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

Dr. Talabi

“Misinformation about these medications is concerning,” says Dr. Ramsey-Goldman. She explains that many of the medications used to manage rheumatic disease are teratogenic but may be conflated with abortifacients. To help patients access their medications, Dr. Ramsey-Goldman suggests clinicians consider adding information about the underlying rheumatic disease, using ICD-10 codes on the prescriptions.

The ACR is addressing misinformation.⁷ In July 2022, it created the Access to Reproductive Health Care Task Force to explore options related to medication access, as well as other issues of concern to clinicians. The task force has taken several steps, including reaching out to state pharmacy boards and other relevant parties, to ensure methotrexate and other medications remain available to rheumatology patients and encouraging clinicians, patient advocates and patients to report problems with medication access.

Dr. Talabi underscores that cases of medication denials need to be collected to understand the public health impact of abortion restriction nationwide. “We need rigorous data to start to understand the impact of abortion restriction on patient care and outcomes,” he says.

Despite the fact that rheumatologists do not prescribe medications for the purpose of abortion, Dr. Lockshin thinks rheumatologists in some states will face increasing tension between providing evidence-based and effective medications and the fear that they may be prosecuted or lose their license if the medication is used for purposes other than for disease control.

“With abortion restrictions in some states, medical treatment decisions will be difficult when the mother’s rheumatic disease is active or if a fetus is inadvertently exposed to a teratogenic medication, putting the mother and fetus at increased risk of morbidity and mortality,” says Dr. Ramsey-Goldman.

Documentation & Legal Considerations

To protect patients and rheumatologists against potential liability, particularly in states enacting strict abortion bans with ambiguous language, clinicians may need to consider what they document during a patient visit.

“Doctors should consider how much documentation is necessary to include in the patient’s medical record,” says Jessie Hill, professor of law at Case Western Reserve University School of Law, Cleveland. “For example, it’s possible that information about a patient self-managing her own abortion could lead to legal liability for the patient or the patient’s friends or family,” she says.⁸

Ms. Hill

In general, however, Ms. Hill doesn’t think rheumatologists have to worry about the abortion laws because, even in states with strict abortion bans, the laws shouldn’t impede clinicians from prescribing medications that are optimal for their patients’ health. “Prescribing a drug that could result in miscarriage in order to treat another condition would not generally meet the definition of an abortion,” she says.