Editor’s Note: The names of physicians in this article have been changed at their request due to concerns of legal consequences and/or professional retaliation.
July 26, 2022 – When an OB/GYN in Ohio has a patient who needs abortion This month, he knew he had to act quickly.
Daniel is also seeing patients at the abortion clinic, where she is treating a woman who is about five weeks pregnant for an abortion. She was scheduled for a surgical abortion the following Monday after a mandatory waiting period, ultrasounds required for each appointment, consent procedures and a choice consultation.
But on Monday, preoperative tests showed her blood pressure Very high and would pose a serious health risk if Daniel went ahead with the surgery.
Before the Supreme Court overturns Roe v. Wade in June, Daniel will send patients home with instructions on how to lower blood pressure over time. But patients now have only four days to show the necessary improvement.
In this case, everything is resolved. The patient returned on Thursday and was able to undergo surgery. But it’s just one of many day-to-day medical decisions that abortion providers must make now, and changing legal risks are as much a concern for physicians as patient safety.
Daniel said he doesn’t want Ohio’s abortion law to change the way he communicates with patients.As far as he knows, it’s still legal speech Self-managed abortions can be introduced to patients as long as everything is impartial and clearly stated, he said.
“But I don’t think I’m going to get a lot of institutional support to have these conversations with patients because I think there’s a legal responsibility,” Daniel said. “I’ll still have these conversations, but I’m not going to tell my employer that I’m taking them, and I’m not going to record them in a chart.”
Daniel is aware that engaging in such discussions, or considering the possibility of omitting certain information from patient records, carries risks of legal and professional consequences. The enforcement of these rules is also vague.
Under Ohio law, if a colleague suspects that you are violating the law, you may be reported to a supervisor or licensing agency. Abortion providers know they have to be careful with what they say as anti-abortion activists pose as patients, secretly recorded Daniel said past conversation.
Law enforcement: past, present and future legal risks
Before Roe, enforcement of illegal abortions was mixed, said Mary Ziegler, a professor of law at Florida State University School of Law who specializes in the legal history of reproductive rights. In the early 1800s, doctors who provided illegal abortions were, in most cases, prosecuted if the patient died as a result of the procedure.
A physician named Robert Spencer in Ashland, Pennsylvania, became famous for providing abortions in the mining town where he practiced in the 1920s.He was reportedly arrested three times – Once a patient died from complications of a miscarriage – but was eventually acquitted.
For many doctors performing abortions at the time, “it was very much a roll of the dice,” Ziegler said. “There is a sense that these laws are not being enforced very well.”
Given the sheer volume of abortions, few doctors were arrested, recalls Dr. Carole Joffe, a sociologist with expertise in reproductive health. The American College of Obstetricians and Gynecologists estimated that in the years leading up to the original Roe decision, about 1.2 million women There are illegal abortions in the U.S.—the number exceeds today’s estimate.
The most notable cases in which doctors were detained were Gynecologist Jane Hodgson arrested 1970. Hodgson knowingly violated Minnesota law, which prohibits all abortions except in situations that pose a threat to the patient’s life.
After a miscarriage in a patient infected with rubella (also known as rubella) rubella, Hodgson was arrested and sentenced to 30 days in prison, suspended for one year. She ultimately did not serve time in prison, and her conviction was overturned after Roe’s sentencing in 1973.
Abortion restrictions passed in many states now authorize harsher penalties than those before Roe. According to Joffe, we can now expect more doctors to be arrested, which is a key reason.
“There is simply no modern anti-abortion movement as we know it,” she said. “In the past, there wasn’t as much legal monitoring and things were very unsafe. Fast forward to now and we now have safer options — like mediating abortion pills — but we have a very different legal environment.”
Carmel Shachar, J.D., an expert on law and health policy at Harvard Law School, also expects that we will see more frequent prosecutions of doctors who provide abortions.
“There’s more data available by keeping medical records and the information our cell phones and internet searches generate, and I think it’s very difficult for doctors to fly under the radar,” Shachar said.
