Moral distress

There are a huge number of people directly affected by Idaho’s abortion bans who don’t make it to our office. I work in a private OBGYN clinic, so most of the time when people are calling for pregnancy visits, they know they’re pregnant and want to continue care. We see a small number of unexpected pregnancies. 

But things can come up in any pregnancy and the laws affect all of them, whether wanted or unwanted. Moral distress comes up because I can offer certain medications or procedures to one patient but not the next. It feels stupid because I am capable and our system is capable. Professionally it feels bad. Morally it feels bad. 

For patients who have to travel out of state, knowing the impact of travel, time off work, other children, it’s huge. People think we walk in the exam room and out with our day. We go home thinking about these things, worrying about patients, making sure they get follow-up and resources. Professionally, it makes things hard because our job is very time-sensitive. Decisions on labor and delivery in the ER need to be quick. Now, some of that time is occupied by hesitancy: Is this legal? Do we have to call for approval? That affects outcomes.

Patients aren’t sure if they can discuss options with me, which is not about me but it’s hard because the legislature has inserted itself in the exam room. OBGYN is defined by intimacy between provider and patient: not just physical, but emotional. Intimacy is eroded by the law.

There is also the fear that someone not on the same page will report us. The laws create a penumbra of fear that touches a greater expanse than the laws themselves. People worry unnecessarily about what the restrictions mean, which is stressful.

I bring all of it home from work, to some degree. Post-Dobbs, non-viable pregnancies where the patient cannot terminate for weeks are traumatizing for patient and provider. We are trying to prevent suffering, not increase it. There’s emotional exhaustion. 

To stay is an active choice. If I left, patients wouldn’t be cared for. Support and advocacy from our communities is vital. Acknowledgement from patients—simple thank yous—make a huge difference.

The disconnect between lawmakers and medical reality causes suffering. To legislators I would say, listen to us and believe us. Complex, time-sensitive situations aren’t black and white. Delays due to legal barriers harm patients.