Doctors’ Reactions to the Federal Abortion Ban

Dr. Paula Hillard

Physicians are full of questions about how the Supreme Court's ruling will affect them and their patients. This decision endangers women's health and makes it harder for physicians to provide the best possible care to women.

Editor’s Note, July 8th, 2008: In response to the recent flurry of news coverage concerning Barack Obama’s statements on late term abortion, the federal abortion ban, and health exceptions for pregnant women, Rewire is republishing relevant articles that we hope
will focus the debate and add the crucial voices of those who are directly affected by these laws – women and physicians.  

The Supreme Court dealt a stunning blow to doctors last Wednesday, when they upheld a federal law banning a particular abortion method. As a board member of Physicians for Reproductive Choice and Health (PRCH), I’ve spoken with many abortion providers in the days since the ruling. They are full of questions, concerned about their patients and confused about the language of the ruling. Most of all, the physicians I’ve spoken with are asking how this ruling affects the way they practice medicine and the safety of the treatments their patients receive.

As physicians, we have a responsibility to act in our patients’ best interests—but the Supreme Court has just allowed Congress to override doctors’ expert opinions and ban a specific abortion method. This decision endangers women’s health and makes it harder for physicians to provide the best possible care to women. The doctors I’ve spoken to are angry and upset that they can no longer use a method they consider safest and best for many patients.

Dr. Christopher Estes shared a story with PRCH about a patient he treated last year. In an op-ed he wrote for The Daily News, Dr. Estes recalls treating a woman he calls Lisa. She was pregnant with her third child, and suffering from a heart condition that developed during her last delivery.

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"Her condition had worsened substantially within the last week, and we were not sure how much longer her heart could withstand the strain of her pregnancy," he says. Dr. Estes believed the safest treatment for Lisa was an abortion using the method Congress has banned. "I will have to think long and hard about what I will do the next time I take care of a patient like Lisa. What am I supposed to say to her? ‘I’m sorry, but you’re part of the small fraction of women our laws ignore?’"

It is absurd to think that politicians know more about medicine than the physicians who care for women every day, yet that is just what this decision says. Even as Justice Kennedy acknowledged that some of Congress’ findings were "factually incorrect," his opinion upheld the law as written.[img_assist|nid=3187|title=undefined|desc=|link=none|align=right|width=150|height=190]

The Supreme Court’s decision asserts many things that are simply not true. For instance, the ruling contends that because some women might regret having an abortion if they knew what was involved, the state should anticipate that and protect them. Essentially, this ruling says that untrained politicians can make medical decisions for all of America—even when doctors vehemently disagree with Congress’ supposed findings.

The language used in both the law and the Court’s decision troubles physicians. PRCH member Dr. Amy Autry notes that so-called "partial birth abortion" isn’t even a medical term: "That’s just a lay term," she says. "What they describe could be actually almost any abortion procedure."

Though Kennedy’s opinion refers to the procedure as intact dilation and evacuation, many physicians I’ve spoken to still aren’t clear about which abortion methods they can legally use. Dr. Deborah Oyer, another PRCH member, spoke to National Public Radio about the ban. "How to define exactly where the line is between legal and illegal in the procedures we do isn’t clear to me," she notes. "If I interpret it as drawn in one place and the courts interpret it somewhere else, I may have crossed the line."

Doctors are rightfully concerned about crossing that legal line. According to the act, we face up to two years in jail and hefty fines if convicted of violating the law.

We’ve heard from legal experts that the ban will go into effect 25 days after the Supreme Court decision, which gives doctors a tiny window to puzzle through the legalese and make plans to continue providing quality care to women. In the meantime, physicians are consulting with their lawyers—and with other colleagues and professional organizations—to make sense of the ruling.

Ultimately, this decision won’t change the need for abortion in America, or the desire of pro-choice physicians to care for our patients based on the best medical evidence. What we must do now is speak up about the dangerous effects this decision could have: fewer options for patient care, no legal protections for women’s health, and a wide-open door for further restrictions on abortion and other medical procedures. What’s next? Will Congress ban every medical procedure they personally oppose?

