Access to reproductive care in the U.S. continues to evolve nearly a year after the fall of Roe v. Wade, the landmark ruling establishing a constitutional right to an abortion. Now, decisions on abortion are left up to states — and some have highly restrictive measures.
In South Carolina, for example, the proposed Prenatal Equal Protection Act covers an "unborn child at every stage of development from fertilization until birth" and would charge anyone who had an abortion with homicide, which would make that person eligible for the death penalty. The bill would provide a few exceptions, including if the mother had an abortion "because she was compelled to do so by the threat of imminent death or great bodily injury." The bill would also exempt physicians who provide an abortion to prevent the death of the woman but "results in the accidental or unintentional injury or death of her unborn child when all reasonable alternatives to save the life of the unborn child were attempted or none were available."
In Texas, Senate Bill 8 allows an exemption for an abortion to be performed only in the case of "medical emergencies," a term that is not well defined. As a result, many medical providers err on the side of caution and won't intervene in a woman's pregnancy until she's gravely ill. Five women are suing the state of Texas over the law, including one who said she had to fly out of state to get an abortion after her water broke a few months into her pregnancy and she was told her baby would not survive. The woman says she was told that Texas doctors could not help her until her life was actively in danger.
Abortion is banned in 13 states, according to the Guttmacher Institute. While language varies according to the legislation, many measures include exemptions only if the mother's life is in danger, which is often referred to as "imminent death" or "imminent peril."
But what does "imminent death" mean in terms of abortion care, and what are the consequences if doctors wait too long? Experts break down the issues.
What does 'imminent death' mean from a medical perspective?
It's a medical term, Dr. Lauren Streicher, a clinical professor of obstetrics and gynecology at Northwestern University's Feinberg School of Medicine, tells Yahoo Life. "It means that someone is in the process of dying," she says. "The problem with 'imminent death' is that there's no time frame. If someone is said to be imminently about to die, it may be in five minutes or a week. But what it suggests is that this trajectory is no longer reversible."
Determining if death is imminent ultimately comes down to a medical practitioner's judgment, Dr. Emily Barker, an ob-gyn in Missouri and a fellow with Physicians for Reproductive Health, tells Yahoo Life.
What does 'imminent death' mean from a legal perspective?
It's usually not clear, Heather Shumaker, director of state abortion access at the National Women’s Law Center, tells Yahoo Life. "Health and life exceptions to state abortion bans are intentionally vague, contributing to the risk to pregnant peoples’ lives," she says.
Shumaker says the aftermath of Dobbs v. Jackson Women's Health Organization, the landmark ruling of the U.S. Supreme Court that overturned Roe v. Wade, has "created an unprecedented legal and public health crisis."
"Extreme state laws banning abortion have intentionally created chaos and confusion for pregnant people and medical providers," Shumaker says. "Patient care should always come first. In an emergent situation, medical providers should be able to focus on the care that the patient needs. But in a climate hostile to abortion access and with increasing criminalization of care, doctors fear prosecution."
Why the 'imminent death' exemption is problematic
Women's health expert Dr. Jennifer Wider tells Yahoo Life that "it's hard to figure out the reasoning behind a restriction like this. It makes no sense to place a woman's life in imminent danger. Waiting until there is a serious threat to a person's life is not an optimal time to start reacting in an operating room."
Streicher agrees. "You're basically saying, 'She's got to be dying in order to intervene.' How do you prove that? I guess she was dying because she's dead now?" she continues. "This whole notion of you can do an abortion when someone is imminently dying ... It's too late. She is dying. The idea that this is going to reverse the process and she's going to be fine is so problematic."
This exemption also makes it difficult for patients to receive informed care, Barker says. "It's critical that all clinicians can offer counseling based on a patient's individual medical circumstances, and that patients can weigh the information they are provided to make decisions that are most in line with their needs and values," she says. "Any legal or political interference in this process threatens the ability of physicians to provide safe and essential health care for their patients."
What does 'imminent death' look like in pregnant women?
It really depends. "In my practice, I've cared for people with serious heart or kidney disorders, new cancer diagnoses and life-threatening high blood pressure," Barker says. "I also see people with complications of their pregnancy, like heavy bleeding or rupture of amniotic membranes before the pregnancy is viable."
A common example is sepsis, a life-threatening complication of an infection, Streicher says. "You have a woman who breaks her bag of water early and there's no possibility that the pregnancy is going to continue," she explains. "Infection will set in but it's not until she gets septic that we can terminate the pregnancy. In some cases, if you get lucky, she may survive, but in many cases it's already too late."
In many of those situations, a woman will also need to have a hysterectomy "because the uterus is so infected that you can't save it," Streicher says.
An ectopic pregnancy — a nonviable pregnancy that occurs when an embryo implants outside the uterus and often in the fallopian tubes — is another example cited by Wider. As the pregnancy grows, it can cause the fallopian tube to burst, leading to life-threatening internal bleeding, according to the American College of Obstetricians and Gynecologists.
But Barker says that "every patient is unique: their medical factors, values and preferences guide our conversations and their decision making. Abortion bans are based on politics, not science and medicine."
Ultimately, Streicher says, "this is committing women to death and making doctors unwittingly murderers."
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