Additionally, Shachar emphasized prosecutorial discretion in abortion cases, where one prosecutor may choose to apply the law more aggressively than another in the next county.DeKalb County, Georgia, which includes parts of Atlanta, has seen this, and District Attorney Sherry Boston said she plans to use her prosecutorial discretion to address issues such as rape and murder, not ‘may investigate[ing] Women and doctors make medical decisions,” Bloomberg Law report.Georgia Attorney General Democratic nominee and state Senator Jen Jordan also said that if elected, she would will not be enforced The state’s new 6-week abortion ban.
Are there legal access to abortion care in states that ban abortion?
Robin is an OB/GYN who became a sophisticated Planned Parenthood Fellow in Utah seeking further medical training and education in abortion care. Her plan is to solidify it into a field of expertise so that after completing her fellowship, she can move back to her home state of Arizona to serve there.
In Utah, where she currently practices, abortion is banned after 18 weeks.In Arizona, abortion is still allowed Up to 24-26 weeks until pregnancy reaches “vibrancy” (when a fetus has developed enough to survive outside the womb with medical help).but new restrictions Arizona could go into effect as early as September, which would ban abortions after 15 weeks.
Although the future of abortion in Arizona is uncertain, Robin still plans to move there after receiving a scholarship, but she hopes to travel to surrounding states to help provide less restrictive abortion care. Even if she can’t provide abortions at all, she says there are still ways to help patients get safe and above-mentioned abortions without repeating the dangers and dire consequences of self-abortion or abortion. The illegal practitioner before Luo.
“As a doctor, I think one of the roles I can play is helping people with comprehensive care for self-managed abortions,” Robin said. “If they can get [abortion] The pills are online and I can do Ultrasound Before, after I could do an ultrasound, I could talk to them through it. I can help them with this care in all ways, but I can’t give them medication myself. “
Whether doctors will be penalized for “aiding and abetting” abortions that occur in different states remains an open question. For example, in Texas, Senate Bill 8, which went into effect on September 1, 2021, not only created a fetal heartbeat law, but also added the following wording: will allow private citizens Prosecute anyone who “knowsly engages in aiding or abetting the practice or induction of an abortion,” or anyone who knowingly does so.
That’s what happened to Alan Braid, an obstetrician and gynecologist in San Antonio.he is in a Washington post Comments that he had an abortion after heart activity was detected during pregnancy.After realizing the legal risk, he has been indicted by threethese cases are still pending.
But Ziegler said the chances of a doctor in a progressive country actually being extradited and prosecuted in a country with restrictive abortion laws are very low — not zero, but low.
Like Robin, Natalie — an obstetrician in her early 30s — is a sophisticated family planning researcher in Massachusetts. After receiving the scholarship, she wanted to return to Texas, where she completed her residency training.
“I’m in the training phase where everyone is starting to look for jobs and figure out their next steps,” Natalie said. “The Dobbs decision introduced a lot of confusion and then confusion within agencies because of the ambiguity of the laws and how they are enforced, and what their risk tolerance is.”
Looking ahead to her future career path, Natalie said she would not consider working at an agency that would not allow her to teach abortion care to students, speak out about abortion rights, or continue to provide abortion care outside of Texas. She also Seek legal counsel and general guidance first—Ziegler strongly urges physicians to heed these recommendations sooner rather than later.
In states with strict abortion bans, there is still a lack of clarity about what is actually considered life-threatening enough to pass as an exception, aside from life-threatening cases.
“Will it be life-threatening in the next 6 hours? 24 hours? 7 days? a month?” Robin asked. “In medicine, we don’t necessarily talk about whether something is life-threatening, we just say there is a high risk of X things happening in X time periods. What is the threshold for legal compliance? No one has an answer to that. “
In her cancer patients, Robin explained, pregnancy “doesn’t necessarily kill them in the next nine months, but it certainly accelerates their disease and probably kills them in the next year or two. “
Now, she says she doesn’t know what she’ll do if and when she’s a doctor.
“I went to medical school and didn’t become a felon,” Robin said. “Our goal is to make as many legal changes as possible to protect our patients, and then to provide as little harm and as much care as possible within the lines of the law.”