In one of the busiest maternity hospitals in Indiana, Dr. Caroline Rouse is bracing for the unknown.
Rouse, an obstetrician-gynecologist and medical director of maternity services at Riley Hospital for Children’s maternity tower, has watched other states roll out sharp abortion restrictions since the U.S. Supreme Court removed constitutional protections for abortion last month.
Now, as the Indiana General Assembly prepares to convene Monday for a special session to consider new abortion-related legislation, Rouse is worried about possible criminal liability she and other physicians might face for providing abortions, even to save the life of the mother.
Many high-risk pregnancies, she said, are not black-and-white textbook cases but various shades of gray, where illness or death are possible outcomes for the mother, through hemorrhaging, risk of serious infection or other causes.
Those cases could place Indiana doctors in situations where they would worry about going to prison and losing their licenses if they end the pregnancies, Rouse said.
“I’d be very concerned that providers would be scared, honestly, to provide evidence-based medical care,” she said, “… if very restrictive laws are put in place that would make it seem as though it would be illegal.”
Abortions are now legal in Indiana up through 22 weeks of pregnancy, with certain exceptions afterward for medical emergencies. As of press time, the Republican-controlled Legislature had yet to say what the legislation will look like or how soon bills will be filed.
But on Wednesday, Senate Republican leaders presented a bill that would ban nearly all abortions except in cases of rape, incest and pregnancies that threaten the life of the mother.
Some doctors say the new restrictions could ban almost all abortions in Indiana, and any doctor who performed them, even under the narrow exceptions, would be watched closely and threatened with criminal prosecution and losing their licenses.
“I have no doubt that some of us will be targeted and prosecuted to the fullest extent of what they consider to be legal,” said Dr. Katie McHugh, an obstetrician-gynecologist in Indianapolis and board member of Physicians for Reproductive Health, which supports abortion rights.
All eyes are on Indiana, which appears to be the first state to take up new abortion legislation since the U.S. Supreme Court’s decision last month to overturn Roe v. Wade, the 1973 ruling that held the Constitution protected a woman’s right to an abortion before the viability of the fetus outside the womb.
However, other states jumped in even before the Supreme Court handed down its decision. Over the last year, 13 states enacted so-called “trigger laws” banning abortions under most conditions—laws that automatically took effect once the Supreme Court ruled.
Now, medical groups say they plan to lobby the Legislature to get their viewpoint across.
The Indiana State Medical Association, which represents more than 9,000 Hoosier physicians and medical students, said it plans to provide policymakers “an accurate understanding of evidence-based medicine and to advocate for the preservation of the physician-patient relationship, the safeguarding of patients’ physical and mental health, and the legal protection of physicians who follow evidence-based medicine and other overarching laws.”
The American College of Obstetricians and Gynecologists said in a statement that abortion is an “essential component” of health care.
“ACOG strongly opposes any effort that impedes access to abortion care and interferes in the relationship between a person and their healthcare professional,” the group said.
The American Medical Association said it was “deeply disturbed” by the Supreme Court’s decision to overturn nearly a half century of precedent “protecting patients’ right to critical reproductive health care.”
Health care debate
Across central Indiana, some hospitals say they want to continue offering abortions when they are needed as part of medical care. Yet several physicians told IBJ they support the widest possible restrictions on abortion.
Indiana University Health said it performs a “limited number” of abortions annually at its Methodist Hospital and Riley Maternity Tower for women “with certain medical indications, including health or life-threatening conditions, as well as those with life-limited fetal anomalies.”
“IU Health seeks to maintain our ability to provide the necessary care for our pregnant patients,” the hospital system said in a statement to IBJ, “as well as preserve the future pipeline of reproductive health providers that are needed to ensure safe and high-quality pregnancy care in Indiana.”
Community Health Network said in a statement the Supreme Court decision overturning Roe v. Wade affects “not only the reproductive rights of millions, but also has the potential to interfere with the patient-physician relationship.”
“We are concerned that it may limit access to appropriate health care and may worsen health inequities,” Community’s statement continued.
Eskenazi Health, the Indianapolis-based safety-net hospital, said it was committed to providing high-quality care, and added that “it would be speculative of us to predict how providers might make decisions without seeing the proposed legislation.”
