With a number of states, including Texas, banning abortion and enacting laws that greatly limit the procedure, many healthcare professionals are seeking guidance on how to legally provide safe and effective reproductive care for their patients. Baylor College of Medicine is a non-partisan, not-for-profit academic institution. We are committed to educating trainees with the skills they need to competently provide care for their future patients; to providing evidence-based, ethical care to our patients; and to serving the needs of our greater Houston community and beyond. In particular, we are committed to the following ethical principles, which we hope will guide future policy making and practice.
- To fulfill their fiduciary and professional duty, medical providers need to be able to provide medically necessary and beneficial care to their patients, without fear of persecution or prosecution. Uncertainty about how to apply statutes can and will cause healthcare providers to lose confidence in providing services that are medically necessary and legally permissible. Guidance is needed for navigating the legal requirements and ethical principles involved in providing necessary care under heightened scrutiny. Specific clarity is needed on procedural exceptions, which in Texas includes situations where the mother faces a risk of death or substantial impairment of a major bodily function unless the abortion is performed. Additional consideration should be given to other reasonable exceptions, including situations where pregnancy termination is deemed medically indicated and/or the fetus is not expected to survive. Clinicians need to have latitude to make reasonable medical judgments about when these criteria have been met and should be protected from criminal prosecution for acting in good faith. To help mitigate potential issues, hospitals and clinics will need to develop policies, structures and language to provide clarity and address ethical issues that arise, and to educate providers accordingly.
- To protect and promote patient autonomy, medical providers have an obligation to provide objective, value-neutral counseling to patients about all of their medical options, including medical services that might not be available locally and where and how they might obtain those services. There is an urgent need to clarify how best providers can counsel patients about resources or options available, including in other states, under the confines of the law, while addressing patients’ needs and upholding confidentiality. Clarity is also needed on how to navigate and engage in conversations in other areas of reproductive health, such as in vitro fertilization (IVF), genetic screening, fertility treatments and contraception.
- Justice requires consideration of how policies impact the most vulnerable members of our community and requires that they be protected from disproportionate harm. These statutes disproportionately burden already vulnerable populations of pregnant women, such as women who are victims of nonconsensual sex (such as rape and incest), trafficked women, low-income women and women with psychiatric disorders. Many of these women will face transportation barriers that will severely limit their ability to travel to lawfully access healthcare services that were previously legal and available in Texas. Texas patients traveling to bordering states may also place further stress on already limited resources in those jurisdictions, which may impact the availability and quality of care for a larger population. Furthermore, should individuals in these circumstances be able to obtain abortion care out of state, research indicates that travel (especially longer distances) decreases the odds of returning for follow up care and increases the odds of visiting an emergency department for urgent care. Upholding our duty to protect the health and safety of all women and helping them obtain the appropriate level of safe clinical care, especially those in these difficult situations, is imperative. We also need to be concerned about what happens to children once they are born and the potential for limited or lack of access to healthcare and social support.
We as a community will stay committed to open dialogue on these critical issues and encourage community involvement through research, thoughtful discussion and analysis. We will continue to do all that we can to help make reproductive healthcare more accessible and equitable for all Texans and beyond.
Contributors: Clarice Jacobson, Amy L McGuire, J.D, Ph.D., Janet Malek, Ph.D., Joslyn Fisher, M.D., M.P.H., Kimberly Lopez, Dr.PH, M.P.H., J. Wesley “Wes” Boyd, M.D., Ph.D., Michael Coburn, M.D., F.A.C.S., Robert James Carpenter Jr, M.D., J.D, Holland Kaplan, M.D., Claire Horner, J.D., Anitra Beasley, M.D., M.P.H, Michael Belfort, MBBCH, DA (SA), M.D., Ph.D.