Texas is among the twenty-one states where abortion is banned or severely restricted. In Idaho, nearly a quarter of the state’s ob-gyns have left since the ban went into effect, and rural hospitals have stopped providing labor and delivery services. In Louisiana, three-quarters of rural hospitals no longer offer maternity care.
November 25th, 2024 at 11:12PM
This article is pretty irresponsible. In both cases it describes – fetal death and ectopic pregnancy – treatment with a D&C is not only legal but compulsory (certainly in the case of ectopic pregnancy) in Texas. Doctors who don’t do or offer it b/c they’re ignorant of the law or b/c they want to create worst-case scenarios to demonstrate their opposition to abortion restrictions (“the inevitable conclusion for Kornberg was “You don’t want me here? Fine, I’ll leave.””) should be criticized, not lionized.
The other case mentioned here – premature rupture of membranes – is also weasely at best b/c it describes a pretty wide range of scenarios with variable outcomes, not certain fetal (and maternal) death as the author suggests. Abortion is not the first treatment for it even where abortion is legal. (See, eg, this description.)
The longer I live in Texas, the more I hate this particular kind of pro-choice journalism. There actually are scenarios where women will die or suffer serious injuries (like requiring a hysterectomy) if they can’t have an abortion. We’ve already seen this happen in a handful of cases, like the woman in GA. None of the cases in this article are such cases. This kind of writing does nothing to bring about clarification of the law, or to get clearer laws passed that would address actual life-threatening situations. All it does is create absurd panic about pregnancy and reward with fawning publicity doctors who are basically doing malpractice in denying women care b/c they claim to be afraid to violate the law, when the law plainly states that, eg, if the fetus already has no heartbeat, extracting it is not abortion.
There is a kind of vengefulness-disguised-as-compassion underlying this political and rhetorical strategy. Rather than coming to terms with the fact that conservative states are going to restrict abortion whether we like it or not, and trying to model legal approaches that would effectively address the rare cases requiring exceptions, this kind of journalism cheers doctors for demonstrating cowardice and incompetence and harming the women that these journalists claim to be so concerned to protect. The goal is plainly not to protect actual women in practice, but to block abortion restrictions in principle. And obviously the unspoken threat to the residents of these states is, as you note, “Pass laws that doctors don’t like, and soon you won’t have any doctors left! And then you will all bleed to death during labor hahaha!” A very compassionate sentiment!
Of course individual doctors have every right to live and practice where they please, but in 99%+ of cases, abortion restrictions have no effect on their practice (and in the <1% when they do, they should push to have the laws clarified or revised!), and if they're leaving a state solely b/c of such restrictions, that's a political and not a professional decision. They're certainly free to relocate in an effort to punish voters if that's what they want to do, but I don't think the decision looks quite so noble when put in that vindictive light.
November 26th, 2024 at 12:02AM
Not sure we read the same article. This one doesn’t describe – as you do – politicized, cowardly, vindictive drs and nurses refusing to be patient and keep practicing while, as you confidently and vaguely describe it, very rare medical problems in pregnancy are somehow at some point worked out legally to everyone’s satisfaction.
This article describes a Stasi-like situation in which anyone around you – family, hospital staff, some random guy off the street, a neighbor who heard something from someone – can report you and send you to legal hell and possibly jail because word has it you performed an illegal procedure. A situation in which you can’t count on anesthesiologists to assist you in routine procedures because… well, you’d say they’re cowards. I’d say that like a lot of docs long before the Stasi rules, they worry like hell about lawsuits, and this new thing is a bridge too far.
[The] controversial provision… encourage[s] anyone suspecting a person of “aiding or abetting” an abortion to file a lawsuit. In some instances, nurses openly challenged doctors, invoking their right to sue. “People were so hair-triggered to be looking for a crime,” Zoe Kornberg, [a] resident, said. And hey, there’s money in it for the lawsuit filers.
“Even after getting all the mandatory clearances from lawyers and administrators, [noted one doc], “you still don’t know if you’re going to have an anesthesiologist who will agree to do it. By that time, the person has bled out and could die.”
The article makes clear that serious medical problems in pregnancy are not, as you suggest, rare. “I see horrible things go wrong all the time in people’s pregnancies…”
With so many older women having pregnancies, for instance, all sorts of high-risk problems have newly arisen. I know – I was one of those many older mothers, and I presented with serious problems that in a state like Texas might have killed me.
