Earlier this week, I was preparing to write a guest essay with my colleague Dr. Caitlin Bernard, a gynecologist here in Indiana. We wanted to write about the chilling effect the overthrow of Roe v. Wade in just a few weeks has had on medicine in our state and across the country. But then Dr. Bernard a… target of a national smear campaign to speak out about her 10-year-old patient, a rape victim from Ohio who needed an abortion and had to travel to Indiana to get one, given the restrictions in her home state.
On Wednesday evening, our state’s attorney general said his office, Dr. Bernard would investigate. So I’m writing this essay myself, not just to draw attention to the chilling effect on medicine we’re seeing right now—but also because I’m terrified that I or one of our colleagues may soon face what Dr. Bernard continues after delivering care to our patients.
When we talk about the importance of reproductive health care in the lives of our patients, we sometimes weave in patient stories to humanize the often complex legal and medical concepts for the public. dr. Bernard shared the story of her patient from Ohio as an example of how an abortion ban can affect the most vulnerable.
The attacks on her were: instantaneously and powerful. Multiple prosecutors and leading conservatives suggested that Dr. Bernard was a liar. experts interrogated its integrity, and articles in numerous news outlets cast doubt on the story, with the editors of The Wall Street Journal explaining a ‘fantastic story’ that was ‘too good to confirm’.
Wednesday, a suspect in the Ohio rape case was charged after allegedly confess. But the attacks on Dr. Bernard have continued. The Indiana attorney general said on Fox News Wednesday evening that his office is investigating her, despite the fact that the abortion the 10-year-old patient received was legal in the state. The network showed the photo of Dr. Bernard in the air. On Thursday, The Indianapolis Star reported that they… archived the necessary paperwork associated with the procedure.
Political attacks on abortion providers are, of course, nothing new. And that’s not all providers and their staff have to deal with: they are focused, harassed and in some cases even murdered for providing legal healthcare to their patients; some types of attacks against them have recently increased. This moment, following Roe v. Wade, feels particularly terrifying and horrifying for anyone who cares about patients, especially those who provide reproductive health care.
This saga has had real consequences for Dr. Bernard. Local police have been warned of concerns about her physical safety.
My colleagues and I watched all this with horror. We are afraid this could happen to us too. A law recently enacted in Indiana, requires doctors, hospitals, and abortion clinics to report to the state when a patient who has previously had an abortion presents one of dozens of physical or mental illnesses – including anxiety, depression, sleep disturbances and uterine perforation – as these can be complications from the previous abortion. Failure to do so within 30 days could result in a felony for the physician who treated the patient, punishable by up to 180 days in jail and a $1,000 fine.
The law is so broadly written that a primary care provider who sees a patient with depression, an anesthetist whose patient has an allergic reaction to a drug, or a radiologist who finds that a patient has free fluid in the abdomen can be punished with a fine and jail time if they fail to report these things as possible complications of that person’s previous abortion. Any health care provider accused in this way could easily become a target of national attention, with attacks on them, both professionally and personally.
While clinicians generally obliged to have malpractice insurance, such coverage does not typically cover costs associated with criminal charges. And while malpractice insurance often covers legal assistance during a malpractice claim, the same does not apply to criminal charges. In addition to the tangible consequences of such costs, doctors also face a professional and financial risk that could end their careers and affect their families. Healthcare systems should not abandon their doctors when they are most at risk to avoid bad press.
Laws like this are too often written by politicians with no medical expertise and too often use medically inaccurate definitions. Lawmakers may argue that the laws are not intended to hurt patients, but they create fear among healthcare providers that will nevertheless affect patients.
It’s worth noting that this is all happening in Indiana, which currently accepts more abortion and care for pregnant women than some of its neighboring states. It’s worse next door; for now, Indiana is a haven for some of the region’s patients in need of care. This is expected to change when lawmakers in our state begin a special session later this month and seek further abortion restrictions, possibly including a near-complete ban. It’s unclear whether that legislation will include exceptions for rape or incest.
Our medical and ethical responsibility as clinicians is based on providing comprehensive, safe and evidence-based healthcare. If the provision of that care creates threats to professional and personal safety, patients will suffer. Doctors have sworn to do no harm. Obviously, many of those in power don’t.
Tracey A. Wilkinson is an assistant professor of pediatrics at Indiana University School of Medicine.