WELLNESS
Roe v Wade, Dobbs, and Reproductive Justice: A Case for Moral Injury to Physicians By Stephanie Balint and Cindy Bitter, MD, MA, MPH, on behalf of the SAEM Wellness Committee The day the Supreme Court decision on Dobbs v. Jackson Women’s Health Organization was leaked, I was studying with my first-year medical student friends. We discussed the ramifications of the decision on our intended specialties; nursing students and faculty joined in the discussion as they passed by. We were united in our disbelief and sense of powerlessness to affect the final decision that might disrupt access to reproductive health care. A common theme in modeling perinatal mortality in a post-Roe era is that complications and mortality will
disproportionately impact those living at the poverty level. As medical students, it felt like the values we espouse — health equity, evidence-based medicine, improving geographic disparities — would be destroyed by this decision.
Defining Moral Injury
Dissonance between one’s values and an act one witnesses or perpetrates can lead to “moral injury.” Moral injury can also occur when one simply fails to intervene when witnessing a situation that contradicts one’s values. In health care, moral injury describes the challenge
of “simultaneously knowing what care patients need but being unable to provide it due to constraints that are beyond our control.” Emergency medicine (EM) is a field with a great deal of experience dealing with moral injury. We treat victims of interpersonal violence and preventable complications of untreated disease and honor patient autonomy when the patient’s desired treatment goes against evidence-based recommendations. continued on Page 56
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