Advocating for women’s reproductive rights was unthinkable in my 20s, Dr. Zarek says

Doctors who follow the law may be committing medical malpractice.

(Chris Samuels | The Salt Lake Tribune) Coat hangers are left at the Capitol after a rally in defense of abortion rights, Friday, June 24, 2022. Utah enacted a ban on elective abortion after the U.S. Supreme Court struck down Roe v. Wade on Friday.

If you told me when I was 22 years old that someday I would try to gather support for access to abortion, I would have been horrified. Nonetheless, that is my purpose today, as we contemplate the impact of Utah’s SB174. While currently on hold in court, this law will outlaw most abortion care in Utah if allowed to take effect.

I grew up in the South, the second of five children. I was Catholic and proudly against abortion. At the time, for me and my community, abortion was simply wrong. Then I went to medical school and fell in love with delivering babies. During my obstetrics training, I came to understand the inherent risk and complexity of pregnancy. My view of abortion was forever altered.

Over the past 16 years as an OB/GYN physician, I have delivered thousands of babies. I have also cared for patients facing heartbreaking fetal diagnoses. Some of these patients choose to continue their pregnancies and pursue maximal interventions for their babies. Most choose to end their pregnancies early, either by inducing labor and allowing their babies to pass away surrounded by their families, or through a surgical abortion.

There is never an easy answer in these cases, but I believe there is a right answer: whatever a patient decides is right for her and her family. I am honored to care for — and grieve with — all of them. All these patients love their babies fiercely, suffer mightily and are changed forever. Most of these patients would not be able to safely end their pregnancies under SB174.

We often forget that nearly all the terrible medical problems that can happen to people at any point in their life can also occur to people while they are pregnant. Normal, healthy pregnancies can become complicated in an instant by an unlimited number of obstetric complications.

[Read more: Utah medical professionals support the right to legal abortion]

Part of my job as a physician is to educate patients about the relevant risks and range of possible outcomes. Once informed, the patient can make a decision that reflects their own values and acceptance of risk.

With this bill, lawmakers instead task physicians with determining which patients are sick enough to deserve an abortion. The language of the law is so vague that even physicians will not agree on what maternal risks warrant termination. It has turned our counseling upside down, and it has completely removed patients from their role in making decisions about their own health.

If it is allowed to be enforced, SB174 will outlaw medication and surgical abortion at all gestational ages in Utah with narrow exceptions, and subject the physician performing an abortion outside of those exceptions to second degree felony charges punishable by 15 years in prison.

Shall I ask our legislators at 3 a.m. how to best treat the patient with an inevitable miscarriage who is rapidly hemorrhaging when the fetus still has a heartbeat?

Shall I ask our legislators at 3 a.m. what to do for the patient with ruptured membranes at 19 weeks and a live fetus? Do I need to wait until she develops a life-threatening infection to intervene?

How close to death is close enough? Will a prosecutor see it the same way?

If I treat the patient according to the accepted standard of care, I may be committing a felony. If I follow the law, I may be committing malpractice. Can the patient’s best interests really be served by a doctor who must begin by making amateur legal decisions? The language of this law will result in confusion, hesitation, and delays in care that will make all pregnancies in Utah more dangerous. Trying to legislate these scenarios is a fool’s errand, and that is precisely why these decisions should play out between patients and their trusted physicians.

In my profession, I have borne witness to unspeakable tragedies and miraculous outcomes, all of which are intertwined with risk. Pregnancy, at baseline, is a serious and dynamic condition. Patients should have a right to choose whether to take on that risk. I should have a right to practice medicine according to established standards of care without legislative interference that hinders my ability to serve my patients during their time of greatest need.

I remain a hopeless optimist, which means I will persist in shedding light on this issue. My conscience drives me to push through my discomfort and fear to talk about the importance of abortion as healthcare.

I urge you to consider that the real-life situations I’ve described here will affect your loved ones. Abortion is so common that everyone loves someone who has had an abortion, even if the stigma attached to abortion means that you never hear about it. I have to believe that many of my fellow Utahns simply don’t recognize the unintended consequences of this law, which was drafted at a time when the chance of it becoming an enforceable law was entirely theoretical.

The Supreme Court has turned these decisions over to us. If this resonates with you, talk to your legislator. If you’re a legislator who wants to talk about this, give me a call. Let us take stock together and approach this with the care and nuance that patients deserve.

Sarah Heatherington Zarek

Sarah Heatherington Zarek, M.D., is a board-certified obstetrician-gynecologist practicing in Utah. The views and opinions expressed here are solely her own.