Our recent ACEP Now article on attending a Supreme Court rally during EMTALA and abortion ban arguments prompted many responses. In her letter, Dr. Draper argues that abortion bans are clear and do not hinder the provision of standard medical care. This could not be further from the truth.
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ACEP Now: Vol 43 – No 12 – December 2024States with restrictive abortion bans are seeing an increase in maternal morbidity and mortality.1 These laws, written by legislators with little or no physician input, are vaguely written, using non-medical terms such as “dead unborn baby” to describe exceptions. These poorly written laws are causing delays or denials of care and increasing pregnancy complications—even when indicated care would have been allowed by the letter of the law. Proponents claim that the exceptions typically contained within abortion bans are clear enough for effective care, but real-life outcomes tell a different story.
For example, “medical emergency” exceptions are often poorly defined, forcing doctors to interpret vague laws during urgent clinical situations. In Texas, Josseli Barnica presented to a hospital 17 weeks pregnant with a miscarriage in progress. Because of the state’s abortion ban, doctors waited 40 hours until fetal cardiac activity ceased before inducing a delivery. She died three days later from an infection, most likely caused by the prolonged time her cervix was dilated. In a state without an abortion ban, Barnica could have been offered an induction of labor or dilation and evacuation sooner, which could have saved her life.
Furthermore, many pregnancy situations, like preterm premature rupture of membranes (PPROM) before fetal viability, do not fit within the narrow exceptions defined by “medical emergency” exception laws. In these cases, terminating the pregnancy is often necessary to protect the patient’s health and future fertility, and waiting until there is no fetal cardiac activity only prolongs risk to the patient. Denying timely emergency abortion care, as was shown in the case of Mylissa Farmer, violates EMTALA; she was denied care in both Missouri and Kansas after experiencing PPROM at 18 weeks.
Dr. Draper, despite asserting legal clarity, spends much of her response discussing the case of Amber Thurman, a woman who died in Georgia from complications after using legally obtained abortion medication from another state. Georgia law permits treatment for spontaneous miscarriages but lacks clear guidance for induced cases, complicating decisions about treating retained products after an induced abortion. Dr. Draper herself acknowledges that ambiguity around the cause of Amber’s retained products of conception may have contributed to delays in her care and her death, yet she shifts responsibility to doctors to manage within these vague constraints. We wholeheartedly agree that it should be the physician’s responsibility to decide what is the safest and most effective medical treatment for his or her patients. However, this case, and many others, show that the laws as currently written are not providing physicians the needed
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3 Responses to “Point/Counterpoint: Abortion in the Emergency Department”
December 22, 2024
Todd B TaylorIn any contentious debate, it is important to hear from all sides, as the “truth” often lies in the middle. I wish to thank & congratulate Dr. Draper for her courage in bringing this perspective. In our current media-driven ideological “cancel-culture” society, contrarian voices are all too often left unheard.
In the rebuttal, Dr. Draper was called out by name 6 times in 7 paragraphs. While not particularly ad homonym, I will point out her arguments are reflective of the sentiments of many emergency physicians & the even the lay public who have had enough of political posturing.
In attempts to foster political ideology, the media & certain pro-abortion advocacy groups have foisted fantastical catastrophizing on the American public. There is no doubt this has caused many OB\GYN’s to take the most “conservative” (some might say “extreme”) approach in managing inevitable miscarriages.
While this rebuttal calls out a few examples (including in reference #1) of adverse outcomes, there is no doubt there are many more cases in which the usual standard of care in such states was followed, yet no physician has ever been accused, let alone prosecuted.
While this situation has certainly captured attention, there are other similar examples of controversies that have threatened the careers & livelihoods of physicians (albeit without the excessive media attention). In the early days of EMTALA, there were several examples of physicians trying to “do the right thing” that ran afoul of this federal statute, suffering career ending Medicare decertification & hundreds of thousands in fines. EMTALA also precipitated an on-call specialist availability crisis as thousands resigned or limited medical staff privileges. There were numerous hospitals that closed due to direct or indirect consequences of EMTALA. In time, however, advocacy, education, practice accommodation & case law resulted in something we can live with.
So, what I believe Dr. Draper is trying to say, let’s turn down the rhetoric & “right-fighting”, so we can move on to solutions that acknowledge reality & are ultimately best for patients.
December 23, 2024
John TannerFive versus one and you didn’t even give Dr. Draper a chance to respond? What’s up with that?
December 29, 2024
Mike DorrityHere’s a direct quote from the Texas Court opinion in State v. Zurawski the 5 authors cite but seem to ignore:
[2]Under the Human Life Protection Act, a woman with a life-threatening physical condition and her physician have the legal authority to proceed with an abortion to save the woman’s life or major bodily function, in the exercise of reasonable medical judgment and with the woman’s informed consent. As our Court recently held, the law does not require that a woman’s death be imminent or that she first suffer physical impairment. Rather, Texas law permits a physician to address the risk that a life-threatening condition poses before a woman suffers the consequences of that risk. A physician who tells a patient, “Your life is threatened by a complication that has arisen during your pregnancy, and you may die, or there is a serious risk you will suffer substantial physical impairment unless an abortion is performed,” and in the same breath states “but the law won’t allow me to provide an abortion in these circumstances” is simply wrong in that legal assessment.
As others have said on ACEP discussion boards, fear of prosecution is not the same as prosecution.