A SECOND OPINION
them . Indiana ’ s legislature is considering its wording in the coming weeks . 5
Across the country , doctors who work in ERs and obstetricians are bombarding the American College of Obstetricians and Gynecologists ( ACOG ) with frightened questions . If their state ’ s statute , rushed into effect after the Dobbs decision , defines fetal life as a heartbeat , whose heartbeat counts more ? Can the OB on call be charged with murder if , despite seeing a weak cardiac signal on the fetal monitor , she operates urgently to stop rapid bleeding and save the miscarrying mother ’ s life ? The doctor is charged with saving her patient , and if possible , her ability to try again for a child . Medically , this pregnancy and baby are doomed and the parents will suffer the loss of that child , regardless . But must the mother of even a wanted child die because the wording of a statute requires the doctor to withhold lifesaving care ?
That ’ s just one example .
Rapid diagnosis and removal of an ectopic pregnancy is essential ; an embryo outside the uterus cannot thrive , and eventual rupture of tubes / ovary leads to sepsis , bleeding and death . Yet caring for these women immediately with methotrexate or laparoscopic treatment must involve a fine-tuned calculation of “ immediate risk to the mother ’ s life ,” and / or finding another state ’ s treating doctor – whom the patient can actually reach .
Doctors who help those suffering from infertility fear the intrusion of new laws as well . Often , some embryos are hardy and viable , and some are not and are discarded . In-vitro fertilization of eggs ( IVF ) has helped many thousands of couples have a family ; per the CDC , assisted reproductive technology helped nearly 80,000 in 2019 alone . Yet the “ personhood ” lobby in Missouri has attempted since 2016 to enshrine embryonic rights as cancelling out the pregnant woman ’ s rights . With the Dobbs decision , these activists are gaining momentum . 6
So far , ending a pregnancy to save the mother ’ s life is the only exception remaining in the U . S ., but three states fail to cite “ protection of her health .” There are many gray areas in medicine : we make the best choice we can at that moment , for each individual patient , to choose or avoid decisions , medicines and procedures that best protect , and least harm , one particular person at one moment in time . How often , for her health , would you choose to force a brutally raped woman to carry part of that rapist inside her ?
From the ACOG site one month ago : “ Legal restrictions on abortion are and will continue to affect a wide spectrum of patient care . For example , in states with laws criminalizing abortion provision , clinicians may be nervous to provide pregnant patients with needed diagnostic tests ( i . e . radiology imaging ) or interventions ( i . e . anesthesia or surgical intervention for a ruptured appendix during pregnancy ) due to fear of inadvertently causing a pregnancy loss . They may also be confused about the impact of abortion restrictions on miscarriage and pregnancy of unknown location management . In addition , they may be uncertain about what they should document in the medical record when caring for particular patients . There may be scenarios when a healthcare professional acts in an evidence-based and lifesaving way but is still pursued by the state for violating an abortion ban law .”
That ’ s the nightmare : by our lights , the doctors did everything right , but the state can prosecute them anyway .
ACOG recommends that hospitals form a task force in consultation with , among others , maternal / fetal specialists and hospital attorneys , and “ to the extent possible ” provide them with assertion of privilege ( as with ethics and credentialing committees ). The task force members ’ job would include answering questions and advising of possible legal implications in emergent clinical situations .
Medical doctors must justify our actions based on best evidence . Those writing the laws that restrict medical care lack medical knowledge and nuance and have never faced the situations that ER docs and OB-GYNs face routinely . Pregnancy loss is common . Not every baby is born alive . Some deliveries result in the loss of the woman ’ s uterus and some , in the loss of her life . Draconian bans on any action that might lead to fetal death will , inevitably , harm women , as clinicians struggle with escalating crises yet feel their healing hands are tied .
The pride of those who have achieved their objectives in reducing abortions will rest on the punishment of thousands of girls and women who got pregnant and regretted it . So far , that pride in forced birth has not translated in this country to pride and provision for bountiful child care , nursing mother support , extended parental leaves or universal early childhood education . Women and their children will be abandoned when they need care most .
There is no way to label that as just or moral .
1 https :// www . courier-journal . com / in-depth / news / investigations / 2021 / 06 / 30 / transgender-sports-bans-pushed-conservatives-citing-untrue-claims / 5152134001 /
2 https :// www . courier-journal . com / story / news / politics / ky-general-assembly / 2022 / 03 / 25 / transgender-sports-ban-bill-passes-kentucky-heres-whatknow / 7084228001 /
3 https :// www . nbcnews . com / politics / politics-news / indiana-attorney-general-says-will-investigate-doctor-treated-10-year-rcna38223
4 https :// www . nytimes . com / 2022 / 07 / 16 / us / abortion-bans-children . html
5 https :// www . acog . org / news / news-articles / 2022 / 06 / questions-to-help-hospital-systems-prepare-for-the-widespread-and-devastating-impacts-of-a-postroe-legal-landscape
6 https :// www . kshb . com / news / local-news / kansas-city-couple-concerned-missouris-abortion-ban-will-lead-to-prohibition-of-in-vitro-fertilization
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .