 Let's see if you people are still in the midst of joining us online seminar today. I'd have my closed caption on I'm going to turn mine off but I'm just going to remind people that if you're interested in closed captioning there is a button right at the bottom of the screen and you can hit it, and you will have post captioning. So, let's get started. I'm Sheila Wildman, and I'm Associate Director of the Health Law Institute. I'm so pleased to welcome you to our penultimate or second to last seminar in this year's Health Law and Policy Seminar series. Today is what you what we fondly call a snow day in Halifax, and here at Dalhousie the university is closed but we're very excited to be able to press on with our online seminar so that you folks are able to join us with this much anticipated lecture of my colleague, Professor Joanna Erdman. I want to start by acknowledging that Dalhousie is in Magmaaki, the ancient and unceded territory of the Magma. We pay respect to the indigenous knowledges held by the Magma people and the wisdom of their elders past and present. We pay respect to the histories and contributions and legacies of African Nova Scotians who have been in this territory for over 400 years. Let me say just a couple words about my colleague, Professor Erdman, before we get started with her lecture. Professor Erdman holds the McBain chair in health law and policy here at the Schulich School of Law. Research focuses on sexual and reproductive health and human rights in a transnational context. Most recently, she contributed a chapter entitled the reproductive subject and the embodied state of international human rights law to the just released Cambridge companion to gender and the law. She has acted as an intervener before various constitutional courts and international bodies, including as an expert advisor on the 2022 World Health Organization's abortion care guidance. Transnational and domestic work in support of reproductive justice and deeper critical thinking on the meaning and preconditions of reproductive justice is valued by scholars and social movement activists at home and abroad. Last note on our process, what to expect. Professor Erdman will speak for approximately 40 minutes, and then we will have time for questions from you. If a question comes to your mind during the lecture or of course after Professor Erdman winds up, you can write it in the Q&A box. There's a little button near the bottom entitled Q&A at the bottom of your Zoom screen and we'll be able to then field those for a chat afterwards. I'd ask you not to use the chat function just so there aren't two streams for us to navigate just the Q&A box would be great. So please join me. I guess it's difficult to be applauding online, but I know that in our minds or otherwise, you will join me with some notional applause in welcoming Professor Erdman over to you. Thank you so much, Sheila, and a big thank you to the HLI as well and especially to Ashley who supports these seminars, especially. And then just a last thank you to everyone joining online, especially in Halifax where under a blanket of snow and so yeah thanks very much for coming out. I'll start the talk today, really back on June 24, 2022. And this was the day when the US Supreme Court overturned Roe versus Wade, and the court more particularly held on that day that the US Constitution does not confer a right to abortion and more importantly, that it never did. The court said this right is nowhere in the text, nor is it deeply rooted in US history or tradition. You are now without the Constitution's protection, and you were never deserving of it. This was a constitutional right, they said that was egregiously wrong from the day it was decided. And then just like that, the authority to regulate abortion in fact abortion itself was taken from a patient and their doctor, which was the language of Roe versus Wade, and it was returned quote to the people and their elected representatives. And with that came a tsunami of state bans and restrictions trigger laws came into effect on the court's ruling 19th century abortion bans were resurrected and more and more laws followed. This is just the last count that I could find, but 13 states now have near total bans on abortion, and another 11 states have severely restrictive laws. And quite frankly, whatever kind of allowances these laws give their truly false entitlements there is no access to care under them. And just to give you a sense of the state of things around 300 bills have been proposed in 40 states so far, and a majority of those bills are restrictive. I think we can say safely that in Dobs, the dissenting judges told their colleagues, when this judgment was issued do not hide from the expansive effect of your ruling. And today we are truly witnessing that expansive effect to really speak in human terms, people have been left absolutely desperate and despairing. They are desperately seeking care, and they are truly despairing for the future. People have been forced across state lines. They have been forced into secrecy and silence. And frankly abortion laws have become the basis for all manner of state intimidation and harassment. We are seeing laws that are criminalizing every conceivable act of abortion to provide an abortion to have an abortion to assist another person in doing so, quite frankly to speak of abortion and eventually I think to even think of abortion. This is really an effect of Dobs that is worth noting which is the chaos and the fear that it has provoked. Indeed, many of these laws they are explicitly targeting doctors and other medical practitioners. They're targeting them with imprisonment with fines with a loss of licensure. And I think the reason to do this is because these laws are really about intimidation. They want all pregnancy care to be practiced cautiously and always with an eye to the law. I don't know if you know this but hospitals now have lawyers who are just waiting on standby to determine people's course of care. And it's again not just abortion care, it is all pregnancy related care. They now have enacted shield laws to try to protect providers who are helping people seek care, and they're also protecting those who have set up clinics now in border regions, and who are trying to help across state lines. And so I think this is truly what it meant when the US Supreme Court said as it did that you are now without the Constitution's protection. It was a constitutional right that never was. And I wanted to repeat those words because I think those words are the words that really resounded beyond the US borders. When Roe was displaced people the world over asked, What did happen here. Do we have abortion rights or how well are they protected. And in Canada, in answer to that question, many people returned to Morgan taller. And just in case anybody doesn't know of the case of Morgan taller. This is a 1988 Supreme Court judgment and it struck down our criminal law on abortion as a violation of charter rights. And so, after dogs over and over again, we were asked this question, does Morgan taller protect a right to abortion. Now, some people emphasize some of the elements of judicial restraint in the Morgan taller judgment that quite frankly if read to the letter of the law could allow for a new criminal law if parliament could ever pass one. But for most others of us, we emphasized how ill placed this question was in the Canadian context, particularly because of our distinct constitutional history and our traditions, which challenged the question. So, we wouldn't be bound by the Charter's text of 1982. We wouldn't be bound by a 1988 Supreme Court judgment to know what