An excerpt from our Medical Editor in Chief Dr. Cedric Dark : As you read our August issue, may also notice a theme emerging from some of the other pieces in this issue: they touch on controversial issues. This is both a symptom and side-effect of our current social, political, and professional climate. The topics discussed in this issue are meant to highlight the work, and the worries, of our profession. No matter which side you take, each topic affects us all professionally and personally. Our diversity of experience and opinion is what makes emergency medicine, the American College of Emergency Physicians, and America itself enriching. I hope that you will enjoy reading this issue, and most of all, learn something new from what you find inside.

First, abortion is not a constitutional right. Nowhere in the U.S. Constitution does it say we can end the life of our citizens with abortion. Second, why do you think we will see an increased number emergency department (ED) visits related to pregnancies? We always have women who come in just to verify their pregnancy or who have complications with their pregnancy. This decision to return abortion laws back to the individual states will make no change in ED visits for the reasons you stated in the first part of your article. I agree with some increase visits of complications from procedures outside your state if your state restricts them. However, in my county there are no abortion clinics within 100 miles and we have been dealing with a very small number of ED visits (Level I trauma center and main obstetrician-gynecologist hospital for the area) related to patients with abortion complications for over 25 years.

Statements such as crisis pregnancy centers are “meant to dissuade patients from seeking abortions through misinformation and intimidation,” show an obvious bias of the writer of the article. While I have no doubt this may occur at times, one could make an equal argument that Planned Parenthood, the largest provider for abortions, does the same for persuading women to have an abortion.

[ACEP Now] should try to stick with medical facts and not biased opinions attempting to worry inexperienced emergency physicians. Mentioning there will be a small uptick in visits from abortion problems from procedures done out of your area is reasonable, but most of the rest is our standard operating procedure and nothing new for emergency physicians.

—David Wharton, MD, FACEP

In this emotionally charged debate, I think it is important to avoid insertion of ideological bias, which for the most part you accomplished. However, I really do not think we have any idea how this Supreme Court ruling will impact emergency physicians at this point. There is no doubt there will be many consequences to this ruling, but I am having a difficult time imagining any untoward consequences on emergency [physicians].

Are we expecting women to come to the emergency department demanding an abortion? Or perhaps prescriptions for mifepristone/misoprostol? Unlikely, but an easy “no” nonetheless.

—Todd B. Taylor, MD, FACEP

I agree with the thoughts of Dr. Wharton and Dr. Taylor. They articulate my thoughts better than I could have. I would like to add that now is the perfect opportunity for our medical community to advocate for improved employer-based benefits to support women in pregnancy. Improved maternity coverage, maternity and paternity leave, employer-based day care, comprehensive affordable family medical benefits, and maternity corporate executive level discrimination protections are perhaps a few examples. At least taking those concerns off the table when making the difficult choices surrounding pregnancy.

One last thought: Is it not interesting that after the recent ruling that simply returns this debate to the states, there are some corporations that cover the cost of travel to have an abortion; yet, at the same time, provide minimal health care coverage for their employees and even less day care support, etc. Who is it exactly who doesn’t want the child brought to term? The company or the mother?

—Anthony Pohlgeers, MD

I think it’s prudent for ACEP to inform and prepare [emergency] physicians for what they might see in their departments, but it’s unfortunate when it’s done in a clearly biased manner. The characterization that pregnancy resource centers are “usually staffed by nonmedical personnel” and “meant to dissuade patients from seeking abortions through misinformation and intimidation” is misleading at best and slanderous at worst. I’m on the board of one such center and I can assure you this is not the case. Our staffing includes nurses trained to perform ultrasounds and limited STI testing, all of which are reviewed and addressed by one of our local OB/GYN physicians. All pamphlets and other information given by peer counselors have been reviewed by physician medical directors. Regarding misinformation, rather than open debate on controversial medical subjects about which physicians disagree (like we do within ACEP for TPA, for example) it seems some would prefer to demonize and silence the other side. Further, the blanket charge of “intimidation” is akin to saying all abortion clinics are like the one run by Kermit Gosnell. On the contrary, in our local center I have witnessed nothing but love and compassion for mothers (and fathers) in tough situations. In addition to the above, our center provides free diapers, clothes, car seats, parenting classes, and much more. It has served our community well for over 30 years. Sadly, since the overturn of Roe v. Wade, centers in multiple states have been the victims of vandalism and intimidation. I would hope reasonable people can see the irony in violence directed at centers whose goal is to help people facing unplanned pregnancies.

—Mike Dorrity, MD, MA