SECOND OPINION
Your Patient Needs Your Help and Guidance
Providing a listening ear , with counsel , is a part of the physician ’ s duty to the patient . The trusting relationship between patient and doctor is essential . This is especially true when the discussion involves sensitive personal matters and is especially challenging when the government has interfered with medical decision-making . When a woman now comes to her physician with questions about current or future pregnancies , the governing bodies ( majority male ) have insisted on regulating both the allowed procedures and required counsel .
Since the Dobbs v . Jackson Supreme Court ruling of 2022 , Kentucky has engaged its “ trigger law ” that automatically prohibits the performance of surgical or medication induced abortion except to save the life of the mother ( see box ). The Kentucky Supreme Court rendered an opinion that those seeking to have the Kentucky law invalidated did not have standing with the Court , so the law remains . The Court indicated only a woman harmed by not receiving an abortion could bring her case forward .
Following the Dobbs decision , most major medical societies have issued strongly worded policies decrying this political and legal hijacking of the practice of medicine . The American Medical Association Code of Ethics on Abortion concludes : “ Like all health care decisions , a decision to terminate a pregnancy should be made privately within the relationship of trust between patient and physician in keeping with the patient ’ s unique values and needs and the physician ’ s best professional judgment .” 1 Likewise , the American College of Obstetricians and Gynecologists ( ACOG ) published its position statement . “ ACOG recognizes that access to comprehensive reproductive health care services is essential to women ’ s health and well-being . Women should have access to scientifically based health care . Prohibitions on essential care that are based on religious or other non-scientific grounds can jeopardize women ’ s health and safety .” 2 The American College of Physicians , the American Academy of Family Practice , and the American Academy of Pediatrics all have similar concerns that medical services , including women ’ s health care , must be based upon medical evidence and not unscientifically derived legislation . 3 , 4 , 5
The medical facts are that medication abortifacient ( e . g . mifepristone and misoprostol ) and early and mid-term surgical abortions are safe and effective . 6 , 7 The current laws in Kentucky , with a few exceptions , class both prescription and procedures to induce an abortion as Class D felonies . Neither medical necessity nor medical
30 LOUISVILLE MEDICINE by TOM JAMES , MD safety is considered in the judicial or legislative determinations .
An early study from the University of California San Francisco documented a rise in morbidity following the Dobbs decision . These included second trimester obstetric complications , ectopic pregnancy , early miscarriage and exacerbation of maternal medical conditions , severe fetal anomalies forced to term , with findings of sepsis .
The Kentucky physician , seeing a patient looking for a pregnancy termination , wrestles with thorny issues . It does not matter whether the rationale for the procedure is because pregnancy at that point in a woman ’ s life is problematic , or because the fetus is not viable . Given the legislation and judicial rulings , the Kentucky physician may not feel secure in referring the patient to a gynecologist who can provide her with the options .
What can the practicing Kentucky doctor do now to help the patient ? The principles of supportive , compassionate and informed care are cardinal . Before providing the patient with resource options , the Kentucky physician may engage his / her patient in Decision Counseling . So many women considering pregnancy termination express internal conflict . The physician ’ s role is to help the patient reframe the conflict through a series of open-ended questions that can help the patient ’ s understanding and help her to normalize and validate her conflicts . The physician may be able to help the patient understand the emotional , spiritual , moral and pragmatic aspects of her conflict . The goals of the decision counseling are to help the woman come to a positive view of her ultimate decision . 8
If the patient wishes to pursue medical or surgical abortion , the Kentucky physician may provide the patient with information and the website of various organizations who can then help the woman in finding care outside of Kentucky . There may be friends or family who live in states where abortion may be allowed , and who may be supportive . The physician may find it helpful to provide her / his patient with several organizations so the patient may evaluate them and determine which feels “ right ” for her . Such organizations for physician referral include :
• National Abortion Federation prochoice . org / patients / naf-hotline /
• I need an abortion www . ineedana . com /
• Abortion Finder www . abortionfinder . org /
• Planned Parenthood www . plannedparenthood . org /
Each of these organizations will evaluate the patient ’ s needs and refer to professionals in states where medication or surgical abortions are legal . Many of these can help with transportation or