Roe Under Attack: How Can I Help?

ROE IS UNDER ATTACK: HOW CAN I HELP?

There are many unique actions clinicians can take that put our specific training to work

Ari Friedman, MD, PhD

In the leaked decision in Dobbs v. Jackson Women's

Health Organization that would strike down Roe v. Wade, Justice Samuel Alito seemingly allows states to take any approach they would like to intervene in patients' healthcare decisions. Healthcare workers need to view this as an opening salvo on fundamental rights, and work to minimize the substantial, documented harms to our patients this decision would cause.

Like everyone else, healthcare workers can support abortion access and abortion patients by volunteering at abortion clinics and donating to abortion access funds. But there are additional actions that physicians, nurse practitioners, and PAs can take thatspecificallyusetheirmedicaltrainingandposition.

Even if you're not in a state that is about to ban abortion:

Our local abortion providers will soon be inundated with out-of-state patients seeking healthcare. Anything you can do to increase local health system capacity to safely provide abortion care helps. This will become particularly important if the FDA shuts down Aid Access, thereby banning telemedicine access to medical abortion. What actions can you take?

First, stop thinking of abortion care as something that happens in a standalone "abortion clinic." Hospital operating rooms and procedure suites are perfectly suited to procedural abortion care, yet these procedures are often restricted or prohibited.

Advocate to expand abortion care at your hospital. Support your obstetric colleagues in advocating for change to your hospital's policies on offering abortion up to state limits. Organize colleagues against the often silent policies that have driven abortion care out of the core of the health system. If your hospital already performs abortions, make sure this information is publicly available and known to referring physicians. Figure out how much your hospital charges for abortion care, and advocate for parity with clinic costs, and for charity care policies aspartofhospitals'nonprofitobligations. Consider proactively advertising your hospital and emergency department (ED) as being a safe space for patients with abortion needs, ectopic pregnancies, miscarriages, and related issues, just as rainbow lapel pins and waiting room stickers have performed a similar role for marginalized LGBT populations. Become comfortable with prescribing medical abortion, regardless of your specialty. Research the drugs, dosages, side effects, patient counseling, follow-up, and protocols just like you would any other drug.

Explore ways your specialty can contribute. Pilot new initiatives and promote them through national thought leaders such as podcast hosts and specialty societies. For instance, anesthesiologists could volunteer to provide light or moderate procedural sedation at a local clinic -- this can greatly improve the experience of patients with more involved procedures or anxiety. Sedation is uncommonly offered, and can be prohibitively costly when it is. Emergency physicians can become familiar with local abortion clinics and practitioners, and refer patients seeking these services. Beyond that, they can explore prescribing abortion medications directly from the ED, andbecomeproficientinfirsttrimesterabortionprocedureslike vacuum aspiration when indicated if ob/gyn coverage at their hospital is spotty.

If every clinician did just one of these things, hospital policies would rapidly change, promoting abortion access.

Ari Friedman, MD, PhD, is an assistant professor of emergency medicine at the Perelman School of Medicine at the University of Pennsylvania. This is excerpted from a longer piece on Medpage, May 2021.