Ethical Conflicts for Clinicians under Tennessee Abortion Law

McCarthy, Allison M.; Boos, Elise W.; Anani, Uchenna E.; Clayton, Ellen Wright

doi:10.1056/nejmp2303213

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…One argument for providing care that is illegal in these cases is that not doing so violates a person's conscience 53 . It is not just the view that abortion bans are wrong but, in addition, that to practice medicine in accordance with them presents a conflict of conscience, where conscience is the “private, constant, ethically attuned part of the human character.” 54 Many physicians faced with the decision of violating the law or withholding care that would prevent death, disability, psychological trauma, or permanent infertility would understandably feel morally responsible for their patients’ health outcomes—and that they could not, in good conscience, follow the law and allow a woman to die or be harmed as a result of their failing to provide appropriate care 55 . In a joint statement, leading reproductive health organizations describe post‐ Dobbs restrictions as an “ethical infringement … in clear conflict with the calling of obstetricians and gynecologists [that] forces members of our specialty to carry a burden of moral injury and distress.” 56 Framed this way, breaking the law could be understood—and defended—as a form of conscientious refusal.…”

Section: The Moral Permissibility Of Breaking Forced‐gestation Lawsmentioning

confidence: 99%

Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post‐Dobbs Landscape

Lyerly,

Faden,

Mello

2024

Hastings Center Report

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Since the U.S. Supreme Court's decision in Dobbs vs. Jackson Women's Health Organization, a growing web of state laws restricts access to abortion. Here we consider how, ethically, doctors should respond when terminating a pregnancy is clinically indicated but state law imposes restrictions on doing so. We offer a typology of cases in which the dilemma emerges and a brief sketch of the current state of legal prohibitions against providing such care. We examine the issue from the standpoints of conscience, professional ethics, and civil disobedience and conclude that it is almost always morally permissible and praiseworthy to break the law and that, in a subset of cases, it is morally obligatory to do so. We further argue that health care institutions that employ or credential physicians to provide reproductive health care have an ethical duty to provide a basic suite of practical supports for them as they work to ethically resolve the dilemmas before them.

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Section: The Moral Permissibility Of Breaking Forced‐gestation Lawsmentioning

confidence: 99%

Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post‐Dobbs Landscape

Lyerly,

Faden,

Mello

2024

Hastings Center Report

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“…However, the broad nature of post– Dobbs v Jackson abortion bans have potential implications for all OB-GYNs in affected states, not just the 14% who provide abortion care . Commentaries have discussed potential impacts of abortion bans on OB-GYNs, pointing to likely increased documentation burdens, ethical challenges, and heightened stress when treating cases in legal gray areas . Workforce-related impacts also include retention and recruitment difficulties .…”

Section: Introductionmentioning

confidence: 99%

“… 19 Commentaries have discussed potential impacts of abortion bans on OB-GYNs, pointing to likely increased documentation burdens, ethical challenges, and heightened stress when treating cases in legal gray areas. 11 , 20 , 21 , 22 , 23 , 24 Workforce-related impacts also include retention and recruitment difficulties. 25 , 26 , 27 , 28 A May 2023 survey found that 55% of Idaho OB-GYNs were seriously or somewhat considering leaving the state due to the abortion ban.…”

Section: Introductionmentioning

confidence: 99%

US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

Sabbath,

McKetchnie,

Arora

et al. 2024

JAMA Netw Open

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ImportanceFollowing the Dobbs v Jackson Women’s Health Organization decision in June 2022, 17 US states have functionally banned abortion except in narrow circumstances, and physicians found in violation of these laws face felony charges, loss of their medical license, fines, and prison sentences. Patient impacts are being studied closely, but less research has focused on the consequences for obstetrician-gynecologists (OB-GYNs), for whom medically necessary care provision may now carry serious personal and professional consequences.ObjectiveTo characterize perceptions of the impact of abortion restrictions on clinical practice, moral distress, mental health, and turnover intention among US OB-GYNs practicing in states with functional bans on abortion.Design, Setting, and ParticipantsThis qualitative study included semistructured, remote interviews with OB-GYNs from 13 US states with abortion bans. Volunteer sample of 54 OB-GYNs practicing in states that had banned abortion as of March 2023.ExposureState abortion bans enacted between June 2022 and March 2023.Main Outcomes and MeasuresOB-GYNs’ perceptions of clinical and personal impacts of abortion bans.ResultsThis study included 54 OB-GYNs (mean [SD] age, 42 [7] years; 44 [81%] female participants; 3 [6%] non-Hispanic Black or African American participants; 45 [83%] White participants) who practiced in general obstetrics and gynecology (39 [72%]), maternal-fetal medicine (7 [13%]), and complex family planning (8 [15%]). Two major domains were identified in which the laws affected OB-GYNs: (1) clinical impacts (eg, delays in care until patients became more sick or legal sign-off on a medical exception to the ban was obtained; restrictions on counseling patients on pregnancy options; inability to provide appropriate care oneself or make referrals for such care); and (2) personal impacts (eg, moral distress; fears and perceived consequences of law violation; intention to leave the state; symptoms of depression and anxiety).Conclusions and relevanceIn this qualitative study of OB-GYNs practicing under abortion bans, participants reported deep and pervasive impacts of state laws, with implications for workforce sustainability, physician health, and patient outcomes. In the context of public policies that restrict physicians’ clinical autonomy, organization-level supports for physicians are essential to maintain workforce sustainability, clinician health and well-being, and availability of timely and accessible health care throughout the US.

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Are state abortion bans an occupational health hazard for obstetrician-gynaecologists? Findings from a multistate qualitative study

Sabbath,

McKetchnie,

Arora

et al. 2024

Occup Environ Med

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ObjectivesSince the US Supreme Court’s Dobbs v. Jackson decision, 17 states have imposed near-total abortion bans. These bans may negatively impact health and well-being of obstetrician-gynaecologists (OB-GYNs), due to high levels of work-related stress that the laws have created for them. The goal of the present study is to evaluate the impacts of post-Dobbs v. Jackson state abortion bans on occupational health and well-being of OB-GYNs.MethodsThe Study of OB-GYNs in Post-Roe America is a qualitative study of 54 OB-GYNs practising in 13 of the 14 states with near-total abortion bans as of March 2023. Using volunteer sampling methods, participants were recruited for semistructured qualitative interviews via videoconference from March to August 2023.ResultsThematic analysis of interview transcripts identified six major domains of health and well-being impacts of state abortion bans on OB-GYNs: anxiety and depression, burden of negative emotions, burn-out, coping-related health behaviours, sleep disruption and personal relationships.ConclusionsState abortion bans following the 2022 Dobbs decision may impact the health and well-being not only of pregnant patients but also of their providers. These provider health impacts include mental health and burn-out but also extend to physical health outcomes and the work–life interface.

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Ethical Conflicts for Clinicians under Tennessee Abortion Law

Cited by 3 publications

References 4 publications

Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post‐Dobbs Landscape

Beneath the Sword of Damocles: Moral Obligations of Physicians in a Post‐Dobbs Landscape

US Obstetrician-Gynecologists' Perceived Impacts of Post–Dobbs v Jackson State Abortion Bans

Are state abortion bans an occupational health hazard for obstetrician-gynaecologists? Findings from a multistate qualitative study

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