The two Catholic health systems in central Indiana, Franciscan Health and Ascension St. Vincent, declined to comment on the upcoming legislation. The official teaching of the Catholic church is that life begins at conception and that abortion in most cases is a “moral evil.”
Not all Catholics share that view, however. According to a five-year aggregate of Gallup Poll data from 2017 through 2021, only about 54% of Catholics say abortion is morally wrong.
Some physicians told IBJ they support strong abortion restrictions.
Dr. Christina Francis, an obstetrician-gynecologist in Fort Wayne and a board member of Indiana Right to Life, said 76% to 93% of OB-GYNs do not perform abortions, citing statistics published in three medical journals.
She said she would support any legislation that would “protect the lives of my fetal patients.”
She said legislation now being considered by several states makes exceptions for health and life of the mother.
“It would still leave leeway for physicians to be able to intervene in cases where the mother’s life was in jeopardy, and this is something that those of us who are pro-life physicians have done for our entire practice,” said Francis, who is also CEO of the American Association of Pro-Life Obstetricians and Gynecologists, an organization of about 7,000 OB-GYNs who oppose abortion.
Dr. Monique Chireau Wubbenhorst, an OB-GYN and senior research associate at the de Nicola Center for Ethics and Culture at the University of Notre Dame in South Bend, said her position is a moral one, as well as a medical one.
“You have two patients in front of you, and one is not disposable,” she said. “You’re going to try, as an obstetrician-gynecologist, to do the best for both patients, and that’s the art and science of OB-GYN. You’re thinking about both of them at the same time.”
Fearing criminal penalties
But some physicians and abortion-rights advocates say it’s not always that easy, and the potential criminal repercussions could be severe if they step outside the lines.
One model abortion law crafted by Jim Bopp, an Indiana attorney who works with the National Right to Life Committee, would outlaw all abortions except to preserve the life of the mother.
Indiana Right to Life officials on Wednesday called the Senate Republicans’ proposal “weak and troubling,” saying it fails to provide any meaningful enforcement provisions. Planned Parenthood said the legislation “eliminates access to basic health care in Indiana.”
Rouse, the medical director of the Riley Maternity Tower, said no two pregnancies are alike and that they shouldn’t be grouped together under a ban that might place physicians and patients in jeopardy.
“The world would be a lot simpler if health care and medical conditions were simple, were black and white,” she said. “But there’s so much nuance and so much that is unique to each patient’s situation.”
She cited several examples of pregnancies that would not neatly fit under a wide abortion ban. In one situation, a patient’s water breaks relatively early in a pregnancy, around 15 weeks.
One risk of continuing such a pregnancy is bleeding, which could lead to severe hemorrhaging, Rouse said. Another is an infection that could not be treated with antibiotics and could lead to sepsis, which could land a patient in the intensive care unit, or even result in death.
“And so the counseling that goes into those situations is very complicated and takes into account the patient’s own assessment of risk to themselves and for their family and desires for the pregnancy,” said Rouse, who specializes in treating high-risk pregnancies.
The medical options in such a case, she said, include staying pregnant and accepting the risks of infection that could require intensive medical therapy or ending the pregnancy and avoiding the risks that grow by the day.
Yet, a legal ban on abortion except to preserve the life of the mother might not cover that situation, she added, because the mother’s life is not in imminent danger.
Lots of questions
In states that have already rolled out wide-ranging abortion bans, doctors are dealing with a baffling array of questions.
In Missouri, one physician, Dr. Julie Rhee, told STAT News, a medical news site, she had to present a difficult pregnancy case to her hospital’s ethics committee for a patient who needed emergency surgery to deal with an embryo implanted in her fallopian tube, which was threatening to break open and cause internal bleeding.
That presentation took more than a half day of work, and Rhee felt the oversight was intended to protect her and the hospital, at the expense of her patient.
“When we graduate medical school and take the Hippocratic oath, we vow to first do no harm to the patient, and to keep the patient’s best interests in mind,” Rhee, an OB-GYN and fertility specialist, told STAT News. “I can’t think of another situation where we’re feeling cornered to choose between the two.”
