“When there’s an elephant in the room, introduce it.” ~Randy Pausch
Professor Randy Pausch began his final lecture titled “Really Achieving Your Childhood Dreams,” also called “The Last Lecture,” at Carnegie Mellon University in September 2007 with the above quote. Dr. Pausch had been diagnosed with pancreatic cancer in 2006, and at the time of his lecture had been told he had three to six months to live.
His lecture was a mixture of humor, advice on working with others, computer science, and engineering. Pausch nearly canceled the lecture given his advanced stage of illness, but decided to speak, explaining that his family — including his wife and three young children — would remember him through seeing his lecture and reading his book of the same name. The difficult elephant in the lecture hall that day was his cancer. Dr. Pausch died less than a year later.
On June 24, abortion came out of a nearly 50-year federally-protected status to become the “elephant in the room” for our nation, profession of medicine, and patients when SCOTUS overruled Roe v. Wade, “returning the issue of abortion to the people’s elected representatives.”
By July 7, ACOG issued a statement along with 75 other health care organizations opposing legislation that thwarted “evidence-based” abortion care, stating it should be provided “without arbitrary limitations, without threats, and without harm.” But if you asked a physician to define what would be an arbitrary limitation, it is unlikely each physician would provide the same answer.
The divisive nature of this topic was in full evidence that same July day here in South Carolina. A House Ad Hoc Committee deliberating South Carolina’s current statutory law, the ‘Heartbeat Law,’ and any changes to those laws related to medical and surgical abortions, heard seven hours of open testimony.
The South Carolina Medical Association Board of Trustees anticipated being asked for comment by our legislators and submitted a statement, which was shared in an email to members the same day, and again in the July 21 Alerts e-newsletter. Your SCMA has never had an official House of Delegate policy on the issue of abortion. The SCMA acknowledges the diversity of opinions existing within our profession of medicine. There is not a consensus among South Carolina physicians on unrestricted access to abortion services. However, there seems to be agreement that physicians must have the ability to: 1) discuss patients’ medical care openly and freely without fear of criminal prosecution, and 2) through shared decision making with a patient, perform an abortion that is medically necessary to preserve the life and/or health of the mother or in cases of fetal anomaly.
Scrutiny by law enforcement and the potential penalties for the physician have drastically changed in our state. What perdures, however, is the gravity of these situations, the difficulty of the medical decisions, the despair of the mother and family, and medical judgment needed. Law enforcement has essentially been invited into the exam room to sit in judgment of decisions which have been and should remain reserved for a physician and their patient and her family.
The South Carolina Legislature has wisely allowed for exceptions to account for these situations in all previous versions of the law, but current law that is more restrictive — or any law going forward — must provide language to allow physicians and patients to navigate these life or health preserving situations, without fear of criminal prosecution.
The SCMA letter:
The SCMA suggested and has followed up with a letter to the BME, asking for an advisory opinion to provide clarity for our profession and patients. These past weeks have created uncertainty, distress, and potential danger for our patients as physicians and hospitals struggle with how and whether to proceed with care that in the past would be unquestioned.
This issue will continue to evolve in the coming months at all levels within our state. The SCMA anticipates ongoing efforts and contact with legislators and regulatory bodies to oppose laws or regulation criminalizing physicians for providing safe and effective healthcare in such pregnancy related clinical scenarios. We need to continue to hear from you as well. I assure you that your concerns and thoughts will be shared with your Board of Trustees for consideration. Please offer your thoughts and feedback at scmayeakel@gmail.com.
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