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In states with abortion bans, hospital ethics boards have the power to make exceptions

AYESHA RASCOE, HOST:

Let's follow up on a story out of Texas, where last week five women announced they were suing over the state's abortion ban. They say they were denied necessary and potentially lifesaving care because doctors there fear legal repercussions. One woman says her ordeal included doctors needing approval from a hospital ethics board. We wanted to find out more about the role such boards might be playing when it comes to medical exceptions in states with abortion bans. Someone who's been following this is Dr. Anne Lyerly. She trained as an OB-GYN and is now a professor at the University of North Carolina, Chapel Hill. Thank you so much for joining us.

ANNE LYERLY: Happy to be here.

RASCOE: So traditionally, what is the role of a hospital ethics board? I know you served on one early in your career.

LYERLY: Yes. So hospital ethics committees or hospital ethics boards are committees that are an important part of many or most medical institutions across the country. They can help doctors and patients navigate areas of ethical conflict or ethical questions - questions that come up about withdrawal of life support or, say, an adolescent is refusing cancer treatment or a range of other medically, ethically complicated questions.

RASCOE: And so what kind of care are we talking about when pregnant patients would require an abortion?

LYERLY: So when we think about abortion, abortion is often a morally complicated and contested procedure. But the kinds of cases that have come up in Texas and indeed around the country where bans are in place are in fact not ethically complicated cases. In fact, the ethical way forward is pretty clear. For example, unfortunately, there has widely been reported situations in which women have had ruptured membranes prior to viability of their pregnancies, which means sort of ruptured membranes several weeks before the baby would be able to survive outside the womb. The standard of care in these cases is to provide a timely abortion to prevent harm to the pregnant woman.

There is nothing to be gained. There's no chance that the pregnancy would be able to continue or that the baby would be able to survive if the pregnancy is prolonged. And in fact, waiting would be against the standard of care and is ethically problematic.

RASCOE: And when you say rupturing membranes, that means like when your water breaks, essentially.

LYERLY: Right. And when it breaks, there is no longer fluid around the baby. The baby cannot exercise its lungs, so the lungs can't develop. It can't grow. And in addition and more dangerously, infection can ensue within the womb and then very quickly go to a woman's other organs and become life-threatening.

RASCOE: So how does it strike you, then, that in some cases hospital ethics boards are being invoked to determine eligibility for these medical exceptions to these abortion bans?

LYERLY: Well, I think this is absolutely not a job for an ethics committee. All of these cases are cases in which everybody knows what the right thing to do is. And in fact, I think that these boards in many cases are being deployed as a legal shield rather than a tool to help doctors and patients get the care that they need.

RASCOE: What can happen to patients who have to wait for this process to play out?

LYERLY: Well, unfortunately, in many cases, the question is whether the provision of abortion is necessary because a patient's life is threatened. And again, in many cases, the doctor has already decided that that patient's life is in danger. And so waiting for the judgment of an ethics board can put her at risk of getting severely ill or dying.

RASCOE: It's not even been a year since the Supreme Court reversed Roe. Where might this be headed?

LYERLY: Well, one of the remarkable, if heartbreaking things that has happened in the last year is that it has foregrounded this really tremendous gray area. Usually when we think about abortion, there are those that are in favor and those that are against it. But as these cases have exemplified, abortion is critical health care. It is needed to keep women safe, women who are pregnant and want to carry their pregnancies to term and has helped the public and many others understand that abortion is central to the good care of all pregnant people.

RASCOE: Dr. Anne Lyerly is a professor of social medicine at UNC Chapel Hill. Thank you so much for joining us.

LYERLY: My pleasure. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.