our rights were today. This question really just ignored the decades of activism on abortion rights in that had happened since Morgan taller as well. And so this idea that we would return to any kind of written text to know our rights was just something out of place in the Canadian context. And indeed, years ago I wrote an article on an abortion rights case that was very much in this vein. It was an abortion rights case that quite frankly never happened. It was when activists challenged the abortion policy that was then in place in Prince Edward Island, and the intention was to bring abortion services back to the island. But the intriguing thing about this case was that the activists, they never had a chance to win their challenge. They didn't even have a chance to litigate their challenge. And the reason was that within months, the premier announced that the policy in the province was likely unconstitutional, and they changed it. And so I think of this case because sometimes you don't need and you don't want a court to give you your rights, lest you create an opportunity for the courts to then take them back. And so I got a lot about that case, particularly when after dogs in Canada, Trudeau proposed a federal law to enshrine a right to abortion and to guarantee its protection here. So these kinds of laws had also been part of the US scene as well in the sense that many states in the United States are scrambling to uphold abortion rights and even to expand them. And if you look at the midterms, any abortion measure that was on the ballot passed, and those were abortion measures that protected abortion care. So those were the only measures on the ballot that passed and, and three of those ballot measures enshrined these rights in state constitutions. So there was a good precedent for this kind of move that Trudeau was proposing. In Canada, no abortion rights bill was ever tabled. Instead, what happened was quite fascinating really, which is that the proposal for a new abortion law to protect our rights was met with a resounding call among abortion rights activists to stay the law's hand. So the National Association of Women in the Law, LEAF, Action Canada, they all campaigned that quote, Canada does not need an abortion law. And I want to share with you some of their reasons why the reasons are really interesting. First, they feared the courts. An abortion law, they said, creates the possibility that such a law could be challenged and overturned in the future. And without a law, it's just really hard to get abortion before the courts. Second, they also feared governments. The making of an abortion law creates endless opportunities to narrow the abortion rights by setting out who and where and how an abortion can happen in the name of its protection. And I really agree with this second fear. Because if you take a look at most abortion laws worldwide, it's quite difficult to classify these laws as either rights protecting or rights restricting. And in Canada to after Morgan taller, this is a curious piece of history. The federal government also argued for a criminal law that would protect a basic level of services nationwide. And so there's just always been this preoccupation with law in the abortion rights field, and even more so a kind of, I don't know what to say here but like an obsessive tinkering with regulatory regimes that end up codifying every aspect of abortion care. And so I think that's why for many, the overturning of Roe versus Wade was something more of an aftershock, even if aftershocks can be devastating to. And that's because, even during the era of Roe versus Wade, many states already had abortion laws that effectively denied all forms of access to care, especially for those most in need and and I can tell you that this is also peculiarity of the US context this is really true of abortion laws generally and it's it's also true of most abortion laws that are written after constitutional judgments. Almost all abortion law has this kind of controlling narrative to it. It always fosters this very narrow way of thinking about abortion. And that's been true of all kinds of sources of abortion law, be they criminal laws be they health laws, and I would say even constitutional law on abortion to. So if you think about it, what really was the abortion right of Roe versus Wade that the Supreme Court overturned. I can tell you and there's this great footnote that Robin West once wrote, and she wrote this that US constitutional abortion rights, quote, must be strangely disorienting to anyone who cares about the moral issues. This is so true. If you read US constitutional abortion rights law before Dobbs. It's really hard to see this as a law of rights. The abortion right had been so compromised already by 2022 languages of obstacles and burdens, they had become part of the right as much as they were a part of its violation. Many people would say we didn't even have an abortion right in constitutional law anymore, long before Dobbs came down. And so I think it's quite interesting then to think about that question that so many Canadian media outlets took up after Dobbs here, they almost hounded us with this question constantly which is, does Morgan taller guarantee a right to abortion does Canadian law guarantee a right to abortion. It's a strange question because it's a very easy one to answer which is, even if the journalists refuse to accept the answer that we gave over and over again the answer is just obviously yes. Canadian law protects the right to abortion. The thing was, this wasn't the most interesting question to ask. The more important question was, what is that right to abortion in Canadian law. The same way we had to ask that question of, what was the right that Roe versus Wade actually protected. What did it recognize what did it give to people. And so if I had to answer that question that I just posed and I answer it here as well it would be, hey, I wouldn't fault the Morgan taller court for not having recognized a right to abortion. I would have faulted it for the abortion right that it recognized, which was a right that was very narrow in scope. It was a right only to abortion care as clinical care. That's again the ruling restrictively read to its letter. And it's actually how almost every province in this country interpreted the judgment after it came down, and when they restricted public funding only to clinically indicated care which, again, most abortions are not. So it took decades of activism after Morgan taller for abortion care to be fully folded into our health care system. But again, I would say that when abortion rights were folded into our health care system. They took on the character of that system. And so in policy discourse, we see abortion rights and they have this almost techno managerial quality to them. It's to be overly focused when we talk about abortion rights of service delivery, and that entirely organizes how we think about, and how we talk about abortion rights in Canada. Now, I do have to admit here that there is one, maybe exception to this which is that we do have Justice Wilson celebrated freedom judgment in Morgan taller and that judgment is now cited most often for the judgment of the court as a whole. But I would contest the idea that Wilson's judgment departs from a controlling narrative in abortion law, it also really ties abortion rights, again, to an exclusive narrative and this is a narrative, which thinks of abortion rights as celebrated decisions and abortion rights as a celebrated decision. And by this I mean that in the judgment abortion rights are tied to an idea of people being free to arrange and manage their