The patient was seven weeks pregnant in Texas, and had kidney failure. Many doctors consider this a life-threatening condition.
Abortions are prohibited in Texas after a fetal beat is detected (around six weeks of pregnancy), unless “a doctor believes that a medical emergency prevents compliance.” Texas will soon see a complete ban on abortions, triggered by Roe v. Wade’s repeal.
“I was like: ‘Don’t give her an appointment’,” Dr. Jessica Rubino at Austin Women’s Health Center recalled telling her staff. “Get her out the state. Talk to someone at another clinic. Make sure she is able to get an abortion. I won’t be able do it here. “I’m going have to wait until she’s actually dead before I can help her.”
Rubino will no longer provide abortions due to legal culpability under Texas law.
Texas’ current heartbeat ban allows private citizens to sue anyone who assists someone in getting an abortion. This is within six weeks. Plaintiffs could receive as much as $10,000 if the lawsuit is successful. A trigger law, which will take effect 30 days after the Supreme Court’s judgment, makes abortion a felony. It does not allow for incest or rape. For each violation, providers can face a maximum $100,000 fine. Rubino was also warned by lawyers that Texas had an outdated abortion ban that was not repealed following the Roe decision.
“My lawyer said to me that unless they are dying on the table, you can’t perform an abortion on them. Or you are violating the law.” She added, “How do I help people get out of jail?”
Many doctors are now in a similar situation. Many abortion bans in force since Friday, or soon to become law, allow for exceptions for life-threatening circumstances that may arise during pregnancy. There is no legal standard for what conditions are eligible for these exceptions or how severe they must be in order for a doctor not to be held liable for an abortion.
“What is the death risk and how urgent must it be?” Lisa Harris, a professor of reproductive medicine at the University of Michigan, published her thoughts in The New England Journal of Medicine this month. “Is abortion permissible for a patient suffering from pulmonary hypertension? We cite a 30-to-50% risk of death in this case. Or is it 100%?
Harris stated to NBC News that doctors who are allowed to perform abortions in states that have legalized them (which is not Michigan’s case) will wait until it is clear that a patient is dead to perform the procedure. This is not a good time to make any type of intervention.
Experts predict that there will be more maternal deaths.
According to the Centers for Disease Control and Prevention, approximately 700 women are already dying each year from pregnancy-related complications in the U.S. About 3 out 5 of these deaths could have been prevented. According to a study, states that limit abortion access have higher maternal deaths than those who allow it.
Harris stated that an ectopic pregnancy, which ruptures the fallopian tubes, is one of the most dangerous conditions for a pregnant woman. This happens when the fetus grows outside of the uterus. It can cause internal bleeding, and may require immediate surgery.
Harris stated that an infection of the uterus could also prove to be life-threatening. Harris said that patients who hemorhage from ongoing miscarriages or traumas can also be affected.
“Often, the rule is that she must be at imminent danger of dying,” stated Priscilla Smock, the director of the Program for the Study of Reproductive Justice at Yale Law School. This means that you are putting people at imminent risk of death rather than putting her life in danger by allowing her to have a pregnancy.
There are many situations in which it is unclear if a patient is near death.
Harris stated that it’s not like there’s a switch that turns on or off that tells someone that they are bleeding but not enough to cause death. Then, all of a sudden, Harris says that there’s enough blood to cause death. It’s a continuum. So even knowing where someone is in that process can be tricky.
Sometimes, when pregnant women are diagnosed with cancer or pregnant women with cancer become pregnant, they must decide whether to terminate the pregnancy and undergo radiation, chemotherapy or surgery. These treatments can cause harm to the fetus.
Smith stated that this situation is unlikely to be life-threatening.
One such case was reported by The Dayton Daily News this week. It involved a woman whose doctors stated she must terminate her pregnancy in order to receive chemo. She will need to leave Ohio to do so. A judge lifted Friday’s injunction that had prevented Ohio from banning abortions when a fetal heartbeat has been detected.
Harris stated that there are many conditions that could pre-exist or have been present for the first time in pregnancy. This is also where there’s ambiguity. The patient may be fine for the first time during early pregnancy but might not be okay later on when all the body systems are working harder.
She stated that she is still concerned about patients suffering from pulmonary hypertension, which is high blood pressure that affects the arteries of the heart and lungs.
“Could a patient ask for an abortion to prevent a 50% chance that she will die?” She said. “That seems like a very good chance to me.”
Smith stated that there aren’t many legal norms around the topic yet because few court cases have dealt with it. Even if there were, medical issues are extremely variable.
Harris stated that “regularly high blood pressure isn’t something that would be considered life-threatening but it could for some people — each person is unique.”
Many abortion bans make it illegal to perform or attempt to perform an abortion. This means that doctors and clinics will be prosecuted and tried rather than individuals.
Smith stated that she believes many states with abortion bans have “zealous prosecutors” who “will be doing whatever they can shut down clinics, either throwing doctors in jail or taking away their licenses.”
Doctors may choose to err on their own legal side when making decisions regarding patient care. Rubino stated that her Texas practice, even before Roe was reversed, wasn’t certain it would be able to secure sufficient funding to pay the civil lawsuit fines or expenses.
She said, “No one knew how often I would be sued.” “How many abortions could I be sued?” Is it possible to sue multiple people for the same abortion?
Although hospitals might not be able to perform emergency abortions if clinics cease performing them, Harris stated that some hospitals do not have enough physicians who are qualified to perform this procedure.
Harris stated that if doctors have to resort to major abdominal surgery in these cases, it would be “at great risk for a patient and a significantly higher cost of complications and threat to your ability to become pregnant in future.”
Rubino expects that there will be more deaths from pregnancy in her state.