear to have tried to save the twins, doesn't mean that they split the difference or prioritized fetal life inappropriately:

"Perimortem Caesarean section (PMCS) is a rare surgical procedure that is potentially lifesaving for mother and child [1]. During resuscitation for cardiac arrest, the gravid uterus over 20 weeks’ gestation can impair chest compressions and ventilation, and reduce venous return to the heart through compression of the aorta and vena cava. Therefore, the primary aim of PMCS is to empty the uterus to aid maternal resuscitation [2, 3]. PMCS is recommended to improve resuscitation efforts primarily with the mother’s well-being in mind, in contrast to the past practice when it was performed on women after they died in childbirth [2, 3]. Current resuscitation and obstetrics guidelines recommend consideration of PMCS at 4 min of failed resuscitation with the aim of delivering the fetus within 1–2min [2, 4]."

Cerovac A, Hudić I, Softić D, Habek D. Perimortem Caesarean section because of a live fetus: case report and literature review. Wiener Medizinische Wochenschrift. May 2021:1-4. doi:10.1007/s10354-021-00847-5

1 hour ago, SedRate said:

Please don't be condescending. I'm not intimately aware of all this. Clearly you have way more understanding of these nuances than I do so I appreciate your input.

Sorry, but I do get tired of "whataboutism" that seems to ask a shotgun of difficult and trivial questions all at once, which is how I reacted to your post. I was a bit exasperated, but condescension wasn't my goal and I'm sorry that it came across that way.

1 hour ago, SedRate said:

Then non-fertile individuals shouldn't engage in sex.

Why not? Sex is also innately pleasurable, and appears to help pair bonding through oxytocin production. That is, even if sex is not procreative, and much is not, it can serve as adaptive in keeping a mated pair together to cooperatively raise offspring, and this extends to many mammalian species. Don't make the Augustinian mistake of assuming that just because sex has procreation as its natural end, that that is the only appropriate use for it. Augustine went from fornicator to monk and became the Western church's authoritative voice on sex, never once having engaged in married intercourse... but apologies for discussing both theology and science together.

"... We also reflect on Harris's observations on vasopressin secretion, on the effects of stress, and on oxytocin secretion during sexual activity."

Leng G, Pineda R, Sabatier N, Ludwig M. The posterior pituitary, from Geoffrey Harris to our present understanding. Journal of Endocrinology. 2015;226(2):T173-T185. doi:10.1530/JOE-15-0087

1 hour ago, SedRate said:

I understand the opportunity of adoption. But what about the effects of pregnancy on the mother in irder to carry. Or the ill-effects on fetal-alcohol children, or meth-positive babies. Should these ALWAYS be carried to term? Thankfully mortality in pregnancy is very low these days.

Not all effects of pregnancy are negative. For example, a woman whose first pregnancy ends in a term birth has a significant reduction in lifetime breast cancer incidence. Both abortion and miscarriage forfeit this advantage, so to the extent that elective abortion is commonly used (that is, when there is no specific risk to the life of the mother), it ends up causing avoidable cancers and hence avoidable maternal morbidity and mortality.

Brind J, Condly SJ, Lanfranchi A, Rooney B. Induced Abortion as an Independent Risk Factor for Breast Cancer: A Systematic Review and Meta-analysis of Studies on South Asian Women. Issues in Law & Medicine. 2018;33(1):33-54. Accessed March 23, 2023

The effects of prenatal substance exposure are unfortunate and unpredictable. There was some correlation between maternal tylenol use and autism spectrum disorder, but causality is impossible to assess without prospective randomized controlled trials, which no one is going to do.

FAS or drug addicted kids can become problematic adults. If they end up being such, why not kill them later rather than aborting them in utero? If there is no difference between the born and unborn from a utilitarian perspective, why not wait until the person's fitness and societal value has been properly assessed?  And, less tongue in cheek, if you're unwilling to have them killed after birth, why advocate they be killed beforehand?

2 hours ago, SedRate said:

You mentioned human beings here and implied brain dead individuals as well, so I wanted to hear your thoughts on the definition. Agree that it would be a very involved discussion. 

Brain dead individuals are indeed an interesting case. Bringing questions of care care back to the antenatal realm, survival of extremely premature babies matters in significant part based on how aggressive hospitals are about deploying best care for them. Bottom line? Centers that use most current evidence, believe good outcomes are possible, and have a culture supporting a belief in a positive potential for exceptionally premature babies do a better job of saving such babies and having them leave the hospital neurologically intact than do similar extremely premature babies born at centers that don't.

Shukla A, Beshers C, Worley S, Chowdhary V, Collin M. In the grey zone-survival and morbidities of periviable births. J Perinatol. 2022 Aug;42(8):1001-1007. doi: 10.1038/s41372-022-01355-z. Epub 2022 Mar 10. PMID: 35273353.

 

So what do we think about how that might translate to how "brain dead" humans might fare? Obviously no direct conclusions can be drawn, but do you think that attitude towards potential outcome--say, human being with worth and dignity vs. source of potential spare parts--matters?