lives. And if they just decide differently from one another, well, that's only a mark of their freedom. There is a way in which abortion rights and Wilson's judgment are tied entirely to this very individual freedom concept. What we don't see in Wilson's judgment is a way in which abortion rights are tied to the hard corners of life in which people also make decisions. In other words, abortion rights is tied or seen as a critical form of social and economic security. And again, unwanted pregnancy is really a measure of social injustice. I want to talk about unwanted pregnancy as a condition of people not wanting their pregnancies because of structural inequalities and reproductive life and living, because they don't believe that they have the support to care for the children that they would have, which is the other end of pregnancy. And so I would fault Wilson's judgment here for having converted some of these structural inequalities into individual freedom, which really cultivates a habit of ignoring these structural injustices. Let me summarize here this idea of if someone was to ask, do we have abortion rights in Canada? The answer would be, yes, but what are those rights? And this might be the root of the fear that an abortion law, if we had one in Canada, it wouldn't so much limit our rights. If such a law would reveal the limits of our rights. In other words, it would just show us how small abortion rights truly are if you read them from the law. And I think maybe this is just a more acute fear of any kind of rights that are really born from litigation. I think we have our abortion rights because how much of a true alternative are they when they are simply the counter image of abortion laws. Sure, they were brought into existence in very powerful and convincing ways, but rights is only the antithesis of their violation. Well, they tend to stay defined by that violation. I think abortion rights in Canada, much as abortion rights in many other places in the world, they keep the imprint of the law that they challenged on their very scope and meaning. And so I think it's quite a caution for us to think about protecting rights that were born of litigation. But if we hold on that idea then maybe it should cause us a little less trouble in Canada. And I'll tell you why, which is that unlike in the US in Canada, we haven't had that much litigation on abortion rights we haven't especially had the kind of dizzying litigation that we've seen in the US context where quite frankly the law has kind of curled in on itself and abortion rights have become this self referential system and the worship of abstract ideas and this desperate attachment to legal rules. The abortion rights in the US have long been alienated from the people whose lives they so profoundly affected and again let's be honest that was what the abortion right had become under row a long, long time ago. But here I want to say something provocative about what happened in Canada in contrast, and it's this, which is in Canada, people have been somewhat left alone by the law. And if you like, they've been fugitives, not of a law, but of law. They've really escaped the terms imposed by any abortion law, and therefore they've been very much free to conceive and to practice their rights in very diverse ways. This is truly alternative ways of having and doing abortion that is quite apart from any legal control of it. And this is something that I believe the advent of abortion with pills has very much strength. Now, here it's why, whenever I'm given the opportunity to talk about abortion rights, I always talk about abortion pills. And I'm going to do the same thing here. So did you know that well into pregnancy, you can use pills safely to end it. It's a common regimen that's used earlier in pregnancy and it's branded here as mythic eye me so I'll tell you about it it's the swallowing of one pill of Mipha pristine, followed 24 hours later by dissolving four pills of misoprostil between your cheeks and misinduces contractions, or you can just use misoprostil you can dissolve four pills under your tongue, three times every three hours. And through this pill taking your abortion will happen over days with cramping and bleeding, usually stronger than menstrual period, but similar to an early miscarriage. Now I'm very particular about telling you the names of these pills I'm very particular in telling you about how you can use them. And I give you all of these details because, well it might just be the most practical thing you hear all day long. But more so, it was because last summer, when all of the news frenzy was happening after dogs. I was just shocked at how few people in Canada knew about abortion pills. In fact, after dogs the Globe and Mail published a report on abortion access, and it included this map of driving times to the nearest abortion clinics in cities across the country and the map was criticized at the time as being outdated but frankly I have to say, it was a strange map to see in the era of abortion pills, which always travel more easily than people. So, in my mind, perhaps we shouldn't have seen any map at all in the newspaper but instead we should have seen a floor plan for your bedroom or your bathroom, and it should have shown you the distance to the drawer where you keep your pills until you need them. And, you know, this idea of just how radical and how revolutionary abortion pills would be for abortion access. Well this was predicted long, long ago. In fact, it was predicted as early as 1988 in this country, 88 was the same year that Morgan taller was decided, and in that same year, the most covered news story about abortion was about this new French abortion pill, and the question of whether or not it to would come to Canada. And I have to tell you this quote because it's a great one which is right before the judgment came down in Morgan taller, the president of the Canadian abortion rights Action League said this. He said, we worry, we worry that after decades of agonizing struggle to change the abortion law with abortion pills. The whole question may be made irrelevant. And why, why were abortion pills imagined as such a game changer. Well, I think it's not just because you can do this by yourself, you can do it with your own hands, you can use your own body to literally enact these basic rights. But I think even more so it's because when you do it, when you use your own body to realize these rights, you really have the flexibility to define for yourself what you're doing. What people do, and they can give meaning to that act in just ways that are utterly unimaginable to anything that has ever been written down in an abortion law. I mean this is really true freedom. I think it's that freedom of abortion with pills, which explains to you why abortion pills are the legal battleground in the United States right now. And it's not just because abortion pills are not covered by these abortion bans or by these restrictive laws. No, absolutely, these laws are full. Yeah, they cover any and all method of ending a pregnancy. But it's instead the idea that abortion with pills is just much harder to regulate in every sense of the word. And the US federal government knows it. That's why they have been expanding access to these pills in recent years. And so during the pandemic, for example, the US FDA allowed doctors to prescribe these pills by telemedicine, they allowed patients to receive them by post and by some specialist pharmacies. And just this year, really importantly they allowed certified retail pharmacies to stock and dispense it, and the big chains signed on here. But I do understand I have to make this note that