COLUMBUS, Ohio — Abortion foes celebrated victory in a 50-year fight on June 24, when the U.S. Supreme overturned Roe v. Wade and allowed states to severely restrict — or even eliminate — women's access to abortion. But for those who care for pregnant women, the ideological victory posed a swarm of burdensome questions they haven’t begun to answer.
Jason Sayat, a Central Ohio OB-GYN, said the Friday the decision came down started as any other. He and his colleagues juggled a full office load with duties in the labor-and-delivery ward.
"Then we were hit with the information that Roe v. Wade was reversed," he said, describing how through the rest of the day they dealt not just patients' medical conditions, but also their fears about what the cancellation of a constitutional right to abortion meant for them.
Within hours, the confusion increased when Attorney General Dave Yost filed a motion to lift an injunction against a 2019 Ohio law prohibiting abortions after six weeks of pregnancy — a point at which as many as a third of women don't even know they’re pregnant.
Sayat said "it really put things dramatically and quickly into focus in terms of how these restrictions were well in place within hours."
The six-week ban is far from the only abortion restriction that could be coming down the pike in Ohio. One lawmaker says she has the votes and support of Gov. Mike DeWine to ban almost all abortions, even in the case of rape or incest.
The flurry of anti-abortion laws and proposals has Ohio's major health systems on their heels.
Individual practitioners such as Sayat, who declined to name his employer, are saying they need to know that Ohio health systems will have their backs in the months ahead. But he said that as of last week, "we're still waiting for directives."
He explained that while the political debate over abortion tends toward the simplistic, caring for pregnant women in the real world is anything but.
For example, Ohio's six-week law allows later abortions if there's a "medically diagnosed condition that so complicates the pregnancy of the woman as to directly or indirectly cause the substantial and irreversible impairment of a major bodily function." But who determines whether those conditions have been met? The Department of Health? The police?
"What this has all come down to is the violation or disruption of personal medical decision-making between the decisions of the patient and their trusted health care team or physician," Sayat said. "It's so individualized and complex that laws like this can't apply to that. It's not as black-and-white."
And, he said, in situations where continuing a pregnancy is incompatible with the health of the mother, doctors and patients need to be able to make decisions "without fear of reprimand or imprisonment on felonious charges."
The American Medical Association didn't mince words in the wake of the Supreme Court decision overturning Roe v. Wade.
The organization "is deeply disturbed by the U.S. Supreme Court's decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive health care — representing an egregious allowance of government intrusion into the medical examination room, a direct attack on the practice of medicine and the patient-physician relationship, and a brazen violation of patients’ rights to evidence-based reproductive health services," AMA President Jack Resneck Jr. said the day of the decision. "States that end legal abortion will not end abortion—they will end safe abortion, risking devastating consequences, including patients' lives."
Ohio's major hospital systems — operating in a state dominated by anti-abortion officeholders — have been much more cautious in their public statements.
The Capital Journal last week asked them four questions:
- Will your organization provide out-of-state abortion care to your employees should they need it?
- Will it defend practitioners making medically sound decisions — for example, terminating a pregnancy to protect the mother — to the fullest extent should they be accused of violating current or future restrictions on abortion in Ohio?
- Are you concerned that current or future restrictions might make it more difficult to attract and retain talented practitioners?
- Does your organization believe that, in restricting abortion, lawmakers and the courts are inserting their religious beliefs into the doctor-patient relationship?
Many responded by saying they don't have any answers yet. Tausha Moore of Toledo-based ProMedica gave a typical response.
"Regarding your inquiry, we are in the process of evaluating recent changes to better understand the impact they will have on health care in the communities we serve," she said in an email.
Marti Leitch of Ohio State's Wexner Medical Center made a similar statement.
"Ohio State is closely examining the decision from the Supreme Court and changes in state law," she said. "If necessary, the medical center and College of Medicine will make adjustments to be in compliance with the law."
Dorsena Drakeford of Cleveland's MetroHealth said her system is also reviewing the situation.
Amanda Nageleisen of the University of Cincinnati Health System also said it was continuing to review the situation, but "We remain deeply committed to the sanctity of the patient-health care provider relationship and will balance patients' and health care providers' interests in accordance with all federal and state laws."
It appears that a big question the state's hospital systems are grappling with involves ending pregnancies when they’re deemed medically necessary.
"While OhioHealth hospitals and clinics have not and do not provide elective termination procedures, we acknowledge that there are times when the life and safety of a patient may be threatened by acute medical complications, even early in pregnancy," spokeswoman Stephanie Stanavich said in an email. "We will continue to offer care to our patients within the confines of any new regulatory landscape and always within the best practice standards of care."
As the big hospital systems formulate their policies, Sayat, the OB-GYN, said he hopes they keep practitioners in mind.
"I think that the biggest part is that we as providers need to feel supported and feel like we have the resources to navigate the complexity of scenarios we're presented with," he said.
Read More: Ohio Capital Journal