GOVERNMENT AND NATIONAL AFFAIRS COMMITTEE
Navigating the Impact of Overturning Roe v. Wade on EM Physicians Kendall I. Moore, MD MBA
U
nless you have been living under a rock, you will have heard that the U.S. Supreme Court, in their decision in the case of Dobbs vs. Jackson Women’s Health (Dobbs), reversed precedent on Roe v. Wade, a 1973 decision in which the Court ruled that women had the constitutional right to abortion under the 14th amendment. With the CDC citing abortions being performed over 500,000 times a year, how will this ruling impact emergency medicine (EM) physicians across America? Will there be a noticeable impact, such as patients seeking post abortion care or requesting abortion resources? Will we have to change the discussions we have with patients or limit resources offered due to fear of legal jeopardy at the state level? The Dobbs decision will certainly impact some emergency medicine physicians more than others based on their state of practice. In some states, a full ban on abortions was automatically triggered once the Supreme Court decision was published. EM physicians in these states must face the reality of quickly changing their practice without clear guidance on how to provide care while complying with the law in emergency scenarios. In certain other states, abortion laws remain unchanged and, while the in-state treatment by physicians in such states may remain the same, the influx of out-ofstate patients seeking care in their emergency departments presents a myriad of issues and questions that hospital systems will need to resolve. What follows is an exploration of the potential impacts of the Dobbs decision on the emergency medicine practice. Please note, it is not meant to provide any legal advice for
physicians to follow; it is simply an exploration of what we can expect.
higher rate of unsafe abortions and, in turn, abortion complications.5
Leaving political views aside, based on data published by the University of California San Francisco (USCF), complications from legal abortions are rare. Less than 1% of legal abortions lead to emergency department (ED) visits. Likewise, less than 1% of abortion related chief complaints present to the ED.1 As such, if women in abortion-banned states only sought legal out-of-state abortions or abstained from getting abortions altogether, then the USCF data could be reassuring for ED physicians. However, research and history show that the Supreme Court’s decision will not stop women from seeking abortions; rather, patients will look for alternative options and, for those without the economic means to obtain legal out-of-state abortions, the alternatives are dangerous. As is seen in countries with restrictive abortion laws, a prohibition on abortion may contribute to a
With the possible increase of patients presenting to the ED due to complications resulting from unsafe and/or illegal abortions, novel questions arise as to what obligations emergency physicians will have under this new legal paradigm. For those of us who practice in a state where abortion is illegal, could we find ourselves faced with an obligation to report our patients to authorities? If we treat a patient with abortion-related complaints, are we subject to liability as a participating party in the abortion procedure? States where abortions are fully legal may see a large influx of out-of-state patients seeking information on abortions. Will we be able to communicate freely with these out-of-state patients about their care options knowing abortions are illegal in their resident state? Additionally, how do we insure privacy for these patients in the age of interoperability and portable health records? All of these issues are still developing, but we are starting to see bills introduced that protect patients who cross state lines for abortion care, such as the “Ensuring Access to Abortion Act.”3
[A]s physicians, we have a duty to treat any patient presenting to the ED and provide life saving measures when necessary…federal law supersedes state law when physicians are administering what the clinician believes are life saving measures.”
Recently, Centers for Medicare and Medicaid Service and the U.S. Department of Health and Human Services have released guidelines for physicians in states with abortion bans. These guidelines serve as a reminder of the Emergency Medical Treatment and Labor Act, stating that, as physicians, we have a duty to treat any patient presenting to the ED and provide life saving measures when necessary. This
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COMMON SENSE SEPTEMBER/OCTOBER 2022
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