just yesterday I think Walgreens pulled out of the deal. Why? Well, here's why. Because just in 2022 alone, lawmakers introduced 118 targeted restrictions on abortion pills across 22 different states. And there are now multiple legal cases that are challenging those state bans. In fact, one was just brought by a generic manufacturer of mythopristened, called gen biopro and this case basically argues that it is unconstitutional for a state to try to ban access to a drug that has been approved by the federal drug administration by the FDA. And here's what's what's really striking about this case which is that it might all be moot this argument that you cannot ban an FDA approved drug. And the reason why is because we are all awaiting a judgment that is due to come from a Texas federal court. And I have to say, I don't know because I haven't checked my social media just yet on whether this case has come down. But this is a case, I mean it's a remarkable case it is a case that is challenging the FDA's approval of the abortion drug mythopristen an approval that was made almost 23 years ago. And basically the cases claiming that the FDA at the time in 2000 didn't adequately review the scientific evidence or follow proper protocols when it approved mythopristen. And I have to say this is an absolutely unprecedented case. It's an unprecedented case because imagine the effects. It's seeking to deprive people of a safe and effective drug that has been on the market for over 20 years, more than 5 million people in the US have used mythopristen for abortion. These pills are now used in more than half of all abortions in the US, and it is one of the most studied drugs in the history of the FDA with a safety profile, better than thousands of drugs that the FDA has approved. So, the idea that this would be the first time that a court would order the FDA to revoke a drug is absolutely extraordinary. And so from a legal point of view many people are arguing that that this is why this extraordinary challenge can't succeed. And most importantly it can't succeed they say because it's a futile effort because in the end, even if the court could order the FDA to revoke an approval of a drug, the only agency that can enforce that would be the FDA. And the FDA has a lot of discretion about whether they would enforce such an unapproved status of a drug. And so if they could give assurances to manufacturers and distributors, well maybe they would continue to manufacture and distribute the drug in the US. And the fact of the matter is that the FDA might have another courts backing to do this. Because at the very, very same time that we are awaiting the Texas courts decision, there is another federal case that's been filed in Washington State. And this time it is the attorneys generals of 12 states, and they are suing the FDA. And they're suing the FDA, not because it's been too lax in its regulation of abortion drugs they're suing the FDA because it has been too restrictive. So they are asking the court to order the FDA to remove any remaining restrictions on the drug, and in the process to declare that the FDA's approval of the drug was valid at the time, and to stop the FDA from taking any action to remove Mipha Pristin from the market. And so, just in case you didn't get that whole flurry of activity. It's a very strategic lawsuit. What they're trying to do is to basically produce two conflicting judgments. There's going to be a federal judge in one jurisdiction that tells you approval is lawful and you can't remove the drug. There's going to be a federal judge in another jurisdiction that tells you it's unlawful and ordering the FDA to remove the drug. And in the end, the FDA will say, Hey, there's a conflict of foot. We don't know how it's going to get resolved. And so the abortion drug stays in limbo and stays in the market. But here's the thing. All of this activity might be moved. And here's the reason, which is that abortion law has always been a little bit of a fiction, when it comes to this gap between life and law. And so just days ago, it was reported that after dogs, more than 20,000 pills have been shipped across the US, and these aren't pills moving through formal channels of the health care system. It's a thriving network of mutual aid and support. The US has never been very good on drug policy. Their war on drugs has failed many, many times. And this is proving to be no different of a case. And so I want to use this idea of pills pills everywhere to bring us back to the Canadian context. Because in my opinion, abortion law aside, the most significant act that our federal government has ever taken on abortion rights has been to approve these pills in 2015. And then to relax regulation around their distribution. So as we have simple prescription and local pharmacy access supported by provincial funding. And when I was asked for my policy advice to Canadian governments on abortion rights after dogs. I answered without blinking, free the pills, put abortion pills into people's hands, and then provide them with the information and the support to use it. Do it for every person who would ever need them, and do it for every person who could then put those pills into the hands of another person in need. And then I gave a series of policy levers. Yeah, expand your class of providers. Allow for advanced provision. Why don't you rethink clinical supervision altogether. Let's remove prescription controls on these pills. Let's move them over the counter we have the evidence. And then make these pills available and affordable in every retail outlet, including internet platforms, community care models. And then if abortion pills on this scale require a reliable supply no problem. The government has done it before. We know that there are supplier contracts of essential goods in cases of critical need. And in fact, in 2022 for the first time ever the World Health Organization included in its global guidance, recommendations for people to safely manage abortions on their own, and service delivery approaches to support them. We have not seen any government fully implement these recommendations. And so I say, why not Canada be the first. I'm not offering this vision of abortion pills in the sense of solving the crisis of care that we have in this country there will absolutely always be a need for safe clinical services and abortion care professionals. But what I'm really offering it for us is a way to have just a different vision for abortion rights and abortion law. Because what underlies this vision is the belief that if people are informed if they're resourced if they're supported, if they are trusted and respected, then they can manage their own abortions and they can do it in ways that are most meaningful to them. And I think that this is such a different way of thinking about what an abortion law could be. And I think it's such a different way than what abortion laws have been. And I think it was that old sense of an abortion law, where people really had a fear of it in the Canadian context. There was always just this fear, yeah, that was articulated in these statements of no law about subsuming abortion rights into a legal order, any legal order. The idea of setting these rights down in terms that would be too inflexible too insufficient to really capture what people are doing when they have abortions and, and really just the diversity of feeling that they have about that. There was this fear of state sanctioned ways of knowing and acting with your body. It was a fear that abortion law was going to capture these fugitive rights, pin them down and associate them with a state agenda. And I think that's