Pro-Lifing Idaho to Death
The US Supreme Court is considering Idaho’s anti-abortion laws — laws that drove away the doctors who saved my baby’s life.
The question before the US Supreme Court today is whether emergency rooms in Idaho are required to provide care to pregnant patients who need an abortion — to save their lives or, potentially, their reproductive systems.
Josh Turner, arguing on behalf of Idaho, attempted to skirt the issue by saying doctors “could in good faith” make a choice to save a woman’s life or her reproductive organs, but it was on a “case by case” basis.
“But some doctors couldn’t,” Justice Amy Coney Barrett replied. “Some doctors might reach a contrary conclusion.”
The reality is that many Idaho doctors have reached that conclusion, and have left the state over it. The doctors that saved my life and my baby’s life had to leave the state because they could not, in good conscience, practice medicine in a state that prevented them from potentially providing care for patients who might otherwise die.
In fact, the entire OB ward that saved my life closed a year ago due to anti-abortion laws. I read the news on one of the OB nurse’s social media pages — the nurse who sprinted to get a bag of blood for me while I breathed, unconscious, through cold and distant stars. I’d transferred the four blocks to Bonner General from my living room after an unsuccessful home birth. I agonized about going those four blocks, already depleted and with infection setting in.
Blind with pain and dry-heaving into a plastic bag, I jostled in my sister’s car while the midwife called ahead for a wheelchair. Amelia Huntsberger was on call when I arrived, the air outside scented with burnt-hay and hot asphalt. In the metaphorical arms of a warm and competent OB ward, I relaxed between the life-threatening complications of intra-amniotic infection and hemorrhage. I knew, as I retreated deep into the recesses of my blacked-out, labored breathing, that I could die; the world had faded, and was now in the hands of others. I’d seen my daughter briefly before passing out, long enough to know that she was vigorous and perfect.
When it shuttered the OB ward, Bonner General cited “Idaho’s legal and political climate” among other factors. “Highly respected, talented physicians are leaving… In addition, the Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care. Consequences for Idaho Physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.”
Bonner General was not talking about abortion as it’s commonly understood — the hospital has never performed “elective” abortions. However, Idaho’s anti-abortion laws, similar to many anti-abortion laws across the United States, potentially restrict life-saving procedures for pregnancy complications, including the treatment of sepsis, ectopic pregnancy, and incomplete miscarriage. I say “potentially,” because most of the statute is undefined, and a zealous prosecutor could argue that nearly any pregnancy-ending action is a felony.
Today, Idaho is arguing that its anti-abortion statutes should take precedence over a federal law that prohibits emergency rooms from denying necessary care to patients. It should be obvious that allowing hospital administrators to turn people in medical emergencies away from the emergency room will have detrimental outcomes for everyone involved, and yet, this is exactly what Idaho is doing with this Supreme Court case.
These Idaho anti-abortion laws put more women and more babies at risk of dying, and do not explicitly save a single life. Preventing ER doctors from caring for people whose abortions are medically necessary — incomplete miscarriage, sepsis — is highly unlikely to save the life of any fetus. These are situations where the fetus has almost no chance of survival, and thus the only choice is how soon to intervene to stabilize the pregnant person. The choice doctors have is “may I treat this emergency, or must I send the patient out of state for this treatment?” and the increasing answer if Idaho gets its way will be “I am required by Idaho law to deny care to this patient.”
Homeschooled by a doctor, I grew up in hospitals, including one in rural Idaho just north of Bonner General. In keeping with my religious upbringing, I considered abortion murder, and of my own inspiration, created a serious little Stop Abortion Now club with pilfered pro-life leaflets. As an adult, I married and promptly divorced a Sandpoint prosecutor who often spent his workday embroiled with Bonner General. Because he liked having a free editor, I would read over his legal documents and make suggestions. I can say with absolute certainty based on everything I witnessed firsthand that sometimes, prosecutors use the law to attempt to settle vendettas and push personal agendas.
Idaho’s anti-abortion statute allows abortion in a few cases, including when the physician determines “the abortion is necessary to prevent the death of the pregnant woman,” and as long as, simultaneously, “the physician performs the abortion in a manner that provides the best opportunity for the unborn child to survive.” This caveat could complicate things, since it is often impossible to prevent the loss of pregnancy. According to the statute, any stage of development from egg fertilization onward constitutes an “unborn child” under Idaho law. Since the law was originally passed, Idaho has specified that it is permissible to treat ectopic pregnancies and molar pregnancies, which are never viable. However, many other scenarios are not addressed.