Dr. Nisha Verma, an OB-GYN in Atlanta, where a ban on abortions beyond six weeks into pregnancy could soon be activated, told The Washington Post some surgeons are uncertain whether routine treatments, such as giving anesthesia or chemotherapy to pregnant patients, could put doctors at risk.
“Are surgeons going to be afraid to intervene when a pregnant patient ruptures [her] appendix because they might inadvertently end the pregnancy?” Verma said.
The Indiana State Bar Association said it is in a “holding pattern” until new laws are passed, and its members know the details of the law.
“Until our statutes are finalized here, it’s somewhat of a guessing game,” Joe Skeel, the state bar association’s executive director,” told IBJ in an email. “And the last thing we would want to do is offer education or information about something that may not be relevant to Indiana practitioners.”
Some Indiana lawyers who specialize in health care law say any legislation should specifically exempt ectopic pregnancies (high-risk pregnancies where the fertilized egg implants in the fallopian tube) and non-viable pregnancies, such as a fetus that has no kidneys.
Indeed, the legislation unveiled on Wednesday includes those exceptions, said Sen. Sue Glick, R-LaGrange. She noted the bill would not affect treatment of miscarriages or ectopic pregnancies; in-vitro fertilization procedures; or prohibit ending a pregnancy when the unborn child would not be able to survive due to a fatal fetal anomaly.
Jody Madeira, professor of law at Indiana University’s Maurer School of Law in Bloomington, and co-director of its Center for Law, Society and Culture, added that legislation should contain a “safe harbor” clause that would protect doctors who treat women in good faith, so they would not be prosecuted or face licensure investigations.
If a woman comes to a doctor and says she’s having a miscarriage, the doctor shouldn’t have to do a full legal investigation, she said.
“First and foremost, their duty is to treat patients,” she said. “Their duty is not to be lawyers.”•
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As a seventh generation Hoosier, raised a Methodist (and Quaker), from a long line of religious women, let us leave these decisions to those best positioned to do so themselves: women, in consultation with their medical providers. It is obscene and morally reprehensible for the state to substitute its judgment.
How are the unborn child and the child’s father to be represented in that “consultation,” alexander m? There are three distinctly different human beings involved at that point, only one of which is the woman carrying the child. DNA science has proven that the unborn child’s DNA is distinctively different from that of the mother, so it is not “part of her body.” That’s not a Biblical or philosophical conclusion, it is a scientific fact.
If you were raised a Methodist and a Quaker, chances are pretty good you’ve not been exposed to many Biblical truths.
Bob, do you remember why the movement to legalize abortion took place?
Bob, you intentionally misrepresent the case by using the term “unborn child” to bias opinion. The development of the fertilized egg is a continuum and an objective person must accept that “unborn child” does not apply to the entirety of that continuum. The debate needs to be about the balancing of competing rights, not an absolute declaration of a right by one or the other entity in the equation. In that way, both extremes of absolutism have it wrong, or more likely that both ends of the spectrum simply engage in bad faith argument.
Tim D, the notion that an unborn child isn’t an objective person is as ludicrous as the notion that Jesus lived with the dinosaurs on an earth that is just 3,000 years old. A fertilized egg is a human in its earliest stages, just as a 105-year-old is a human in its final stage. When a person kills a pregnant woman, it is deemed a double homicide, even if no one (including the woman herself) knew she was pregnant.
Both extremes of absolutism do indeed have it wrong, which is why many of us in the center lauded the Bill Clinton adage of “safe, legal and rare”. With “rare” being struck from the current activism (“abortion is healthcare!”) you will inevitably get an equivalent inverse reaction among the holy rollers on the right. In many states (less likely Indiana or Ohio than the deep south) the holy rollers outnumber the pro-choicers significantly, leading to these inevitably legislative outcomes.
There needs to be an active voice for women. And there is.
There needs to be an active voice for the unborn. Since they themselves lack a voice, it comes from pro-lifers.
What continues to rankle the pro-choicers is that, even as women have equal political power to men and greater political involvement than they did in 1970 (when 9 MEN conferred the right of abortion to women), the pro-life movement in about 30-35 states has grown organized and often outstrips that of the pro-choice. Bearing this in mind, the pro-choicers cannot continue to assert that women are persecuted, when an enormous and politically active subset of women disagree and feel it is the unborn who are persecuted.
