Dan Gorenstein, Ryan Levi – Tradeoffs
Dr. Lisa Harris has spent the past few months helping her health system prepare for the possibility that abortion could become illegal in Michigan.
When a draft document leaked on May 2 indicated the U.S. Supreme Court might overturn Roe v. Wade, she realized she needed to double down.
The fall of Roe would end 50 years of health care practice and end the constitutional right to an abortion. It then would be up to each state to allow or ban the practice.
For many Americans, the draft opinion signaled the nation could be headed for a major health care shake-up. Harris understood if the Court’s new conservative majority overturned Roe, about half of the states, including Michigan, could quickly ban abortion.
Harris had been bracing for the possibility that Roe could be lost since the Supreme Court held oral arguments in December in Dobbs v. Jackson Women’s Health, where Mississippi asked the court to affirm its ban on elective abortions after 15 weeks.
Harris has carved out 10 hours a week this year to prepare her hospital to operate in a post-Roe world. She met with colleagues. She conducted presentations. She collected unanswered questions.
Only around 4 percent of abortions in the U.S. happen in hospitals. Harris said people who end up there usually have a medical issue too complex for outpatient clinics.
If Roe is overturned, a 1931 state law would make performing the procedure in Michigan a felony, except when necessary to save the woman’s life. Harris said knowing when that standard is met is complicated.
“What does the risk of dying from pregnancy need to be? Does it need to be 100 percent, like that person who’s extremely ill in the intensive care unit and will die shortly?” she said.
What if a pregnant patient has cardiac disease and a 25 to 30 percent chance of dying if they were to continue the pregnancy – is that a high enough chance to warrant the procedure?
“Chemotherapy or radiation or surgery can cause significant harm to a fetus or a baby. So [a patient] may want to end a pregnancy so they can start cancer treatment immediately, as opposed to wait months, deliver, start their treatment, and maybe now have more advanced disease,” she said. “It might shorten their life a great deal.”
Those are the kinds of nuanced decisions Harris said health professionals may face. She wants her colleagues to be ready.
“These are the questions that doctors and health care professionals are thinking about that I’m imagining legislators and justices have not thought about,” Harris said.
Harris foresees a self-imposed dividing line: “At some point, we will have to say, ‘We can justify taking care of these patients because the threat to their life is high enough.’ But there’ll be some point where we’re going to have to say to patients, ‘I’m sorry, we can’t help you. You can go out of state. You can go to Canada. You can drive several hundred miles.’ And they will say, ‘But I can’t do that,’ and we will need to say, ‘I’m sorry, I can’t help you.’”
Harris said the need to be prepared extends beyond her own OB-GYN department to primary care doctors, specialists and hospital leaders.
“It feels like throwing a grenade into a meeting every time I [bring this up] because legal abortion has been in the background through the lifetime of most people who are in practice now and it just doesn’t seem real to them,” she said.
Harris recently met with a group of emergency department doctors. She told them she hopes their main job would be reassuring nervous patients who used abortion pills at home.
“But,” she warned, “there will be some people who didn’t have access to those safe medications and who put something inside them, who took a poison or a toxin. Those people you’re going to have to jump and provide critical lifesaving care.”
Harris said this would be a big change for emergency physicians since abortion complications are so rare that they've rarely had to make these kinds of triage decisions.
And it’s more than patient care Michigan Medicine must plan for. Michigan has one of the top ranked OB-GYN training programs in the country, and they have to be able to teach doctors-in-training how to perform abortions.
That raises the question: How does Michigan Medicine teach those skills if the procedure is all but outlawed?
Harris said they’re contacting colleagues in other states that protect abortion care to ask: “Could you accommodate an extra learner at your site? What kind of contracts do we need? How many days a week would they be there?”
The questions can seem unending, said Harris. Others at the top of her mind: How would Michigan Medicine handle the likely uptick in births? How would contracts with insurers change if that happens?
In this uncertain time, what seems certain — if abortion did become illegal in Michigan — is that many people who want that care would not get it.
Harris said she wishes people, especially her state’s lawmakers and U.S. Supreme Court justices, could glimpse what she’s seen over the past 20 years.
“They would see mothers,” she said. “Most of the patients I care for already have children. They would see people drive through snowstorms and blizzards. They would see a lot of poverty. They would see people who, if they had more resources, would definitely continue their pregnancies. I think what you would see in a nutshell is all kinds of injustices and inequities all rolled into one that happens to manifest itself in someone requesting an abortion.”
It’s been helpful for Harris and her coworkers to think about the systemic questions Michigan Medicine must address. It’s productive, and it’s a distraction. The work has helped quiet some personal questions like, “What happens if the care I’ve devoted my career to offering is outlawed?”
“There is stress and distress and pain that is very often woven into a decision to end a pregnancy. And when I think about needing to turn people away, giving birth when they don’t want to, I just see magnification of that pain and distress and injustice and inequity,” Harris said.
Reckoning with this moment, said Harris, means accepting that she would be able to help and yet be forbidden from offering any assistance.
The Supreme Court still could decide to keep Roe. But if Roe goes away, Harris is determined to help her hospital be as ready as it can be for all the patients who deserve nothing less.
Side Effects Public Media is a public health news initiative based at WFYI.