Chloe Franzia is majoring in biology with a minor in public health and is a 2022-23 health care ethics intern at the Markkula Center for Applied Ethics. Views are her own.
As discussions surrounding abortion rights continue in the United States, it is essential to understand all of the impacts that changes to abortion accessibility will have. Certain states have already started to individually take action to some extent to either ban or protect a woman’s right to an abortion, and the impacts of these changes are becoming visible. If the Covid-19 pandemic was not enough, the overturning of Roe v. Wade in the United States has resulted in emergency departments being completely overwhelmed both in regards to their bandwidth and ability to provide comprehensive care due to a number of resulting impacts.
Abortions Will not Stop
Although abortions may be illegal in some or even all situations per a specific state’s ruling on the matter, this will not prevent women from attempting an abortion using unregulated and potentially unsafe methods in certain situations. As abortion legality continues to be decided on a state-by-state basis, women who want to get a medically performed, and therefore safer, abortion are left with no other option but to travel extended distances to locations where abortion services are legal. Attempted “illegal” abortions and extended trips to abortion-legal states has yielded a massive increase of women requiring treatment for resulting complications from these extreme situations.
With medical professional shortages from the pandemic coupled with this increased patient influx, emergency department personnel and medical professionals are continually required to work harder, longer, and faster. Even with increased effort from medical personnel to assist those impacted by unregulated or self-performed abortions, the damage and detrimental impact to both the patient and emergency department is impossible to fully mitigate. As an increasing number of states continue to place restrictions on abortions, locations where abortion is legal have become overwhelmed by incoming patients from other states, and locations where abortion is illegal or even partially illegal will become overwhelmed by patients with complications from dangerous abortion procedures.
Confusion in the Worst Way
The biggest ethical challenge emergency departments are facing is the violation of nonmaleficence. In a hypothetical scenario, a 24 year old female is transported to the emergency department after fainting at work. Her colleagues inform respondents she has been complaining about severe abdominal pain for several days. Upon arrival, it is clear to the physicians that the patient is suffering from an ectopic pregnancy. Her vitals are slowly declining with each hour and it is only a matter of time before the patient is in cardiac arrest. The physicians know they must intervene quickly to save the patient’s life, however, they are not sure when they can. Usually, the sooner medical care is provided, the better the patient's outcome.
However, in some states that have banned abortion, physicians are only allowed to perform abortions in life-threatening situations. This limit in life-threatening situations is unclear at best. It is extremely difficult to understand all of an individual's underlying conditions that may complicate the situation and how serious any risk may truly be. It is apparent that the patient is in distress and will die unless she is treated, but she is currently stable. As time goes on, she will not be stable, but, at this particular moment the patient is stable. So, the physician cannot provide an abortion. They must wait until the patient is on the verge of death to provide care, even though it might be too late then. In doing so, physicians have violated the ethical principle of nonmaleficence, to do no harm. By refraining from using their medical expertise, physicians are actively causing harm to the patient that could have otherwise been avoided. Under the current ruling of the law, this issue will only be further exacerbated until it cripples the healthcare system.
Stacking the Odds Against Patients
It is essential to highlight the fact that the position some medical personnel are in right now is not due to their own faults. Rather, the ethical dilemmas these physicians face are a direct result of new governmental policies and societal beliefs. As discussed in a New York Times article, the 13 states with abortion banned do have some very specific exceptions on abortion, however, “making that determination has become fraught with uncertainty and legal risk.”To make matters worse, as discussed by the ACOG, “the specific language used in many of these laws to describe exceptions is often confusing and unclear.” Physicians are now trying to protect themselves by withholding treatment until the last possible moment while still trying to provide the best care in fear of losing their medical licenses, facing large fines, or going to jail. In the face of serious medical concerns, medical personnel assume full responsibility for a patient's health, while now also needing to place high stakes bets on the patient’s life in circumstances of abortion. Emergency departments are the experts within their field, and as such, medical treatment decisions should be made based upon their best judgment that is not guided or hindered by rulings made by those who do not.
Navigating reproductive medicine in a post-Roe world is extremely confusing for all medical personnel involved and has significantly increased the risk associated with women. As the number of women requiring treatment for complications with reproduction grows and healthcare providers continue to be overwhelmed, the severity of the situation will only get worse. Emergency departments will be left to fend for themselves. As far as physician uncertainty, it has become increasingly confusing, risky, and tolling to attempt to provide those in an abortion scenario with proper health care. These issues are only a small portion of those created by the overturn of Roe V. Wade, and they will continue to get worse as more states make abortion illegal. Therefore, it is essential that the proper support systems are in place to ensure women can access safe and legal abortion services when it is necessary, and that emergency departments are able to provide comprehensive care based on expert opinions.