Abortion law from a physician’s perspective

This column’s intention is to give readers a look at what resulted from Indiana’s abortion legislation from a physician’s perspective.

It is not meant to take a position on the pro-life and pro-choice debate.

This legislation is termed as one of the most restrictive in the country as it bans abortion from zero weeks gestation. But it’s not as restrictive as it could have been. It allows certain exceptions to protect the health and life of the mother, fetal anomalies, incest and rape.

Indiana’s abortion bill is the most consequential legislation enacted in memory. But unfortunately, it was passed in haste. Public testimony was cut short, and legislators should have given more time to engage with physicians and other health professionals to study the legislation’s ramifications thoroughly and thoughtfully.

The introduced bill was pretty much a done deal, only tweaked around the edges before passage. Legislators were largely deaf to the long procession of physicians who testified to the high potential for unintended consequences and who offered solutions to mitigate potential problematic outcomes.

According to the new law, abortions involving rape and incest must be performed at 10 weeks gestation or earlier. Especially for pregnant children, more time is needed to identify the pregnancy due to delay in diagnosis from unawareness, hiding the pregnancy because of intimidation or shame, irregular menstrual cycles, denial and rationalization.

Although there may be confusion due to inconsistent bill language, the law allows for abortion throughout the entire pregnancy to protect the health and life of the mother. However, the legislation utilizing a standard of “reasonable medical judgment” for that determination is problematic, as it is open to interpretation.

What is reasonable medical judgment? What conditions are legitimate risks to the mother? At what point is the disease severe enough for an allowed termination?

Further, there needs to be a certificate with clinical documentation filed first with the hospital to justify the termination. I cannot find any provision for emergency situations demanding immediate action.

There is an exception for “the fetus is diagnosed with a lethal fetal anomaly” defined as a condition that with reasonable certainty results in death not more than three months after birth. “Reasonable certainty” is subject to opinion and clinical variability as is the life expectancy of a specific condition.

My above concerns largely result from the inclusion of physician felony criminal prosecution. The abortion ban beginning at zero weeks gestation creates many more potentially unlawful situations. Physicians will be second-guessed and challenged on acting in a responsible, evidenced-based, good-faith manner by nonphysicians, some with political or philosophical agendas. Physician accountability belongs with the Indiana Medical Licensing Board, not in criminal court.

Physicians may hesitate to act or withhold care in emergent situations, weighing their duty as a physician with criminal prosecution. Criminality should be a matter of intent and only for blatant and egregious violations. This will have a chilling effect on practicing obstetrics in such a punitive, adversarial and restrictive environment. Maternity care access and Indiana’s already high maternal/infant mortality rates will suffer.

Admirably, the General Assembly enacted companion legislation (SB2) providing much-needed funding, especially for low-income families, in support of healthy pregnancies, infants, children, families and adoption. Allocations total $75 million with $45 million for the establishment of the Family First Fund. More funding will be needed. Time will tell what impact this will have.

Commitment to pro-life should not end with the birth of the baby.

Dr. Richard Feldman is an Indianapolis family physician and the former state health commissioner. Send comments to [email protected].