On Friday, the U.S. Supreme court voted to strike down Roe v. Wade, the 1973 decision which affirmed the constitutional right to abortion. While the supreme courts’ decision to overturn Roe v. Wade will have an impact on nearly every citizen, it will certainly bring new complications for those who work in healthcare. In the 26 states that are certain or likely to ban abortions, healthcare workers are heading into uncharted waters. They will be responsible for familiarizing themselves with their state laws, and procedures regarding abortions, and reporting events, as they try parse out the legalese of their states’ constitutions. And furthermore, in many states, healthcare workers need to do this quickly.
This situation is uncharted in large part because of the technology that now exists, which didn’t before the 1972 ruling that protected abortion rights. The world is much more connected electronically, and patients’ health data can be accessed easily if needed. Period-tracking apps, EMR, telehealth appointments, other data could potentially be used as evidence in criminal cases for those involved in abortions. This leaves many healthcare workers between a rock and hard place – between their ethical obligations to safeguard the health and privacy of their patients and the potential for punitive or judicial proceedings. In an amicus brief to the Supreme Court in the case Dobbs v. Jackson, two dozen medical groups, laid out this dilemma:
“The Ban […] impermissibly intrudes into the patient-physician relationship by limiting a physician’s ability to provide the health care that the patient, in consultation with her physician, decides is best for her health. Moreover, the Ban undermines longstanding principles of medical ethics and places clinicians in the untenable position of choosing between providing care consistent with their best medical judgment, scientific evidence, and the clinicians’ ethical obligations or risk losing their medical licenses.”
This will also add more stress to the relationships between healthcare professionals and their patients, as those relationships may understandably change. Patients may feel more distrust of the medical system, especially in states that have abortion bans. This could lead them to feel the need to be more secretive, and to not disclose certain symptoms or medical histories making the job of the healthcare workers more difficult. Many mental health professionals are warning that this will contribute the negative mental health outcomes, for patients and workers alike.
Of course, healthcare workers in OB/GYN settings will be greatly affected but general practitioners and specialists will face difficulties as well. Rheumatologists, for example, often prescribe medications to patients with autoimmune disorders that could cause miscarriages. For example, methotrexate is prescribed for a variety of diseases such as rheumatoid arthritis, severe psoriasis, lupus, and multiple sclerosis but it can also be used to terminate ectopic pregnancies. Under these potential state laws, it is unclear whether restrictions on drugs such a methotrexate will be put in place, if there will need to be justification reviews prior to prescription, or any other hoops to jump through.
Future physicians will also be impacted. According to a study by researchers at the David Geffen School of Medicine at UCLA, of the approximately 6,000 obstetrics and gynecology residents across the country, nearly 44% (2,638) are located in one of 26 states that are certain or likely to ban abortions. This could lead to the next generation of providers not receiving adequate education and training in those areas. The authors of the study also added that their report likely underestimates the impact of overturning Roe v. Wade, since their review did not include family medicine and other specialties that also train new doctors in proper abortion procedures.
Docket No. 19-1392. Supreme Court of The United States. (2021, September). Retrieved June 29, 2022, from https://www.supremecourt.gov/DocketPDF/19/19-1392/193074/20210920174518042_19-1392%20bsacACOGetal.pdf
Vinekar, K., Karlapudi,, A., Nathan, L., Turk, J. K., Steinauer, J., & Rible, R. (2022). Projected Implications of Overturning Roe v Wade on Abortion Training in U.S. Obstetrics and Gynecology Residency Programs. Obstetrics & Gynecology.