UW Medicine responds to high court decision on abortion
The healthcare system reaffirms its support for access to abortion care. A Q&A addresses potential impacts of the court decision.
[Editor's note: The Q&A below was updated and augmented with new information on Nov. 7, 2022.]
Today’s Supreme Court decision overturning Roe v. Wade and Planned Parenthood v. Casey will have significant impacts nationally on healthcare justice, affecting the health, financial stability and opportunity for many people across the country. These impacts will fall disproportionately on women, people of color, and those who are unable to travel out-of-state for their medical care. In the wake of this decision, UW Medicine leadership reaffirms our support for access to abortion care as part of a full continuum of reproductive healthcare services.
We will continue our current practice of broad access to abortion for our patients, where permissible, and seek to minimize any impact this change will have on our teaching programs and the provision of abortion care for our clinicians, faculty and staff.
The Court’s decision does not affect abortion services provided in Washington, which are protected under state law. However, we recognize that there may be implications for UW faculty, clinicians, residents and students in the WWAMI region outside of Washington, as well as patients from states who may seek care in Washington because of this decision.
UW Medicine has convened a team including clinicians, faculty and attorneys to review the Supreme Court decision and provide guidance to ensure that all faculty, clinicians, residents, students and staff are aware of implications for the practice and teaching of reproductive care within Washington as well as the other WWAMI states. Additional information will be shared as it becomes available. In the meantime, we affirm the following:
An individual’s right to an abortion:
- We will continue to support the principle that everyone should have full access to the healthcare services they need, including reproductive care. We also believe that all medical decisions, including the decision to have an abortion, should be a decision made by a pregnant individual with the support of their clinician.
- Patients in Washington will continue to be able to access abortion services. However, we recognize there will be impacts to patients in many other states. Changes to laws in these states may have implications for UW Medicine clinicians traveling to care for patients who live in other states or providing care through telemedicine. We also recognize there could be an increase in non-resident patients seeking reproductive care in Washington. We will be developing information to guide our UW Medicine clinician community as we navigate abortion restrictions imposed in other states.
Our students, residents, and fellow trainees will continue to learn about all aspects of reproductive healthcare:
- As an integrated clinical, research and learning health system, UW Medicine is committed to training the next generation of healthcare professionals, and we believe that our medical students, residents and fellow trainees must learn about all aspects of reproductive healthcare, including family planning, contraception and abortion, to care for patients effectively and responsibly.
- The Supreme Court’s decision will not affect the School of Medicine’s curriculum. Our medical students learn about abortion in a classroom setting. Medical students are not required to participate in abortion care; however, those who request clinical exposure to abortion will continue to be able to receive this training in Washington, as they do today.
- Currently, there are regional variations in what students are taught during their clerkships, depending on the clerkship site and where they are located in the WWAMI region. For example, Catholic institutions in all states do not teach abortion care. Some OB-GYN and Family Medicine clerkship sites in states where abortion care was available will no longer offer abortion care to patients, and those educational opportunities may no longer exist. We do not anticipate any curriculum changes for residents in our Department of Obstetrics and Gynecology or for our Complex Family Planning fellows, as these programs currently train exclusively within Washington.
- We do not yet know how the Court’s decision may impact Family Medicine residents in the other WWAMI states of Wyoming, Alaska, Montana and Idaho. While Idaho and Wyoming have laws limiting abortion access that became effective when Roe v. Wade was overturned, we will need to see how the leaders in those states enforce their laws. Each state will have its own authority to limit, restrict or preserve abortion access, and we will be watching to be sure that we understand how any changes in the law will impact our teaching and clinical care activities, particularly in the WWAMI region. UW Medicine’s leadership remains committed to providing teaching, training and access to reproductive healthcare to the full extent permitted by law and will provide additional information as it becomes available.
Q&A on court decision and its potential impact
What is UW Medicine’s position on abortion services?
UW Medicine supports access to abortion services for all patients who need them. UW Medicine’s mission is to improve the health of the public. As a part of this mission, we have always supported — and continue to support — the principle that everyone should have full access to the healthcare services they need, including reproductive medicine. We also believe that all medical decisions, including the decision to have an abortion, should be a decision made by a pregnant individual with the support of their clinician. As a learning organization committed to training the next generation of clinicians, we believe that our resident and fellow trainees should have experience in all aspects of reproductive health, including family planning, contraception, and abortion. See this May 10, 2022, letter to the UW Medicine community.
When did the U.S. Supreme Court overturn Roe v. Wade?
Yes. In June 2022, the United States Supreme Court issued its opinion in the case of Dobbs v. Jackson Women’s Health Organization, which overturned a half-century of precedent that recognized a federal constitutional right to privacy protecting abortion care from state and federal regulation under most circumstances.
