With states across the country passing legislation to restrict abortion access, clinicians need to be aware of not only the medical implications of these possible changes but also the potential legal ramifications they could face in treating or counseling patients should the Supreme Court overturn Roe v. Wade and open the door for the enforcement of these new laws.
To bring rheumatologists up to date on various recent proposals to restrict reproductive health care for women and how that may impact care of their patients, a rheumatologist will join an attorney to review pending laws and their status during a session on Tuesday. Reproductive Health Legislation: An Update on Current Trends in Healthcare Legislation and How It Potentially Impacts Care for Women with Rheumatic Diseases will take place 2:30 – 3:00 pm in Thomas Murphy Ballroom 1-2, Building B in the Georgia World Congress Center.
Rheumatologist Bonnie Bermas, MD, Professor of Medicine at the University of Texas Southwestern Medical Center, Dallas, will discuss the potential impact new laws may have on women with rheumatic diseases.
“As rheumatology providers, we need to understand that current reproductive health legislation can impact the way we practice,” she said. “Several states have recently passed legislation that significantly limits abortion rights, which could affect our patients. Rheumatology patients often have worse pregnancy outcomes. For example, the pregnancy mortality rate in women with systemic lupus erythematosus is 20-fold what it is for healthy women. Our patients do best in pregnancies that are planned for times when their disease is under good control.”
In addition, many of the medications used to manage rheumatologic diseases are teratogenic.
“Given that 50% of pregnancies are unplanned in the United States, unintentional exposures to teratogenic medications are inevitable,” Dr. Bermas said. “To quote a recent New England Journal of Medicine editorial, ‘access to legal and safe pregnancy termination, a legal right in the United States for the past 46 years, is essential to the public health of women everywhere.’
“This topic is extremely relevant to rheumatology patients, as many of our patients are women of reproductive age. We have an obligation to our patients to be aware of how recent reproductive legislation can impact their family planning decisions.”
Paul Lombardo, JD, PhD, Regents’ Professor and the Bobby Lee Cook Professor of Law at Georgia State University College of Law, Atlanta, will summarize what is happening legally across the United States regarding reproductive rights.
“There’s activity everywhere,” he said. “More than half the states are considering changes to laws.”
However, these laws vary by state. Some are limiting or outlawing abortion after 18 to 20 weeks gestation — with no exceptions in some cases. There are also states outlawing abortion after six to eight weeks.
Then there are states making access to abortion more difficult by penalizing specific procedures.
“For example, we’ve seen dilation and evacuation being outlawed in places like North Dakota and Indiana,” Dr. Lombardo said. “We also have some states more severely regulating abortion but allowing exceptions for rape, incest, or medical emergencies. Other states are enacting what they’re calling trigger laws. With these, if Roe v. Wade is overturned, then those states will outlaw abortion. So they’re making it contingent on how the Supreme Court rules.”
Conversely, there are some states relaxing restrictions. And, in the case of Kansas, deciding abortion is a right under state law — regardless of what the Supreme Court says.
“The unanswered question is to what degree will the Supreme Court take a case that could conceivably have an impact on these proposals,” Prof. Lombardo said. “Odds are high that Supreme Court will leave this up to the states. That will make the impact on medical practice variable by state, and in some cases, the impact may be significant. In some states, for example, making a referral for abortion would be illegal.”
He said physicians will need to pay attention to what extent states go to in criminalizing abortion or referral for abortion and whether those laws are upheld.
“We have some states proposing to classify this as murder for the patient and the doctor,” he said. “Idaho right now has proposed legislation that would charge women and participating doctors with murder. That’s pretty dramatic and definitely something physicians need to be following.”