The Supreme Court’s decision stripping away the constitutional right to abortion is having devastating impacts on patient care, along with sowing legal chaos and confusion for physicians, doctors told lawmakers during a House oversight committee hearing Tuesday.
Dozens of states have outlawed or enacted harsh bans on the procedure in the month since the court overturned Roe v. Wade, resulting in patchwork access to reproductive care in the U.S.
The laws have had a chilling effect on patient care, resulting in providers — confused and concerned about the potential for legal action — delaying or denying in some cases life-saving obstetric services, jeopardizing maternal health, according to numerous reports.
“In this moment, I am terrified for my patients and my community,” testified Nisha Verma, a practicing OB-GYN based in Georgia and fellow at Physicians for Reproductive Health.
The restrictions are already affecting patients seeking a wide range of reproductive healthcare and threatening lives. In one case, a woman in Wisconsin bled for more than 10 days from an incomplete miscarriage after hospital staff did not remove fetal tissue, according to The Washington Post.
As a result, state lawmakers looking to curb elective abortions are putting providers in a moral quandary where they’re forced to violate their ethnics to comply with laws not based on medical fact, doctors testified.
Verma cited the example of a pregnant person with pulmonary hypertension, which is associated with significantly high morbidity rates. The risk of death if that patient continues their pregnancy is between 30% and 56%, according to the Pulmonary Vascular Research Institute.
“But under these laws, if these people come to me at six or seven weeks, can I perform an abortion? Or wait until they’re extremely sick?,” said Verma. “The idea of having to wait until someone gets sick is just counterintuitive.”
Doctors are consulting ethics boards, lawyers and peers for second opinions in a bid to continue operating in an increasingly gray legal area.
“Our members in many states are reporting chaos and confusion,” testified Jack Resneck, president of the American Medical Association.“Physicians are worried about the prosecution for their patients and themselves in the midst of significant legal uncertainty. Let me be clear — this is dangerous for our patients.”
Resneck cited patients with ectopic pregnancies, when a fertilized egg implants outside the uterus, or miscarriage complications, as it’s now unclear when physicians are allowed to intervene. As many as 30% of pregnancies can end in a miscarriage, which traditionally requires the same treatment and medication as an elective abortion.
“Doctors take an oath to do no harm,” former physician Rep. Kim Schrier, D-Wash., said at the hearing. “Who draws that line? Kidney failure? Heart failure? Who draws that line?”
Earlier this month, the HHS issued guidance clarifying that doctors nationwide are required to provide lifesaving abortions in emergency situations under the Emergency Medical Treatment and Labor Act. Texas has challenged the guidance in court.
Christina Francis, CEO-elect of the American Association of Prolife Obstetricians and Gynecologists, testified the directive was unnecessary. Francis also argued all state bans on abortions have exceptions for life-threatening situations.
But “it is the fault of the restrictive abortion laws that are on the books that individuals are being denied access to lifesaving care,” said Leah Litman, a law professor at the University of Michigan.
The restrictions are also affecting treatment for a wide range of conditions beyond abortion care, experts said.
Resneck noted doctors in specialties unrelated to reproductive health, including dermatology, anesthesiology and radiology, are concerned about providing care that could inadvertently affect a fetus.
Some pharmacists are also refusing to fill scripts for medications that could potentially cause a miscarriage, including drugs for autoimmune conditions and rheumatoid arthritis, the AMA president said.
The rollback in care access stemming from the demise of Roe will fall more heavily on traditionally underserved populations, including Black Americans and people who have low incomes. The U.S. is likely to see health disparities and already grim maternal mortality rates worsen as a result, witnesses said.
“I want to be very clear — to attack the right to access abortion care is to wage war on the poor. Individuals of wealth and means have always been able to access abortion care and will always be able to access abortion care no matter what the laws decide,” testified Paulina Guerrero, national programs manager at pregnancy support group All-Options.
Guerrero said her clients are feeling a “huge sense of urgency,” along with “mass confusion” and “fear” in the wake of the Supreme Court’s decision.
”What is already an untenable situation has become close to impossible,” Guerrero said.