Dobbs decision 'opened the door for complete and utter chaos,' physicians and legal experts tell Congress

Hamstrung physicians and limited access to reproductive and non-reproductive care stemming from states’ “broadly worded laws” were in the spotlight during a Tuesday House Subcommittee meeting polling medical experts and abortion advocates on the ramifications of the Supreme Court’s overturning of Roe v. Wade.

The majority of witnesses called before the Democrat-led Subcommittee on Oversight and Investigations of the Committee on Energy characterized abortion as a private healthcare decision between a pregnant person and their provider.

Medical professionals who testified also corroborated media reports from the past month describing practitioners who were told by their organization’s lawyers to withhold certain procedures until a patient’s condition deteriorated to the point where their life was at risk.

“Physicians are struggling every day. These are not rare examples,” American Medical Association (AMA) President Jack Resneck, M.D., said during the meeting. “The lack of flexibility due to that government intrusion is very frightening.”

Nisha Verma, M.D., an OB-GYN and a fellow of Physicians for Reproductive Health, highlighted conditions like pulmonary hypertension where the risk of death is 50% if a patient continues with their pregnancy. Under laws enabled by the Supreme Court’s decision, she said there are open questions on whether she’d be legally allowed to provide an abortion to such a patient.

“The idea of having to wait until they get sick is just counterintuitive to what we train to do as physicians,” she said. “But that’s what we’re seeing in our communities. That’s what we’re being told by these laws we have to do.”

Resneck said the AMA is concerned about pharmacies that have restricted access to medications that have uses beyond aborting a pregnancy. Methotrexate, for instance, is commonly prescribed in oncology and rheumatology to treat a range of autoimmune conditions.

These scenarios are direct results of laws and legal decisions that “opened the door for complete and utter chaos” in several states, said Leah Litman, assistant professor of constitutional law at the University of Michigan Law School.

The language of the top court’s decision also puts other established constitutional rights relevant to healthcare such as privacy and access to contraception into jeopardy, she told the subcommittee.

Verma added that many of the new questions regarding the legality of non-abortive reproductive health—such as in vitro fertilization—are due to the laws being written by legislators with no medical expertise or concern for how the new rules would affect care delivery.

“I don’t understand how these laws apply to the day-to-day practice of medicine because it’s not clear to anyone,” she said. “That’s the issue here: We know how to do the medicine, we don’t know how [to interpret] these laws … we’re trying to figure this out just like everyone else is. It wasn’t thought about in advance.”

Resneck warned that the desire to provide care would drive many physicians from practicing in their home states. Those with unwanted pregnancies, meanwhile, will still seek them out in harmful ways.

“We’ve only begun to assess the full impact of the Dobbs decision—I haven’t even touched on the impacts on medical education, privacy of medical data, travel across state lines or the physical safety of patients and physicians,” he said.

Republican members of the subcommittee decried the hearing’s composition of witnesses, who five to one said the post-Roe landscape was a danger to women and worsened care delivery.

The Republican members, some of whom are current or former medical providers, pointed the majority of their questions toward the other witness, Christina Francis, M.D., CEO-elect of the American Association of Prolife Obstetricians and Gynecologists.

Francis warned of self-managed, medication-assisted abortions, telling the committee that these approaches that exclude a medical professional can have dangerous complications, such as excessive bleeding, which the patient wouldn’t be able to recognize on their own. 

Francis also said that she and other pro-life OB-GYNs have always intervened when a mother’s life is at risk, and that to her knowledge no current laws restrict providers from treating an ectopic pregnancy. 

She said the existing Emergency Medical Treatment and Labor Act (EMTALA) provides for both a mother and “her unborn child” and that interventions can be performed in line with current laws and in a way that “respects the dignity of that unborn life.”

"I too have heard the stories about physicians hesitating to take care of women with miscarriages or with ectopic pregnancies," she said. "I'm not a legal expert, but at least as far as the laws that I've seen that's not the fault of the law. It's the fault of the hospital systems or the state departments of health; it's their responsibility to educate physicians on what the law says and what it means."

Litman flatly disagreed, telling the committee that newly enacted laws and those reinstated after more than 100 years are directly blocking medical care because they are either too vague or include extremely narrow exceptions.

Resneck said the AMA welcomed the federal government’s recent guidance on EMTALA protections in regard to life-saving abortion care and had even requested the release in order to help reassure hospital legal counsels in restrictive states.

That guidance will be the next front in the legal battle on abortion thanks to a lawsuit brought by the state of Texas against the Biden administration. Filed last week, the suit argued that the federal government overstepped EMTALA by “compel[ling] healthcare providers to perform abortions.”