Pregnancy-related complaints are a leading cause of visits to emergency departments around the country.
Listening to oral arguments on Tuesday in the Supreme Court’s medication abortion case as an emergency room physician who has seen my share of miscarriage management, it was hard to escape a feeling of rage and disequilibrium. Were these abortion opponents really saying what I thought they were saying about how to handle emergency room patients presenting with miscarriages?
First: On almost every one of my emergency department shifts, I care for a patient who is having vaginal bleeding while pregnant or being evaluated for a possible ectopic pregnancy. Unfortunately, patients who are bleeding and pregnant will often learn in my emergency department that their pregnancy has ended, and we will sit and discuss their options, often in consultation with my obstetrics colleagues.
They may need supportive medication or a procedure to help them complete the miscarriage that started before they walked into my emergency department. The care we offer to patients who are miscarrying is consistent, and hopefully offered with compassion. It has no relationship to any action the patient might have taken prior to their time in my emergency department., made during Tuesday’s oral arguments. I am not generally in the practice of listening to Supreme Court oral arguments.
This is where Hawley’s argument went wildly astray. By arguing that her clients could refuse care to any patient during a course of care because of the possibility that they may have taken a medication that already definitively ended the pregnancy, she opened a Pandora’s box of ways physicians, and other providers, could refuse care to patients, including at least one that is entirely inconsistent with the practice of medicine as I know it.
Our foundational mantra in emergency medicine is that we care for any patient, any time, for any reason. A claim like one Hawley makes, that it’s actually just some patients, if we want, and only when we feel good about it, is antithetical to our practice and dangerous for us
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