Note: this research article is adapted from a group PowerPoint presentation. I conducted the research along with four other students and primarily edited the presenter notes. The work was finished by June 26, 2024, one day before the Supreme Court made its decision on Moyle v. United States. The original PowerPoint presentation is attached to the article. The References section is also attached.
“... [A] pregnant woman[,] who is early into her second trimester at 16 weeks, goes to the ER because she felt agush of fluid leave her body. She was diagnosed with [premature rupture of membranes].
The doctors believe that a medical intervention to terminate her pregnancy is needed to reduce the real medical possibility of experiencing sepsis and uncontrolled hemorrhage from the broken sac.
This is a story of a real woman.
She was discharged in Florida because the fetus still had fetal tones and the hospital said she's not likely to die, but there are going to be serious medical complications.
The doctors there refused to treat her because they couldn't say she would die.
She was horrified [and went] home.
The next day, she bled.
She passed out.
Thankfully taken to the hospital.
There, she received an abortion because she was about to die.”
—Justice Sonia Sotomayor during the oral argument for Moyle v. United States, April 24, 2024 (Moyle V. United States, n.d.).
This is one of the scenarios Supreme Court Justices brought up to case advocate Joshua N. Turner in the Moyle v. United States argument. Indeed, since Roe v. Wade was overturned not only did the friction between pro-choice and pro-life increase, but the healthcare system also became confused. Many states have enacted anti-abortion laws; a legal conflict has recently arisen between Idaho’s near-total abortion ban (effective since Aug 2022) and Congress Emergency Medical Treatment & Labor Act (EMTALA, passed 1986).
Purpose
The following research aims to increase awareness of the legal conflict Moyle v. United States. It also analyzes the impacts of laws on the healthcare system and ultimately patients themselves. Indeed, politics can affect healthcare both positively and negatively. It focuses on the anti-abortion law in Idaho, but the conclusion applies to other states as well. Other situations, including issues about medical insurance, access to healthcare, patient autonomy, beneficence, etc., can be dissected similarly.
The Issue
According to the Idaho state law, abortion is illegal in Idaho unless (1) it is necessary to prevent the woman’s death, or (2) the woman is under rape or incest and specific age or pregnancy conditions (Section 18-622 – Idaho State Legislature, n.d.). Meanwhile, if a patient comes to the emergency department and requests treatment for a medical condition, EMTALA requires the hospital to provide appropriate and necessary stabilizing treatment within the department’s capability (42 U.S. Code § 1395dd - Examination and Treatment for Emergency Medical Conditions and Women in Labor, n.d.).
Healthcare providers are pressed to decide between providing emergency abortion care to the pregnant patient—which might mean prosecution from Idaho if they unconsciously “cross the line” of law—and leaving the patients in crisis—which might mean violation of EMTALA.
The Supreme Court case Moyle v. United States was debated on April 24, 2024. It was about whether the state laws conflict with EMTALA and whether EMTALA automatically preempts the state laws. Idahoans, the Court Justices, and healthcare providers were all urged to answer the question: Is following EMTALA principles more ethical compared to following the Idaho state law?
When considering a high-risk pregnancy with possible outcomes of death or serious injury, is following EMTALA principles more ethical as opposed to following Idaho state laws? While this dilemma implies greater issues, such as how beneficence is practiced in healthcare and whether EMTALA preempts state law, the squeeze has already brought troubles to Idaho.
Methodology
Extensive online research was conducted on Moyle v. United States and the (see References). Main sources include the Supreme Court oral argument, patient experiences, and OB/GYN statistics in Idaho.
OB/GYN Availability in Idaho
The near-total abortion ban in Idaho has significantly impacted its local obstetrician-gynecologist availability. Since the ban came into effect in August 2022, 21.6% of the practicing OB/GYNs in Idaho have left the state over the course of 15 months, including 55% of high-risk obstetricians (The Idaho Physician Well-Being Action Collaborative et al., 2024). Also known as perinatologists, these high-risk obstetricians specialize exactly in pregnancies where the woman or the fetus “has a health complication” (Perinatologist, 2023). Their leave puts pregnant Idahoan women with emergencies in a severely disadvantaged situation. According to the Centers for Medicare and Medicaid Services, 90% of the United States may have better pregnancy outcomes than Idaho (The Idaho Physician Well-Being Action Collaborative et al., 2024).
Furthermore, only 22 out of 44 counties in Idaho have access to OB/GYN care (The Idaho Physician Well-Being Action Collaborative et al., 2024). Among these 22, only 10 meet bare minimum coverage standards: 3 doctors per county to “cover call 24/7/365”(The Idaho Physician Well-Being Action Collaborative et al., 2024). Ironically, the question becomes: can the OB/GYN department in certain Idaho counties even sustain under an emergency situation? Just as Turner claimed in the Court argument, abortion care might not be “[legally] available” in Idaho even if the woman exhibits certain complications (Moyle V. United States, n.d.); however, if only for the sake of life/rape/incest exceptions, it should be “[physically] available.” The lack of OB/GYN resources both threatens the women and undermines the Idaho state law itself. Also considering that OB/GYNs have even more responsibilities besides abortion care, such as delivering babies and treating other diseases of the female reproductive system, many are concerned about a future paralysis in the healthcare system, radiating from Idaho.
The Patients
Over the past two years, some Idaho women have been airlifted to other states to receive abortion care. These cases were brought to the Supreme Court’s attention in the argument. Solicit General Elizabeth B. Prelogar commented, “[Such a situation is] untenable, and EMTALA does not countenance it” (Moyle V. United States, n.d.). Huge spending and long delays before treatment inflicted the women and their families. The women’s health could quickly deteriorate before they receive abortion care in another state—or perform an abortion on themselves. Besides the case described by Justice Sotomayor, below are two other stories of women struggling to receive care.
Stories retrieved from the Center for Reproductive Rights' report (Ray, 2024).
In many situations, abortion care is the only treatment that can “stabilize” a pregnant patient experiencing an emergency (Idaho V. United States and Moyle V. United States: The Supreme Court Will Decide if States Can Block Pregnant People From Getting Emergency Abortion Care, 2024; 42 U.S. Code § 1395dd - Examination and Treatment for Emergency Medical Conditions and Women in Labor, n.d.). These include common conditions such as miscarriage, as well as complications of gestational diabetes and preeclampsia. Other life-threatening conditions to the woman, such as a car accident injury, also require abortion care. The cases tell how difficult it is for Idaho women to access their stabilizing treatment, and how much risk women, along with the fetuses, carry when they are rejected by Idaho hospitals.
Summary
The topic is still hotly debated among the US population and many people are fighting for either side. By June 26, the Court was still hesitating on the decision, while Idaho provided little information about its maternal outcomes—in fact, it is the only state that does not track maternal outcomes. Areas of further research include federal government-state relationships and fetal personhood versus maternal will. The moral question is challenging and personal, but the phenomena in Idaho’s healthcare system are hardly optimistic.
The Authors' Words
After all, our research is not for naught. We learned how complex and multifaceted the issue is, and how difficult and convoluted policy-making is as well. All we can hope is the decision be made by the brightest minds in the nation, who strive for a healthier future.
Easter Egg (or Not)?
Quote from a Washington Post article by Marimow and Diamond (2024).
