How medical providers are navigating the legal shifts in reproductive rights

Geoff Bennett:

The Supreme Court will soon weigh in on reproductive rights again, as the justices agreed this week to hear a case about access to mifepristone for medication abortions, which make up more than half of abortions in this country.

For many Americans, these Supreme Court decisions have immediate real-life implications.

Amna Nawaz:

And that is playing out this week in Texas, where the state Supreme Court overturned a ruling that would have allowed Dallas resident Kate Cox to terminate her nonviable pregnancy. Cox had to leave the state to get that abortion, but the ruling has broad repercussions.

And it's put medical providers on the front lines of interpreting legal language while caring for their patients.

We're joined now by one such medical provider. That is Dr. Amna Dermish. She's an OB-GYN based in Austin, Texas.

Dr. Dermish, welcome. It's so nice to have someone with my same name on the show, though we differ slightly in pronunciation.

I want to ask you about this exception in the Texas law, though. There's a near-total abortion ban in the state, the exceptions in the case of a risk to the life of the mother. In the Kate Cox case, she said it was a risk. The court disagreed. And they said in the ruling, the exception is predicated on a doctor acting within the zone of reasonable medical judgment, which is what doctors do every day.

Does that make sense to you? Do you understand what the exception encompasses?

Dr. Amna Dermish, Planned Parenthood of Greater Texas: I don't. And I think that really gets to the heart of the matter, is that it's really — we have been set up as health care providers to be put into a situation where every medical decision that we make is being second-guessed by the legislature and the judiciary.

And so physicians are placed in a situation where they are unsure whether what they consider to be their sound, reasonable judgment would be acceptable to our attorney general or to judges in the state of Texas.

Amna Nawaz:

And we spoke with Kate Cox before that court ruling. Here is just a clip of what she had to say about learning her pregnancy was nonviable.

Kate Cox, Plaintiff:

She will either die in my belly or I will carry her to term and have to deliver her stillborn, or, if she arrives into this world, her life will be measured in minutes or hours or days and plagued with medical devices.

She would need to be placed directly onto hospice. So imagine receiving that news and pairing that with the risks and complications of continuing the pregnancy and the childbirth.

Amna Nawaz:

Dr. Dermish, knowing the uncertainty you just expressed around interpreting the law, how do you talk to your patients about this kind of thing, knowing many of them will face the same thing that Kate Cox did?

Dr. Amna Dermish:

Yes.

Well, given that there is a — essentially a complete ban on abortion in Texas, these conversations are really hard to have, and they're not happening in the way that they should and did even two years ago.

Listening to Kate is heartbreaking, because nobody should ever be in that situation. We're in a situation where doctors are having to say, how sick is too sick? How close to death does somebody need to be? And who is allowed to make that determination?

Patients aren't allowed to choose their own risks. Is it a 20 percent risk of death that is good enough to have an abortion in Texas? Or does it need to be 70 percent? How much blood is too much blood for somebody to lose before we can say that this is an acceptable abortion in the state of Texas?

And it's an untenable situation. People are forced into these terrible choices that they're not even allowed to make. And, as a physician, it's just — it's heartbreaking to be there. I have the training and the capacity to provide care to these people. I live here in the state of Texas, and I am prevented from providing essential medical care to patients based on my judgment and the patient's desires by my state.

Amna Nawaz:

There's the mission to serve your patients. There's also the legal risk you and your colleagues face in having these discussions.

What's the conversation been like among other OB-GYNs in Texas?

Dr. Amna Dermish:

I mean, I think there's a culture of fear that exists now. People aren't sure what is safe to say to their patients. They're unsure what kind of care they can offer their patients.

And they are afraid that, if they offer the standard of care, that they will be punished, that they will lose their license. They will lose their livelihood. Their family will suffer. And again, as — and then on the other side, you have this patient who suffers even more from this.

And you go into medicine to help people. And to be held back from that is really devastating as a provider. And I think what we have seen in Kate Cox's case is that the state is determined to prevent us from practicing safe medicine.

We see that with the letters that the attorney general sent to the hospitals and to the physician, threatening them if they were to proceed with providing the standard of care. And I think it's just going to continue to harm people in ways that we can't even imagine at this point.

Amna Nawaz:

Well, Doctor, as you know, Texas is not alone in its abortion restrictions there. There's some 15 other states that have near-total bans.

The landscape shifts quickly as well. The Arizona Supreme Court just heard arguments about an abortion ban. A Wyoming judge is now weighing whether or not to uphold a medication abortion ban. Do you consult and compare notes with other doctors in other states?

Dr. Amna Dermish:

I mean, we have — I'm fortunate to belong to an amazing community of providers across the country. And in some ways, it feels like a race to the bottom.

And when we talk about this, the focus is always on the care that our patients need and what we can still do to help them in the face of all these restrictions. Our patients are terrified. My colleagues are telling me that patients are leaving their phones behind when they travel across state lines to get abortion care because they are afraid that they will be tracked and they will be punished for seeking health care. That's the environment that we live in.

Amna Nawaz:

That is Dr. Amna Dermish, OB-GYN, based in Austin, Texas, joining us tonight.

Doctor, thank you so much.

Dr. Amna Dermish:

Thank you so much.