always been the inherent violence of abortion law. It's been that your life in your body has been treated as though it was just some kind of philosophical exercise of another person. And I think that that's what we've really escaped in Canada by virtue of having our laws not define abortion rights, but really abortion rights as sitting in life worlds that transect the law. So I love this idea that after Dobbs, when many people in Canada were asked whether or not we have an abortion rights, they just answered in Canada that they knew we had a right. They didn't quite know why or they didn't know what law to point you to answer that question but they really knew that they had this sense of a right. And that's what we want to keep. Yeah, in our abortion law today, we want to keep this sense of abortion rights as just continually open to new ways of knowing that we have them of ways of knowing what they are a sense of a law that's very future oriented and quite expansive in its scope. So I'm going to conclude here and with this final thought, which is, I think in Canada in many ways, our abortion rights are just both too small and too big for law. I think that's the way we've tended to think about it, but I think that's also because of the way we think about law. And then that shapes the view of whether or not we are better off without it. But I don't think that we should let our fear of law really dictate our action. And that's true no matter how terrifying the current state of abortion law is in the US. Because I think anytime we're given this offer by a government to protect our rights, we should always ask the question of whether or not there's another kind of law. Whether or not there is a statutory scheme, or I would say even provocatively whether or not there's a kind of legislative package that can be imagined in a different way. One that wouldn't control abortion and its meaning, but one that would really structure a very different kind of care network in this country one that would support people, trust and respect them in all their reproductive decisions, and in all the realities of their lives. This would be a law that would protect the right to end a pregnancy but also the right to continue one, the right to parent your child in a healthy and safe environment. It would be a sense of law that would hold a space for that new political future, and that might even give protection to it. And so this is something that many of us have asked since the overturning of Roe versus Wade. We've asked for that real visionary politics of abortion rights that are about so much more than access to a single health service. They're about rights to information safe supply supportive networks. They're about rights to adjust social and economic policy. And so I think we can absolutely bury ourselves in the fall of Roe, or quite frankly we can take its opportunity to nourish other ways of being, and really an opportunity to grow alternatives for a more just and livable world. So thanks so much. And I look forward to our conversation. And I want to thank you so much for that. I'm dazzled by the ideas that you've put into play, and I just want to turn to some of the questions that have been raised. I see three of them at the moment, and one of them came on very early in your talk and so I think that some of what you said subsequently may have, you know, unpacked a lot of the questions that were asked here but I still would like to put it on the table for you to respond to. So the first question I see here says, rather than talking about abortion rights, why don't we discuss the right to bodily autonomy. And I think you're right Sheila, this one is really a sense that was picked up later and saying, it's not really about an abortion right as a body right. Of course it's about the freedom of people to control their reproductive lives, but it's also about the creation of a world that supports, embraces and celebrates that freedom for everyone. And that means that abortion rights have to be cultural rights, economic rights, political rights. They're rights that really imagine a whole new role for the state and the law. And I think that's why many of us are moving away from the idea of a singularity of law and really speaking about this kind of sense of a legislative package, a social program. Again, much more than about abortion, it's really about reproductive justice, and it's about bundling together all of those reproductive decisions and realities of people's lives. Because we know the right to abortion is intimately tied to the right to continue your pregnancy, and to parent a child in the future and so that separation I think between maternity and motherhood that separation between procreative rights and rights in social reproduction, that's been a kind of falsehood that I think we could potentially undermine in the sense of breaking down those boundaries or barriers in the future. And that I'm going to, and you may come back to this question of rights and located in the individual, you know, sort of claims maker, and the types of broad, you know, reimagining of social structures that your work is pressing us to think about. And I'm going to move to a second question here which reflects something that came to my mind as well. I have to say, one of my questions arose as you were talking about the free access to and distribution of drugs and one of the lawsuits, the pharma company was pushing back against restrictions on pills and in my own world. And I guess many of ours involved in health law where where pharma becomes sort of the friend of social movements in a sense pitched against the state, as opposed to a participant, you know, squarely in structural injustice. It raises some potential alarm bells but at the same time it reflects the complexity of the field. So I'm going to read a question from Jennifer Taylor it says we're depending on the goodwill of companies in many respects. For example, we depend on tech companies in order to keep sharing information about abortion pills online. And we depend on the drug manufacturers in order to have access to pills in the first place. So how are you thinking about these intersections between abortion access and capitalism, and what role, if any, the law should be playing to mediate. Yeah, great and thanks so much Jen for the question is great to see. So I think, I think your answer is in your question, which is, we are depending on the goodwill. Yeah, it is need we depend on goodwill. Yeah need we depend on the goodwill of companies in the sense of when I started to chat about all of the different policy levers to be able to ensure access to abortion pills as public goods. And indeed these wouldn't stay in the private realm. Absolutely. Yeah, but the idea that the sharing of information about abortion pills should be part of every public health program. I mean this should really right be true and I, and I think it's about thinking of new and creative ways to share that information, you know, including taking ads out on buses that travel through, you know the cities letting people know about these issues. The kind of amazing lack of knowledge about pills last summer. That was really something quite striking and so I think this is in the field of health promotion that is absolutely part and should be part of public health policy. We depend on drug manufacturers in order to have access to pills in the first place. But again, I think we have a lot to learn about why suddenly what government always claimed was in the private realm suddenly was moved over during the time of COVID when we saw governments suddenly doing all kinds of things to ensure the supply of