With Roe vs. Wade reversed, doctors face an ‘impossible choice’: Shot

A 33-year-old mother of three from Central Texas was taken down the hall by a clinic administrator in October 2021 before having an abortion at the Hope Medical Group for Women in Shreveport, LA.

Rebecca Blackwell / AP

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Rebecca Blackwell / AP

A 33-year-old mother of three from Central Texas was taken down the hall by a clinic administrator in October 2021 before having an abortion at the Hope Medical Group for Women in Shreveport, LA.

Rebecca Blackwell / AP

Now it is up to the Supreme Court Reversed Rowe v. Wade, Medical ethics experts say many physicians will be trapped in a constraint: unable to fulfill their professional responsibilities to care for their pregnant patients because of what state law prohibits.

Physicians vow to “do no harm” as part of their medical training. They learn how to stay up to date, throughout their careers, about the best standards of care for treatment. And they learn about patient privacy and protection and how patients should have a say in their care based on their values ​​and life experiences.

“The goal is for a patient to decide what is right for themselves,” said Dr. Stephanie Mitchell, a family physician in Dallas who is a physician collaborator for reproductive health.

Often, however, Michelle said, her conversations with pregnant patients have less to do with their values ​​and health and more to do with navigating a maze of legal requirements. “There is an ongoing list of various restrictions and prohibitions that exist in abortion care, including pre-love restrictions, mandatory waiting periods, mandatory counseling, restrictions on telehealth – Texas really has them,” she says.

Under the 6-week abortion ban in Texas, many patients are unaware that they are pregnant early enough to get a legal abortion. “Every day I have a conversation with a patient where I say, ‘Abortion will be a really safe and legal option for you and I’m so sorry I can’t do it here,'” she says.

Two dozen medical groups, including the American Medical Association and the American College of Obstetricians and Gynecologists, raised the ethical dilemma faced by physicians at an Amicus briefing before the Supreme Court in the case. Dobbs vs. Jackson: “The ban forces physicians to make an impossible choice between maintaining their moral obligation and following the law,” the brief reads.

That “impossible choice” has already become a feature of reproductive health care in the South over the years, says Dr. Lewis King, an obstetrician and gynecologist at Brigham and Women’s Hospital in Boston, who is also an attorney and ethicist. “It’s going to be a lot more, a lot worse,” he says.

“Ask that the law will exist [physicians] Depriving the person in front of them and behaving in a way that is medically harmful. And there will be fines for not doing so, including loss of license, loss of money, and possibly even criminal sanctions, “King explains.” How can you resolve that dispute? “

Seeing patients become ‘sick and ill’

State physicians, including abortion restrictions, are running to understand the exact outline of restrictions that have just been implemented – or are imminent – in pregnancy complications.

“It’s very scary and confusing for the therapist and the whole team that cares to know patients, what can we do, what’s right and what’s not right?” An ob-singer and professor at the University of Michigan. Lisa Harris, who joined a university task force last December to prepare Rowe to be overturned He wrote about their work New England Journal of Medicine In May, and his arguments were quoted Dobbs Dissent

He is confused by the language of Michigan’s decades-old abortion law – which is currently on hold – which makes abortion a serious crime when it was “necessary to save a woman’s life.” Most abortion restrictions in other states include a variation of that language.

“How imminent is death to be?” Harris asks. “There are a lot of conditions that people have when they are pregnant, they are fine early in pregnancy, but as the pregnancy progresses it puts a lot of pressure on all the organs of the body – heart, lungs, kidneys. So they can be good. At the moment – There are no life-threatening emergencies now – but three or four or five months from now, they could have life-threatening consequences. “

So, she asks, does the language of these laws allow abortion early in pregnancy if a life-threatening complication can occur later?

If it doesn’t, the law puts both the physician and the patient in a position to “stand there and see someone get sick and sick and sick for a while – and where is that point?” Who is the Vice Chairman of the Ethics Committee of the ACOG

Harris says the diagnosis of cancer also raises questions. “There are some cancers that increase and spread the pregnancy hormones rapidly, and people will choose to terminate the pregnancy because the treatment that their oncologist is recommending can be toxic or potentially fatal for a developing baby,” she says.

If abortion is not an option in their state, will they afford to treat their pregnancy for duration and delay? “This may mean that their cancer is more severe and more widespread than the early stages of pregnancy, and therefore their risk of death may be higher, but it is not a risk that is going to happen immediately – it may recur in a few months or years.”

If the Michigan abortion ban goes into effect, Harris further wonders whether it would be legal for him to prepare patients for abortion outside the state by blood work and ultrasound in Michigan.

Even in states where abortion is reliably legal, like the King of Massachusetts, there are legal and ethical questions for providers. “Let’s say I’m providing abortion care to people I know who are traveling to me from outside the state – so does that mean I can’t travel, for example, to Texas?” He asked.

