When I was a medical student, I was one of thousands of students who received a mailing from an anti-abortion organization that included this so-called joke:
Q: What would you do if you were in a room with Hitler, Mussolini, and an abortionist and you had a gun with two bullets?
A: Shoot the abortionist twice.
I was infuriated that people were trying to scare me and my fellow students out of providing care that people need. At the time, only 12 percent of ob-gyn programs included abortion training. I founded Medical Students for Choice to ensure that in the face of these threats, students like me could get trained to provide the competent, compassionate abortion care that patients deserve. Nearly 30 years later, I’ve personally helped train hundreds of students and residents at top medical schools around the country. Some things have changed: Training is more widely available, but restrictions making it harder for patients to access care have multiplied. What hasn’t changed is that students and residents keep showing up to get trained because the people they serve need that care.
The state of Louisiana and anti-abortion allies recently turned their energy toward pushing the Supreme Court to rule that people like the doctors I train could no longer represent their patients in court to challenge abortion restrictions. This would have reversed more than 45 years of precedent in abortion rights cases. While the Supreme Court gave us a reprieve on that question today, opponents of abortion rights still perpetuate the caricature of malicious abortion providers as they did in that threatening mailing decades ago. It’s important to understand that their portrayal of our relationship with patients couldn’t be further from the truth.
I was inspired to go to medical school after I had the opportunity to work as a peer educator at a women’s health clinic. I saw firsthand the way clinicians can create a deep level of trust and connect with patients at their most vulnerable. Having a baby can be scary. So can confronting an unwanted pregnancy. I saw how beautifully the best clinicians can make people feel comfortable and safe and help them make decisions that align with their values and desires.
Not every resident I work with has made up their mind about whether they will provide abortion care in their practice. If they’re uncomfortable with the idea, I talk with them about the root of their discomfort. If they decide providing abortion care isn’t right for them, I support them in their decision and make sure they know how to support a patient through making a decision about their pregnancy. I also make sure they learn the skills that help them care for those experiencing a miscarriage.
In fact, my research has shown that ob-gyn residents who don’t plan to provide abortion care still value participating in family planning training to their comfort level; it increases their skills in counseling, makes them feel more empathetic for patients, and gives them skills they need to safely provide treatment in the setting of a miscarriage or emergency. One resident talked about being on call and seeing a pregnant woman at 16 weeks who was hemorrhaging and wanting to learn the skills that kept that woman from needing an abdominal surgery or dying. They are committed to our professional values as physicians — to respect a person’s decisions and ensure that patients get the care that they themselves are not trained to provide.
But more often than not, ob-gyn residents decide it’s their responsibility to provide that care, even if they started out as one of the 15 percent who are unsure about becoming trained in abortion care. Ultimately, as they meet patients, this decision is solidified; they see that the patients know what is best for them and ask themselves, “How can I not be there for this person?”
We do not presume to know why someone needs an abortion, and that’s what we teach our learners. We teach them to ask the patient how it felt to come to this decision, and if they feel supported by people in their lives. If someone is crying, we let them cry. It can be uncomfortable, but they learn to honor the feelings of their patients and see each person as an individual who needs this care.
In fact, providing abortion care is one of the best ways to train compassionate doctors. Abortion is so stigmatized, and sometimes learners feel emotional discomfort or nervousness going into it. They’re often moved by getting to know the patients and realizing that they can navigate these complex situations with compassion and skill.
One of the most inspiring things I see in the future abortion providers I have the privilege to teach is just how hard they work for their patients. They’re fueled by a passion to provide equitable care to people no matter who they are, where they live, or what pregnancy decisions they make. I’ve seen young doctors work tirelessly to make sure a patient can have the healthy pregnancy she wants when she has a severe medical condition that makes continuing a pregnancy extremely dangerous. If someone wants to end a pregnancy because that person can’t be a parent right now, they work to help the patient navigate barriers to make that happen.
Speaking up for our patients in the courtroom is a natural extension of our care. The fundamental principles of medicine — patient autonomy, primacy of patient welfare and social justice — all underscore our responsibility to advocate for our patients. The people we serve face enough burdens without having to stand in a court of law to get the care they need. Our mission as doctors is to fight for our patients’ well-being. We do this every day in exam rooms and operating rooms. When the law puts a person’s health and well-being at risk, we can and will advocate for them in the courts, too. I am relieved that after today’s Supreme Court decision we can continue to do so.
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