It can be easy to forget about anesthesiologists, often hidden away in operating rooms. However, anesthesiologists, known for leaping into action during a crisis, are rising up in the wake of the Dobbs decision.
The loss of federally protected abortion access will harm our patients, our colleagues, and our profession. Clinical care, from obstetric anesthesiology, critical care, pain management, and millions of surgeries annually in America, will suffer the impact directly and indirectly.
Anesthesiologists themselves must consider the risks to their physical safety due to lack of access to medical care and from hostile laws targeting physicians who provide both reproductive and non-reproductive services to those of childbearing capacity.
We write on behalf of a rapidly growing group of anesthesiologists concerned about the decision's direct and indirect consequences. We can strengthen our profession by speaking out on issues that directly impact the ability of anesthesiologists to provide safe, evidence-based care to patients and for our colleagues' ability to receive reproductive healthcare.
Individual doctors and organizations may believe that staying neutral or silent will shield them from the abortion controversy. But this isn't the answer. Every day, anesthesiologists speak up for patient safety in operating rooms, delivery rooms, intensive care units, and clinics -- the crisis of reproductive healthcare access should be no exception.
Patient Safety
Medical evidence on state restrictions' effects on reproductive healthcare indicates that this decision will negatively affect patient safety, privacy, health, and maternal and infant mortality. State-mandated restrictions deliver higher maternal and infant mortality rates across a range of geographical settings and time periods. The Dobbs decision will disproportionately impact marginalized populations, who already experience gross inequity in maternal morbidity and mortality and access to care.
Not only are safe abortion services lost, but previously routine reproductive healthcare has already been affected (e.g., emergency treatment for ectopic pregnancy), as well as treatment for medical conditions requiring potentially teratogenic medications. These changes will harm our patients, colleagues, and friends.
Anesthesiologists' Safety and Well-being
As both patients and physicians, anesthesiologists' physical safety and well-being may be threatened in the wake of this ruling in many, often unforeseen, circumstances. Major decisions regarding whether to practice in or travel to states with restrictions and bans on reproductive care will be recalculated.
These safety concerns are not limited to abortion providers, as similar states have also clarified their intolerance of the LGBTQIA+ community. We are likely to see an erosion of hard-won advances in gender and racial equity in our profession, further harming our professional well-being.
Ethical Considerations
Beyond abortion access, the Dobbs ruling rocks the foundation of professional medical practice. We recognize a variety of strong and polarized opinions related to reproductive care, including among anesthesiologists. Physicians already benefit from legal protection against providing treatments counter to their own ethical values.
Restrictions and bans on essential healthcare prevent anesthesiologists from following our own moral and ethical obligations to patients. In many situations, we may be forced to either follow our own ethical commitments to do the right things for patients or follow restrictive laws, constraining ourselves to the interpretation of medical dilemmas by non-medical personnel. The wave of avoidable moral distress over being legally prevented from providing and receiving evidence-based medical care will be unparalleled.
The American Society of Anesthesiologists (ASA) Guidelines for the Ethical Practice of Anesthesiology, which incorporate the AMA Principles of Medical Ethics, guide us during this monumental time. The AMA Principles of Medical Ethics and each of the five sections in the ASA Guidelines address specific ethical obligations of anesthesiologists impacted by the SCOTUS decision. The AMA Principles of Medical Ethics state: "A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient." Further, the Guidelines for the Ethical Practice of Anesthesiology state: "Anesthesiologists respect the right of every patient to self-determination."
We take pride in several of our most trusted anesthesiology professional organizations speaking out against legislative interference in medical practice and upholding every patient's right to make decisions about their own bodies. The American Board of Anesthesiology joined more than 75 other organizations to affirm these ethical principles. The California Society of Anesthesiologists, Women in Anesthesiology, Society for Obstetric Anesthesia and Perinatology, Anesthesia Patient Safety Foundation, and ASRA Pain Medicine shine their attention on this critical issue for anesthesiologists.
Legal Considerations
Anesthesiologists who provide any abortion-related care in the U.S. should be aware of the potential risk to their physical and psychological safety as they travel to states with significant limits on abortion care, including the risk of possible criminal charges. The landscape of these restrictions may change rapidly as legislatures across the country propose new legal actions against patients and healthcare workers.
Professional Development
In addition to the monumental clinical impact, abortion restrictions insert necessary complexity in deciding to practice in and/or participate in professional development activities in certain geographic regions. Anesthesiologists may be unable to access appropriate emergency reproductive care for themselves while attending professional meetings in states with these limits. As legal action against healthcare workers evolves, we expect additional risks may emerge.
Anesthesiologists rely on professional meetings for networking, education, governance, and scientific collaboration. The commitment of any professional society to its members should be based on a society's guiding values. When selecting locations for in-person professional meetings, these values, and their membership's needs should be considered.
The American Medical Informatics Association outlines how organizations may approach venue selection consistent with most professional medical societies' standards. They provide robust guidance for other societies moving forward after the Dobbs decision. These items include the right to benefit from science, safety and security, freedom to travel, freedom of speech, right to nondiscrimination and civil discourse, human rights, access to professional development, and transparency and veracity. Society leaders have a fiduciary responsibility to their members to consider these values when planning future meetings.
It is time to put aside political rhetoric and act to protect our patients, each other, and the practice of safe medical care. Anesthesiologists are Made for this Moment.
The work is the opinion of the authors, who are not representative of any organization or institution.
Alyssa M. Burgart, MD, MA, is a clinical associate professor in the Department of Anesthesiology and an ethicist in the Stanford Center for Biomedical Ethics at Stanford University. Linda B. Hertzberg, MD, is retired from private practice in California, and past president of the California Society of Anesthesiologists. Harriet W. Hopf, MD, is a professor in the Department of Anesthesiology and an adjunct professor in the Department of Biomedical Engineering at the University of Utah. Christina Menor, MD, MS, is an anesthesiologist in private practice in Los Angeles, and speaker of the California Society of Anesthesiologists. Amy Vinson, MD, is an assistant professor of Anaesthesia at Boston Children's Hospital and Harvard Medical School, and chair of the American Society of Anesthesiologists' Committee on Physician Well-being.