Healthcare crisis
Authors: Grace Keegan; Julie Chor, MD, MPH
Keywords: healthcare, abortion, abortion access
As a medical professionals, we are committed to helping our patients achieve their full health potential and cannot be silent as our patients experience forced pregnancy. But while the final Supreme Court decision will have many tragic consequences for our patients, it will also inflict a moral injury on medical trainees and providers who will be legally restricted from providing essential medical care..
The Court’s decision on Dobbs v. Jackson Women's Health Organization will have substantial implications on medical training, which will in turn only worsen existing health inequities. The case will limit where future doctors may receive the training necessary to provide essential healthcare to people who could become pregnant. And with this ruling we have lost the right to uphold our patients’ dignity, bodily autonomy, and reproductive freedom in our medical practice. Limitations on abortion training will also impact education and training surrounding contraception, miscarriage management, and ectopic pregnancy management. Educational training for abortion care is imperative to ensure continued capacity to provide the full spectrum of reproductive healthcare.
As states will be able to impose restrictions on medical education and training related to providing abortion care and counseling, consequently, the already small number of residency training programs that offer family planning rotations will drop in many states in the coming year. Given that one in four people who can become pregnant in the US has an abortion in their lifetime and that abortion bans do not reduce the number of people needing abortion services, abortion restrictions will leave tens of thousands of people seeking these essential services with few places to turn for care. Doctors and trainees who live in states that uphold their right to provide abortion care are already becoming inundated with requests from people seeking this care from other states. Such overwhelmed systems will almost certainly lead to poorer health outcomes for patients and moral distress for medical trainees and providers.
As healthcare providers, we are trained to uphold the ethical principle of “beneficence,” or to act for the ultimate benefit of the patient above all. As a medical student, I am compelled to seek further medical training only in states that will allow me to uphold these commitments. As a medical educator, I am compelled to advise students to train only in states that will prepare them to provide comprehensive reproductive healthcare which includes abortion care.
Accordingly, we cannot justify pursuing or recommending training in a state whose laws prevent doctors from making decisions or providing services they feel are in the best interest of patients.
We are not alone in these beliefs with regard to medical training. Medical students are already expressing their intentions to avoid residency training in states banning access to abortion care and training. Many states that are expected to ban abortion already have less access to obstetric care and higher rates of maternal mortality. The reversal of Roe will only exacerbate this problem of access to care in the coming years if it we do not reaffirm the right to abortion in every state.
Currently 47% of OBGYNs practice in states where they completed residency training. Anticipating that fewer medical students will seek residency training in states without access to abortion training and care, abortion restrictions may have downstream effects on the availability of OBGYNs in these states. Therefore, in addition to immediate repercussions on access to essential reproductive healthcare, our country must recognize that one potentially unforeseen consequence of the decision to overturn Roe v. Wade also includes the loss of well-trained future physicians in states with the greatest health challenges.
Our privilege as medical students and providers is that we will likely always have the resources to obtain an abortion, should we need this care. However, we must speak out as healthcare professionals, knowing that our most vulnerable patients will be disproportionately affected by the confirmation of this ruling.
The United States has the highest maternal mortality rate among developed countries; it fails to provide universal healthcare, childcare, or paid family leave, and lacks equitable access to contraception. Due to structural barriers to equitable healthcare, those at greatest risk of being impacted as Roe is overturned are also at a higher risk of experiencing negative health outcomes in pregnancy, outcomes which include complication and death rates that far exceed these risks for legal abortions. In the states that have already passed laws to ban abortion, and those that will do so in the coming days and months, the loss of this previously guaranteed right will cause immeasurable harms to these patients and their families. Put simply, forced pregnancy is not only a violation of fundamental freedoms; it presents a threat to many people’s lives.
Given the profound medical, social, and economic consequences prescribed by our country for having a child, abortion is essential health care. We need well-trained physicians in providing essential health care to be accessible everywhere.
About the authors: Grace Keegan is a medical student at the University of Chicago’s Pritzker School of Medicine. Julie Chor, MD, MPH, is an Associate Professor of Obstetrics and Gynecology, The University of Chicago; Assistant Director. MacLean Center for Clinical Medical Ethics, The University of Chicago.
