Opinion: All-or-Nothing Abortion Politics Will Leave Women With Nothing
Dr. Osmundson is a maternal-fetal medicine physician in Tennessee.
Before the Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization, I did not consider myself an abortion provider. Ninety-five percent of my work as a high-risk obstetrician was helping women through complex pregnancies to achieve healthy outcomes for both them and their babies.
But I also served the 5 percent of women who did not think they could get pregnant on dialysis, who develop life-threatening hypertension and need delivery before their babies can survive preterm or who learn halfway through pregnancy that their baby has life-limiting birth defects. Before Dobbs, I did not use the word “abortion” when I talked to these patients about ending pregnancies; I opted instead to talk about terminating or interrupting pregnancies. But I wish I had. I should have conveyed that abortion is health care, can be lifesaving and happens more frequently than many of us acknowledge.
Now that abortion is banned in Tennessee, my fellow physicians and I face a new dilemma of how to operate under extremely restrictive abortion laws while maintaining our ethical responsibilities to provide needed health care. Part of this work requires advocating incremental changes that would have real, tangible effects on patients’ lives and accepting progress, however imperfect.
Other health care professionals in Tennessee and I are trying to reform one of the most restrictive bans in the country: the Human Life Protection Act, which became law in Tennessee after the Dobbs decision. It considers any action in which a live pregnancy is ended, other than in an effort to increase the probability of live birth, a felony punishable by up to 15 years in prison. Removing a six-week ectopic pregnancy in a fallopian tube or treating inevitable miscarriage is, by definition, a criminal offense.
There are no exceptions to the law. There is only an affirmative defense: If charged or prosecuted, physicians can present evidence that they performed an abortion to prevent death or “serious risk of substantial and irreversible impairment of a major bodily function.” For physicians considering their professional reputations, threat of criminal prosecution is terrifying and comes with immense financial costs because most hospitals do not pay for criminal defense.
As a physician practicing in Tennessee, I now must guess whether a prosecutor would charge me with a crime when I help women through those 5 percent situations, contending with the spectrum of risks and imperfect predictions. If a woman’s amniotic membranes rupture at 16 weeks, if she is febrile and bleeding, I think the risk of prosecution is low. If she is medically stable but at high risk for infection and hemorrhage, I am not sure.
I believe the state’s law was intended to be ambiguous and confusing, to make physicians scared to provide abortion care. We’re incentivized to pause, wait, reconsider — actions that can be life-threatening. Women with ectopic pregnancies have waited in emergency rooms for hospital lawyers to determine whether an abortion can proceed. We have denied abortion care to women with cancer and other complex medical problems who find out they are pregnant. Women with pregnancies affected by life-limiting fetal anomalies — anencephaly (no skull or brain), renal agenesis (no kidneys, no proper lung development) — have had to seek abortion care out of state. One patient I managed who was unable to receive abortion care ultimately required an emergency hysterectomy and delivered an extremely premature infant, 14 weeks early.
State Senator Richard Briggs, a Republican and a physician, is the Senate sponsor of a bill in Tennessee that would amend the law to provide true exceptions to perform abortions for ectopic pregnancies and lethal fetal anomalies and to prevent maternal death or serious bodily harm. It has been developed with tireless input from physicians and in coalition with other anti-abortion state legislators. But the powerful anti-abortion group Tennessee Right to Life, which crafted the original law, has mobilized against the reform, threatening lawmakers that voting for it will affect their “pro-life score.” The group’s opposition has made the fate of Dr. Briggs’s amendment uncertain. (Right to Life has now lent support to a weaker alternative bill that would remove language about abortion care for women carrying pregnancies with fetal anomalies and may leave open the possibility of criminalizing contraceptive methods that could interrupt implantation of a fertilized embryo.)
Dr. Briggs’s amendment, which I support, is still very conservative and falls short of what I want for women in Tennessee. It does not include abortion exceptions for rape and incest, despite strong support among Tennessee residents for these provisions. It is not clear enough in protecting women who are miscarrying when a heartbeat is still present. Even if the amendment passes, Tennessee’s law will be more restrictive than the anti-abortion laws in nearby states like North Carolina, Georgia and Florida.