Last week the House passed HR 358. A very charitable interpretation is that, as written, it’s ambiguous on what would seem (at least to people who give a hoot about pregnant women) a rather important detail: Does it allow a hospital staff person to let a woman die rather than provide the abortion she needs to save her life?
Supporters of the bill say that it doesn’t come right out and amend the Emergency Medical Treatment and Active Labor Act. EMTALA, which has been the law since 1986, says that hospitals which accept Medicare reimbursements from the government cannot refuse to treat anyone needing emergency treatment. That’s basically the agreement: if you’re a hospital, and you accept Medicare reimbursements, you have to agree to stabilize anyone who shows up needing emergency care, even if they can’t pay, and even if they are not in the country legally.
One might imagine that a hospital which can’t in good conscience agree to those terms could simply opt out of receiving Medicare money and then put all the bouncers it wants at the ER door—indeed, that this might be the very definition of “standing by one’s principles and letting the chips fall where they may.”
Sort of like how, if your conscience could never allow you to participate directly in abortion—even to save a life—you might think seriously about getting employment in any of the many fields where you will never ever be asked to perform one, instead of in one of the very few fields where you eventually will. (There are actually a lot of non-abortion-doing occupations. Florist! Web designer! Particle physicist! Google Ad rater! Deli manager! Or, gosh what about: Pediatrician! Brain surgeon! Doctorly Specialist in Non-Emergent Health Situations Utterly Uninvolved With Pregnancy or The Lady Bits!)
But that view seems to be a minority, so we have conscience provisions like the ones in HR 358. And no, it’s true, the bill doesn’t say any version of, “Here’s the part where we remove EMTALA protections just for pregnant women.” What it does say, though, is that health care providers can deny service to any woman seeking an abortion, and they don’t have to refer her to another facility where she can receive an abortion.
Ah, but! We don’t have to go very far to consider where the provisions of this bill seem to conflict with EMTALA, do we? I mean, it’s not exactly the Super Genius Challenge Brain Bonus Puzzler, is it? Doesn’t really require Sunday-Times-like attention to detail and mental storage of arcane knowledge to ask the obvious question! Because in fact, the only scenario we need to raise is this one: What if it’s an emergency and the woman needs the abortion or she’ll die? Which is, like, not outside the realm of possibility. From the American Journal of Public Health (PDF):
Dr B., an obstetrician–gynecologist working in an academic medical center, described how a Catholic-owned hospital in her western urban area asked her to accept a patient who was already septic. When she received the request, she recommended that the physician from the Catholic-owned hospital perform a uterine aspiration there and not further risk the health of the woman by delaying her care with the transport.
“Because the fetus was still alive, they wouldn’t intervene. And she was hemorrhaging, and they called me and wanted to transport her, and I said, ‘It sounds like she’s unstable, and it sounds like you need to take care of her there.’’ And I was on a recorded line, I reported them as an EMTALA violation. And the physician [said], ‘This isn’t something that we can take care of.’ And I [said], ‘‘Well, if I don’t accept her, what are you going to do with her?’’ [He answered], ‘‘We’ll put her on a floor [i.e., admit her to a bed in the hospital instead of keeping her in the emergency room]; we’ll transfuse her as much as we can, and we’ll just wait till the fetus dies.’”
And, ta-da, all of a sudden we are asking again whether pregnant women, as a class, are actually going to get the protections that EMTALA is supposed to give.
If you are never going to be pregnant, and you don’t care about anyone who might ever be pregnant; or, alternately, if you have been sprinkled with magic fairy glitter that ensures that nobody you care about will ever have a pregnancy complication, then congratulations! I suppose this could be your cue to stroke your chin thoughtfully and say “Hmm” and remark that it’s an interesting legal and ethical question. (Psst: In emergencies it’s generally a great idea to have instructions that are as clear as possible. I learned that as a lifeguard. Hope it helps!)
Or possibly you might also ask the rest of us to trust you. You might point to the part of the bill that just reiterates the restrictions from the Hyde amendment: the part that says federal money can’t be used for abortion unless “the pregnancy is a result of rape or incest” or “in the case where a pregnant female suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the female in danger of death unless an abortion is performed, including a life-endangering condition caused by or arising from the pregnancy itself[.]”
Yeah, funny thing, though! All the bill does there is say that there might be federal reimbursement for an abortion necessary to save the mother’s life. It doesn’t say that there will be a doctor! It doesn’t forbid patient-dumping and arguably enables it, which means that EMTALA is in doubt again. But, hey, this should be easy to fix. Why not just add an amendment saying “Nothing in this bill amends EMTALA”?
Well, Rep. Lois Capps of California must be a Super Genius Challenge Brain Bonus Puzzler winner, because that’s what she did: offered an amendment that would continue the prohibition against using federal money for abortion except in cases of rape, incest, or threat to the mother’s life; but would simply require hospitals to follow EMTALA if a woman shows up needing emergency treatment.
It failed, right along party lines.
President Obama has said he would veto the bill were it to come to him, so the lesson here is mostly anthropological. That lesson is this: There is, evidently, a sort of mind which contemplates a woman coming to a hospital needing an abortion to save her life and thinks, “This should never happen.” Oh, no, not her pain. Not the frightened family. Not the danger. Not the awful decision they face. Not, really, anything having to do with her.
No, evidently, here are people in the world who contemplate this scenario and zero in on the health care staff; or perhaps their mental cameras zoom even further out, panning down the hallway and up several floors to a hospital administrator’s office. Or it cuts away—miles away—to a bishop’s residence. “This should never happen,” they think. “These people should not be put in such an awful position of having their views on abortion compromised in this one very specific circumstance. It is an outrage.” Contemplating a woman bleeding out from a uterine rupture, or going into shock from sepsis following a miscarriage, or developing pulmonary hypertension and dying and leaving behind a grieving family including several small children, these people think: “But, but, but! My beliefs about things!”
This is good to know, if you’re someone who gives a hoot about anyone who might ever be pregnant. Here is a rundown of the votes.