I have no doubt that the Supreme Court’s ruling on the federal abortion ban will have repercussions for years to come. As doctors, we are angry and outraged at this intrusion into women’s personal healthcare decisions. But we are also getting organized to fight back against the next wave of incursions on reproductive health. The Supreme Court may not think women’s health is paramount, but we do and we’re not backing down.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Law and Policy

Pastors Fight Illinois’ Ban on ‘Gay Conversion Therapy’

Imani Gandy

Illinois is one of a handful of states that ban so-called gay conversion therapy. Lawmakers in four states—California, Oregon, Vermont, and New Jersey—along with Washington, D.C. have passed such bans.

A group of pastors filed a lawsuit last week arguing an Illinois law that bans mental health providers from engaging in so-called gay conversion therapy unconstitutionally infringes on rights to free speech and freedom of religion.

The Illinois legislature passed the Youth Mental Health Protection Act, which went into effect on January 1. The measure bans mental health providers from engaging in sexual orientation change efforts or so-called conversion therapy with a minor.

The pastors in their lawsuit argue the enactment of the law means they are “deprived of the right to further minister to those who seek their help.”

While the pastors do not qualify as mental health providers since they are neither licensed counselors nor social workers, the pastors allege that they may be liable for consumer fraud under Section 25 of the law, which states that “no person or entity” may advertise or otherwise offer “conversion therapy” services “in a manner that represents homosexuality as a mental disease, disorder, or illness.”

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The pastors’ lawsuit seeks an order from a federal court in Illinois exempting pastoral counseling from the law. The pastors believe that “the law should not apply to pastoral counseling which informs counselees that homosexuality conduct is a sin and disorder from God’s plan for humanity,” according to a press release issued by the pastors’ attorneys.

Illinois is one of a handful of states that ban gay “conversion therapy.” Lawmakers in four states—California, Oregon, Vermont, and New Jersey—along with Washington, D.C. have passed such bans. None have been struck down as unconstitutional. The Supreme Court this year declined to take up a case challenging New Jersey’s “gay conversion therapy” ban on First Amendment grounds.

The pastors say the Illinois law is different. The complaint alleges that the Illinois statute is broader than those like it in other states because the prohibitions in the law is not limited to licensed counselors, but also apply to “any person or entity in the conduct of any trade or commerce,” which they claim affects clergy.

The pastors allege that the law is not limited to counseling minors but “prohibits offering such counseling services to any person, regardless of age.”

Aside from demanding protection for their own rights, the group of pastors asked the court for an order “protecting the rights of counselees in their congregations and others to receive pastoral counseling and teaching on the matters of homosexuality.”

“We are most concerned about young people who are seeking the right to choose their own identity,” the pastors’ attorney, John W. Mauck, said in a statement.

“This is an essential human right. However, this law undermines the dignity and integrity of those who choose a different path for their lives than politicians and activists prefer,” he continued.

“Gay conversion therapy” bans have gained traction after Leelah Alcorn, a transgender teenager, committed suicide following her experience with so-called conversion therapy.

Before taking her own life, Alcorn posted on Reddit that her parents had refused her request to transition to a woman.

“The[y] would only let me see biased Christian therapists, who instead of listening to my feelings would try to change me into a straight male who loved God, and I would cry after every session because I felt like it was hopeless and there was no way I would ever become a girl,” she wrote of her experience with conversion therapy.

The American Psychological Association, along with a coalition of health advocacy groups including the American Academy of Pediatrics, the American Counseling Association, and the National Association of Social Workers, have condemned “gay conversion therapy” as potentially harmful to young people “because they present the view that the sexual orientation of lesbian, gay and bisexual youth is a mental illness or disorder, and they often frame the inability to change one’s sexual orientation as a personal and moral failure.”

The White House in 2015 took a stance against so-called conversion therapy for LGBTQ youth.

Attorneys for the State of Illinois have not yet responded to the pastors’ lawsuit.


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