Our research shows a new Texas abortion ruling could have a negative impact in NC | Opinion

On Jan. 2, a federal appeals court ruled that Texas can ban emergency abortion services without violating the federal Emergency Medical Treatment and Labor Act. This puts Texas physicians in the crosshairs of an impossible choice: provide the standard of care and risk a felony sentence, or follow state law and risk a patient’s life.

The Texas ruling lays bare the moral dilemmas that have emerged for physicians who treat pregnant patients in the 18 months since the U.S. Supreme Court’s decision in Dobbs v. Jackson Whole Woman’s Health.

We are University of North Carolina researchers who’ve spent the past year studying how post-Dobbs abortion restrictions have affected obstetrician-gynecologists (OB-GYNs) in states with abortion bans. Our findings reveal a serious threat to the OB-GYN workforce in the wake of Dobbs: moral distress.

Moral distress in healthcare arises in situations in which one knows the correct course of clinical action yet is prevented from taking that action by external constraints like policies or laws. Nearly all of the OB-GYNs we interviewed (50/54) reported situations of moral distress experienced by themselves or colleagues, using words like “muzzled,” “handcuffed” and “straitjacketed” to describe working under these conditions. They suffered profound anger, distress and frustration, and they relayed feeling helpless, hopeless and constantly uneasy.

One OB-GYN explained that she had been instructed to wait to provide medically necessary abortions for obstetric patients with serious health complications until the patients had a greater than 50% risk of death. Speaking about such delays in care, another said, “There’s only so many times you can transfuse somebody and they’re begging for their life before you say, ‘This is unconscionable.’”

Being forced to choose between providing good care to seriously ill patients and obeying the law is an impossible choice for physicians.

OB-GYNs in our study relayed how making these choices carries devastating personal and professional consequences, including anxiety, depression and chronic sleep disruption. The inability to provide full-scope reproductive care has eroded their sense of professional integrity. Notably, most of the OB-GYNs we interviewed were not themselves abortion providers. But the effects on their ability to provide obstetrics care safely are unmistakable.

An OB-GYN who had been deployed by the military to practice medicine in a war zone told us, “It’s never felt like this.” Another said, “It’s a living nightmare to practice OB here.” Again and again, OB-GYNs described working conditions that are unsafe for patients and increasingly unsustainable for physicians. One described lying awake at night, terrified that she would be arrested in front of her children for providing what she knew to be the evidence-based care that her critically ill patient needed.

OB-GYNs in states with abortion bans now must weigh relocating to states where they will not face a felony conviction for treating a patient at risk of dying from their pregnancy. Six in our study had left their state and 29 more had considered doing so. Many of those who remained reported great difficulty in recruiting OB-GYNs to join their practices. States with abortion bans are also having trouble attracting OB-GYN residents.

Unfortunately, states with the strictest abortion bans, without exceptions for maternal health, fatal fetal anomalies — or, now in Texas, medical emergencies — already had high concentrations of maternity care deserts and high rates of infant mortality prior to Dobbs. Our findings suggest these states now risk further declines in access to high-quality obstetric care.

If the Texas ruling is upheld, it will eliminate a key safeguard by which OB-GYNs are legally permitted to care for their sickest patients. It will also intensify the moral distress they already feel at being unable to provide standard pregnancy care. Geographic disparities in access to safe, proximate and high-quality obstetric care are at risk of widening as OB-GYNs leave for states where they do not risk becoming felons for providing lifesaving care.

Mara Buchbinder and Kavita S. Arora are UNC School of Medicine professors. Erika L. Sabbath is a researcher at the Harvard Center for Work, Health and Wellbeing.