WADA votes to oppose punishing doctors when necessary care results in fetal death

Following the Supreme Court’s June decision to overturn Roe vs. Wadethe American Medical Association (AMA) House of Delegates voted on Monday on a resolution to fight against any policies or laws that punish clinicians or their patients in the event a woman loses a pregnancy as a result of medically necessary care , such as treatment for cancer.

“A growing number of current and pending laws insert government into patient-physician relationships by placing limits on reproductive health prohibitions while also seeking to criminalize physicians who provide services that result in pregnancy loss” , said the resolution, which was debated at the AMA’s interim meeting of the House of Delegates, held virtually and in Honolulu.

The AMA’s endorsement – to oppose ‘criminalization or civil penalties for’ care that results in pregnancy termination – came after a 45-minute debate in which speakers told stories of women arrested and imprisoned after miscarriages or stillbirths, and doctors in legal danger. Dozens of speakers tweaked, clarified, debated, and changed the language for greater accuracy.

“The criminalization of pregnancy loss makes pregnant women vessels rather than people,” said Anna Yap, MD, on behalf of the AMA Resident and Fellow Chapter. “In 2019, prosecutors in 45 states used these laws to charge pregnant women who lost their pregnancies after using drugs, including legal prescription drugs,” she said. “Pregnancy loss can be attributed to drug use, whether or not these drugs contribute to the miscarriage in any way.”

Mark Kashtan, MD, MPH, of the New England delegation, also supported the policy. “In our post-Dobbs In reality, tens of millions of women and tens of thousands of doctors live and work in parts of the country where they are now subject to erroneous civil and criminal penalties resulting from the loss of a pregnancy resulting from adverse events of medically necessary treatment, trauma or other unexpected events.”

“It’s not just a hypothetical concern,” he said. “Women have been unjustly incarcerated under these laws. Doctors have lost their careers, their livelihoods and their reputations.”

Kashtan added that “Government officials acting without regard to medical science have confused tragedies with misguided attempts to assign blame for political gain. This cannot be authorized by WADA. Our organization must stand avail of all the tools at its disposal to advocate at the federal, state and local levels to protect our patients or colleagues and the doctor-patient relationship, and these travesties of justice.”

Tani Malhotra, MD, of the Ohio delegation, received warm applause when she insisted that the WADA resolution should not be limited to protecting doctors. “In Iowa, a pregnant person fell down the stairs and was reported to police after seeking help at a hospital. She was arrested for attempted fetal homicide.”

“In Utah, someone gave birth to twins. One was stillborn. Medical professionals believe she had a stillbirth as a result of the patient’s decision to delay cesarean section. [section delivery]. She was arrested for fetal homicide. And in Louisiana, a woman who went to hospital for unexplained vaginal bleeding was locked up for more than a year on second-degree murder charges before medical records revealed she had a miscarriage between 11 and 15 weeks,” Malhotra said.

All of these events happened before deer was knocked down, she said. Now that it is, she added, “I expect it will only get worse.”

Because AMA debates typically need speakers to speak both for and against, and no speaker objected to the measure, Oran Lee Berkenstock, MD, of Tennessee, volunteered. to express a negative opinion. “I don’t think it goes far enough,” he said.

In Tennessee, due to a legal policy called the “affirmative defense” in its pregnancy laws, if a physician treats a patient in a manner “he deems appropriate for the care of pregnancy” and something does not wrong, “he is still held accountable and can be arrested and then must prove his innocence.”

Seema Sidhu, MD, obstetrician/gynecologist from the California delegation who spoke as an individual, wanted the resolution to include the word “termination” to exonerate treating physicians and their patients who choose to terminate their pregnancies because they are taking drugs with teratogenic effects. . She has a patient who was taking methotrexate for arthritis, which can cause serious birth defects or fetal death and found out she was pregnant, she said. “Now she wants to terminate the pregnancy; she should be allowed to do that.”

But Brandi Ring, MD, a delegate from the American College of Obstetricians and Gynecologists, objected to the inclusion of the word “termination,” saying it is the AMA’s policy to oppose “the imposition of sanctions criminal and civil or other retaliatory efforts against patients, patient advocates, physicians, other health care workers and health systems for receiving, assisting and referring patients to or providing reproductive health services”. approved this policy in June.