Red states may be dangerous for physicians
27 January 2023
In the past, the medical aspects of a physician’s practice were usually determined by characteristics of the physician’s medical group or employer, perhaps modified by the State’s malpractice laws. Today, however, the political party that controls the State’s government may have a marked influence.
I suggest that practicing medicine in red states (i.e. those governed by Republican elected officials) or those with anti-abortion laws may be particularly dangerous for physicians, for these reasons.
We cannot provide appropriate medical care and focus on the best interest of our patients if we are worried about being prosecuted for murder or other crimes for doing so.
This is particularly true because most red states have, or will soon have laws that restrict the use of abortions, even though these laws damage the health care of women and girls. For example:
In Louisiana, a woman carrying a fetus with no brain could not get an abortion and had to travel out of state, which delayed the procedure until it posed a greater risk to her health and future fertility.
In Ohio, a pregnant woman was discharged from the emergency room without treatment for her miscarriage even though she had been bleeding profusely for hours.
In Florida, a pregnant woman with twins had her water break (i.e. her membranes ruptured) at 20 weeks with one of the twins partially delivering. She was forced to come to the office every day until cardiac activity stopped or she developed signs of infection before the hospital would agree to end her pregnancy. In Texas, a pregnant woman had her water break at 18 weeks and was told she could wait for the fetus to die inside her or to develop a life threatening uterine infection.
Dr. Jessian Munoz, an OB-GYN in San Antonio, Texas who treats high-risk pregnancies, said medical decisions used to be clear cut. “It was like, the mom’s life is in danger, we must evacuate the uterus by whatever means that may be,” he said. “Whether it’s surgical or medical — that’s the treatment.” Now, he said, doctors whose patients develop pregnancy complications are struggling to determine whether a woman is “sick enough” to justify an abortion.
But medical professionals say it’s impossible to know how close a patient must be to dying before a needed abortion is exempt from a state ban. Even if a clear line existed, they say, medical ethics require doctors to treat patients as early as possible to avoid any negative outcomes.
“The overall impact of these laws is a chilling effect on the practice of medicine,” said Villavicencio of the obstetricians’ organization. “Regardless of the specific language, abortion bans scare health care providers into thinking that their profession is at risk, their freedom to provide the best possible care for their patients.
This fear of criminal prosecution even extends to the treatment of women or girls who are not pregnant because treatments for unrelated medical conditions may damage an unborn child in a future pregnancy, including:
The use of methotrexate for rheumatic diseases or immunologic conditions.
Other uses for methotrexate or misoprostol, pregnancy related or otherwise.
Receiving radiation therapy for cancer.
In addition, state abortion laws may limit the use of in vitro fertilization to become pregnant because of the increased risk of pregnancy complications inherent in these therapies.
Many physicians, including pathologists who do not do forensic work, do not want to have to testify in criminal investigations relating to miscarriages or abortions. This is not what we signed up for.
Physicians and other health care professionals may not want to risk being political targets, as has happened in Indiana, simply for doing their jobs appropriately.
The number of these cases is currently small considering that there are one million active physicians in the U.S. Yet how many cases must occur for physicians to feel threatened about practicing in their anti-abortion rights state?
Moving is an inherently difficult process involving many factors other than employment. But I suggest that physicians in red states should start thinking about alternative places to practice and what conditions would push them to start the moving process.