I’m a doctor The law should not compel me to hurt my patients like this

Editor’s note: This essay is part of the CNN Opinion series “America’s Future Starts Now,” in which people weigh in on how the biggest issues facing the nation have affected them and experts offer proposed solutions. Dr. Mae-Lan Winchester, an obstetrician-gynecologist and maternal-fetal medicine specialist, is an assistant professor at Case Western Reserve University and a member of Physicians for Reproductive Health. The opinions expressed here are his own. They do not represent the views of Case Western Reserve University. Read more reviews on CNN.


Life is never easy for pregnant patients who enter my Maternal Fetal Medicine clinic in Cleveland, Ohio.

Because I specialize in diagnosing and treating high-risk patients, people who come to me are already facing something they couldn’t have planned for. I constantly think: the mother carrying twins, faced with the risk of miscarrying one fetus or losing both. The terrified 21-year-old emerged with a life-threatening infection two days after her water broke prematurely.

I live in a state where the realities of abortion are harsh and politicized. The Supreme Court of June 24 Dobbs v. The Jackson Women’s Health decision in Roe v. Since he overruled Wade, I am saddened by what will happen to patients like mine – and has already happened.

Tara and Justin, whose story I’ve been allowed to share (we’ve all spoken with CNN), were forced to leave their hometown because the hospital’s lawyers disagreed with my medical opinion, the risks of his blood clotting disorder and autoimmune condition. it significantly outweighed the potential benefit of carrying a fetus with fatal abnormalities. Tara was finally able to get the care she needed in Michigan, but at great emotional toll, financial cost, and delay. God forbid, if something medically went wrong with Tara during the days she had to wait to terminate the pregnancy, I’m not sure what I would have done.

During an ultrasound in July, Winchester noticed that there was no amniotic fluid around the baby.  More tests that day and the next morning indicated that the baby had kidney failure and multiple heart defects.

As a physician specializing in maternal-fetal medicine, my daily job description is to navigate the delicate balance between the pregnant woman and the fetus. I cannot consider one without the other; I’ve spent my entire career treating pregnant patients struggling in the morally tough and emotionally exhausting gray areas that so many anti-abortion politicians ignore or try to pretend don’t exist. And so, after more than 11 years of post-graduate medical training and expertise, I was told by lawyers that my medical opinion is not sufficient to provide the care that I am legally qualified to provide.

Like many doctors, I have more than one job. My other office – where I work as a board-certified obstetrician-gynecologist, not a maternal-fetal specialist – is in a clinic that provides abortion care to all types of patients. Their lives are never simple either.

They’re the graduate student who must complete rigorous experiments before the grant money runs out, the misinformed new mother of twins who was misinformed that breastfeeding was a stupid form of birth control and can’t have a third child. The hospitality worker who lost her job due to the Covid-19 pandemic, the patient whose plans to escape abuse did not include binding her forever through a child, the patient whose pregnancy was not a goal at this time.

Patients sometimes drive more than 12 hours to seek care at this clinic. Just as I am honored to care for my medically at-risk patients, I am proud to ensure that patients who need abortion care for these other reasons have access to it. I am proud to help them live their lives as they were meant to.

In the more than 100 days since Roe came down, people in my position – those who provide abortions and care for pregnant patients – have completed 10 years. Many of us feel like pawns in a game where we have no say. Naive as it may seem, most of us never thought our careers would become the political casualties they are today: torn between caring for the sick, losing our medical licenses, or going to jail.

The mistreatment of patients who need care and my colleagues who can provide that care, the constant misinformation about abortion, the long trauma of the endless hoops patients have to jump through, all weigh heavily on us.

The legal reality of abortion changes frequently and unexpectedly in my state of Ohio. In 2019, Governor Mike DeWine (who is up for re-election next month) signed a law banning abortion after early heart activity is detected, usually around six weeks into pregnancy (before many women know they are pregnant). That law, which was blocked by a federal judge who said it would likely be unconstitutional, went into effect in Dobbs v. Roe. After Wade was thrown.

Already, since Tara and Justin’s experience, that law that forced them to travel out of state has been suspended by a judge’s preliminary injunction, meaning it won’t be enforced while the lawsuits surrounding it are still pending. But the contested races in the midterm elections will have a big impact on the next one. I need to be aware of the laws in the states around us because I often coordinate out-of-state abortion care.

It’s hard to practice medicine when you’re dealing with the next legal crisis that could harm your patients. I talk to hospital lawyers more often than any doctor should, begging and pleading on behalf of patients, frustrated that patients can’t get the same care they would otherwise get.

Every time I’m forced to turn a patient away, that candle lit inside me, once a roaring, fiery fire in a young student excited to embark on a career of helping others, dims a little. This grave breach of my duty as a physician is not easily remedied, even when I have no power to do otherwise.

I care about my community, both providers and patients. I think about how scared my patients must be to travel to another state, how quickly their finances run out, how alone they must feel. I’m worried they’ll think I didn’t fight hard enough for them, even though I know they can hear the cracks in my voice when I tell them the hospital wasn’t sick enough.

But most of all, I worry that the next lawyer I discuss a complex case with will not understand, and the patient who needs an abortion will be denied. I worry that they will lack the time, money, transportation, and support to get the care they need. And this refusal, which is not in line with my medical opinion or the wishes of the patient, will change their life forever. I’m afraid they will die.

But I still feel joy in my work sometimes. A college student’s trembling hands, after suddenly swallowing the first pill of her abortive medication regimen, whispered with growing confidence, “I’ll be fine.” A transplant recipient’s tears dry when she knows she doesn’t have to go back on the transplant list when her already weak kidney fails again in another pregnancy.

A huge weight is lifted off the shoulders of a single mother, who can now focus on the family she has and the career she wants, without the restrictions of an unwanted pregnancy. It gives me some comfort to know that Tara and Justin’s broken hearts – who desperately wanted their baby to say goodbye – can finally begin to heal now, knowing they did what was right for Tara’s health and saved their baby, who could. do not live, the short life of pain.

It is these moments of hope, often shrouded in sadness, that help those of us tired of dogfighting in the political trenches to rise once more. Our sails are raised by the general public, our colleagues in other specialties and our governing bodies (such as the American College of Obstetrics and Gynecology and the American Medical Association) who are encouraging us to organize and rally on our behalf. who are unequivocally against the ban on abortion.

But this fight comes at a high cost to everyone. Patients seeking abortion care and providers of such care should not be used as political pawns or brought to the forefront of national elections.

Patients should be allowed to simply be patients, to make medical decisions consistent with their faith, family needs, and health, without government interference. They should be able to receive accessible and compassionate care regardless of their circumstances. And doctors should be allowed to simply be doctors. I must be allowed to care for my patients without reprisal or legal risk.

When there are bans on abortion, this simple goal becomes impossible.