Imagine a 9-week pregnant patient who comes to the emergency department with vaginal bleeding and abdominal cramping. Like nearly a quarter of pregnancies, she is experiencing early pregnancy loss, also referred to as spontaneous abortion or miscarriage. As she continues to bleed, she becomes progressively tachycardic and hypotensive, entering hemorrhagic shock, requiring an emergent procedure in order to preserve her health and save her life.  

Now imagine she lives in a state with laws that restrict clinicians from performing abortion care, even in emergency scenarios. Although this patient’s pregnancy is nonviable, because dilation and curettage can also be used in abortion care, in certain states this may fall under the abortion ban. Abortion is completely illegal, regardless of gestation age, in fourteen states, including Idaho, North and South Dakota, Indiana, and most of the South, with exceptions only if the patient’s life is threatened. Few have exceptions for threat to the patient’s health, though the definition of “health” varies and can be arbitrary. In these cases, she would either have to be transported to another state where abortion care is not criminalized (one Idaho hospital had to airlift 6 patients in just the first three months of 2024) or wait until she is quite literally near death to be treated.  

This is the situation at hand as the Supreme Court, as well as several lower courts across the nation, considers the right to emergency abortion care – in particular, whether the Emergency Medical Treatment and Labor Act, or EMTALA, protects patients in these scenarios. EMTALA mandates that any patient who comes to an emergency department experiencing an emergency medical condition must be treated and stabilized, which may involve an abortion. 

On April 24, 2024, the highest court in the nation heard oral arguments on the consolidated cases Idaho v. United States and Moyle v. United States, which argue that state restrictions on emergency abortion care can override EMTALA. As emergency medicine residents at George Washington University, we had the unique opportunity to participate in the rally outside the Supreme Court which is right in our backyard here in Washington DC. Showing up en masse in our white coats along with our medical school’s OB-GYN residents and fellows, we came together to advocate for continued access to emergency abortion care; to advocate for our patients. It was an unprecedented experience in place of our usual weekly didactics, which felt all the more impactful to have our entire program, including faculty and leadership, declare that this is an important effort worth learning about and spending time on.  

The Supreme Court has since dismissed these cases as improvidently granted – meaning that the Court should not have accepted the cases in the first place, but made no comment on the subject of the case itself. This decision means that while the case goes back to the lower courts, emergency abortions to protect a pregnant person’s health will be allowed in the state of Idaho; however it does not unequivocally affirm that emergency abortion care across the nation is protected by federal law, and thus keeps the door open for other states to enact similar laws. In fact, there is already another case raised by the state of Texas regarding the validity of EMTALA in protecting emergency abortion care.   

Training in the nation’s capital gives us front row seats to national health care policy making and discourse while we, at the same time, see individual patients who are impacted directly by these critical government decisions. Participating in the demonstration on April 24th allowed us to join local and national organizations, a refreshing break from long hours in the hospital, to declare that abortion is healthcare and reproductive rights are human rights. This aligns with the American College of Emergency Physicians policy that supports the development of clinical practices that protect medical care services for pregnancy-related concerns, including abortions, and that protect emergency physicians in cases of conflict between state and federal laws, such as EMTALA. They also encourage hospitals and residency programs to provide education, training, and resources on abortions.  

It is even more urgent now to support the lawyers, physicians, and nonprofit leaders who work tirelessly to enable access to care at both the micro and macro levels. As Justice Ketanji Brown Jackson stated in her dissent, this decision is “not a victory for pregnant patients; it is a delay. Pregnant people experiencing medical complications remain in a precarious position, as their doctors are kept in the dark about what the law requires.”  

Directly or indirectly, all of us providers in the country are being affected. As physicians, even as resident physicians in training, our white coats and degrees hold weight, and our responsibility should not be limited to the walls of an emergency department. This case and the rally we participated in remind us that our patients are depending on us to advocate on their behalf, and we cannot afford to be silent on this issue; we cannot wait until our patients are near death before our nation’s lawmakers take action.  

Neha Gupta, MD is a PGY-2 resident in emergency medicine at George Washington University in Washington, DC. She is Vice Chair for Admin & Operations for EMRA and Editor for Urgent Matters.  

Karen Hou Chung, MD is a PGY-4 resident in emergency medicine at George Washington University in Washington, DC. She is interested in a wide variety of topics related to health equity and population health.  

Breanne Jacobs, MD is an Assistant Clinic Professor of Emergency Medicine at the George Washington University School of Medicine and staff physician at US Acute Care Solutions.  She is an ACEP Ethics Committee member and her research interests include palliative care and ethical considerations in emergency medicine 

EDITORS’ NOTE: As abortion restrictions are state specific, emergency physicians are encouraged to discuss with legal counsel or risk management to determine the appropriate course of action in their own states.