Since Roe vs. Wade was overturned in 2022, Texas has proven to be a flashpoint in the ongoing fallout of the Supreme Court’s decision. A recent example is that of Kate Cox, a Texas woman who in 2023 sought an abortion in response to her fetus having trisomy 18, a known “lethal fetal anomaly.” Continuing the pregnancy put Cox’s health and fertility in jeopardy, and she and her physician decided an abortion was the best choice to preserve her health. However, Texas’s abortion ban, Tex Health & Safety Code § 170A.002(b)(2), only allows for abortion when a physician “in their exercise of reasonable medical judgment” finds that the pregnant woman “has a life-threatening physical condition” caused by the pregnancy that places the woman “at a risk of death” or “poses a serious risk of substantial impairment”. The statute’s language is vague and had not yet been legally tested, and considering the potentially harsh penalties against physicians—a “$100,000 fine and the loss of a medical license”—Cox sued to allow for her abortion. The Travis County District Court ruled in Cox’s favor, granting a temporary restraining order allowing Cox to receive an abortion without legal risk to her physician. In response, the Attorney General of Texas issued a letter threatening physicians that the temporary restraining order “will not insulate hospitals, doctors, or anyone else, from civil and criminal liability for violating Texas’s abortion laws” and asked the Texas Supreme Court to intervene in the case.
The Texas Supreme Court reversed the District Court’s order, holding that the statute’s exception “requires more than a doctor’s mere subjective belief and that Cox’s physician only had a “good faith belief” that her pregnancy was life-threatening enough to meet statute’s exception. The Court explained that a physician must exercise “reasonable medical judgment”, which is an objective—not personally subjective—standard. Ultimately, before the Texas Supreme Court issued its reversal, Cox left Texas to receive an abortion in another state.
Abortion bans like those in Texas—now broadly allowed around the country by Roe’s reversal—have profound ethical consequences. They limit a patient’s autonomy and privacy, while jeopardizing the patient’s safety. They also prohibit physicians from being able to offer necessary care and from upholding quality safety standards for their patients. Importantly, abortion restrictions that provide exceptions for “life of the mother” are not more ethically sound, as such exceptions are often vague, untested, and, as demonstrated by the Cox case, still allow for a chilling effect on abortion access, even in cases where the health and life of the mother is at risk.
Opinion 4.2.7, “Abortion”, notes that“[l]ike all health care decisions, a decision to terminate a pregnancy should be made privately within the relationship and trust between patient and physician in keeping with the patient’s unique values and needs and the physician’s best professional judgment”, underscoring that abortion is a private decision, one that is grounded within the relationship between patient and physician. Also, Opinion 4.2.7 explains that the Principles of Medical of Ethics “permit[s] physician to perform abortion in keeping with good medical practice.” In addition, Opinion 1.1.6, “Quality”, obligates physicians to “ensure that the care patients receive is safe, effective, patient centered, timely and equitable.” Abortion bans, even with exceptions, do not allow physicians to properly adhere to Opinion 1.1.6, as quality care may be denied or postponed due to fear of criminal penalty. Opinions 1.1.3, Patient Rights” and Opinion 1.1.1., “Patient-Physician Relationships”, and Opinion 2.1.1, “Informed Consent”, all broadly reinforce the ethical values of patient autonomy, decision making, privacy, and trust between patients and physicians. These values are incongruent with strict abortion bans, especially those with minimal or vague exceptions that do not allow protection of the health and life of the patient, and thus prohibit physicians from adhering to their professional duties and ethical obligations.
To further explore the AMA Code of Medical Ethics, please visit AMAethicscode.org.
Published on February 6, 2024