I’ll never forget taking the Hippocratic oath. In a somber, dark, wood-paneled room at my medical school, rows of other graduating medical school classmates and I stood wearing pristine white coats. We raised our right hands and solemnly swore to the Most High to uphold the highest possible ethical standards in treating patients for the rest of our careers.
We pledged to serve patients to the utmost of our abilities, to put their benefit first, preserve their confidentiality, and avoid harming them. The seriousness of our oaths deeply moved us.
Being a health care provider is different from being a business executive, salesperson, or politician: We commit ourselves to a very high moral code. That’s not to say that an individual in another field can’t do the same, but for providers, it’s part of the job description.
The oath, a version of which was written some 2,000 years ago, remains our traditional moral compass, our North Star, deeply engrained within to guide us when we face conflicting demands— those middle-of-the-night struggles with sick patients when we ‘d prefer just to go home and sleep.
It enables countless patients to trust us and allow us, as strangers, to probe their bodies and hear their deepest secrets, whether it’s about sexual activity, illicit drug use, or mental health. We also learn and dedicate ourselves to more recently acknowledged bioethical principles, such as the upholding of patients’ rights and autonomy, and justice and protection of vulnerable groups.
But the Supreme Court’s decision to overturn Roe v. Wade now forces providers to grapple with having to violate these principles because of a judicial mandate that most Americans oppose.
Patients discuss potential abortions not only with OB-GYNs but also with family medicine doctors, internists, psychiatrists, and mental health professionals. As a psychiatrist and researcher, I have spoken to women about abortion decisions they have faced.
I’m lucky to work in New York, which will undoubtedly preserve abortion rights, but many of my fellow providers in other states are terrified and deeply troubled by the court’s opinion. With the fall of Roe, doctors may now have to face a disturbing decision between following the law or following the Hippocratic oath.
States already vary widely on whether, when, and under what circumstances a woman may have an abortion. Sixteen states, as well as Washington, DC, have laws that protect the right to abortion. Another 13 have so-called trigger bans outlawing the procedure that have now taken effect in the overturn of Roe (although trigger laws are facing court challenges in multiple states). Nine additional states have restrictions on abortion that could now be brought back into effect.
In Michigan, for example, Roe superseded a 1931 law that bans nearly all abortions unless the procedure is “necessary to preserve the life” of a patient. Last month, a judge issued a preliminary injunction blocking the law while a decision is still pending in a Planned Parenthood lawsuit arguing that the 1931 law violates the State Constitution.
With Roe overturned, the situation in Michigan shows the way my colleagues in various states may be forced to confront dilemmas about how to interpret restrictive abortion laws—and how high the risk of death needs to be, for example, in order to intervene. Similar questions now face doctors in Arkansas, which only allows abortion to save a woman’s life in “a medical emergency.”
I try to put myself in the position of colleagues in states where abortion will be banned or severely restricted and imagine the immense strain of these providers now confront.
In some states, laws will prohibit physicians from not only performing abortions but also “aiding and abetting” them in any way. These doctors could potentially be prosecuted if they tell a pregnant woman who does not wish to have a child that she could go to another state for the procedure. Texas encourages private citizens to sue abortion providers and any individuals aiding and abetting such a procedure, in return for a reward of up to $10,000.
These laws could effectively extend beyond state lines if a patient from Texas, for example, seeks an abortion from a provider in a state where abortion is legal. Providers who “aided and abetted” an abortion for a woman from Texas, for instance, could be arrested if they ever travel to or through that state.
A handful of states have recently begun to pass laws to protect their physicians from such suits. This month, New York Gov. Kathy Hochul signed the New York Freedom From Interference With Reproductive Health Advocacy and Travel Exercise Act, letting doctors in New York countersue in abortion-related lawsuits. Connecticut has passed a similar law, and California and New Jersey are debating such legislation.
But in most states, uncertainty reigns, and providers are worried.
Other states should adopt similar protections, but whether they will, and how this patchwork of laws will play out is uncertain.
Unsurprisingly, in states with restrictive abortion laws, my OB-GYN colleagues are talking about moving. Medical students are telling me they do not want to train in states where they cannot discuss abortion. Far fewer trainees from our nation’s best medical schools will likely want to move to such states, which will only undermine the quality of care there.
The Covid-19 pandemic has already strained providers, around a third of whom are now thinking of leaving the field, or have already done so. Repeating Roe v. Wade will exacerbate these stresses and reductions in personnel.
We need to recognize these broader harms to providers, hospitals, health care systems, and patients—regardless of whether those patients support or even seek an abortion or not. An understanding of these dangers can help state and national policymakers as well as voters to reconsider carefully whether to support abortion bans. Citizens who care should tell their elected officials to keep these challenges in mind in considering the enactment and implementation of abortion restrictions.
Overturning Roe v. Wade doesn’t just hurt women seeking abortions it potentially harms us all.
An earlier version of this essay appeared on CNN.com