Originally published June 25 on KTVB.COM.
Following the Supreme Court's decision to overturn Roe v. Wade on Friday, the political and legal sides of the ruling have been widely discussed.
A part of the abortion equation that hasn't been discussed much over the last few months is from the provider's perspective.
Doctors are the ones in the room when the decision to have an abortion is made and they are the ones on the receiving end of Senate Bill 1385 — Idaho's trigger law that will ban abortions under most circumstances — which will go into effect sometime in August.
The bill says, "every person who performs or attempts to perform an abortion as defined in this chapter commits the crime of criminal abortion." That is unless they can prove it was to save the life of the mother.
Dr. Loren Colson is a family physician in Boise who provides obstetrics and reproductive care, including options counseling like abortion.
Colson is a member of the Idaho Academy of Family Physicians and sits on the Reproductive Health Committee. He's also one of the state leaders for the Reproductive Health Access Project.
Knowing a bit about the topic, Colson calls the Supreme Court's ruling a huge step backwards for reproductive health care.
Colson: "We know that without abortion access, that more mothers will die because they can't get the care they need. What we do know is pregnancy is a dangerous condition for a lot of people and that the U.S. has a pretty high maternal morality rate already for a developed country and that this is only going to make it worse. So, even though the law says that there's a provision for the life of the mother to allow for abortion, more mothers will still die because they did not have access to abortion care."
KTVB: "How do you weigh that with the rights of the unborn, which is the other side of this argument?"
Colson: "My belief and the belief of our professional organization here, the Idaho Academy of Physicians, is that this is a very personal decision between the patient and the provider and that is a decision that should stay in that area and not should be decided upon by anyone else, including our legislators."
KTVB: "You're going to be in this place where you're going to make a decision, like you, I will not be liable for this if the physician determined in good faith medical judgment that the abortion was necessary to prevent the death of the pregnant woman. Are there going to be situations where you're going to have to weigh your legal options over your medical options?"
Colson: "Absolutely. It's not always clear at an appointment early on in the pregnancy or later on in the pregnancy if the life of the mother is eminently in danger. There will definitely come a time when a patient is concerned based on their own health risks, that they might have pregnancy complications and that they don't want to continue the pregnancy for that reason, but in that moment it might be hard to justify that that is to protect the life of the mother, because it would be theoretical at that point that they wouldn't have had that complication already and by the time they have that complication, it might be too late."
KTVB: "What instances would that be the case?"
Colson: "Probably the most prevalent one would be a condition called preeclampsia, or if one develops high blood pressure and then a lot of different organ failure problems, such as swelling of the brain, seizures, and ultimately could lead to death. That doesn't usually happen until later on in the pregnancy."
KTVB: "Does it happen that people are given this risk assessment of preeclampsia and they say, 'I don't want to deal with that,' and they make the decision to have an abortion?"
Colson: "Yeah, I would say that is one of many factors that the folks say, 'I (don't) want to be pregnant or (put) my family at risk.' These people aren't first-time parents, they have kids, they have a family already and I think while they may even be excited about the pregnancy, it may not be an unwanted pregnancy when they weigh that against, 'is it worth it for me to leave my family to die by continue this pregnancy?' A lot of them will come to the decision of 'no, it's not worth it to me, I would not like to continue this pregnancy.'"
KTVB: "There's a lot of gray area, they say, when it comes to: what's that medical decision versus what's the life of the mother, kind of thing. What's it like to be in that gray area?"
Colson: "I think that's what's hard for folks that don't have a medical background to understand is, that is the area we always deal in is gray area, and we're constantly weighing our decisions of, these are the probabilities, what decision do you want to make as the patient, as part of shared decision-making process? It's almost never a clear-cut answer on most of medicine, and so that's why it's super important to us that we keep it between the patient and the provider and for the patient to be able to make that choice that they feel they need to make that choice, based on the information that's been laid out in front of them."
KTVB: "How is this going to change your life? Your career? Your job going forward?"
Colson: "It's going to be really tough, because I think myself and my colleagues are going to feel like we have to make a decision for patients to continue a pregnancy they may not want and to follow them throughout that entire process. So, for nine months, help them to manage themselves medically and carry a pregnancy that they don't want, that they expressed to us that they didn't want, from the very beginning."
Colson said doctors, as a species, are pretty risk averse and instead of having to face that gray area of abortion - most who now provide the option - will likely just stop providing the option to avoid the chance of any legal trouble.
He also told KTVB that, right now, a decision to have an abortion is 100% upon the patient.
When asked if this ruling shifts some of that onus to the doctor to make that decision, worrying about the legal ramifications, Colson said that decision has been made by Idaho lawmakers.
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