Prior to the Supreme Court's Dobbs decision, what was the state of U.S. law regarding access to abortions?
Prior to this decision, U.S. Supreme Court precedent — based primarily on the cases Roe v. Wade, Planned Parenthood v. Casey, and Doe v. Bolton — prohibited states from banning abortions prior to the viability of a living fetus. For simplicity, we refer to this line of precedent as Roe v. Wade.
Does the Supreme Court opinion in Dobbs affect Washington’s laws protecting abortion rights?
No. Washington law protects a pregnant individual’s right to an abortion in Washington, and the federal constitutional issues decided in Dobbs do not change those rights.
Do any states in the WWAMI region have laws that prohibit abortion prior to viability that become effective now that Roe has been overturned?
Yes. Both Idaho and Wyoming have restrictive abortion legislation. Idaho’s has gone into effect now that Roe has been overturned. Wyoming’s law is stayed pending judicial review. Both states’ abortion restriction laws have been challenged in court and we are monitoring those cases closely. We are working to analyze what impacts these laws may have on our educational and clinical activities in those two states.
How are UW School of Medicine faculty clinicians protected when providing abortion services within the course and scope of our UW Medicine practice?
The University of Washington provides professional liability coverage for faculty clinicians providing abortion services within the course and scope of their UW Medicine practice so long as the clinician is not acting in bad faith. Additionally, UW Physicians (UWP) and Children’s University Medical Group (CUMG) provide legal representation for members who are the target of a license-related investigation, such as when a complaint is filed with the Washington Medical Commission, when the activity at issue involves the faculty member acting within the course and scope of their faculty practice and not acting in bad faith.
For clinicians who are not members of UWP or CUMG, the university may provide similar coverage for licensure matters, based on whether the employee is acting within the course and scope of their employment and not acting in bad faith. For all of these options, an individual who knowingly violates the law or employer policies may be acting in bad faith. If you have questions as to a proposed course of conduct, you may contact UW Medicine Compliance or the UW Division of the Attorney General’s Office for guidance.
Washington's governor and several legislators have announced that, during the 2023 session, the Legislature will consider additional protections for healthcare professionals providing abortion services in Washington.
Clinical Practice Implications
Does the Supreme Court opinion in Dobbs affect how UW Medicine provides abortion care to individuals in other states?
We are working with a team of attorneys from the state Attorney General’s Office to understand the full impact of the Dobbs decision on abortion rights and access to abortion care for individuals in other states, including how states begin to implement laws that restrict abortion access. Some impacts are discussed below. We will continue to update this FAQ as we know more.
Can a faculty member or UW clinician perform an abortion in a state that declares it illegal?
No. Even if licensed in a state that permits abortion, faculty and UW employees must abide by the laws in the state in which care to the patient is provided.
Can a faculty member or UW clinician provide an abortion consult, in person or through telemedicine, with a patient located in a state that declares it illegal?
No. The practice of medicine occurs in the location of the patient. Faculty and other UW clinicians must abide by the laws in the state in which care to the patient is provided. If abortion is illegal for the patient based on their location and individual health circumstances, then it cannot be a treatment recommendation for that visit.
Can a faculty member or UW clinician provide general education about abortion to a patient in a state that declares it illegal under most circumstances?
Generally, yes. A UW faculty clinician can provide general education to anyone about the standard of care for a particular healthcare circumstance which may include abortion as long as the healthcare professional does not provide abortion services to a patient in a state where abortion is illegal or recommend that the individual seek an abortion. The clinician may inform the patient that abortion care is illegal in a state in which abortion services are illegal and also that abortion services are legal in other states.
Can a faculty member or UW clinician perform an abortion procedure for a patient located in Washington even if Washington is not the patient’s permanent residence?
Generally, yes. While it is possible that in the future some states may attempt to reach across state borders to prohibit abortion for individuals who live in their state, such restrictions are almost certain to be challenged in court. We are not aware of any states that have successfully implemented such laws and will continue to monitor the legal landscape.
Can a faculty member or UW clinician dispense an abortion-inducing medication across state lines to a patient in a state that makes abortion illegal?
No. If a state prohibits abortion by medication, faculty and UW employees must abide by the laws of that state when treating a patient who is physically present in that state.
Can a faculty member or UW clinician dispense an abortion-inducing medication to a patient located in Washington who came to Washington to receive abortion services?
