Post-Roe v Wade: Its Impact on Many Medical Specialties

This transcript has been edited for clarity.

Hi. I'm Art Caplan. I'm at the Division of Medical Ethics at the New York University Grossman School of Medicine.

Probably the most controversial ethics issue of the past year is abortion. As we all know, the Supreme Court overthrew the constitutional basis for a right to abortion, Roe v Wade, and basically said it's up to states to decide whether and how they want to restrict abortion.

Some bills are entering Congress by those who say we should have a national ban on abortion. Some states are moving to put the right to abortion into their constitution or see it voted on, as happened in Kansas and will happen in Michigan, to affirm the right to abortion.

Organizations like the Veterans Administration are saying that, at their hospitals, whether they're in states that don't allow abortion or not, they're going to permit veterans and their families (I assume) to get abortions, even if the state that the facility is in is restricted. Some places, like New York and California, are also saying that you don't have to live there if you need an abortion — that they'll try to make it possible for you to get there.

These are obviously issues and questions built on very strong feelings about the morality of abortion that divide and start heated discussions.

What I want to mention today is the ways in which the restriction of abortion influences medical practice for everyone, and has fallout that we need to be paying attention to because it has some challenges, I think, for medical professionalism that are going to come home to roost sooner or later.

I've talked to oncologists here at NYU and they point out that, for many pregnant women who are suffering from cancer, they want to quickly begin treatment for their cancer, even if it means imperiling the fetus and causing an abortion. In the states, they wonder where there are restrictions on that. Do they think that doctors are going to wait?

I've actually heard one or two reports already from oncologists in restricted states saying that until the woman gets sicker to the point where we could say her life is in danger, we're not going to start oncologic treatment on pregnant women. That puts, obviously, the life of the mom in much more jeopardy. You might lose both mom and fetus that way. I think it is a restriction with an implication on oncologic practice that, I would argue, isn't ethical.

Similarly, you have situations where many drugs might cause birth defects and have teratogenic effects on the fetus. Accutane, the commonly used acne treatment, and other treatments for skin diseases and other diseases often carry warning labels along the lines of "You need to understand that you shouldn't get pregnant if you're using this, or you're going to have to have an abortion if you use this, because the risk of having a child with a birth defect is significant."

The question is whether that will influence the willingness of doctors: "Well, I can't prescribe this for you. Abortion isn't available. Here is an option. So we're not going to be able to use this drug or this dermatologic treatment because we certainly don't want to risk a situation where you, unfortunately, have a child with a serious birth defect, but there's nothing you can do about it."

Is that going to influence how medical practice goes? How do we handle restrictions — where people create either restrictions on abortion or fetal personhood laws that say an embryo is a person from the moment of conception? How's that going to impact people who want infertility treatment?

Overall, the key issue, clearly, is whether women have the right to decide whether they want to have an abortion or end a pregnancy, and does the state have any ability to tell them that they can't make that choice, that they must carry a pregnancy to term, even in cases of rape, incest, and risk to their own health?

Roe v Wade, when it went away, reverberated out. It has implications for all manner of medical practice, whether it's in oncology, infertility, or dermatology, and I think we'd best be aware of that.

Medicine, at some point, is going to have to step up to the plate more publicly and say, "I understand that there are many who oppose abortion, but to practice medicine, we need more leeway when some of our medical practices create a situation where abortion may be the only reasonable option for someone who's getting a treatment for some other problem, illness, or disease."

I'm Art Caplan at the Division of Medical Ethics at the New York University Grossman School of Medicine. Thank you for watching.

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