WASHINGTON — It’s an exception written into some policies and laws – that abortion is only acceptable in cases of danger to the life or health of the mother. However, that has very little medical or legal weight, and some healthcare providers call it an added burden.
THE QUESTION:
Does that “life or health of the mother” exception have a generally-accepted medical or legal definition?
THE SOURCES:
Dr. Jennifer Villavicencio, OBGYN and Lead for Equity Transformation at The American College of Obstetricians and Gynecologists
Professor Naomi Cahn, University of Virginia Law
THE ANSWER:
No, and the variety of answers on a state-by-state or even hospital-by-hospital basis has our experts concerned.
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WHAT WE FOUND:
The Supreme Court decision overturning Roe v. Wade means states are able to make more restrictive bans on abortion; many are on the way to outlawing it completely. Often these will include exceptions aimed at protecting the mother—in theory.
“You read you can intervene to save the life of the pregnant person or the mother. That sounds reasonable,” said Dr. Jennifer Villavicencio, an OBGYN with The American College of Obstetricians and Gynecologists, which supports abortion access. “When you're actually in the situation, it's very difficult to tell whether or not that line has been crossed.”
In its policy recommendations, The World Health Organization recognizes both physical and social factors when it comes to the parent’s health and well-being, but that’s merely a recommendation. In practice, Dr. Villavicencio says it’s all about the patient-doctor relationship, and the patient’s determination of their own lifestyle.
“Pregnancy affects every single organ in the body and requires significant changes in the way that a person's physiology and their body works. Our bodies have figured it out pretty well, but that doesn't mean that there aren't significant complications and risks with pregnancy,” said Dr. Villavicencio. “That's not to say that pregnancy is a bad thing. But it certainly is something that impacts someone's life or near on a year, it takes over how they live their life. And so we want to make sure that people are entering into this not only with all of the information, but also all of the support they have.”
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“Every institution is going to look at them and risk analyze them a little bit differently. And people are going to be harmed because doctors are not able to offer the full complement of care unless somebody is on the brink of death. And that's just not the way medicine should be practiced," she said. “We do everything that we can to prevent people from getting so far to a point where we can't bring them back. And I'm very concerned that these laws are going to push us to wait and wait and wait. And that people are going to be harmed or die."
Professor Naomi Cahn, an expert in reproductive technology and family law with University of Virginia, says the laws can give authority to the physicians to determine when aborting a fetus is life-saving for the parent, or choose to more clearly define it.
“Does it have to be that she will die at that moment unless the procedure is performed? Does it mean that she is likely to die if the procedure is not performed? Does it mean that there's a 50% chance that she will die if the procedure is not informed? There’s a great deal of ambiguity about what saving the life of the mother is,” said Cahn. “Then there's a question of what kind of documentation healthcare provider will need to offer in order for the in order not to be prosecuted for violating a statute that bans abortions.”
Documentation could be critical because Cahn says even with more clear diagnoses, it could still be up to the courts to determine if the doctor was right.
“Even if an abortion is can be justified can be shown to be necessary to save the life of the mother, it is still possible to face prosecution and then to have to be tied up in the court system,” said Cahn. “I think the problem will be that physicians will be worried about being prosecuted unless they have engaged in extensive documentation of just what supports their beliefs.”
Dr. Villavicencio says that could be distracting in life or death situations.
"An example that I've used recently, because it just happened to me, was someone who came in with an ectopic pregnancy. She had a pregnancy in her tube, which is not viable. It will never become a healthy pregnancy or a baby. She was devastated because she wanted the pregnancy, but we needed to intervene. She was safe, and wasn't bleeding at that time. But at any moment in time, that could have changed. In fact, it did on our way to the operating room, she started to decompensate, her blood pressure went down, her heart rate went up and she started bleeding inside of her belly," she explained. "I was able to make these quick decisions in this life threatening situation. Unfortunately, abortion bans make it much more difficult to make those decisions. The patient that I took care of, there was cardiac activity and a fetus in her tube. She was around nine weeks pregnant. And so had I been in a state that banned it or criminalized abortion, I may have thought twice about how I treated this patient and waited longer. And I worry about that. I know that my colleagues in other states are worried about that," she said.
“It's creating confusion. It's unclear how people are supposed to abide by these laws, because they're not written in language that makes sense with the reality of how medicine is practiced,” said Dr. Villavicencio. “They're introducing an element into already complex situation, meaning already complex pregnancy diagnoses and ongoing processes. It's introducing another variable that doesn't need to be there."