One day after Indiana Gov. Mike Pence (R) signed a controversial bill that would block women from seeking abortions based on medical diagnoses, doctors grappled with how the measure could impact their patients.
The mandate, which takes effect July 1, bans the procedure if, among other restrictions, a woman requests it “solely” because a fetus has Down syndrome or any other disorder. She could legally obtain an abortion in the event of a lethal fetal illness — but would have to inform the state that she chose to terminate her pregnancy.
A doctor, meanwhile, could face a wrongful death lawsuit if an abortion is granted to a woman who requests one after learning about a pregnancy complication.
Brownsyne Tucker-Edmonds, an obstetrician-gynecologist in Indianapolis, said in a statement Friday that the law could dissuade physicians from performing a legal medical procedure and, by doing so, imperil patients' health.
“It will require a woman, during one of the most devastating times in her life after learning of a fetal anomaly, to prolong her pregnancy even if against her wishes, and to potentially assume the greater health risks associated with doing so,” Tucker-Edmonds said. Some women have “cases in which the risk of death during a full-term pregnancy is more than 14 times higher than for a termination of pregnancy.”
Pence, who called the move “a comprehensive pro-life measure that affirms the value of all human life,” supported the legislation despite pushback from Republican women in the statehouse. Indiana currently outlaws abortions after 20 weeks, and the law adds a raft of new restrictions that abortion advocates call the country's strictest.
It would make the state America's second (after North Dakota) to prohibit abortion because of a fetal anomaly. It would ban the procedure in instances where the choice stems from the fetus's sex or race. It would make Indiana the first state to require fetal remains to be buried or cremated. And it would require physicians to inform patients about perinatal hospice care, a service for women whose babies aren’t expected to survive outside the womb.
Hal Lawrence, chief executive of the American Congress of Obstetricians and Gynecologists, said the group, comprising roughly 30,000 doctors nationwide, strongly opposes the law because it could encourage a patient to withhold information from her doctor.
A woman who, for example, learned her fetus carried a severe disability may pursue an abortion from an out-of-state provider and then, out of fear, skip follow-up care from her regular doctor.
“She shouldn't be under legal duress when she came back to where she lived,” said Lawrence, who practiced gynecology for 30 years. “Patients need postpartum or postoperative care. They need to be counseled for contraception. Discouraging that is highly destructive.”
Betty Cockrum, head of Planned Parenthood of Indiana and Kentucky, suggested in a statement that medical decisions should stay between doctors and patients. "It is clear the governor is more comfortable practicing medicine without a license,” she wrote, “than behaving as a responsible lawyer, as he picks and chooses which constitutional rights are appropriate.”
PPINK also said it planned to attack the measure in court. "It is fraught with unintended consequences that will prove dangerous to women," the group said in a statement. "PPINK is now working with the ACLU of Indiana to seek judicial review and fully expects to file a complaint and request for preliminary injunction."
But Christina Francis, an obstetrician-gynecologist in Fort Wayne, Ind., who is opposed to abortion, said she believes the law will strengthen her relationships with patients.
“Too often, women learn their baby has Down syndrome and the first thing their physician tells them about is abortion,” Francis said. “To my patients, I’d say, ‘Yes, this is not what we were expecting -- everyone wants to have a healthy child -- but now, you know what? That child still has potential for a significant life.”
That conversation, she said, could lead to increased follow-up care and a healthy mother and child.
Charles Camosy, a theology professor at Fordham University and a board member of Democrats for Life, said he supports Indiana’s abortion restrictions but wonders how they will be enforced.
“What do you say?” Camosy said. “Are you having this abortion because the baby has Down syndrome?”
Regardless, he said, the attention to babies with disorders or alternatives to abortion, such as perinatal hospice care, could inspire women to take more time to consider all their options.
“There will be a way,” he said, “to take care of the child that’s pain-free and dignified.”