Roe v. Wade is in immediate jeopardy and we are now staring into the face of a country without legal abortion, and regardless of where you stand on the issue it is imperative that you understand that it is you who are now in professional jeopardy. As an abortion provider from Arizona, a state with some of the most conservative abortion laws in the nation, let me tell you what you can expect if abortion becomes illegal either in your state, or across the nation as a whole.
Expect every medical decision to be questioned. Do you have a patient who needs a D&C to finalize a missed miscarriage? Misoprostol to expel the remains of an embryo? It is not unreasonable to expect that your files will be subject to scrutiny if all abortion is banned. Anti-abortion officials will be checking to ensure no physician is attempting to slip in a clandestine abortion by calling it miscarriage management. A missing piece of documentation, a lost ultrasound proving fetal demise prior to follow up, anything suspect could land you in jail or get your medical license revoked.
Expect more pregnancy complications in your offices. The inability to access abortion care means patients who continue unwanted pregnancies without adequate prenatal care, or without full recovery from a prior birth. It means patients with weak hearts, high blood pressure, previous complications from prior births or other risk factors who are forced to put their health in jeopardy because abortion will only be available for those whose lives are at immediate risk.
Expect patients with incomplete medical histories. When abortion becomes illegal, those who have them or attempt them will hide them from you out of fear of prosecution, or because they worry you will not provide your best care if you know what they have done. Never again will you be able to simply take a patient at their word about their medical pasts. Their history will be guesswork and assumptions, and you will be forced to fly blind.
Expect to be the last generation to know full spectrum women’s reproductive healthcare. For those of you who have been trained to terminate a pregnancy, you well may be some of the last to do so. For those of you who haven’t – because you believe your faith would oppose it, because it was too difficult to access it in med school, or because your current hospitals won’t let you and it is more important that you stay in your financially secure job and not make any waves – understand that you are the ones who opened this door for good. No surgeon would be allowed to say, “I just don’t believe in removing gallbladders” and still be allowed to practice. Yet when it comes to abortion, you’ve now set the standard. You’ve allowed a procedure that is conducted more than any other in the nation to be moved to the fringes. You’ve encouraged medical schools to make it elective, and to cave to political pressures to block training and end fellowships teaching the skill.
Expect to be forced to encounter abortion face to face in the hospitals. For decades, those of you who do not perform abortions have been able to keep abortion in the distance and out of your practices. You’ve referred your patients to me and to clinics like mine and kept your offices free of it. Even in the rare case where an abortion was medically indicated and they preferred an office or a hospital, you sent them away for the procedure so you didn’t have to be involved. These patients will be yours, now. There will be no one else to provide it. It will now be in your hands. You will no longer be able to pretend it doesn’t exist.
Expect to fight your own hospital administration when eventually one of your patients does need care. When abortion is returned to the medical wards, it will be the hospital, not you, who will eventually decide what is in your patient’s best interest. They will be the one to decide if is it best to let a pregnant patient bleed out while labor is induced, rather than do a direct abortion and more quickly save her life. Decisions won’t be made based on medical best practices. They will be made based on hospital policy, political fear and financial interests. And as a result, more of your patients may die.
This is the landscape you will see if Roe is overturned and if abortion returns to being illegal. It’s the choice you physicians made when you refused to learn even simple abortion procedures, assuming providers like me would always be there if your patient really was in need. It’s the choice the hospitals made when they accepted that partnering with religious organizations was worth losing full spectrum reproductive healthcare like terminations, sterilizations and emergency contraception after a sexual assault as long as there was enough money involved in the partnership. And it’s the choice that medical schools and universities made when they chose to cower in the face of pressure from the right over abortion training fellowships or internships at reproductive health clinics, afraid of the financial consequences of losing donations or public funds.
This is the new normal unless you finally say “Enough is enough” and demand to treat each and every patient with whatever medical service she may need. You must stand up against it now – as this may very well be our last chance to save our profession.