Far better to come from the angle of bodily autonomy and to work that as a point compromise, which is how we got “safe legal and rare” in the first place. Since that no longer seems to work, the only option is to let the states work through their democratically elected representatives, and hopefully the legislatures will carve out compromises that will differ widely among the 50 laboratories of democracy. Otherwise, use the courts to make your arguments. But if we keep thumping away at the “women are oppressed” canard, don’t expect it to work any better than it has been working the last 15-20 years. Time to try something new.
Yes, we are about to get something new. The “pro-life” crowd will prove how they’re not really all that pro-life, they’re just anti-abortion, and they will remind us of the past we forgot.
Because there will be more stories about women dying in back alley abortions, like there were back in the 50’s/60’s/70’s which is why abortion was legalized in the first place. More stories about women dying in childbirth for a kid they didn’t really want but their state banned access to contraception, because the Pharisees in their state believe a woman’s role in life is to be a baby carrier. More child rape victims who give Jim Bopp the opportunity to say something stupid to change people’s minds.
Then enough people will get together at the federal level and pass a law and there will be access to abortion and it will look very much like the status quo from 1973 to 2021. Because the anti-abortion extremists blew it and thought banning abortion was the answer, when they should have taken the tact of reducing the number of unplanned pregnancies.
It’ll be a repeat of Prohibition, or what’s happened in Ireland. Funny how we don’t learn lessons in America.
Lauren, the double homicide argument isn’t an analogue. In that case, the death of the fetus is outside the control of and against the will of the mother and thus the third party causing the homicide is held accountable.
It is precisely this distinction in the termination of the fetus that has allowed us (most of us, at least) to always understand that abortion post-Roe, while morally wrong by some codes, hasn’t been considered homicide by all but the most extreme idealogues.
The bodily autonomy argument doesn’t work when those who scream to demand it when asked to roll up their sleeves to take a shot move the goalposts when a woman in poverty with a long-gone sperm donor asks for the same consideration but is told she shall carry the child to term, her wishes be damned. Despite the fact that there certainly are anti-abortion women, the outcome for women collectively will be inferior to that of men collectively, unless the states that take abortion off the table via legislation also use the law to place constraints on the fathers of those to be born children.
I’m a pro-Clinton position on abortion and I believe that is where most of us fall. I believe we will determine that most of us, while not necessarily pro-abortion are indeed pro-Roe. And most lack the imagination to understand the second order consequences headed our way.
Quote: Indeed, the legislation unveiled on Wednesday includes those exceptions, said Sen. Sue Glick, R-LaGrange. She noted the bill would not affect treatment of miscarriages or ectopic pregnancies; in-vitro fertilization procedures; or prohibit ending a pregnancy when the unborn child would not be able to survive due to a fatal fetal anomaly.
Jody Madeira, professor of law at Indiana University’s Maurer School of Law in Bloomington, and co-director of its Center for Law, Society and Culture, added that legislation should contain a “safe harbor” clause that would protect doctors who treat women in good faith, so they would not be prosecuted or face licensure investigations.
So what’s the problem, all you fear-mongers?
The intent of the drafters has to make it on the paper. Witness those in Ohio who proclaimed that “oh, that 10 year old could have gotten an abortion.” That’s not what their law actually says.
And when you’ve got the head of the Indiana Right to Life running around proclaiming he’s disappointed in the bill because it has rape and incest provisions and doesn’t have enough enforcement provisions, who knows what the final bill is going to look like?
Reminder, these are Republicans who are ignoring the will of the voters. Reports are they’re sitting on a poll that shows support for abortion in the first trimester.
Wrong, Joe. The 10-YO could have received an abortion in Ohio according to certain specific provisions of their law. Take off your Hate-All-Conservatives-and-Christians-and-Pro-Lifers blinders because you deem them intellectually inferior to you for a moment and do some intelligent research into what Ohio’s law actually says.
Joe B – is that poll a national poll, or an Indiana poll? And even if a state one, such a result is likely because noone under Medicare age is old enough to know a country that that didn’t allow abortion. People typically prefer things they know vs the unknown; would expect those number to shift once there is a new reality, if implimented competently; like you say, has to make it on the paper.
