Doctors Caught Between the Law and the Patient
- Shriya Mehta
- Apr 6
- 5 min read
In emergency medicine, minutes matter. But for physicians treating pregnancy complications, the decision to act is increasingly shaped not just by clinical urgency, but by legal uncertainty. For decades, federal law through the Emergency Medical Treatment and Labor Act (EMTALA) reinforced that decisions in the emergency department should be guided by clinical need. EMTALA is a federal law passed in 1986, requiring hospitals that receive Medicare funding to provide emergency evaluation and stabilizing treatment to any person who requests help in the Emergency Department [3]. However, the legal landscape surrounding reproductive care has changed significantly in recent years, creating new issues between federal emergency care obligations and state abortion restrictions. Following the Supreme Court’s 2022 decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and returned abortion regulation to the states, the legal framework surrounding emergency reproductive care has become increasingly unclear.
Now, clinicians in some emergency departments face uncertainty about how to treat pregnancy-related emergencies when termination of a pregnancy may be the medically indicated intervention.
Pregnancy Emergencies and Medical Decision-Making
Obstetric emergencies frequently arise in emergency departments and can progress rapidly [10]. Conditions such as ectopic pregnancy, premature rupture of membrane before fetal viability, and severe preeclampsia can quickly become life-threatening. In some cases, terminating the pregnancy is the only intervention that can stabilize the patient and prevent severe complications such as hemorrhage, infection, or organ failure [1,2]. Historically, EMTALA has functioned as a federal baseline ensuring that hospitals provide weather stabilizing treatment is necessary. The statute requires hospitals to offer stabilizing care when a patient has an emergency medical condition. An emergency medical condition is a condition that could place the patient’s health in serious jeopardy or cause impairment if untreated [4]. For decades, physicians interpreted this requirement to include abortion care when necessary to prevent significant harm to a pregnant person.
Conflicting Federal Guidance and State Abortion Laws
After the Dobbs decision, many states enacted or enforced abortion bans that restrict when pregnancy termination can legally occur [6]. Several of these laws allow exceptions only when a patient’s life is at risk, often without clear guidance on how imminent that risk must be. This creates uncertainty for physicians practicing in emergency departments, where medical conditions rarely progress in neat legal categories [2]. In response to these conflicts,the federal government initially issued guidance stating that EMTALA requires hospitals to provide abortion care when it’s the stabilizing treatment for an emergency condition. That interpretation effectively asserted that federal emergency care obligations could preempt state abortion bans in certain circumstances. However, federal policy on this issue has shifted in recent years, leaving hospitals and clinicians with less clear guidance on how the two legal frameworks interact.
Delays in Care and Implication for Patient Safety
The resulting uncertainty has significant implications for clinical decision-making. When physicians have to consider legal risk alongside their clinical judgement, care delays can occur. Nearly 80-90% of physicians report practicing defensive medicine to avoid liability [8].
For example, patients experiencing previable premature rupture of membranes have a high risk for infection if the pregnancy continues, and termination of the pregnancy can reduce the likelihood of sepsis or severe complications. This happens when the amniotic sac breaks before the fetus is viable, meaning it cannot survive outside the womb. However, in states with strict abortion laws, physicians hesitate to intervene until the patient's condition worsens enough to meet the definition of “life-threatening.” This delay contradicts long-standing medical practice (established by the EMTALA) that emphasized early intervention to prevent complications rather than responding only once a patient becomes critically ill.
Reports from clinicians and patient advocacy groups have mentioned that these legal uncertainties are already affecting patient care significantly. For example, in Texas, multiple patients experiencing previable premature rupture of membranes were denied immediate abortion care and instead instructed to wait until signs of infection developed, increasing their risk of sepsis and hospitalization [11]. In another case, a woman in Wisconsin with an incomplete miscarriage was told to return home and wait until her condition worsened before receiving treatment, despite ongoing bleeding [9]. However, these events are not isolated incidents. A national survey of obstetrician-gynecologists found that over two-thirds reported changes in their clinical practice due to abortion restrictions, including delaying or altering care for pregnancy complications [7].
System-Level Challenges for Hospitals and Emergency Departments
Beyond individual cases, these legal conflicts are reshaping how emergency departments operate. Hospitals now have to translate ambiguous laws into clinical protocols. This often requires real-time consultations with legal teams before physicians can act. In high-acuity settings where minutes matter, this added layer of decision-making can delay care and shift responsibility away from clinical judgement toward institutional risk management.
Emergency departments already face staffing shortages, increasing patient volumes, and financial strain [5]. Legal uncertainty surrounding reproductive emergencies adds another operations burden, requiring additional documentation, staff training, and administrative oversight. These changes can slow workflows and increase system inefficiencies, particularly in hospitals serving high-risk or low-income populations.
This shows a mismatch between how healthcare policy is designed and how care actually happens. Emergency medicine depends on rapid and standardized decision-making, but the current legal landscape introduces variability at the point of care. As a result, access to stabilizing treatment will depend not only on medical need, but also on how legal risk is interpreted within a given hospital or state.
Works Cited
ACOG: “Abortion Bans Are to Blame, Not Doctors.” (2024). Acog.org.
Bridwell, R., Long, B., Montrief, T., & Gottlieb, M. (2022). Post-abortion Complications: A
Narrative Review for Emergency Clinicians. Western Journal of Emergency Medicine,
Centers for Medicare and Medicaid Services. (2023, September 6). Emergency Medical
Treatment & Labor Act (EMTALA). CMS.gov. https://www.cms.gov/medicare/regulations-
Definition: emergency medical condition from 42 USC § 1396b(v)(3) | LII / Legal Information I
nstitute. (n.d.). Www.law.cornell.edu.
https://www.law.cornell.edu/definitions/uscode.php?
Emtenan Alaskar, Albarrak, N., Ghaida Alamri, Ahood Almutairi, Bayan Binswileh, Haya
Alhariqi, Maymunah Sowayd, Sharah Alahmry, & Hani Al-Sayed. (2025). Impact of
Nursing Staff Shortage on the Quality of Care in Emergency Departments. Jmans, 5(2).
Guttmacher Institute. (2025, July 7). State bans on abortion throughout pregnancy.
Www.guttmacher.org; Guttmacher Institute. https://www.guttmacher.org/state-
Frederiksen, B., Ranji, U., Gomez, I., & Salganicoff, A. (2023, June 21). A National Survey
of OBGYNs’ Experiences After Dobbs | KFF. KFF. https://www.kff.org/womens-health-
policy/a-national-survey-of-obgyns-experiences-after-dobbs/
Lorenc, T., Khouja, C., Harden, M., Fulbright, H., & Thomas, J. (2024). Defensive healthcare
practice: systematic review of qualitative evidence. BMJ Open, 14(7), e085673.
Sharp, R. (2022, July 17). Woman left to bleed for 10 days from incomplete miscarriage amid
post-Roe confusion. The Independent.
Singh, A., & Nandi, L. (2012). Obstetric Emergencies: Role of Obstetric Drill for a Better
Maternal Outcome. The Journal of Obstetrics and Gynecology of India, 62(3), 291–296.
Under Texas’ abortion ban, where a pregnant woman lives can determine her risk of
developing sepsis. (2025, May 12). CNN. https://www.cnn.com/2025/05/12/health/texas-
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