I’m An Emergency Physician. Here’s How Dangerous This Supreme Court Abortion Ruling Could Be.

Protesters march around the Arizona Capitol in Phoenix after the U.S. Supreme Court decision to overturn Roe v. Wade on June 24, 2022. The court will hear oral arguments Wednesday on emergency care in states with abortion bans.
Protesters march around the Arizona Capitol in Phoenix after the U.S. Supreme Court decision to overturn Roe v. Wade on June 24, 2022. The court will hear oral arguments Wednesday on emergency care in states with abortion bans. Ross D. Franklin/Associated Press

The U.S. Supreme Court is about to rule on a case in which abortion bans in several states collide with the daily reality of emergency medicine in hospitals across the nation ― and its decision will have life-and-death implications.

As an emergency physician with more than 25 years under my belt and who has seen just about every medical crisis come through the doors at my hospital, I’m worried that the deeply conservative court will gut the bedrock protections every patient relies on when they stagger into an emergency department desperate for care.

At the heart of Idaho v. United States and Moyle v. United States is whether hospital emergency departments in states that ban abortion can effectively refuse care to patients who may need an abortion, violating the Emergency Medicine and Treatment of Active Labor Act that guarantees no patient gets turned away at an emergency department.

Before EMTALA was signed into law nearly 40 years ago, hospitals could deny care to patients who showed up at emergency rooms. Profit-driven hospitals denied care to uninsured patients and redirected them elsewhere. With delays in care, these patients often faced significant risks to their lives. For emergency physicians today, treating “anyone, anywhere, anytime” is our mantra, and most of us wouldn’t have it any other way.

As states enact draconian laws that essentially ban abortions, many of us are horrified that patients with serious pregnancy complications are now being kicked out of emergency departments in those states because the specter of serious legal repercussions looms over the heads of hospital staff. As a physician, I strongly believe every patient who seeks emergency care deserves to get access to the best medical care, even if the recommended course of treatment may be an abortion. At the same time, I empathize with the doctor facing an impossible choice between doing their job and avoiding jail due to egregious and unnecessary state laws undermining EMTALA.

That’s why I’m watching closely to see what happens as the Supreme Court prepares to hear testimony in a case that could decide if EMTALA supersedes state bans. I hope the justices will side with the notion that no one should be denied emergency care, for any reason, so my fellow emergency physicians in states that ban abortion can get back to practicing medicine without fear of prosecution.

That fear is real and threatens to harm health care in profound and long-lasting ways. I have cared for women in the ER who were actively having a miscarriage. The bleeding was significant and they were in pain ― they needed standard medical care from myself and my OB-GYN colleagues to help complete the miscarriages and save the mother’s life. This care can be considered an abortion, and in states with abortion bans, even though the fetuses in these scenarios were not viable and we provided the appropriate standard of care, very soon, a prosecutor in these states could charge us and send us to jail. The system cannot work when medical professionals such as myself fear prosecution for simply doing what we were trained to do and what our patients expect us to do.

As a late-career physician, I can travel away from my home state of Michigan to practice emergency medicine, and I currently do so in Maine and Colorado. I’m also licensed to practice in Illinois and Wisconsin. Abortion is still legal in these states. Caring for every patient who walks into an emergency department where I may be working is, and will always be, my priority, regardless of the medical circumstances. As emergency physicians, we took an oath to use all our skills and our knowledge to ensure that no one in our care comes to any harm. That ironclad oath did not include exemptions in states where an overzealous county prosecutor might try to put us behind bars for trying to save a patient undergoing a miscarriage, bleeding heavily from placental abruption or suffering a stroke from severe preeclampsia.

If the Supreme Court allows states to set aside the emergency medicine act to enforce their abortion bans, I ― and I suspect many doctors ― will never practice medicine in any of the 21 states where abortion is not legal. Abortion bans are causing physicians to leave the reddest of states. Rural communities already face a significant physician shortage. Because many of the reddest states with the most extreme abortion bans also have large rural populations, the threat of prosecution without the full safeguards of the EMTALA will drive more physicians, particularly my fellow emergency physicians, away from these states. As a result, an already fragile health care infrastructure will likely go into a death spiral in many communities.

Doctors should not be threatened with jail. Patients’ lives should not be put at risk because of extremist politicians like Donald Trump, who proudly took credit for eliminating the federal protection of abortion rights under Roe, and his Republican political enablers.

The Supreme Court’s EMTALA case is more than a bureaucratic tussle over legalese and turf. It is one with potentially seismic implications that will determine whether patients will get the care they need during a medical emergency or will be turned away while their lives are on the line.

As a physician, I’m hoping the justices will side with established medical practices, uphold all of EMTALA and let all doctors do our jobs so we can care for our patients, in blue states and in red states.