A family physician's response to the overturning of Roe v. Wade
I want to respond to the many strong emotions and fears expressed by many of my patients regarding the recent Supreme Court decision overturning of the Roe v. Wade. Abortion is a very polarizing topic. I do not intend to debate with anyone their views on abortion. I try as much as possible to avoid political and polarizing topics with my patients because I recognize that we all have different beliefs, and that is okay. I care deeply about each and every one of my patients, and I do not want a difference in opinion to create a wedge in our relationship. However, this particular decision infringes on my ability to practice medicine ethically, so I feel it is important for me to respond.
When I was a medical student at Baylor College of Medicine, I participated in their Ethics track. This included additional classes in medical ethics as well as a scholarly project examining the medical ethics of a specific clinical situation. All physicians are trained in medical ethics, but I have always taken a particular interest in this field. Medicine involves many extremely ethically challenging situations. These are intellectually interesting but often personally devastating to the patient and family involved. There is no easy or "correct" answer in these situations. What I loved about my ethics classes was the focus on the four pillars of medical ethics. Examining these pillars allowed us to break down challenging situations to allow us to come to an ethical solution. The four pillars are Autonomy, Non-maleficence, Beneficence, and Justice.
Autonomy: a patient has the ultimate decision-making responsibility for their own treatment
Non-maleficence: duty to do no harm or allow harm to be caused to a patient through neglect
Beneficence: promote the course of action that the physician believes is in the best interests of the patient
Justice: a fair and equitable distribution of health resources and keeping in mind the needs of the community at large
All four of these pillars must be considered and balanced when making any medical decision. Many people think of "first do no harm" as part of the Hippocratic Oath taken by all physicians, but in reality there are situations where we cause some harm that is outweighed by benefit. Chemotherapy for cancer is an example in which harm is done to the patient by side effects from the drugs, but the overall benefit to the patient of curing the cancer is greater. A patient must have the autonomy to choose whether in their individual situation, the potential benefits outweigh the potential harms. The healthcare system must provide care in a just way so that those who need care have access to it. This is relatively easy for straightforward medical decisions like taking an antibiotic for an infection, but becomes complicated during more complex situations. Pregnancy is always a more complicated situation, even a relatively low-risk pregnancy, because there are always risks to the mother involved that must be balanced with the benefit to the fetus, and her autonomy regarding these decisions is paramount.
What Roe v. Wade guaranteed was not just the right of a woman to terminate her pregnancy, but the right of a patient and their physician to consider these four pillars privately and come to a decision together without government interference. The crux of the decision was based on the due process clause of the 14th amendment: "No state shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any state deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws."
Those who oppose abortion rights have celebrated this decision, but I think this is unwise. While they may agree with the trigger laws in place that will outlaw abortion in many states, I believe that this decision has opened the door to future laws that may abridge a patient's autonomy in other situations (in my opinion, the most important of the ethical pillars to an individual patient). This is not to mention the significant harms that we can expect to see shortly from unsafe self-induced abortions and from delays in care for nonviable pregnancies due to limitations placed on healthcare professionals.
The last few years have been extremely medically and ethically challenging due to the COVID-19 pandemic. Now more than ever we need to make sure that we are taking into account all of the pillars of medical ethics when making decisions that affect patient care. I fear that this decision has limited our ability to do that, and the future implications are far-reaching and extremely concerning.
I started this practice partially because I was uncomfortable with the way I was able to provide care in previous clinics. I felt that I was not able to provide patients with a full discussion of their options to allow them to come to an informed decision, whether due to time constraints or restrictions from administrators. I strive to provide a welcoming environment to all patients regardless of their beliefs, to provide them with informed consent for anything that I recommend, and I do not judge patients who choose not to proceed with my recommendations. The trigger laws in Texas that will come into play shortly after this decision will restrict my ability to do that. I want all of my patients to know that I respect your privacy, I respect your beliefs and choices, and I will continue to provide you with all of your options for as long as I am legally able to do so. My office is a safe space. Please feel free to discuss any concerns you may have with me at any time.