Instead of moving out of states where their lives can be destroyed because they operate in a gray area that makes them extremely vulnerable to legal/criminal action, docs, you say, should “push to have laws clarified or revised” – thus becoming the politicized force you’re attacking them for being when they choose to leave. Clearly that choice – which many, many are taking — and of course many are refusing to do their residencies in these states in the first place — represents their interest in spending their time not lobbying obdurate anti-abortion politicians but practicing medicine. Add the fact that these same states tend to be our anti-vax, and often anti-science itself, states, and you really can’t be surprised women and men of science look elsewhere.
The solution is obvious and is already emerging. These states will get for their medical practitioners people desperate for a job – the very worst graduates of the worst foreign medical schools.
‘Too many horror stories of women going septic or dying because physicians have to wait until a patients health is compromised to perform an abortion, etc etc I wouldn’t be able to sleep at night. Which is why I retracted my apps to hospitals in those areas’
November 26th, 2024 at 1:08AM
Problems in pregnancy are not uncommon at all, but problems necessitating abortion are. For example, none of the three situations described in this article as necessitating abortion actually necessitate abortion, except in some cases the third one, but we’re given no info on the case, so who knows. They might require a D&C, but that is both legal and available in Texas (though like all medical treatment, probably harder to get in rural areas).
Maybe there is something I’m missing here and in the Georgia case, but the law seems unambiguous that there is no need to delay a D&C when the fetus is already dead. Why should doctors who do so be treated with kid gloves by journalists, like it’s totally understandable that they’d be afraid…that a fetus will come back to life? That the remaining pieces of placenta will acquire a heartbeat?
As far as I’ve been able to tell, at present, zero doctors in Texas have been prosecuted for providing abortions under SB 8. One case was brought and dismissed a couple yrs ago. So it’s a little short of a Stasi situation here. Seems more like medical professionals generally agree on when abortion is necessary, so the threat of being reported for unnecessary abortion is not quite so high as these articles suggest, or is at least worth testing, since all your colleagues will back you up. And doctors – or rather their paid representatives – do lobby politicians all the time. They have an entire professional association with a lobbying wing for this purpose. Medicine is not exactly an impoverished profession. So if they can lobby for all kinds of other malpractice and hospital legislation, why can’t they lobby for clearer abortion laws? (It also seems that they can get legal and ethics clearance in other challenging situations, so again not clear why abortion restrictions pose uniquely difficult hurdles compared with, say, organ distribution?) Do you think that clarification of restrictive laws is impossible, or just undesirable because the restrictions themselves shouldn’t be permitted?
November 26th, 2024 at 1:51AM
Again, the problem is that a terribly compromised fetus may take weeks to die (and of course the moment of death may be for a long time unknown), and lucky would-be mothers in states like Louisiana therefore may well get to carry their dying/dead baby for weeks until they finally miscarry, or until the fetus makes them bleed out to the point of near-death.
As for lack of prosecutions, all docs need are a couple of high profile national lurid stories to get the message, and we’ve had those. Ten year old victims of incest/rape get to carry their child to term (unless their immature body is broken in the effort) in various American states, and docs who try to help them can expect not only legal/criminal consequences, but a lifetime of death threats.
The problem with your idea about fine tuning the laws through discussion and compromise is that this is not a legal debate. On one side it’s legal, and on the other side it’s religious. If your transcendent truth is that zygotes have souls, you’re not the compromising type. In fact, docs who stay in states like this are right to anticipate that things will get worse, with groups of citizens pursuing women who try to get care out of state, etc. Those women are trying to murder souls, and the people of the state must save those souls.
I would again note the larger picture in many almost totally restrictive states. Not only anti-vax, but anti-science, pro-nutty conspiracies altogether. What self-respecting doc/nurse wants to put up with that? “OB/GYN residency programs in states with total abortion bans saw the largest decrease in applicants last cycle, 10.5%, more than double the national average.”
November 26th, 2024 at 1:18PM
All legal questions are legal debates, whatever other principles or beliefs the parties bring to them. Do you think that one simply cannot compromise with red state legislators, and the only options are total restriction or total legalization? And since this is the case, rather than compromise, the best strategy is to make the lives of restrictionists maximally miserable until they give in to total legalization?
I think we are unfortunately past the point where one can divide the country into pro- and anti-science constituencies. Conservatives are anti-vax conspiracists b/c of whatever they think is “the science,” but liberals kept their schools closed into 2022 and forced kids to wear masks for three years even though they were barely affected by Covid b/c of “the science.” Conservatives think zygotes have souls that shouldn’t be murdered, but liberals think souls have genders that contradict bodies and to which bodies must be forcibly aligned through the administration to children of puberty blockers and cross-hormones. And to object to this process is to violate “the science.” It’s a wild world of science we’re living in! Maybe one day, a politically neutral consensus will re-emerge, but I don’t think we’re presently in one.
