The country’s top medical organizations condemned the overturning of Roe v. Wade today, saying the removal of federal protections for women to access abortion services marks a “dark day.”
“It is unfathomable. It is unfair. It is wrong,” said President of the American College of Obstetricians and Gynecologists (ACOG) Iffath Abbasi Hoskins, MD.
“Today is a very dark day in healthcare. It is a dark day, indeed, for the tens of millions of patients who have suddenly and unfairly lost access to safe legal and evidence-based abortion care,” Hoskins said at a press conference today sponsored by ACOG.
“It is dark for the thousands of clinicians who now instead of focusing on providing healthcare to their patients, have to live with the threats of legal, civil and even professional penalties,” Hoskins added.
ACOG has 62,000 members and is the leading group of doctors that provides obstetric and gynecologic care.
Dilemma for Some Doctors?
“I’d like to take a moment to talk about the future of the medical profession,” said ACOG Chief Executive Officer Maureen G. Phipps, MD, MPH. “Today’s decision is, as Dr Hoskins clearly said, a tragic one for our patients in states across the country, but the harm does not end there.”
Phipps described overturning Roe v. Wade as “the boldest act of legislative interference that we have seen in this country. It will allow state legislators to tell physicians what care they can and cannot provide to their patients.”
“It will leave physicians looking over our shoulders, wondering if a patient is an enough of a crisis to permit an exception to a law,” Phipps added. “This is an affront to all that drew my colleagues and me into medicine.”
Although the impact on doctor training remains to be seen, she said 44% of Ob/Gyn residents are trained in states now empowered to ban abortions.
The effect of the Supreme Court decision on miscarriage management is another unknown.
“It’s going to be very difficult for us, the clinicians, to manage miscarriage,” Hoskins said. “Many miscarriages could be what we call ‘incomplete’ in the beginning,” where there is still a heartbeat and the patient is cramping and/or bleeding.
In that instance, Hoskins said, clinicians may be thinking that they have to wait.
“They may be needing to get additional opinions, whether it’s a legal opinion…or another medical opinion.”
“It’s going to have a devastating effect on every aspect of a woman’s healthcare including if she is spontaneously miscarrying,” Hoskins predicted.
Physician Protect Thyself?
To what extent doctors can shield themselves from potential prosecution “is a hard question to answer,” Molly Meegan, JD, ACOG’s chief legal officer and general counsel, said.
Meegan recommended members speak to the risk managers at their individual institutions for guidance.
“It is a real patchwork [of laws] out there, she said. “And that patchwork itself is a danger to people as they seek essential reproductive healthcare.”
Also, she added, “If a doctor can’t tell what the law is at the time they’re trying to provide the care, it has a terribly chilling effect on medical care.”
Another potential threat to doctors in states that still allow abortion services is action from a neighboring state.
“We are going to be advocating very strongly that states do not have extra-territorial jurisdiction to reach beyond the edges of their state,” Meegan said.
The worry is if a doctor in New Mexico, where abortion is legal, performs an abortion for a person from Texas, where it will soon be illegal, is then prosecuted by Texas, for example.
Asked about any potential effects on medication abortions, ACOG’s Jen Villavicencio, MD, said it remains to be seen.
“Certainly many of the laws that we have seen, including trigger ban laws, encompass medication abortion,” she said. Several states have these so-called trigger laws, which put into effect laws passed to ban abortion in case Roe was overturned.
This means, she said, that any abortion option, whether it’s procedural or medication, could be and will be banned in some of these states.
Meegan added that ACOG will continue to support access to medication abortion, and that it should be decided by the US Food and Drug Administration and not individual states.
Maternal Mortality May Rise
“Maternal mortality in and of itself is a very difficult topic,” Hoskins said, but today’s decision amplifies the implications. “I think of the patients who will have to manage severe complications and mental health challenges while they are carrying a pregnancy that they are forced to carry.”
“I also think of the patients who need to end their pregnancies in order to save their own lives,” Hoskins added.
Hoskins said the United States already has a high maternal mortality rate. This new law, she added, could force women into higher risk situations if they experience high blood pressure, pre-eclampsia, or bleeding after the birth of the baby.
Growing Inequality Possible?
“The grievous inequities that exist in this country will grow and expand unchecked without safe access to legal abortion,” Phipps said.
She noted that women, based on location, will continue “to have protected access to safe evidence-based abortion. Others will have the means and resources and opportunities to secure the care.”
But the same may not be true for women in underserved or disadvantaged communities, Phipps added.
American Medical Association
ACOG was not the only group to react. “The American Medical Association is deeply disturbed by the US Supreme Court’s decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive healthcare,” President Jack Resneck Jr, MD, said in a statement.
The decision represents “an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient–physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services.”
American Academy of Family Physicians
“The American Academy of Family Physicians is disappointed and disheartened by the Supreme Court’s decision to strike down longstanding protections afforded by Roe v. Wade and Planned Parenthood v. Casey,” President Sterling N. Ransone Jr, MD, said in a statement.
The organization has 127,600 physician and medical student members.
American College of Physicians
“A patient’s decision about whether to continue a pregnancy should be a private decision made in consultation with a physician or other healthcare professional, without interference from the government,” President Ryan D. Mire, MD, said in a statement. “We strongly oppose medically unnecessary government restrictions on any healthcare services,” added Mire on behalf of the group’s 161,000 members.
American Academy of Pediatrics
“This decision carries grave consequences for our adolescent patients, who already face many more barriers than adults in accessing comprehensive reproductive healthcare services and abortion care,” President Moira Szilagyi, MD, PhD, said in a statement.
“In the wake of this ruling, the American Academy of Pediatrics will continue to support our chapters as states consider policies affecting access to abortion care, and pediatricians will continue to support our patients,” Szilagyi added.
American Public Health Association
The court’s decision “is a catastrophic judicial failure that will reverberate differently in each state and portends to jeopardize the health and lives of all Americans,” Executive Director Georges C. Benjamin, MD, said in a statement.
American Urogynecologic Society
“The American Urogynecologic Society opposes any ruling that restricts a person’s access to healthcare and criminalizes the practice of medicine,” the group said in a statement. “This ruling ultimately poses a serious threat to the patient–provider relationship and subsequent decision-making necessary to ensure optimal outcomes for patients. As practitioners, we should be free to provide what is in the best interest of our patients.”
Kara Grant, Kaitlin Edwards, and Leigha Tierney contributed to this report.
Damian McNamara is a staff journalist based in Miami. He covers a wide range of medical specialties, including infectious diseases, gastroenterology, and critical care. Follow Damian on Twitter: @MedReporter.