“Now no one has the answer, and my fear is that the fear that doctors and nurses and healthcare administrators and leaders will feel – the fear of their intervention – means that some patients will die when they were not needed,” Harris said.

Disorder and fear in the months ahead

The path to clarity of these questions is itself obscure.

“These can be resolved by a legislature that seeks to engage with more specificity, which they will not,” predicts Kim Mucharson, co-dean of the Rutgers Law School whose profession focuses on biology and reproductive justice. Where abortion is illegal, legislators are widely said to “want to make it as difficult as possible, and one way you can do that is to [by] Creating a standard where people don’t know exactly what they’re doing is right or wrong. “

Instead, he said, “You have to wait until someone gets in trouble. You have to wait until a lawsuit is filed. You have to wait until someone is arrested. And then you start to understand, ‘OK, This What are the parameters? ” It can take months, if not years, to get clarity through the court system.

Meanwhile, Dr. Amy Advante, an Illinois-based ob-gynecologist who is a colleague of physicians for reproductive health, suspects that new legal restrictions on abortion will have a cooling effect on healthcare institutions and medical providers. “From a medical perspective and from a legal point of view, I think a lot of healthcare systems, even individuals, are going against a very high risk,” he says.

“I am providing for those who are afraid for my colleagues [obstetrical care] In these states where they can not only make treatment decisions based on good clinical judgment and evidence, but ‘what is the law?’ There is no “how to” class in most medical schools and residences. What you are doing is to make sure that the obstetrics is valid, “she added.

“I have no interest in going to jail – I didn’t go to medical school to go to jail,” Dr. Dishon Taylor, an ob-gynecologist in Arizona, told NPR in May. Arizona has an abortion ban that can be enforced if one of the many states Rowe Reversed

“I’m just going to be honest – I don’t have the color to guess and say the risk, then slap my hand. We see. [pregnant] Those who have already been criminals – they are not white, “he said.” So I have no illusions about where I stand on this and what kind of risks I can and cannot take. “

From an ethical point of view, King says, “I can only help patients if I keep my license, so if you are a useful one, you will say, ‘Well, the greater good is to claim that I only abide by these laws because if we all have our licenses Take it, there will be no one to take care of, ” he explained.

With all this uncertainty, how things actually go depends on what authority you have, Harris says. “I think it’s just going to be deeply local,” he predicted – state by state or even county by county. “You’ll see some prosecutors in some counties say, ‘I’m not judging it, it doesn’t break the law,’ or ‘I don’t want to enforce the law.’ “

“It’s going to be very messy,” he adds.

Physicians and medical teams do not always champion abortion

Physicians played a key role in the abortion ban movement in the United States in the 1860s – in particular, doctors who were members of the American Medical Association. Today’s AMA has become increasingly vocal in support of the right to abortion. A few years ago, it sued North Dakota for an abortion ban.

In a statement issued on Friday, AMA President. Jack Resneck Jr. has condemned it Dobbs The verdict states that it is “a direct attack on the practice of medicine and the patient-physician relationship and a blatant violation of patients’ rights to evidence-based reproductive health services.” He added that the AMA would fight these restrictions, which could signal further legal action from the group on abortion.

Former AMA president Dr. Gerald Harmon told NPR in early June that the AMA did not specifically survey the abortions of its 270,000 outstanding doctors – and that individual physicians may have religious or conscience-based objections to abortions – but as an organization, The AMA is united in its fight against government intrusion.

“We speak with one voice against the government – politicians and lawyers and judges – in the examination room, be it fetal medicine, women’s reproductive health, gender. [identity] Medical treatment, “she said.” We need to be more outspoken and protect the ability to have a medically appropriate safe abortion and be able to teach it. “

Not all physicians subscribe to this view, nor do they view physicians as an ethical conflict when treating patients in areas where abortion is restricted. In fact, the American Association of Pro-Life Obstetricians and Gynecologists calculates the risks of miscarriage by submitting its own amicus brief to the court and says that opposition among doctors is part of the medical tradition. “By refusing to perform abortions, doctors are maintaining a long tradition in their profession. For thousands of years, abortion has been considered the opposite of proper medicine,” the summary said.

But most medical groups and journals protect access to abortion as a legitimate and safe healthcare option, especially in recent weeks. “The reality is that if the US Supreme Court upholds its draft decision, women will die. Judges who vote on strike Rowe They will not succeed in stopping abortions, they will only succeed in ending safe abortions. Alito and his supporters will have the blood of women in their hands, ”the Lancet editorial board wrote in May.

King says doctors, hospitals and medical groups do not always speak “loud enough” to defend abortion. “I’m always outspoken, but I’m a minority,” he says. “Usually, hospitals are not vocal about providing abortion care because they do not want to invite controversy and protest on the streets. That means – we don’t want to disrupt patient care,” she says.

But the country has reached a tipping point, he argues. Abortion providers like her “should be very proud of the care we provide and be very vocal about how we all believe it is essential healthcare.”

Pien Huang contributed to this report.

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