Physicians and Decisions About Abortions
By Robert A. Hatcher, MD, MPH, Senior Author, Contraceptive Technology; Professor Emeritus of Gynecology
and Obstetrics, Emory University School of Medicine
Sadly, we have arrived at the day when fully half to two-thirds of all states have passed laws to ban abortions as completely as possible. The situations in which abortion is banned vary from state to state. In some states, the punishment for failing to adhere to complicated laws is harsh. For a woman to have control of her body, she should be able to choose consciously whether she will have sex, use effective contraception, continue a pregnancy, or obtain an abortion.
I often think back to a case in 1969 that spoke to me so clearly. The patient sitting before me had five children and lived in public housing where rats roamed about and occasionally bit her children. She found an alternative public housing development that was safer, but it limited the number of children in each apartment to a maximum of five. She was using the most effective contraceptive we had at the time, an intrauterine device. It fell to me to tell her that she was pregnant again. She was devastated. A sixth child would eliminate her opportunity to move to safer housing. Safe, legal abortions were not available in Atlanta at that time. I found $300 for her and sent her to the Emory Clergymen’s Counseling Service where she received information about the availability of safe abortions in Mexico. She traveled there, and her pregnancy was terminated with no complications. From that day on, I became an advocate for a woman’s right to choose to have an abortion.
Recently, I read a thoughtful article by Katie Watson, JD, regarding the physician’s role in states with abortion bans.1 If a woman is clear that she wants an abortion, neither she, her counselors, individuals making referrals, nor physicians performing abortions know what will happen to them now if they help her, Watson noted. The same confusion exists for a physician and a woman seeking care for a miscarriage. All parties simply do not know the consequences that will befall them if they help a woman terminate a pregnancy.
From November 1973 until the June 2022 Dobbs decision, physicians exercised their professional medical judgments and followed a medical standard of care to decide how to protect the life and health of a pregnant woman seeking an abortion. They accomplished this very well, and abortions by pills or by surgical procedure during that time were safe. Now, nearly half the states have enacted laws prohibiting abortions, and exceptions vary from state to state. Nevertheless, numerous state and federal laws require physicians to act to protect the health and lives of their patients. Abortion bans encourage physicians not to act in the best interests of their patients — and, indeed, to violate existing laws requiring the protection of the health and life of the patients. If a physician’s medical judgment is that an abortion is needed to protect the life or health of a woman, the physician can nevertheless be subjected to civil and criminal penalties for providing such care, simply because state lawmakers (usually elderly, white, male judges or legislators) have decided that physicians should withhold abortion services. Current laws are creating impossible choices for women seeking abortions and physicians, between what they know to be life- or health-saving care on the one hand, or no care on the other.
As Watson explained, physicians find themselves walking down dark alleys trying to exercise their clinical judgment under the constraints of our nation’s new abortion bans. She urges the medical community to practice medicine bravely, writing that “providing standard medical care to people whose health or life is threatened by their pregnancy is neither civil disobedience nor covert lawbreaking; it isn’t even resistance. It is wise interpretation of existing law as applied to specific facts, fidelity to clinicians’ fiduciary duty to stay focused on patients in medical need, and acceptance that choices of historic consequence rarely come with zero risk.” I interpret this to mean that physicians should do what they need to do to protect the life and health of their pregnant patients.
Watson challenged physicians forced to walk the dark alley of ethics with these words: “So head up. Walk tall. Walk with friends when possible. Move like you live in a world where physicians define life- and health-preserving medical practice and make that world more likely.”
- Watson K. Dark-alley ethics — how to interpret medical exceptions to bans on abortion provision. N Engl J Med 2023;388:1240-1245.
The United States has arrived at the day when fully half to two-thirds of all states have passed laws to ban abortions as completely as possible. The situations in which abortion is banned vary from state to state. In some states, the punishment for failing to adhere to complicated laws is harsh.
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