On June 24, 2022 the Supreme Court released its final decision regarding Dobbs, State Health Officer of the Mississippi Department of Health, et al. v. Jackson’s Women’s Health Organization, et al. This case specifically challenged both Roe v. Wade and a later case, Planned Parenthood of Southeastern Pa v. Casey. SCOTUS overturned all three cases and ruled that the Constitution does not confer a right to abortion; this then gives the authority to regulate abortion to the people and their elected representatives. Several states, including Missouri, have recently or are in the process of passing “trigger laws” that vary by state and put a variety of prohibitions in place that restrict access to and provision of abortions. Missouri’s law, known as the “Right to Life of the Unborn Child Act,” prohibits abortion except in cases of medical emergency and makes performing an abortion in violation of this rule a class B felony, in addition to potential suspension or revocation of professional licensure. Any person providing an abortion must prove “more probably true than not” that the abortion was a medical emergency. The woman who undergoes the abortion is not subject to prosecution.
It is important to note that Missouri law has long held the belief that human life begins at conception and has for 200 years limited access to abortion through a variety of means. Thus, for many years the only abortion clinic in Missouri has been the Planned Parenthood on Forest Park Parkway. Attempts to close this Planned Parenthood have been significant and ongoing throughout the five years I have lived here such that relatively few abortions have been performed in Missouri in recent years. Moreover, no insurer within the state of Missouri, including our Student Health Clinic, has been able to cover the cost of voluntary termination of pregnancy for many years. Most women who require or desire a termination of their pregnancy currently receive this out of state, most commonly in Illinois.
For many women the SCOTUS decision signifies a profound loss of autonomy, control and equity. They fear being forced to carry an unwanted, unintentional, or even physically forced pregnancy (i.e. through rape or incest). They worry that their health or welfare will be sacrificed for the sake of their unborn child without regard to their wishes or that of their partner. And yet, for many this decision signifies an affirmation of their beliefs regarding the sanctity of human life. While there is relative medical clarity about when a fetus is viable outside of a mother, when life truly begins is up for debate and is often associated with religious and moral beliefs that are deeply held. It is imperative that we approach this time with compassion and caring for one another — with a deep desire to understand differences in opinion and the individual stories and histories that shape these opinions.
Some healthcare providers are worried that the sanctity of their relationships with patients— to care for patients as medically necessary and in alignment with their wishes is being obstructed. They may have concerns that their fear of being prosecuted or losing their license will interfere with making sound medical decisions or cause delays in care. They worry that they will watch more women suffer and die. And some healthcare providers have been and may continue to be in deep conflict between their own personal or religious beliefs regarding abortion and their responsibility to provide patient-centered care.
For students and trainees, you may be wondering what impact this will have on your education. We will continue to teach you about when termination of pregnancy may be indicated and the mechanisms available to terminate a pregnancy. We will also continue to teach you how to counsel a patient about options. Students have generally not participated in abortions unless they specifically elected to or as part of a medical emergency. Both options will continue. The ACGME mandates that residents in OBGYN must be provided with training or access to training in the provision of abortions, how to educate patients on the surgical and medical therapeutic options related to the provision of abortions and the management of complications of abortions. This training will continue, largely out of state, as it has been. Students who wish to learn these skills can also do so through these training sites on a purely voluntary basis. Residents who have religious or moral objections may opt out, as before.
More information will come out in the weeks to follow about how this affects operational changes and care. In addition, there will be opportunities for dialogue and to better understand how Wash U will be supporting women and our providers to ensure they get the care they need. In the meantime, for those of you who are suffering in the wake of this decision for any reason, whether you agree or disagree with what has happened, please remember that there are a multitude of resources available to support you. If you are a faculty member or staff, those can be found here; if you are a resident or fellow, they can be found here; and if you are a student, they can be found here.
“Dignity of human nature requires that we must face the storms of life.” – Mahatma Gandhi