Friday, 29 Mar 2024

Opinion | Medical School Doesn’t Teach the ‘Woman’s Life Is in Danger’ Curriculum

Over the past few weeks, Georgia, Alabama and several other states have passed restrictive, medically illiterate abortion laws that allow the procedure if the mother’s life is at risk.

I am an obstetrician and gynecologist trained to do abortions. I do not know how to translate these laws into clinical practice because often the language is preposterously vague and they include terms with no medical meaning.

In Alabama, for example, a doctor can “deliver the unborn child prematurely to avoid a serious health risk to the unborn child’s mother.”

The legislation does not define what constitutes a “serious” maternal medical condition nor how “serious” it must be to prompt intervention. The language about how to terminate the pregnancy is similarly problematic. Does the vague word “deliver” mean an induction of labor, or does it also apply to a surgical abortion?

Consider this untenable scenario from 1998 that sadly may become more common if these laws stand.

I was asked to perform an abortion for a very sick pregnant women in her first trimester. She had a medical condition that was deteriorating much more rapidly than expected because of her pregnancy. She was not seconds away from dying, but her medical specialists were concerned that, in the next day or two, she would be likely to develop kidney failure.

While kidney failure can be managed with dialysis, preventing that from happening is the best medical course. Not only in the short term, but saving my patient’s kidneys also would prevent a cascade of medical events that could end her life prematurely in the long term. After all, life expectancy is shorter on dialysis. That’s why we do renal transplants.

My patient’s specialists believed that, if she were not pregnant, they might be able to avoid dialysis. Ending her pregnancy would not save her life that day, but it might next week or next month or in five years. We don’t have crystal balls in medicine, so we often can’t say with certainty who will deteriorate with a given medical condition or precisely when.

But that year, the Kansas legislature had passed a law banning abortions on state property, which included the medical center where I worked. But under the law, an abortion would be allowed to save the life of the pregnant woman.

So when I received a call asking whether I could help this patient, my next phone call was not to the operating room to make arrangements — instead I called the hospital’s attorneys. They did not know how to interpret the law either. Unless my patient was actively dying — for example, we were running a code for a cardiac arrest — an abortion would most likely be illegal. If I did the procedure, I would be fired.

To reconcile our disagreement, the hospital’s attorneys felt the only course of action was to get the opinion of the legislator who wrote the law. An attorney set up a conference call with this man so that I could plead my patient’s case.

I began to explain the medical situation, how ill she was. He interrupted me after a few seconds: “Whatever you think is best, doctor.”

My patient got the abortion and her health improved as a result. But I was furious. How dare some legislator applaud this monstrous law in public all the while deferring to a doctor’s expertise in private.

And things could have gone very differently. If the hospital’s attorney had agreed that the abortion fit the legal requirement, then I would have provided the abortion without calling the legislator. But someone could still have reported me to the police. And then who would have adjudicated whether I was in acting in line with the law? The police? The district attorney? Twelve jurors? The governor?

How would I have defended myself if I had been arrested? Medical malpractice insurance does not cover criminal prosecution.

Or what if the hospital attorneys had simply said no? I could have risked being fired. Or I could have faced a malpractice lawsuit for not intervening as was medically indicated. I would have had to endure the emotional burden of knowing I had the training to help save a patient but did not act because I was afraid of the government.

If abortion restrictions come to pass, doctors may have to start calling politicians at home to find out how a law applies to their patient or else deal with the various ways these situations can go wrong.

And what of the answers they might get when they call? I know a woman who is 21 weeks pregnant with ruptured membranes who has an intrauterine infection and medically needs an abortion. Does Gov. Kay Ellen Ivey of Alabama know this?

Women will die if laws like those passed in Georgia and Alabama are allowed to stand.

The people who write our abortion laws are living in a post-truth world. So let me share some medical truths: Abortion is sometimes medically necessary, and women will have abortions whether they are safe and legal or not. Creating legislation that suggests otherwise does not change that truth.



Jen Gunter, an obstetrician and gynecologist, is a columnist for The Cycle, which covers women’s reproductive health, and appears regularly in The Times’s Styles section.

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