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How doctors weigh the legal risks of abortion care

Editor’s Note: The doctor’s name in this article has been changed at their request due to concerns of legal consequences and/or professional retaliation.

July 26, 2022 – When Ohio OB/GYN had a patient who needed an abortion this month, he knew he had fast action .

Daniel is also seeing patients at the abortion clinic where she is treating a woman who is about 5 weeks pregnant for an abortion. After a mandatory waiting period, ultrasounds required for each appointment, consent procedures and options consultation, she was scheduled for a surgical abortion the following Monday.

But on Monday, preoperative tests revealed her blood pressure was very high, posing a serious risk to her health if Daniel went ahead with the procedure.

Before Supreme Court overturned Roe v. Wade in June, Daniel would send patients home and provide tips on how to lower blood pressure over time instruction of. But patients now have only four days to show the necessary improvement.

In this case everything worked out. 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 to physicians as patient safety.

Daniel says he doesn’t want Ohio’s abortion law to change the way he communicates with patients. He said, as far as he knows, talking to patients about self-administered abortions is still legal, as long as everything is impartial and clearly stated.

“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 liability,” Daniel said. “I still have these conversations, but I don’t tell my employer that I have them, and I don’t record them in a chart.”

Daniel Consciousness However, 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 knew they had to be careful what they said, Daniel said, because anti-abortion activists posed as patients and secretly recorded past conversations.

Enforcement: Past, Present and Future Legal Risks

Mary Ziegler, a professor of law at Florida State University School of Law who specializes in the legal history of reproductive rights, said that before Roe, the enforcement of illegal abortions spotty. 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 Ashland, Pennsylvania physician Robert Spencer is best known for practicing in a mining town in the 1920s. He was reportedly arrested three times — once after a patient died from complications from 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 was a sense that these laws were not being enforced very well.”

Dr. Carole Joffe, a sociologist with expertise in reproductive health, recalled that there were few doctors Arrested given the number of abortions performed. The American College of Obstetricians and Gynecologists estimated that some 1.2 million women in the U.S. had illegal abortions in the years before the original Roe decision — a number that exceeds today’s estimates.

One of the most high-profile cases of physician detention was the arrest of gynecologist Jane Hodgson in 1970. Hodgson knowingly violated Minnesota law, which prohibits all abortions except in situations where the patient’s life is endangered.

Hodgson was arrested and sentenced to 30 days in prison and suspended for a year after aborting a patient infected with rubella, also known as German measles. 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 more than those that existed in the pre-Roy era. 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, JD, a law health policy expert and health policy expert at Harvard Law School also expects that we will see more frequent prosecutions of doctors who provide abortions.

“There’s more data available through medical records – saved and generated by our cell phone and internet searches, I think it’s hard for doctors to fly under the radar,” Shachar said .

Also, Shachar emphasizes prosecutorial discretion in abortion cases where one prosecutor may choose to be more aggressive than another in the next county applicable law. That’s the case in DeKalb County, Georgia, which includes parts of Atlanta, where District Attorney Sherry Boston said she plans to use her prosecutorial discretion to deal with crimes such as rape and murder, while Not a decision to “potentially investigate the medical conditions of women and doctors,” Bloomberg Law reports. State Sen. Jen Jordan, the Democratic nominee for Georgia attorney general, has also said that, if elected, she would not enforce the state’s new 6-week abortion ban.

Is there a legal access to abortion care in states that prohibit abortion

Robin, an obstetrician, became a complex in Utah Planned Parenthood Fellow to further her search for medical training and education in abortion care. Her plan is to consolidate it into a field of expertise so that upon completion of the fellowship, she can move back to her home state of Arizona to provide services there.

In Utah, where she currently practices, abortion is prohibited after 18 weeks. In Arizona, abortion is still allowed for up to 24-26 weeks until the pregnancy reaches a “survival rate” ( when the fetus has developed enough to survive outside the womb with medical help). But new Arizona restrictions could go into effect as early as September, which would ban abortions after 15 weeks.

although The future of abortion in Arizona is uncertain, but Robin still plans to move there after her fellowship, but she hopes to travel to surrounding states to help provide less restrictive abortion care. Even if she can’t provide abortion services at all, she says there are still Ways to help patients get a safe and fair abortion without repeating the dangers and dire consequences of self-abortion or abortion. Luo’s previous illegitimate child.

“As a doctor, I think one of the roles I can play is to help People have comprehensive care for self-managed abortions,” Robin said. “If they can buy [abortion] pills online, then I can have an ultrasound beforehand, and I can have an ultrasound after that, and I can talk to them through it. I can help them with all aspects of these cares, I just can’t give them the medication myself. “

Whether doctors will be penalized for “aiding and abetting” abortions occurring in different states is still 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 a law that would allow ordinary citizens to sue anyone who “willfully engages in or abets an act or induces abortion” or anyone who intends to do so.

That’s what happened to Alan Braid, an OB-GYN in San Antonio. He admitted in a Washington Post column that he had an abortion after heart activity was detected during his pregnancy. Realizing the legal risk, he was indicted by three people and the case is still pending.

But Ziegler said the chances of a doctor in a progressive country actually being extradited and prosecuted by a country with restrictive abortion laws are pretty low — not zero, but low.

Like Robin, Natalie – an ob-gyn 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 and everyone is starting to look for jobs and figure out their next steps,” Natalie said. “Because of the ambiguity of the laws and how they are enforced, Dobbs’ decision introduced a lot of confusion and then confusion within institutions and their risk tolerance.”

Looking ahead to her future career path, Natalie said she would not consider working at an agency that would not allow her to teach students about abortion care, speak publicly about abortion rights, or allow her to travel outside of Texas. Continue to provide abortion care. She also preemptively sought legal counsel and general guidance — Ziegler strongly urged doctors to take advice as soon as possible.

In states with strict abortion bans, except for life-threatening cases, for what actually What is considered life-threatening enough to pass as an exception still lacks clarity.

“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. “

Robin explained that in her cancer patients, pregnancy won’t be “for the next 9 months, but it will definitely accelerate their disease, Might kill them in the next year or two.”

Now, she says she doesn’t know what she’ll do if and when she’ll get a doctor’s position.

“I didn’t go to medical school to be 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 limits of the law.”



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