vaccines where there was a need. And so again, the idea of relying on goodwill for drug manufacturers, we don't have to do that. There are many places in which in fact, what's quite interesting is there's a history here, which is when the pill was first approved in France in the 80s, because of threatened boycotts, the company did threaten to take it off the market and in that moment, the French government intervened and said, No, this is the moral property of people, and they kept it in the market. And so I think there's a lot of history on abortion pills, but there's a lot of history, frankly, just on thinking about medicines as public goods that we don't have to rely on the goodwill of companies. And the other piece I would say too is these companies are in an interesting position in so far as remember they've got back 20,000 pills coming through. And so in this moment, there's been something quite interesting happening, which is safe supply of pills outside of formal channels. And so including of these drugs that have been formally approved for distribution and use in the US. And so pills are moving, these are public goods that are being shared in community based networks. And so I think that there's another way to kind of think about so many different levels operating here there's the state. There's your private actors, and then there are your community actors who have quite literally formed community care networks in the US that would rival any public health care system we've seen. Yeah. One of the things Joanna and then I'm going to turn the next question but one of the things that I find so thought provoking about the way you address these problems is your resistance to and it's a good resistance, but sort of falling really on one side or the other of many divides and one, if I understand properly is that divide between, you know, decriminalization as just as understood as wholly removing from any, any sort of space of the state, or of law, versus legalization as you presented in your talk has in many of its manifestations in the regime sure addressing has been so heavy and so obstructive, even though legalization looks like you know regulation which is in some way friendly to safe access. So rather than falling squarely on one or the other side and one of the sides that I understand, you know, many of those of us working in ways that try to be responsive to community based, you know, social movement organizing. There's a tendency to reflexively say the state and the law are the aggressors, and, and for lots of great reasons. And we need to create a space that is other than an apart from law. And my understanding is you kind of walk walk a really interesting line where you say yes to that in a yes but or yes and we can also imagine inviting the state and law in as you did at the end of your presentation with that sort of imaginative invitation. Before I move to the next one, could you just comment at all on your the challenges of participating in these conversations, which often are very much, you know, one or the other law or anti law state or other than state in this context. No, I think it's a great question and it's, it's really about abortion rights, truly reimagining the role of the state and its law. Right. And so you don't even take that as a given and ask whether or not it would be good or bad. You actually imagine that you could reconstruct it. And I think that this is what is so extraordinary about self managed abortion activists who have really been developing these care networks in places in which abortion has been criminalized. And so what they've been doing is really building models of care that are apart from the state sanctioned or as you say regulated models of care. And sometimes they're building them in the sense like you said, to be apart from law and the state deliberately. Do you know they have and make no claim on the state, but sometimes they're actually building them almost in prefiguration. Do you know we say this term, they're imagining what could be. And they're actually giving a vision for care and for care networks. And one of the most striking aspect about these networks that have developed is just how diverse they are how plural they are. Do you know and part of that is fighting the command and control logic of regulation. Do you know that what we need to keep people safe is to push them into a single system of regulated control. And they're really taking people where they are with what resources and what needs they have. And it's a totally different way of really coming up to need. All of the diversity of what it means. And guess what everyone this challenges those ideas of scale and sustainability. Those kind of policy jargon terms of health policy, but it's modeling an entirely different way of living and being not building perfect systems, and then shoving people into them, but really recognizing. And then add this diversity of people and then kind of building a legal environment up around them. So different it has such a different orientation. It's non competitive. It's not hierarchical. It really challenges some of the things that I think we've taken for granted in health system design. I would just add, because I do want to move on to these other questions. But I would just invoke for people the model of safe supply of drugs as it has. You know it's got a very storied history in Canada in terms of interaction with law but I think some of the work of Marco young and others that has looked at developments in say the Dantani side of Vancouver where there were social you know, impelled expressions of safe supply which then were regulated and approved by the state, and then social movement actors found those regulatory structures to controlling, and moved to other spaces which were unregulated and so I think it's something that could, it's a narrative over time, whereby you may have attempts to be responsive that then become controlling, and then sort of resets or rethinks of those. But that's maybe one, one model where there's a continuing sort of will and need to evade regulation and press reset whereas in what I understand if you're imagining we at least hold out the hope that there would be a public response that was truly, you know, and, and receptive and sensitive to the experiences of folks who, yeah, but I would have to say you have to, you have to really adopt an alternative mindset. Yeah, because the idea and why those have failed is because of built in biases into the law. The idea that informal is always worse than formalizing something. The idea of, like I said, ideas of sustainability scale. Do you know all of those are intended to defeat these other kinds of ways of caring. Yeah, and the truth is if real respect was given. It's a entirely different model which is not to try to overtake them in a formal structure, but to have a very different orientation from the supremacy of regulatory models. So, yeah, so for me, it's like, it's not that I'm imagining that they would come out differently than they have in the safe supply drug world I'm imagining no that that is actually not not what I am. You said I mean that I do understand yeah that the way. Yeah, of thinking about the role of law. Yeah. Yeah. Let me turn to another question. The next question on board asked, what is a sense of a right. If there is no institution to enforce a right. Does it exist. It's a great question and I would say, yes, it does exist. Because of exactly what we have just been talking about where all of these non institutional forms have been created and sustained by people's belief and sense that they have the right. Do you know and I would say that's