The BPR High School Program invites student writers to research, draft, and edit a college-level opinion article over the course of a semester. Adeline Caetano is a sophomore at West Warwick High School in West Warwick, RI.
Porsha Ngumezi, a thirty-five-year-old mother, suffered a preventable death and experienced a miscarriage at eleven weeks. The obstetrician assigned to her case decided to prescribe her a drug called misoprostol, instead of providing a needed dilation and curettage, commonly referred to as a D and C. Misoprostol, a drug used to carry out early-term abortions, was intended to help her body pass the tissue needed to stop the excessive bleeding. Three hours later, Ngumezi died from excessive bleeding.
Ngumezi’s case is becoming commonplace in post-Roe America. According to research from ProPublica, there has been a 54 percent increase in blood transfusions in post-Roe Texas to treat women who have experienced miscarriages and did not have a D and C. They are being treated this way because physicians are hesitant to provide this procedure due to Texas’s abortion restrictions. They are instead being discharged without treatment until they inevitably return, blood hemorrhaging. Several healthcare providers and researchers believe that this trend is directly related to the chilling effect of the new laws affecting reproductive healthcare.
When a patient’s life is at risk, who is responsible? Is it a state legislature or a healthcare provider? This question fundamentally defines a growing crisis that healthcare workers face every day. Physicians have to question whether or not they should rely on the standard of care or follow what politicians have ordered. The stress between state restrictions regarding abortion and federal directives like the Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals to provide stabilizing treatment in medical emergencies, becomes plainly evident in similar cases. This raises concerns about the legal prosecution of providers. Restrictive state laws regarding abortion access offer insufficient exceptions to protect a pregnant person’s life, creating a legal and ethical problem for healthcare providers who are trying to obey the Emergency Medical Treatment and Active Labor Act.
With the rollback of abortion rights, healthcare workers potentially face legal action when treating patients with a miscarriage. 61 percent of OBGYNs, who practice in states with strict abortion bans, experience uncertainty about legal risks when practicing in their communities. This creates ambiguity around how to treat pregnant patients because healthcare workers question if the standard treatment is compliant with new state laws. The main concern around legal prosecution stems from the concept of “reasonable medical judgment,” which is a legal standard used to determine if an abortion meets the exception requirements. Court cases involving abortion use testimonies from other healthcare providers to ultimately determine how to penalize the physician, usually legally or professionally. This evidence emphasizes the prevalent fear of persecution, the intense confusion that disables patient care, and the heightened influence of “reasonable medical judgment” standards for healthcare providers. With the anxiety around legal trouble, hospitals have decided to create “risk management committees,” which review cases, leading to delays in care. The resulting delay is a direct violation of EMTALA, which requires the hospital to respond swiftly when an emergency situation with a need for immediate intervention occurs.
Consequences to healthcare services have resulted from the uneasiness around caring for patients. In states with high numbers of abortion restrictions, there is an over 4 percent decrease in OB-GYN practitioners compared to states without restrictions. This decrease in practitioners is associated with the rise of legal action faced by healthcare providers. The legal or criminal penalties include jail time and fines. In Alabama, physicians who violate the abortion restriction are charged with a class A penalty. Considering abortion a class A penalty puts it into the same category as murder and domestic violence. This sentence carries a minimum weight of 10 years and a maximum of 99 years. Healthcare providers can also be charged with fines. In Texas, physicians can pay 100,000 dollars in fines, as it is a first-degree felony. A professional consequence is license revocation, which means even after they have served their sentence, they cannot return to practicing medicine. The revocation of their license can also sometimes mean that they cannot practice medicine in other states.
Proponents of abortion bans argue that healthcare workers should be held accountable for their actions and that doctors following their oath have nothing to fear. They believe that any violation of a state law is a crime and should be treated as such. However, as healthcare providers, physicians also have ethical duties to their patients. These include the duty to preserve life and health. A healthcare provider cannot provide a patient with these duties due to the abortion restrictions. Therefore, they do have something to fear because they could violate their oaths. An oath violation often leads to medical malpractice lawsuits, where they typically face civil penalties and, in serious cases, license suspension or probation.
State laws that pertain to abortion bans and certain allowed exemptions become an ethical dilemma for health care providers. They are often unsure whether to abide by the federal law of EMTALA or their state’s abortion laws, which inhibits their ability to provide necessary care to their patients. For example, to be able to provide a patient with an abortion, healthcare providers have been instructed to wait until the onset of sepsis to avoid legal action. This provides an ethical problem for physicians, as the action of waiting for sepsis is a violation of the basic medical principle of early intervention and EMTALA. In Texas, 57 percent of pregnant patients suffered extreme complications when healthcare providers waited for their condition to worsen to give them the necessary care. This is a direct consequence of the ethical and procedural dilemmas faced by physicians.
These dilemmas arise from the tension between the argument that a fetus is a patient and the reality that prioritizing the fetus’s life can put the pregnant patient at further risk. This issue is intensified by laws like EMTALA, which ensure emergency care but can be difficult to navigate when the emergency involves complex ethical and legal debates surrounding abortion. These restrictive laws often lack adequate exceptions for life-threatening situations, which places healthcare providers in a difficult position where they must make challenging decisions with potentially dire consequences for either the pregnant patient or the fetus.
The basis of abortion is a highly debated topic in politics today because banning abortion is associated with increases in maternal mortality. A potential solution for this problem would be to create a law that specifies certain exemptions to legalize abortions. Without clear, explicit exemptions to the abortion bans, it makes it nearly impossible for physicians to make decisions regarding patient care. The conflict between state laws regarding abortion and EMTALA’s policies creates a dangerous environment for physicians, forcing them to choose between avoiding legal action and their ethical duty to provide for their patients.