How a Midwestern doctor is preparing for a world without Roe

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Dr. Lisa Harris has spent the past few months helping her health care system prepare for the possibility of abortion becoming illegal in Michigan.

When a draft document leak on May 2 indicated that the United States Supreme Court could overrule Roe v. Wade, she realized she needed to double up.

“I realized, wow, we really have to think through all the details about this,” said Harrisan OB-GYN at Michigan Medicineone of the largest health systems in the state.

Roe’s downfall would end 50 years of health care practice and end the constitutional right to abortion. It would then be up to each state to authorize or prohibit the practice.

For many Americans, the draft advisory signaled that the nation could be heading for a major shake-up in health care. Harris understood that if the Court’s new conservative majority overturned Roe, about half of the states, including Michigan, could quickly ban abortion.

Harris had braced for the possibility that Roe could be lost since the Supreme Court held oral arguments in December in Dobbs v. Jackson Women’s Health, where Mississippi asked the court to affirm its ban on elective abortions after 15 weeks.

Lisa Harris is OB-GYN, Professor of Reproductive Health and Professor in the Department of Obstetrics and Gynecology at the University of Michigan. Photo submitted

Harris has dedicated 10 hours a week this year preparing her hospital to operate in a post-Roe world. She met colleagues. She made presentations. She collected the unanswered questions.

Only about 4% of abortions in the United States occur in hospitals. Harris said the people who end up there usually have a medical condition that’s too complex for outpatient clinics.

If Roe is overturned, a 1931 state law would make performing the procedure in Michigan a felony except when necessary to save the woman’s life. Harris said it’s complicated to know when that standard is being met.

What should be the risk of dying from pregnancy? Does he have to be 100%, like this person who is extremely sick in the intensive care unit and who will soon die? ” she says.

What if a pregnant patient suffers from heart disease and has a 25-30% chance of dying if she were to continue the pregnancy? Is the risk high enough to warrant intervention?

“Chemotherapy, radiotherapy or surgery can cause significant damage to a fetus or baby. So [a patient] may want to end a pregnancy so they can start cancer treatment immediately, instead of waiting months, giving birth, starting their treatment and now maybe having more advanced disease,” a- she declared. “It could significantly shorten their lives.”

These are the kinds of nuanced decisions Harris said medical professionals may face. She wants her colleagues to be ready.

“These are the questions that doctors and medical professionals are thinking about and that I imagine lawmakers and judges haven’t thought about,” Harris said.

Harris foresees a self-imposed dividing line: “At some point, we’re going to have to say, ‘We can justify caring for these patients because the threat to their lives is high enough.’ But there will be a time when we have to say to patients, “I’m sorry, we can’t help you.” You can get out of state. You can go to Canada. You can travel several hundred kilometers. And they’ll say, “But I can’t do this,” and we’ll have to say, “I’m sorry, I can’t help you.”

Harris said the need to be prepared extends beyond her own OB-GYN service to primary care physicians, specialists and hospital leaders.

I feel like throwing a grenade into a meeting every time I [bring this up] because legal abortion has been in the background of most people’s lives now and it just doesn’t feel real to them,” she said.

Harris recently met with a group of emergency department doctors. She told them that she hoped their main job would be to reassure nervous patients who were using abortion pills at home.

But,” she warned, “there will be people who haven’t had access to these safe medicines and have put something in them, taken a poison or a toxin. These people you are going to have to skip and provide essential care to save lives. »

Harris said it would be a big change for emergency physicians since abortion complications are so rare that they rarely had to make these kinds of triage decisions.

And it’s more than patient care that Michigan Medicine needs to plan. Michigan has one of the top-ranked OB-GYN training programs in the nation, and they must be able to teach doctors-in-training how to perform abortions.

This begs the question: how does Michigan Medicine teach these skills if the procedure is virtually banned?

Harris said they are reaching out to colleagues in other states that protect abortion care to ask, “Could you accommodate an additional learner at your site? What kind of contracts do we need? How many days a week would they be there?

The questions can seem endless, Harris said. Others in mind: How would Michigan Medicine handle the likely surge in births? How would contracts with insurers change if this happened?

In these uncertain times, what seems certain – if abortion became illegal in Michigan – is that many people who want this care would not get it.

Harris said she wants people, especially her state lawmakers and US Supreme Court justices, to get a glimpse of what she has seen over the past 20 years.

They would see mothers,” she said. “Most of the patients I deal with already have children. They saw people driving through snowstorms and blizzards. They would see a lot of poverty. They would see people who, if they had more resources, would certainly continue their pregnancies. I think what you would see in a nutshell is all kinds of injustices and inequities rolled into one that manifest in a person seeking an abortion.

It has been helpful for Harris and his colleagues to think about the systemic questions that Michigan Medicine needs to answer. It’s productive and it’s a distraction. The work has helped ease some personal questions such as, “What if the care I have spent my career providing is off limits? »

There is stress, distress and pain that is very often linked to the decision to terminate a pregnancy. And when I think about the need to send people back, to give birth when they don’t want to, I only see an amplification of that pain and distress, of injustice and inequality,” said Harris.

Counting on this moment, Harris said, means accepting that she would be able to help and yet being barred from offering any assistance.

The Supreme Court could still decide to keep Roe. But if Roe leaves, Harris is determined to help her hospital be as ready as possible for all the patients who deserve nothing less.

Dan Gorenstein is the founder and editor of the Tradeoffs podcast, and Ryan Levi is a reporter/producer on the show, which aired a version of this story May 5. Side Effects Public Media is a public health information initiative based at WFYI.

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