In the Wake of Dobbs v. Jackson Women’s Health Organization

She acknowledges, however, that clinicians may be hesitant to provide patients of childbearing age with medications that may result in harm to a baby who is ultimately born or to a pregnancy that ends in a miscarriage. It is conceivable, she says, that a clinician could be subject to liability for medical malpractice or other claims depending on their state’s law (e.g., wrongful death) and may, therefore, want to consult a lawyer licensed in their state with questions about a specific situation.

To avoid this situation, Cuoghi Edens, MD, assistant professor of internal medicine and pediatrics at University of Chicago Medicine, says documentation is critical, particularly in states with ambiguous abortion laws where, for example, definitions of aid and abet are gray.

Documenting conversations with patients and families about the risks of pregnancy and recommendations for contraceptive use protects rheumatologists from potential liability in the future, she says, adding that such documentation can help the patient’s other care providers as well. For patients, documentation is helpful because they can access their medical records to review information discussed during their clinical visit.

In general, Ms. Hill emphasized that physicians should familiarize themselves with the rules of their state about what sorts of conduct they are required (or not required) to report to law enforcement or other state agencies. For example, she cited a scenario in which a physician practicing in a state with restrictive abortion laws refers a patient for an abortion to a state without an abortion ban. In this case, physicians “should consult legal counsel to ensure they are not at risk of violating any state laws,” she says, adding that most states don’t forbid this, but “it’s better to be safe, especially given that most abortion restrictions carry criminal penalties.”

Going Forward

Dr. Edens

Stressing that rheumatologists should not change treatment plans or veer from evidence-based practice based on the recent ruling, Dr. Edens put a positive spin on what the ruling has offered rheumatologists.

“The Supreme Court ruling has brought an often taboo subject to the forefront of rheumatology and demonstrated that reproductive health is essential to rheumatology care,” she says. “The effect of the lack of access to abortion for patients on medications that cause congenital malformations or who have severe, organ-threatening rheumatic disease is obvious.”

She emphasizes that rheumatologists who care for patients of child-bearing age should evaluate their patients’ sexual activity and pregnancy intentions at every visit and when new medications are prescribed. She cautions against assuming a patient’s primary care provider is discussing these issues with them, and emphasizes that patients want their rheumatologist to be involved in their reproductive health.