With Roe v. Wade overturned, doctors face an 'impossible choice' : Shots - Health News Physicians must treat in line with patients' wishes and standards of care. Some medical ethicists say that abortion bans will force doctors to disregard these obligations in order to follow the law.

For doctors, abortion restrictions create an 'impossible choice' when providing care

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What does today's Supreme Court ruling allowing states to ban abortion mean for doctors? Well, many leading medical groups and journals are condemning the decision, including the American College of Obstetricians and Gynecologists. Here's ACOG President Dr. Iffath Abbasi Hoskins at a press briefing this afternoon.


IFFATH ABBASI HOSKINS: Today is a very dark day in health care. It is a dark day, indeed, for the tens of millions of patients who have suddenly and unfairly lost access to safe, legal and evidence-based abortion care.

CHANG: She went on to say the Supreme Court is forcing clinicians to, quote, "betray the sacred covenant that we made to our patients."

NPR health policy correspondent Selena Simmons-Duffin has been reporting on this very issue and joins us now. Hi, Selena.


CHANG: So what is this sacred covenant that Dr. Abbasi Hoskins is referring to there?

SIMMON-DUFFIN: So this is the idea for physicians that when a patient comes to you asking for help, you have a professional and ethical duty to provide them care. In an amicus brief filed in the case decided today, leading medical groups, including ACOG and the American Medical Association, laid out the way that abortion bans conflict with those duties. They described physicians as being forced into, quote, "an impossible choice between upholding their ethical obligations and following the law." And today, AMA President Dr. Jack Resneck condemned the ruling, saying it was, quote, "a direct attack on the practice of medicine and the patient-physician relationship." And he said AMA wouldn't give up the fight, which may mean legal action from AMA defending abortion.

CHANG: Though, I am sure there are physicians who are celebrating today, right? Like, how do they explain their positions at this moment?

SIMMON-DUFFIN: Yes. The American Association of Pro-Life Obstetricians and Gynecologists is one group that's celebrating. They released a statement that reads, quote, "as medical professionals, it is our highest responsibility to provide all our patients, mothers and pre-born children, the best health care possible." So their view is that there are two patients, the patient who's pregnant and the embryo or fetus.

CHANG: Well, already today, we have seen several states - Missouri, Alabama, just to name a couple - these states are announcing laws on their books banning abortions are now in effect. So what does that mean for the doctors in those states?

SIMMON-DUFFIN: Well, it means there's a whole new legal regime that could very well affect how they practice medicine. I've spent the past month speaking with physicians, medical ethics and legal experts about this. And I want to start in Texas, where a six-week abortion ban has been in place since the fall. It can give a preview for physicians in all of the states where the laws just changed.

So Dr. Stephanie Mischell works in Dallas. She's a family physician and a fellow with Physicians for Reproductive Health, and she's already very familiar with government regulations in the exam room.

STEPHANIE MISCHELL: You know, in Texas, there's sort of a, like, running list of different types of restrictions and bans that exist on abortion care, whether it's mandatory waiting periods, mandatory counseling, bans on telehealth. There are so many different types of restrictions, and Texas really has all of them.

SIMMON-DUFFIN: Her goal with patients, she says, is to provide them with accurate information to guide them through a decision and make sure they get the care they want. But too often, because of the Texas law that outlaws abortion around the time many people first learn they're pregnant...

MISCHELL: Every single day now, I have a conversation with a patient in which I say, you know, abortion would be the really safe and valid option for you, and I'm so sorry that I can't do it here.

SIMMON-DUFFIN: This is how the dilemma will play out in a lot of places with new or newly restrictive abortion laws. Patients will say, I want this care, and doctors will say, I can't provide it; the law won't let me. Then there are the ethical conundrums that arise in particular cases, when there are complications in pregnancy.

LISA HARRIS: It's very frightening and confusing for physicians and the whole team that cares for patients to know, well, what can we do? What is OK and what's not OK?

SIMMON-DUFFIN: Dr. Lisa Harris is an OB-GYN at the University of Michigan who's been working on a task force to prepare for the possibility that the state's 1931 abortion ban takes effect. That law would make abortion a felony except, quote, "to preserve the life of the pregnant woman." She says that language is incredibly unclear.

HARRIS: How imminent must death be? Does it mean they have to die immediately? There are many conditions that people have that, when they become pregnant - they're okay in early pregnancy, but as pregnancy progresses, it puts enormous stress on all of the body's organ systems - the heart, the lung, the kidneys. And so they may be fine right now, there's no life-threatening emergency now, but three or four or five months from now, they may have life-threatening consequences. So again, it's unclear. Could they have an abortion early in pregnancy to prevent a life-threatening complication later?

SIMMON-DUFFIN: If the answer is no, physicians will have to watch their patient get sicker and sicker until some undefined point when they can intervene and provide an abortion legally. Then there's cancer. Harris explains, sometimes pregnancy hormones make cancer spread faster, or treatment isn't safe to start during pregnancy. If abortion is not an option for patients in this situation, they may have to carry their pregnancy to term and delay crucial treatment.

HARRIS: That might mean their cancer is more serious and more widespread than early in the pregnancy, and so they may indeed have a higher risk of dying, but it's not a risk that's going to happen immediately and might be a recurrence in months or years.

SIMMON-DUFFIN: There are a lot of questions without easy answers, and Dr. Amy Addante says a lot of health care providers will be scared to do the wrong thing. She's an OB-GYN based in Illinois and a fellow with Physicians for Reproductive Health.

AMY ADDANTE: From a medical malpractice and legal standpoint, I think a lot of health care systems and even individuals are going to be very risk-adverse.

SIMMON-DUFFIN: Especially, she says, when the penalties are felony charges, loss of medical license or jail time. Illinois is a state where abortion is legal, and it's likely to become a haven in the Midwest for patients seeking abortions. But Addante says she's scared for colleagues in restrictive states.

ADDANTE: They can't just make their medical decisions based on good clinical judgment and evidence, but also have to consider what is the law. They don't teach you that in med school. There's no lecture on, you know, how to make sure what you're doing is legal in obstetrics.

SIMMON-DUFFIN: And again, many of these laws are unclear on the medical details. Of course, legislators could go in and make these laws more clear on these questions. But Kim Mutcherson, co-dean of Rutgers Law School, whose work focuses on reproductive justice, says she thinks that's unlikely. The ambiguity is a feature, not a bug, she says, because lawmakers are trying to make getting an abortion as difficult as possible.

KIM MUTCHERSON: That's exactly what all of this kind of legislation is meant to do. It's meant to put people in a position where they no longer feel confident and comfortable about providing the level of care that they think is appropriate.

SIMMON-DUFFIN: So instead of revised laws bringing clarity, Mutcherson says...

MUTCHERSON: You have to wait until somebody gets in trouble. You have to wait until, you know, there's a case. You have to wait until somebody gets arrested. And then you start to understand, OK, this is what the parameters are.

SIMMON-DUFFIN: That legal process will be slow. It will probably be state-by-state or even county-by-county. It will be confusing, she says, and it will be messy. Dr. Lisa Harris, the OB-GYN in Michigan, says in the meantime, with this ambiguity hanging over everything and providers stuck between their ethical obligations to their patients and the law...

HARRIS: My fear is that - the fear that doctors and nurses and health care administrators and leaders will feel - their fear of intervening will mean that some patients will die when they didn't need to.

SIMMON-DUFFIN: Selena Simmons-Duffin, NPR News.

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