Having retired from the practice of emergency medicine over 10 years ago now, I realize that I may be a poor spokesperson for the post-Roe ER. However, please bear with me as I could not pass up the opportunity for some gentle musings on the subject. Before I begin, I must confess to my readers that I am suffering a low level of perpetual survivor’s guilt due to the fact that I never had to contend with the overwhelming stress of the COVID pandemic while working in the ER. I cannot imagine the unbearable physical and emotional toll that experience has taken on so many of you ER physicians, nurses, and other ER staff. I hear it in the voices and see it in the faces of my EM colleagues, many of whom are suffering from PTSD as a result of their heroic work during the recent pandemic.

Now comes the SCOTUS overturn of the historic and precedent-setting 50-year-old Roe v. Wade decision, which transformed the moral and ethical landscape of this country and recognized the rights of fully one-half of the human population to make decisions regarding their bodies and their lives as free, living, human rights-enjoying women who were no longer subservient to male decision makers and political policy engineers. You can just reverse all the statements located in the previous sentence and you have the predicament we are enduring post-Roe.

So by now, I am sure that most of you actively practicing ER docs have engaged with colleagues and leadership with any changes in practice (or better lack thereof), anticipating potential blow back from law enforcement, politicians or other community members. I have to confess, I worked the last 12 years of my EM career in a hospital without OB services on-site, so there was liberal referral and transfer to outside OB practitioners, due to the lack of both in-house OB facilities and physician back up. In the U.S., 25% of women experience abortion during their reproductive years. Seven percent of U.S. women have participated in a self-managed abortion, which means they induced abortion via medical (such as mail-order mifepristone and/or misoprostol) or other means, including herbs, blunt abdominal trauma, or intrauterine manipulation to induce abortion. Women seeking help in the ER must obtain non-judgemental expert, acute emergency treatment, even in states where abortion is outlawed.

President Biden has reminded the emergency medicine community that providing emergency life-and limb-saving medical care trumps all state laws speaking against such matters. EMTALA, the cursed statue that many times made our lives miserable in the ER by mandating unfunded emergency care and and created sometimes endless disputes about what constitutes a safe and proper patient transfer between health care facilities, is now saving our bottoms with respect to potential litigation in the post-Roe world. How ironic!

So what does all of this mean for practicing ER docs, ARNP’s and PA’s? I do not exactly know. I suspect OB patient ER traffic will be increased, maybe significantly in states with adverse abortion rights laws in effect. Some of these states, like Texas, have passed anti-abortion bounty hunter laws enabling citizens to tattle on any human being having anything to do with enabling a woman in Texas to obtain an abortion. This Machiavellian law provides $10,000 to such individuals, incriminating healthcare workers, Uber drivers, do-gooding family members and others. Please keep these people out of Texas ER’s, and if they or trouble-making litigation-minded people in any other state go after ER personnel or their patients, let us hope EMTALA shields us all! Good grief.

In closing, I am still trying to wrap my head around the recent SCOTUS decision striking down a U.S. woman’s right to an abortion. I would be the first to acknowledge that anti-abortion rights advocates in this country have fought long and hard for their position. They were boisterous, energetic, and passionately committed. Roughly 60% of U.S. citizens are pro-choice, or at least in favor of a woman’s right to choose what happens to her own body or how to manage her own personal health. Unfortunately, far fewer Americans are willing to get up on soapboxes and trumpet the cause of pro-choice. Astonishingly to me, the highest court in the land appears to have caved into political partisanship, and nullified a precedent-setting insurance of basic human rights to half of the population of this country. Interestingly, this recent Supreme Court ruling seems to have aroused a huge amount of sentiment on the opposite side and may galvanize more political support against the apparent red wave, which has been predicted to occur in the upcoming midterm election, which typically favors the political party out of power. Hold on to your hats and buckle your seat belts for this one. Happy Autumn. ■