You can know if a fetus is dead pretty easily via ultrasound, which you can now do at home (probably somewhat incompetently), and confirm in a few mins at a doctor’s office. If the fetus is alive but “compromised” in the sense of carrying some defect that will likely result in its death later, it rarely poses any greater physical risk to the mother than a normal fetus (ectopic pregnancy, the most common case that does pose medical risk, is already excepted). Otherwise, I’m not sure what you mean by compromised. Interestingly, this line of argument – abortion necessary for women who don’t want babies with birth defects – has not been widely pushed, presumably b/c it works less well on public opinion than the one under discussion. But in any case, you don’t have to carry a dead baby until you miscarry naturally. The law doesn’t require this and doctors who make someone do this out of fear of violating the law should be held as much accountable as any other withholding of appropriate care rather than being encouraged in their fear or belief in the law’s ambiguity.
Doctors who performed abortions have faced death threats from pro-lifers long before Dobbs, and this didn’t seem to generate journalistic encouragement to flee. The legal threat is real but clearly not being much deployed, suggesting no great appetite to use it in practice among medical practitioners or state judges, regardless of what religious zealots may desire. This seems like a promising context to test the law in order to get clarification, if you believed clarification was possible.
November 26th, 2024 at 2:30PM
We can kick this around all we want, but the facts are there: Trained medical professionals are voting with their feet in America, and the trend is growing.
In a free state in a free country, citizens are free to reject science, scientists, and people of science. The good people of South Dakota, Indiana, and other total restriction, anti-vax, anti-mask, anti-science states can legislate themselves back to pre-empiricism. But they can’t expect people who carry with them the human benefits of enlightenment thought to go along with the cultural reversion. One can indeed divide the country increasingly neatly into states where science is profoundly rejected – they’re the places our just-trained physicians wouldn’t, er, be caught dead in – and states where our best young medical practitioners are competing hard to work in — like my enlightened state, Maryland.
If you’re the sort of person who’d rather live in W Va., go to it. Can’t help but notice that docs aren’t the only category of Americans NOT flocking to states like these.
I keep trying, in our discussions, to point to the larger hyper-religious, anti-science context in most of the total restriction states. It’s like that back and forth we had about ultraorthodox communities, the most enthusiastic concentration of Trump voters in the country. They know perfectly well he will appoint anti-science freaks like RFK jr so that they can continue for instance refusing to vaccinate their children against disease. Polio has recently appeared in this community, and with Trump in charge we can expect other epidemics, as with whooping cough, for goodness sake, reappearing in Idaho.
Whether it is obvious facts about maternal health in relation to childbirth, or child health in relation to contagious disease, human beings seem always to have to learn all over again the basic civilizational facts of advanced cultures. But okay – significant numbers of Americans want to sample once more diseases eradicated in the 19th century. Surely you don’t expect the rest of us and our loved ones to stand around next to them and take a deep breath. You bet we’re going to flee, leaving gloriously empty West Virginia to its glorious fate.
November 26th, 2024 at 5:17PM
Right, no one’s flocking to WVa. But the fastest-growing states are almost all what you call anti-science backwaters – TX, FL, SC, NC, GA. The states that people are fleeing fastest are the enlightened, pro-science ones – NY, CA, IL. (Enlightenment crown jewel Maryland is, alas, not growing, but at least not shrinking.) How do we account for these patterns, given how barbaric the places getting the most new residents are?
I’m afraid the larger hyper-religious, anti-science context you’re trying to point to doesn’t exist, at least not in the major cities of red states where people are moving. Science itself has become a political football – the anti-vaxxers are wrong but “anti-maskers” were right precisely bc the anti-vaxxers were wrong. It was insane to be closing down the NYC public schools in Dec 2021 when everyone was already vaccinated. It was equally loony to require college and school kids to be masking well into 2022. The total abortion restrictionists are wrong, but so are the gender experimenters. There is no coherent party of science anymore; both side are in thrall to their respective ideologues. But there remains a pretty moderate middle of educated people in places like Houston who believe in vaccines, aren’t COVID hysterics, don’t want to pump their kids with hormones, want moderate immigration restriction but not mass deportation, etc.
Of course you can panic over the extremes on both sides, and you can hope for your side’s total victory by advancing disingenuous arguments like the ones in this NY’er article about how any restrictions on abortion will result is the mass death of women, but this all seems like a waste of time to me. Texas is not going to run out of obstetricians and it’s not going to allow unrestricted abortion anytime soon, so the urgent and humane thing to do in a context where people plainly are trying to work within the law and aren’t reporting every doctor who performs a D&C is to clarify the laws respecting marginal cases and medical complications and to make the restrictions workable. Obviously there are many people who can brook no restrictions at all and would rather let women die to prove their point than compromise with pro-lifers, but this seems to be a choice and not a political necessity.