probably stronger than any institutionalized form of guaranteeing it. And so there's a kind of sense of again, rethinking the relationship of institutions to rights that the idea is not necessarily to formalize them as to give them space to breathe to give support to give protection do you know it's a totally different mindset than institutionalization of it. But just in the sense of, I gave the example of the Prince Edward Island abortion case because I think it's a beautiful case. Why I wanted to write that up as a case is because in fact there was no court judgment. Do you know what I mean there was no legislative action in that case. There was just a sense that there was this right, and the government acted on the basis of it. There's an extraordinary moment of saying absolutely, you can have rights and more importantly you can have public policy framed on them without having to need that institutional affirmation. Yeah. I have a question and response taking us back to these foundational matters. I see I actually missed one on my way there. So Asia's question, where she says thanks for this talk. I'm interested if the route Canada has gone, not regulating abortion has been done in other countries around the world. And can those countries tell us anything about the future of abortion access in Canada. It's a great question. And it's interesting one because Canada is one of very few countries that doesn't have a specific law on abortion in the sense that we do not regulate it through unique provisions between only two abortion. And so that that is something quite unique and actually many places point to us as a kind of purely unregulated space, if you like, and what happens in Canada. And again, once you start to look at countries and a little more detail, you actually realize there's a lot of innovation happening in legal form and legal purpose around abortion regulation. And so some of the other things that have been quite interesting, especially in restrictive environments so places where politically is just never been possible to fully decriminalize abortion. What they've done is quite interesting acts around redefining what is an abortion, and putting certain acts, both at the very start of pregnancy, and the very end of pregnancy to say this is in fact no abortion at all. And so they've deregulated abortion in that way so if I can be more particular. It's been quite fascinating around some scientific innovation that says, are these abortion pills, because in the end, if you take them and you don't know you are pregnant, is it the ending of a pregnancy, or are you taking these pills and they are called fertility drugs then which is to just manage your menstruation and to manage your fertility and you don't really buy in to the categories of law, which put things as contraceptives versus abortifacients and you just ignore those kinds of categorical divisions of the pregnancy. This is a very different way of quote decriminalizing abortion that comes through scientific innovation and social norms and practice, and we've seen it happening in many different places under terms like menstrual regulation. This is the end of pregnancy, where we say, hey, all pregnancies have to end at some points yes. And so sometimes at the end, it ends in birth but sometimes it also ends in things like the premature delivery. Yeah, which is, why is it different than an abortion, maybe maybe not in kind of philosophical terms but the law truly treats it as something different, and it's absolutely legal and it's classified as just a very different medical act. And so I think that there's a lot of innovation that happens in abortion regulation, but the reason why many people don't spot it is because the innovative move is to challenge what is an abortion. It has the most, you know, creative act of freedom here and I think that's for me also why abortion pills are so very exciting, because you take them in your home. You can take them with your family and friends, you can take them and look up online or social media years and app, and you really get to define for yourself what's happening in your body. And when you think about that creative freedom. It's quite extraordinary as against any kind of control logic of the law to tell you what's happening, you know it really takes a lot of that freedom back. Thank you so much for that I have another question here that is a nice. It picks up on what you just said I think very nicely and situating that freedom and creativity that you've just been describing. But in a framework that's concerned about safety about risk and about the sorts of supports that may be in place for folks that says do you have concerns on opening medication options without appropriate following up in social supports. This approach still is not quite as simple as a couple pills mild pain, it's pain often requires several attempts and can have a high fail rate, having personally experienced this four times related to miscarriage. I can only describe my experiences violent and required further medical intrusion. My single experience of D and C was quite the opposite. What are your concerns on protecting a woman's choice and critical follow up care when required or desired. No, thank you for that for that question and I'm really sorry that that was that that was your experience of it and to say that indeed no one, no one should have that experience. And so, absolutely information and support for people to have and and experience self managed abortion in ways that are utterly dignified and in ways that are meaningful to them and recognizing there is an extraordinary diversity of experience. My sense though is, let's put the information and support out there, and let's include in that people's access to other forms of care, where it is desired or wanted. So for me, this is never a reason to restrict. This is never a reason to restrict. It's only a reason to further provide the information, the support and the care to make sure that people can do this with the knowledge and the comfort to make it an experience that is truly valued. And there are some reasons why it's not. When people started to use pills in this way. Many of the, the experiences that you had were shared by people they didn't know dosages they didn't know what to expect of their body. They didn't know what kind of pain was acceptable or what to do about it. And that was an awful condition to be in, but it was also a constructed condition by the law, because in many ways we've been so alienated from our own bodies and understanding what's happening in them, being connected to them. And part of the self managed abortion movement has really been about that kind of enfranchisement that rebuilding one sense of care and control in your life. And I think that that's really important to build back the history of abortion law here is to have taken that from women it was a very deliberate move. Especially to move from plant based abortion care which mimicked in many ways abortion pills and move it into procedural surgical care, which was done again as part of the medicalizing of women's health. It's all part of the kind of the same moment of rendering people vulnerable and dependent on institutional care systems. And so I think here the fact that people experience it. I don't want to take that as an inherent condition of reproductive life. I would want to ask about the conditions that render people unable to care for themselves and I would want to acknowledge here the deep misogynist history of pregnancy based care, and a lot of these efforts are ways to bring us back into our bodies and bring us back into community care cultures, which