In the Wake of Dobbs v. Jackson Women’s Health Organization

Since the Supreme Court ruling in June 2022 overturning 50 years of precedent protecting abortion as a constitutional right (Dobbs v. Jackson Women’s Health Organization), states are enacting and implementing new laws to regulate abortion, and medical organizations and healthcare providers are assuming the large task of understanding what the new laws mean for their practices and patients.

According to Michael D. Lockshin, MD, professor of medicine and obstetrics-gynecology, Weill Cornell Medicine, and director emeritus of the Barbara Volcker Center for Women and Rheumatic Diseases at the Hospital for Special Surgery (HSS), New York, the aftermath of the Supreme Court ruling can be summed up in one word—chaos.

“There is no uniformity of legal standards and hospital rules,” says Dr. Lockshin. “Some hospitals require a board to approve a termination even when a patient is desperately ill, while others refuse all terminations, and some leave it to the doctor’s discretion.”

Dr. Lockshin

Compounding this chaos are disputes about what abortion means:¹ Does abortion mean termination of a pregnancy regardless of intent, or does intent matter? If intent matters, when is termination of a pregnancy permitted under laws that prohibit abortion? In Wisconsin, for example, the law now defines abortion as the intentional killing of an unborn child, which is defined as an embryo or fetus from the time of conception through birth, and bans abortion with one exception: for what is called a therapeutic abortion, when a termination is deemed necessary to save the mother’s life.² Would an elective termination of a pregnancy in a patient with lupus at high risk of dying if they went to term and delivered the baby be considered a therapeutic abortion?

While all of this is playing out on the larger stage, rheumatologists and patients are living with the impacts, given their state of residence and specific circumstances. With many people of child-bearing years under their care, rheumatologists know only too well the challenges that a condition such as lupus or rheumatoid arthritis can present to someone who wants to become, or is, pregnant. Among the adverse effects a patient faces when pregnant are disease flares and the risk of death, underscoring the importance of appropriate medical management of their disease throughout their pregnancy.

For people with rheumatic diseases who become pregnant, current evidence-based guidance supports continuing medical management throughout pregnancy to avoid the risk of disease flares.³ Adhering to these guidelines in the midst of the upheaval of the Supreme Court ruling is critical to ensure patients with rheumatic diseases continue to receive the best care for their disease while pregnant.