This November we are asked to vote on Proposition 115, which bans all abortion after 22 weeks gestation. As a physician, I am distressed at the lies spread by backers of this ban – that it makes exceptions to protect the life of the mother. The truth is that it does not. The alleged exception will protect no one – but it will increase the likelihood that health systems will eliminate essential healthcare.
According to the text of the proposition, abortion is illegal unless “immediately required to save the life of the pregnant woman when her life is physically threatened.” Sounds great – if we lived in a prime-time medical drama. A ‘patient’ on TV can trust they will be brought back from the brink by a little CPR and the heroics of a dashing young doctor.
In real life, people whose lives are “immediately threatened” do poorly – especially pregnant women with a severe disease. A pregnant woman with an aneurysm might have a major blood vessel burst and bleed to death in minutes. One with severe heart disease might quickly go into shock, or have her lungs suddenly flood with fluid and stop being able to breathe on her own. If we wait until these things happen, the chance that both the woman and her fetus will die regardless of medical intervention is high. To save the life of a pregnant woman who is not tolerating pregnancy, it is important to identify problems early and address them before the threat is “immediate.”
Luckily, doctors and patients often have the tools to do so. We have risk models to let us predict which women are likely to do poorly. We closely monitor expectant mothers’ health for early warning signs. We help our patients understand the risk they face and the chance of a successful delivery at different points in their pregnancy, and let them decide how much of a threat to their life is tolerable. In the best case, Proposition 115 would bind both our and our patients’ hands if they start to deteriorate, forcing us to watch disaster approach until it was “immediate” — and much more likely to end in death. But the reality is that Prop 115 will do much worse.
Consider a woman with severe heart disease, whose doctor estimates she has a 50% risk of death in pregnancy. Medical guidelines would recommend that she be allowed to obtain an abortion if desired to prevent lethal complications. Under Prop 115, could a physician provide this guideline-recommended treatment? Is a 50% chance of death “immediate?”
Prop 115 doesn’t say. Nor does it say who gets to decide what risk or time frame makes a threat “immediate.” It is clear doctors don’t get to make that decision – the proposition already excludes life-threatening psychiatric diagnoses as justification for triggering the exception regardless of doctors’ clinical judgement. Physicians must therefore assume that prosecutors, rather than medically trained individuals, will have the last word.
What does this intrusion of the state into a medical decision mean for doctors? A physician who performs an abortion banned by Prop 115 faces mandated loss of their medical license. Any doctor performing an abortion to save a pregnant woman’s life would take the chance that someone unfamiliar with medicine could disagree – and take away their livelihood and ability to serve patients.
We already know what this will achieve. In other states that have such abortion bans, many doctors stopped performing abortions in all circumstances, even when the mother’s life is at risk, to avoid potentially career-ending legal action. Women’s lives will be endangered by Prop. 115, not protected. This erosion of abortion care is the intent of the ambiguously worded “exception.”
Again, this is why decisions around medical care – including abortion care – must be left between patients and doctors, using the best information they have in the best interests of the patient.
It is my sincere hope that this November, Coloradans will agree that providing essential healthcare should not be punished. The best way to protect the lives of pregnant women in Colorado is to reject Proposition 115.