Part of political leadership is to lead the people, and stake their elected office on doing what they believe is the right thing and convincing others through words and action that it is. Wish elected officials (especially the federal ones) did more of that.
Scott – here’s what I am referring to.
“Recent Indiana abortion surveys are few and far in between — with big changes in support and opposition based on wording and level of detail — so Indiana Republicans commissioned their own poll, as they draw up abortion-restricting proposals for a special session this month.
The House and Senate GOP campaign committees conducted a poll on abortion shortly after the U.S. Supreme Court handed down the Dobbs v. Jackson decision on June 24. The polling firm is reliably Republican, but the results were shocking to some conservative members of the caucuses.
Multiple GOP insiders spoke to the Indiana Capital Chronicle anonymously because the poll is being heavily guarded. Requests about the survey to House Speaker Todd Huston as well as both the House Republican Campaign Committee and Senate Majority Campaign Committee were ignored.
What is clear, according to the insiders, is that Hoosiers don’t want a near-virtual ban on abortion. Instead, they support exceptions for rape, incest and the life of the mother. And many are supportive of allowing abortion up to 15 weeks of gestation.”
https://indianacapitalchronicle.com/2022/07/19/abortion-gop-poll-shows-little-hoosier-support-for-total-ban/
Joe and Scott–
I certainly intend to vote against the most extreme and teeth-gnashing GOPers who support a complete ban.
The only problem is, given what much of the the Democratic party has become, in much of the country (certainly central Indiana) the alternative far too often is an obese purple-haired 45-year-old cat lady who wants abortion up until the woman is going through contractions. Hopefully I’m wrong, but what if I’m not?
We shouldn’t be forced to make these choices, but many of us who want abortion “safe legal and rare” will get stuck holding our noses and opting for the Bible-beaters. And if the Bible beater ends up winning election as a result, a sane DNC will see this as a cue to try again so they can clock-out that Bible beater with a more moderate challenger. Will that happen?
The two parties aren’t supposed to embody two blocs that work in lock-step opposition to one another and complete concordance within their party. They should ideally represent two opposing points of view, both of which can realistically capture 45-55% of the population. We’re losing that structure: the center won’t hold.
Can you find me the Indiana Democrats who are campaigning on a platform of legalizing third trimester abortions that are not being recommended by a medical professional to save the life of the mother? Heck, I can’t find a Democrat who wants to change the current 22 week status quo in Indiana. They may exist. I can’t find them.
So to spite cat owners, you’re going to side with the folks who introduced a zero week ban and are grumbling about the rape/incest provisos being too liberal … over the folks who just want to maintain the status quo. To be blunt, you’re part of the problem. Your actions would be condoning the actions you claim to not like, and you would not be affecting the change you desire.
Voting out Republicans over the zero week nonsense is the only option if you’re not happy with what Republicans are proposing. The moment Democrats go too far, the only option is to vote the Democrats out. But you’re creating your own bogeyman to justify your actions. That doesn’t take much courage.
That Indiana Republicans have introduced a zero week ban tells you where the majority of Senators are at. If they actually introduced a bill without the support of 26 senators after all that time in caucus, they should fire Bray from his role. Barring some major curveball, this bill will pass out of the Senate this week.
Would you be upset if you ordered eggs at a restaurant and received a chicken breast instead? I know I would be, because I don’t think of eggs as a living chicken.
If you think eggs are living beings, wouldn’t IVF disgust you? Who would think it’s okay to freeze a “baby”? The “pro-life” crowd is a joke.
You don’t understand science. Like, at all.
Then like, please explain it to me.
Don’t think God made chickens in the image of himself like he did man!
Apple and orange analogy.
The Dr goes in and squeezes the live placenta and pulls it out. If the pregnant mom is far enough along. The Dr. has to pull the baby out in sections. On a monitor, you can see the baby trying to get away and screaming in pain. The mother sometimes has complications because body parts get left inside her. And she has emotional problems whether she believes the fetus was alive or not.
I never understood why anyone thought it was ok (especially Doctors) to KILL babies in the first place!
A good and precise summary, Peggy A.