Roe v Wade Reversal is Our Opportunity to Address the Issues That Influence Abortion Choice

Writing down my thoughts about the Supreme Court overturning Roe v Wade is challenging. The day the ruling came out, I composed a blog outlining my views and what I thought we needed to do as a country. Rereading it the next day, I wasn't sure I captured the complexity of what I wanted to say in simple language. So, I set about writing another draft and then another.

The struggle I am having with expressing my thoughts on this emotionally charged complicated topic is one that many people share. I've read posts and blogs, articles and analyses, news stories and opinion pieces. Some were well-written and carefully constructed and made me think differently. Others were emotional diatribes that engendered a visceral reaction. My hope is that the following words are compelling and make you think, perhaps in a new way, because what we most need right now is dialogue on a national level about how we are going to solve this new twist to an old problem.

I am pro-life. I attended pro-life rallies as a child along with my mom and served as the president of the pro-life group at my university. Both explicitly and implicitly, I was taught in medical school that it was "wrong" to oppose abortion and was asked to meet one-on-one with my obstetrics clerkship director to defend my decision to not participate in abortion training. I was bluntly informed that my views precluded me from doing a residency in ob/gyn, which I believed at the time. I wrestled with how I could stay true to my beliefs while also being an excellent doctor to my patients.

I wish someone had told me then that doctors have differences of moral opinion with their patients all the time. It could be a decision about end-of-life care or the decision to not vaccinate a young child. We will never be perfectly aligned with every one of our patients, but we do have an obligation to care for them despite our differences and to do so in a way that supports and cares for our patient's best interest as they define it, not as we would.

I wish that my ob/gyn clerkship director had taken the time years ago to challenge me on how I would balance my moral views (which he was unlikely to change in an hour-long conversation) with the obligations I would have as a physician rather than try to convince me to see the situation as he did.

I've changed my thinking a lot since I was a 20-year old college student who saw the world as much more black-and-white than it actually is. I remain pro-life, and I support the reversal of Roe v Wade on legal principles which have been articulated by legal scholars much better than I ever could. However, I also support both availability of and accessibility to abortions in specific circumstances. If you are like the majority of Americans, you feel the same way, although we may disagree on what those circumstances are.

A number of years ago, I conducted research on conscientious objection to determine the prevalence of physicians' moral objections to legal and available medical procedures running the gamut from circumcision to abortion. I was not surprised to learn that the large majority of respondents (who supported abortion access in most cases) had an objection to abortion being used for gender selection. I selected this indication because I was curious if those who strongly supported abortion rights would view them as an absolute right (eg, abortions should be completely up to the pregnant woman no matter what).

There are some who believe abortions should be a never event. I disagree with this. There are many situations in which, in the balance between the rights of the woman and the rights of the fetus, it is both a moral and medical imperative that abortion be available.

There are others who believe that abortion should be available without restriction as it is always a woman's choice what she does with her own body. I disagree with this because I do not view a fetus as solely a part of the woman's body, like an appendix or an unfertilized egg.

Those who believe in either extreme are in the small minority. This places the burden on those of us in the middle — between these two extremes — to engage with, not vilify, each other in dialogue and practical solutions to the root causes of why women choose to have an abortion.

Practically speaking, many of my patients, especially those who are at a socioeconomic disadvantage, did not have reasonable access to an abortion prior to June 24, regardless of the law of the land. For many in this country, abortions may have been legal but not accessible. I'm not sure that more permissive legislation changes many of the factors that are barriers to abortion access.

Likewise, many of these same patients have limited access to contraception, prenatal care, transportation, education, day care, and employment — all of which are needed in order to expect that there are both fewer unwanted pregnancies but also that if a woman chooses to carry a pregnancy to term, she is able to do so.

We, as physicians, learn about our patients through their stories. More so than any argument, speech, or essay, I have been influenced by walking alongside my patients as they faced unwanted pregnancies or pregnancies that would have no happy ending. I've seen how pregnancy itself can threaten the very life of the woman who is carrying that pregnancy. In obstetrics, it is a first principle that the mother's health is the most important component to the baby's health. To not allow women access (both practical and legal) to abortion when it is necessary (however that is defined) is a moral wrong.

I've also seen my patients choose abortion for less compelling reasons — reasons that have better solutions than abortion, in my mind. To the best of my ability, I support my patients, regardless of how I view their choice, but I also feel compelled to voice my opposition to access to abortion for any reason in our national debate.

The piece I've read that has resonated most with me was written by a law professor. He argues three main points. First, Roe v Wade was a bad legal decision. Second, people on both sides of this issue are advocating for something important — whether that is autonomy, equity, or the sanctity of life. Third, Roe v Wade being overturned is our opportunity — and I would argue our obligation — to work together, across the great divide created and perpetuated by making abortion primarily a legal issue, to create something better which honors the common ground between us.

We have (and have had) opportunity to do better for women and babies. The June 24 SCOTUS decision only increases our obligation to transform this from a primarily legal argument to a collaborative approach to the social justice issues that contribute to women considering abortion. Beyond that, as physicians, we must share factual, medical knowledge to inform the conversation, especially as it relates to pregnancy risks and outcomes, recognizing that there is no simple solution to this complex issue.

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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Jennifer Frank. Roe v Wade Reversal is Our Opportunity to Address the Issues That Influence Abortion Choice - Medscape - Jul 01, 2022.