Here’s What Hospital Care Could Look Like in a Post-Roe World

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Over two years ago, I and a team of researchers set out to learn how policies on abortion at Protestant hospitals in the South impact the medical care that pregnant patients—including those with serious health conditions—receive. What we found surprised us: not only were limits on abortion pervasive at Christian hospitals, but many secular hospitals in the South had similar restrictions. 

Doctors told us how these policies limited the treatments they could provide to pregnant patients with conditions ranging from leukemia to kidney disease. After reading the Supreme Court’s draft opinion that stands to overturn Roe v. Wade this June, it’s clear that our findings will have a new relevancy far beyond what we initially aimed to study. To understand what medical care after Roe will be like if you’re pregnant, look to the hospitals that have long banned abortion—and add the threat of criminal punishment.

In The Southern Hospitals Report: Faith, Culture, and Abortion Bans in the U.S. South, we found that abortion restrictions at Southern Protestant hospitals—including enormous systems like Baylor Scott & White and AdventHealth—are ubiquitous. These policies typically prohibit any doctor in their facilities from performing an abortion except in the narrowest of circumstances, such as (according to one written policy) when “medically necessary to avert…a serious risk of substantial and irreversible physical impairment of a major bodily function, other than a psychological condition.”

Who decides when an abortion is “medically necessary,” and therefore permitted? In some hospitals, we discovered that these determinations are made not by treating physicians, but by dedicated committees, some of which include faith leaders. As one Reverend told us, “every abortion that is…given here at the hospital has to come before this committee of which I’m on.” Even some public hospitals use abortion committees, which may include non-OB/GYN members, such as lawyers. Such committees were common nationwide in the pre-Roe era. 

“Trigger bans” that will automatically prohibit abortion in many states if Roe v. Wade is overturned typically also contain medical exceptions. For example, Arkansas’ trigger ban permits abortion “to save the life of a pregnant woman in a medical emergency.” But determining when a patient’s condition is serious enough to require immediate intervention in order to save their life is by no means obvious. 

There is, perhaps, no clearer example of the dire risk that this tenuous standard imposes on patients than the many women who have told powerful accounts of being denied emergency medical care (or providers having to deny such care) while experiencing a miscarriage. Most recently, an NPR article detailed an account of how Texas’s abortion ban forced a woman to take a plane to Colorado for care after her water broke at only 19 weeks, well before viability. Thankfully, the woman was able to afford and plan the trip. 

If the fear of violating an internal hospital policy can cause doctors to withhold medical care from their patients, the fear of criminal prosecution will have a far more disastrous effect. After Roe, a physician’s medical intervention that’s intended to treat their pregnant patient, but is later deemed unnecessary or premature by a court, could subject the doctor not just to discipline by a hospital administrator, but to prison time. 

While some trigger laws may provide a defense for doctors who provide “treatment to a pregnant woman which results in the accidental or unintentional injury or death to the unborn child,” these standards are unclear, and few doctors will want to take the risk of testing them. Patients will, of course, be the primary victims of this legal threat.

Further, the end of Roe will impact medical care beyond the issue of when and whether to perform an abortion. Absent a medical emergency, pregnant patients may find themselves being denied essential treatments, such as radiation therapy, that could help them but might pose a risk to a developing embryo or fetus. One doctor explained how her hospital’s existing abortion ban impacted a patient with cancer. She told us that, had the patient been able to end her pregnancy in the facility, oncologists could have offered: 

“different treatments, they could do the same treatments but do it more aggressively and they wouldn’t have to worry about fetal effects or anything like that…[but] our hospital has to report…how many abortions are done at that hospital and they try their hardest to make that number zero.”

Most doctors aren’t eager to have their medical practices subjected to criminal investigation. However, a few do wholeheartedly support the end of Roe. One of the most disturbing anecdotes in our report involved a pregnant woman who came to a hospital in Ohio with suicidal thoughts. An obstetrician involved in her care told us that an anti-abortion psychiatrist “interviewed her and came out to discuss the case with the OB team. She told us the patient wasn’t suicidal, but rather, ‘feticidal,’ and should be discharged to jail…They wouldn’t let us keep her in the hospital. We discharged her from the hospital with no help, no support.” 

The doctor added, “[t]he case haunts me to this day.” The Supreme Court’s decision will enable and encourage such actions.

The end of Roe v. Wade will have a devastating impact on millions of people in countless ways, both obvious and unforeseen. One of those impacts will be that pregnant people who step into a hospital expecting treatment for a medical condition find that their own health and well-being no longer comes first.

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