institutionalized care medicalized care has been quite deliberate in causing the very types of experiences that you've described. That once again Joanna and your reference to community care cultures is something that I encourage people to look at other work that you've done. And others that you have co written with have done in trying to draw out some of the community knowledge and community based practices that help us kind of reimagine what supports might look like and just the range of those supports. I have another question and I notice it's it's 119, at least on my machine on our poster it says we end at 120 we in our classrooms we actually have until 125. And I'm going to ask a last question with the regret to express to those who've asked further ones. The question is this it's land Kenan's following the question on bodily autonomy access or the lack there of to almost all pharmaceutical medication which is regulated by the government really suppresses individual autonomy and health. Along with access to abortion. How do you think one could push on policy to expand access to mental health medication in a similar context, and how could this potentially change how we access health independently in our society. No one knows our bodies better than we do. That's a great question and thanks so much for that. So, I do just have to say, it's about imagining alternatives alternatives. And I think there was this sense that prescription controls and clinical supervision and oversight made abortion safe. And so I think we're, if we want to think across sectors, you know, made the taking of drugs related to mental health, safe. But the truth is that we know the clinical encounter has been one of the most unsafe spaces for many patients, and I would speak more broadly, and so what has ended up happening in the abortion world at least has again as I mentioned the fact that the laws have been so hard and have criminalized so much of this care, you have been able to have these truly autonomous, or truly alternative care models develop in other places, and people would look at them when they initially came up, and I'm talking here about social clubs, I'm talking about other forms of organizing to be able to ensure not just access to care but truly access to medicines through alternative channels. And originally people would just look at this and say, it's informal I have no idea how anybody could ever trust, or use these services. And you know what's been amazing is that they have shown you all other kinds of ways of building trust, accountability, and to be able to share outside of again formalized institutional controls like prescription controls like authorizing controls of licensing and so forth so in some ways, we become really dependent on these systems and told to believe them just because they're there. They didn't know who those systems were very dangerous places, or they didn't have the opportunity to access them. We're recognizing a whole other way of building a trust care structure, in which people are better cared for in which they are safer within them. The idea is being able to get that evidence, get that evidence out, and it's often not coming in a research based way. It's really other forms of evidence and most often people talking about their actual lived experience in these care networks that are starting to shift their mind about not only what is not necessary in terms of certain controls, but what are alternative possibilities. Yeah that we're always suppressed, because it was quote literally unimaginable that you could access and take these drugs safely outside of a clinical context. So I think it's really experimentation, but it's also about giving these things spaces to breathe and taking them on their own terms, which has been just so important. Well, thank you so much, and I'm going to, because I just can't help it and I feel so bad because these questions are wonderful your, your talk has inspired on so many. I wonder if you have even just a quick response to the next question on our list, which again seems to carry from carry on from what you just said says thank you for your information and emphasis about Mipha Pristone. So what is the role for laws in getting restrictions lifted from dispensing over the counter or behind the counter and says I know clinicians and researchers are discussing this to you didn't want to miss that very sort of practical pointed question. No thanks Leanne and great, great to see you. So here's the thing that's quite fascinating about what's happening in the US is people are going for it in the sense of and I tried to communicate some of the absurdity of some of the legal challenges and the court judgments that might be coming out. So it's actually allowing people to be a little freer, if I can say it that way in terms of interpreting laws and what they mean. And so there's been some really curious examples by the federal government in the US of saying this law means this, and therefore it fully allows access, even before they change the law. So, right just so innovating in what practices this law allows, even in terms that seem indirect contradiction to what the formal words of the law are, but in conditions of crisis and where need is real. So it is do it first acted out, and the law will follow. And so I think even here in Canada, where we have the political environment that we do, we should really take that and trust people who are practicing abortion on a day to day practices to be able to do just like we do off label prescribing sort of off label practice that kind of challenges, some of the even legal norms in our field as just such an important point in moving our practices forward and not really looking to authorize us as much as we're looking for the space that law provides us to be able to, to care for people. And in the end, if that's what health laws are all about, and that is their objective of protecting the health and lives of people that in truth these, these interpretations should stand, and the law should follow. So much for that Joanna, I think that we should close it up now, although we could easily take another hour just to discuss the rich questions that people have asked. I know in my own work with Matthew herder who's the director of the health law Institute and Matt bond who works with networks of people who use drugs we've taken so much inspiration from the work that you do, and the kind of flipping and rethinking of the law and the meaning of safety, sort of safety from whose perspective in the context of safe supply of drugs and in your case, access to abortion. So thank you so much for the work that you've done and for the talk that you gave today. Before I say a last thank you. I want to let folks know that the next and final seminar in our series this year is coming up on March 24 with Professor Nav Purso, who is with the Department of Family and Community Medicine at the University of Toronto, where he holds a Canada research chair in health justice. His talk is entitled access to essential medicines, more than just a human right. So I think that will allow us to reflect further on medication access on human rights and on the structures that enable or or disable health. So thank you again Joanna and everyone join me and whatever, either psychological or I guess we don't even have those little hand claps, maybe we do but if there were I know there would be hand claps all around. So thank you Joanna so much for this talk today and again I encourage people to look up Joanna's work and learn more about this really important work that she and others are doing. Thanks so much Sheila. Bye folks. Thanks everyone.