Thus, physicians at Bonner General, and across Idaho, have fought to understand when life-saving action is legally allowable. When patients are first diagnosed with life-threatening pregnancy complications, death is not always imminent. If physicians wait, they will likely be able to prove in court that they “prevented death,” assuming the patient survives the delay. Thus, the risk of losing an anti-abortion lawsuit decreases, but the risk of losing a malpractice lawsuit — and causing bodily harm to the patient— increases.
John M. Werdel, a medical director at St. Luke’s, stated that as many as 45% of OB doctors are considering leaving Idaho over this. St. Lukes is a nonprofit Catholic hospital system in Idaho — even Catholic hospitals that never provide abortion (as commonly understood) are hindered from providing necessary care to pregnant patients. Werdel said that “providers are terrified and constantly second-guessing their decisions… because they can no longer safely manage and advise their patients who have pregnancy complications.” And this is something that comes up frequently. “Complicated pregnancies are not rare; the average is 30 per week for the St. Luke’s Health System alone,” Werdel said.
Huntsberger, one of my doctors, interviewed on This American Life about her choice to leave Idaho over this quandary. Take ectopic pregnancies. Ectopic pregnancies are always non-viable because they’re developing outside of the uterus, and if they’re left untreated, they become fatal — but legally, when the abortion ban went into effect, doctors had to stall treatment in order to follow the law. “Per the total abortion ban, I need to wait until [a patient is] really sick. I can’t act just to protect her health. I should be waiting until I’m saving her life. This is totally opposite of my medical training,” Huntsberger said, describing having to consult with legal counsel over her routine treatment of this life-threatening condition. Given the quandary of accidentally letting patients slip past the point of no return when she could save them, or saving them and possibly facing jail time, Huntsberger and doctors like her are choosing the third option of practicing in another state. Huntsberger is now practicing in Oregon.
A six-month study by NPR and ProPublica found that the maternal mortality rate is high in the United States partially because hospitals and doctors “can be woefully unprepared for a maternal emergency,” with protocols that may not reflect the in-the-moment needs of the patient. Put in simple terms, a physician’s lack of experience in labor and delivery can increase maternal mortality.
Since Dobbs, and the subsequent abortion bans in many states, maternal mortality has risen, according to OBGYNs, and abortion rates have not declined. National abortion rates have merely shifted, going into states where abortion is legal. Medicated abortions using pills have increased. And this was something I assumed would happen: when the total abortion ban was originally announced, I wrote: “If the possibility of dying in pregnancy and labor increases due to an OB shortage, it certainly does not encourage women to want to continue pregnancy.”
For elective procedures that are not emergencies, Washington and Oregon are an easy drive away for most of the long, lean state of Idaho. Additionally, the more conservative states like Idaho get, and the more difficult it becomes to be a single mother, both financially and socially, the greater the temptation will be to terminate.
Overall, the abortion rate is not lowest where it’s outlawed, it’s lowest in the Netherlands, arguably the most liberal country in the world. If your personal and political goal is to prevent as many abortions as humanly possible, it stands to reason that you’d study places that have successfully made this happen.
According to recent data from the Guttmacher Institute, making abortion illegal does not decrease abortion — it actually increases it over time. In countries that restrict abortion, the percentage of so-called “elective” abortion has increased during the past 30 years, from 36% three decades ago to 50% more recently. Excluding India and China where large populations and other factors skew the data, abortion rates and abortion legality are inversely proportional. Meaning that where abortion is legal, abortion rates are lower, and where it’s illegal, abortion is higher.
Although this may seem counterintuitive, it actually makes sense, both in terms of correlation and causation. The question Idaho women will be asking themselves is “am I willing to risk death and financial ruin to have a child?” and as with most questions with these potential outcomes, the answer will increasingly be no. This is not opinion, it’s fact — statistically, according to maternal mortality rates and the availability of social services, women do face greater risk of death and financial ruin being pregnant in Idaho than in being pregnant in Washington or, say, the Netherlands. It is also a fact that as a general rule, people don’t want to die if they can avoid it.
Idaho has a higher than average maternal mortality rate even for the United States; it is significantly higher than other states in the Northwest region, where active lifestyles are part of the culture. The Idaho legislature commissioned a task force to investigate maternal mortality that expired last July. In 100% of the cases studied over a three-year period, the deaths were determined to have been preventable. “There is a possibility for us to alter the outcome for some other mom in the future if we know what’s going on, so we can create targeted, specific, local interventions relative to our state,” said Huntsberger, who also served on the Maternal Mortality Review Committee.
Unfortunately, Huntsberger is no longer in Idaho, and the state has stopped investigating maternal deaths. Because why would they, when they’re ignoring them at the highest levels of government?