November 26th, 2024 at 7:23PM
Here’s hoping you’re right that there’s a reasonably enlightened, reasonable, middle. I think the notorious anti-intellectualism of Americans has gotten worse and worse, and I think you can see evidence of that in the triumph of conspiracy-minded know-nothings like RFK jr. I think the book banners, pornography outlawers, and vaccine deniers are about to have a heyday.
But I suppose there’ll be a backlash against all of that, too (the porn thing in particular), and so it goes…
November 27th, 2024 at 6:51AM
“Obviously, there are many people…who would rather let women die to prove their point than compromise with pro-lifers…”
Obviously!?!? Name one. I don’t know what kind of mind could conjure up an image of doctors standing around a dying woman and thinking, “shame about her and her family, but, hey, maybe this will help Kamala win the election.”
OK, so that’s not what you meant. (Well, actually it is; you said so in your original comment.) Then who are these vile people who crave a higher body count so they can have another mic drop moment at the next My Body, My Choice rally?
And what exactly is the compromise solution here? The pro-lifers who are actually passing laws in these states (not those of your imagination) do not want *any* abortions at all. Some come right out and say it, while others pass six-week bans designed to have the same effect. So, seriously, what’s the compromise? We all agree to grant the Texas legislature full control of a pregnant woman’s rights and allow them to force her to give birth against her will, but in return they agree not to prosecute doctors who make a borderline choice to abort a fetus several hours before a woman’s death is imminent. And, hey, maybe they’ll throw in a rape and incest exception as long as, you know, the girl/woman can *prove* it.
If you think it’s possible to compromise with these people on a 20 week or even first-trimester limit, you simply haven’t been paying attention. And if your Fox Newsy view of liberals is so dark that you think they celebrate each woman’s death as another victory over the forces of reaction, then you’re probably not the person to tell others that they need to compromise.
November 27th, 2024 at 11:55PM
UD: You might find this essay of interest on the breakdown of the consensus around “the science” over the past few years, by two liberal poli sci profs at Princeton who’ve recently written a book on the topic: https://www.compactmag.com/article/restoring-trust-in-public-health/.
TFKAU: Yes, I know that’s what pro-lifers want, but “compromise” doesn’t mean giving either side everything it wants. They also don’t want women to die from pregnancy complications, which is why the TX law permits abortion in cases of “medical emergency,” but is ambiguous about what constitutes such an emergency. So this is what should be articulated, by the law or by a medical ethics code acceptable to the legislature.
The insistence that compromise with pro-lifers is impossible suggests that nothing short of full legalization is acceptable or worth fighting for. If that’s your position, it’ll be a long time before you get what you want in many of these states, and in the meantime, women will die from poor obstetric care. You don’t have to celebrate that for this to be the effectual truth of that position.
November 28th, 2024 at 9:17AM
It sounds less like a compromise than a plea: Could you please change your horrible laws just enough so that doctors don’t have to worry about going to prison when they attempt to save the life of a dying woman? There’s no real bargaining there since the pro-choice side in states like Texas has absolutely no leverage. While I agree that pro-lifers don’t want women to die, they still insist that the woman and the fetus are equally human and have equal rights. Thus, they are generally unwilling to amend their laws because they fear that any law under which doctors are presumptively believed will encourage pro-choice doctors to perform “unnecessary” abortions, i.e., kill babies. And any law in which doctors are *not* presumptively believed will lead us back to the same place we are now. Ultimately, that’s why hard-core pro-life legislators invariably reject any exception to protect the *health* of the mother. I’m a political scientist, so I’m always up for a good compromise, but as far as I can tell, the only options for pro-choice Texas doctors are comply, resist (and face the loss of your career and/or freedom), or get the hell out and find someplace to work where women are valued more than fetuses.
November 28th, 2024 at 9:48AM
And, yes, I recognize that the inability (not unwilingness) of the pro-choice side to persuade Texas to change its dreadful laws will cause more women to die. That saddens and sickens me, but the fault for that lies entirely with the Texas legislature. They could, after all, amend their laws tomorrow without bargaining or even consulting with a single liberal.
I also understand (to return to your initial point) that one might regard some doctors as cowardly for being overly conservative when treating potentially dying women. But then again, neither you nor I have to face the possibility of spending our middle years in a Texas state penitentiary, a fate to which death might well be preferable.