Anesthesiology following the Dobbs decision

It can be easy to overlook anesthetists, often hidden in operating rooms. However, anesthesiologists, known to intervene in times of crisis, rise in the wake of the Dobbs decision.

The loss of access to federally protected abortion will harm our patients, our colleagues and our profession. Clinical care, from obstetric anesthesiology, critical care, pain management and millions of surgeries each year in America, will be impacted directly and indirectly.

Anesthesiologists themselves must consider risks to their physical safety due to lack of access to medical care and hostile laws targeting physicians who provide reproductive and non-reproductive services to people of childbearing age.

We write on behalf of a rapidly growing group of anesthesiologists concerned about the direct and indirect consequences of the decision. We can strengthen our profession by speaking out on issues that directly impact the ability of anesthesiologists to provide safe, evidence-based care to patients and the ability of our colleagues to receive reproductive health care.

Physicians and organizations may believe that remaining neutral or silent will shield them from abortion controversy. But that’s not the answer. Every day, anesthesiologists advocate for patient safety in operating rooms, delivery rooms, intensive care units and clinics – the crisis in access to reproductive health care should be no exception.

Patient Safety

Medical evidence on the effects of state restrictions on reproductive health care indicates that this decision will negatively affect patient safety, privacy, health, and maternal and child mortality. State-imposed restrictions lead to higher maternal and child mortality rates in a range of geographic settings and time periods. The Dobbs decision will have a disproportionate impact on marginalized populations, who already experience gross inequality in maternal morbidity and mortality and access to care.

Not only are safe abortion services lost, but routine reproductive health care has already been affected (e.g. emergency treatment of ectopic pregnancies), as well as the treatment of medical conditions requiring drugs potentially teratogens. These changes will harm our patients, colleagues and friends.

Safety and well-being of anesthesiologists

As patients and physicians, the physical safety and well-being of anesthesiologists may be at risk as a result of this decision in many, often unforeseen circumstances. Major decisions about whether to practice or travel to states with restrictions and bans on reproductive care will be recalculated.

These safety concerns are not limited to abortion providers, as similar states have also clarified their intolerance of the LGBTQIA+ community. We will likely see an erosion of hard-won advances in gender and racial equity in our profession, further damaging our professional well-being.

Ethical considerations

Beyond access to abortion, the Dobbs decision shakes the foundations of professional medical practice. We recognize a variety of strong and polarized opinions regarding reproductive care, including among anesthesiologists. Physicians already enjoy legal protection against the provision of treatment contrary to their own ethical values.

Restrictions and prohibitions on essential health care prevent anesthesiologists from meeting our own moral and ethical obligations to patients. In many situations, we may be required to follow our own ethical commitments to do the right thing for patients Where follow restrictive laws, constraining us to the interpretation of medical dilemmas by non-medical personnel. The wave of avoidable moral distress associated with being legally barred from providing and receiving evidence-based medical care will be unprecedented.

The American Society of Anesthesiologists (ASA) Guidelines for the Ethical Practice of Anesthesiology, which incorporate the AMA Principles of Medical Ethics, guide us through this monumental time. The AMA Principles of Medical Ethics and each of the five sections of the ASA Guidelines address specific ethical obligations of anesthesiologists affected by the SCOTUS decision. The AMA’s Principles of Medical Ethics state: “A physician shall obey the law and also recognize his responsibility to seek modifications of these requirements which are contrary to the best interests of the patient.” Additionally, the Guidelines for the Ethical Practice of Anesthesiology state: “Anesthesiologists respect each patient’s right to self-determination.

We are proud that several of our most trusted professional anesthesiology organizations have spoken out against legislative interference in medical practice and defend the right of every patient to make decisions about their own body. The American Board of Anesthesiology has joined more than 75 other organizations in affirming these ethical principles. The California Society of Anesthesiologists, women in anesthesiologythe Society for Obstetric Anesthesia and Perinatology, the Anesthesia Patient Safety Foundation, and ASRA Pain Medicine draw attention to this critical issue for anesthesiologists.

Legal Considerations

Anesthesiologists providing abortion care in the United States should be aware of the potential risk to their physical and psychological safety when traveling to states with significant limitations on abortion care, including the risk of possible criminal charges. The landscape of these restrictions may change quickly as the country’s legislatures propose new legal actions against patients and healthcare workers.

Professional development

In addition to the monumental clinical impact, abortion restrictions add necessary complexity to the decision to practice and/or participate in professional development activities in certain geographic regions. Anesthesiologists may not be able to access appropriate emergency reproductive care for themselves when attending professional meetings in states where these limits are observed. As the lawsuits against healthcare workers evolve, we anticipate that additional risks may emerge.

Anesthesiologists rely on professional meetings for networking, education, governance, and scientific collaboration. The commitment of any professional society to its members should be based on the guiding values ​​of a society. When selecting venues for in-person business meetings, these values ​​and the needs of their members should be considered.

The American Medical Informatics Association outlines how organizations can approach site selection according to the standards of most professional medical societies. They provide solid guidance for other societies moving forward after the Dobbs decision. These elements include the right to benefit from science, safety and security, freedom of travel, freedom of expression, the right to non-discrimination and civil speech, human rights, access to professional development, transparency and truthfulness. Society leaders have a fiduciary responsibility to their members to consider these values ​​when planning future meetings.

It’s time to put political rhetoric aside and take action to protect our patients, each other, and the practice of safe medical care. Anesthesiologists are made for this moment.

The work is the opinion of the authors, who are not representative of any organization or institution.

Alyssa M. Burgart, MD, MA, is an Associate Clinical Professor in the Department of Anesthesiology and an Ethicist at the Stanford Center for Biomedical Ethics at Stanford University. Linda B. Hertzberg, MD, is retired from private practice in California and past president of the California Society of Anesthesiologists. Harriet W. Hopf, MD, is a professor in the Department of Anesthesiology and an adjunct professor in the Department of Biomedical Engineering at the University of Utah. Christina Menor, MD, MSis an anesthesiologist in private practice in Los Angeles and a lecturer for the California Society of Anesthesiologists. Amy Vinson, MD, is assistant professor of anesthesia at Boston Children’s Hospital and Harvard Medical School, and chair of the American Society of Anesthesiologists Committee on Physician Wellness.

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