Generally, yes. Washington law allows Washington clinicians to provide abortion services to patients who are located in Washington, regardless of what state they live in. A patient presenting in Washington for services may be treated in Washington, consistent with the laws of Washington. Faculty should advise patients that the abortion inducing-medication must only be used in Washington. Faculty must dispense abortion inducing medication in Washington and only issue the prescriptions to pharmacies located in Washington. While it is possible that in the future some states may attempt to reach across state borders to prohibit abortion for their citizens, we are not aware of any states that do so successfully and will continue to monitor the legal landscape.
Are UW Medicine patients able to access abortion services through telemedicine?
UW Medicine is actively working to provide access to its patients located in Washington with abortion services through telemedicine. We will update this FAQ with more information as this service becomes available.
Is there anything UW Medicine clinicians should know about miscarriage management post-Dobbs?
Miscarriage management is commonly addressed through use of either the same medications as are used for medication abortion or uterine aspiration. Even in states such as Texas, where abortion restriction is the most extreme, miscarriages may still be managed medically through either of these methods.
What do we need to know about post-abortion care?
While complications from abortion or miscarriage are rare, conditions such as retained pregnancy tissue in the uterus, bleeding and infection can occur. It is critical for patients seeking post-abortion care services to be treated with care and dignity and to have their medical issues addressed upon presentation. Post-abortion care may happen in a clinic or an emergency department setting and includes: managing residual side effects or complications of abortion, emotional support, and providing comprehensive birth control services without discrimination or coercion. UW Medicine provides confidential post-abortion care; patient information remains private for post-abortion care services in the same way other services remain private. It is generally not necessary for patients to disclose that they have had an abortion. Moreover, healthcare professionals are unable to determine whether the complications occur from abortion or miscarriage.
Emergency Medical Treatment and Labor Act (EMTALA)
In light of the U.S. Supreme Court decision in Dobbs, are some hospitals no longer required to provide emergency abortions?
In Washington state, the answer is no. Under EMTALA, all Medicare-participating hospitals with a dedicated emergency department are required to provide necessary medical care to assess and stabilize a patient with an emergency medical condition (EMC). The Biden administration has recently clarified that EMCs include ectopic pregnancy, complications of pregnancy loss, or emergent hypertensive disorders, such as preeclampsia with severe features. A patient who is experiencing any of these EMCs may need an abortion, and therefore the hospitals described above are required to provide an abortion in these cases if it is the necessary stabilizing treatment for the patient’s EMC. The Biden administration’s position has been challenged in Texas and upheld in Idaho. We will update this answer as this issue evolves.
If I have reason to believe an outside hospital refused to provide a necessary emergency abortion to a patient I am caring for, what should I do?
Take the following steps:
- Contact UW Medicine Compliance directly at firstname.lastname@example.org or 206-543-3098.
- Notify your supervisor immediately and work with them to notify your department’s nurse manager and medical director as well as the hospital’s medical director.
- Document and enter the information into your facility patient safety system.
Are there implications for our medical students now that Roe is overturned?
We do not expect any immediate implications for our ability to teach abortion in a classroom setting. It is required by the Liaison Committee on Medical Education (LCME) that medical students learn about abortion. We will continue to teach all second-year UW medical students about abortion in the classroom setting in all WWAMI states, as we do today.
Third and fourth-year medical students can gain practical experience through observing or assisting an abortion as part of an OB-GYN or Family Medicine clerkship if they desire to do so. There have been variations in what students are taught during their clerkships depending on where the student is in the WWAMI region, and the clerkship site. For example, Catholic institutions in all states do not teach abortion care. All OB-GYN and Family Medicine clerkship sites in states where abortion care is now illegal will no longer offer abortion care to patients, and that educational opportunity will no longer exist. However, medical students will continue to have access to this educational opportunity in states where it remains legal, including Washington.
Our medical students often practice medicine in other states after their training here is complete. For students who participated in abortion services as part of their training in Washington, we are not aware of any state, other than Texas, taking licensure action against licensees or applicants who participated in abortion care in a state where it was legal. We expect the position Texas is taking to be challenged in court and we will update this FAQ as this issue evolves.
Are there implications for UW Medicine residencies and fellowships now that Roe has been overturned?
Currently all UW Medicine-sponsored residencies and fellowships where abortion is taught occur in Washington (this includes OB-GYN and Family Medicine residencies and family planning/reproductive health fellowships). The Supreme Court Dobbs decision does not have any immediate implications for these residents and fellows.
Are there implications for the Family Medicine Residency Network (FMRN) now that Roe has been overturned?
Yes. There will be impacts to FMRN residents in Idaho and Wyoming, and there may be impacts in other states that take legal steps to restrict abortion services.
The FMRN is a network of family medicine residency programs throughout the WWAMI region sponsored by healthcare institutions other than UW Medicine. FMRN faculty are not UW employees and generally do not provide care as part of their faculty roles, even though they have appointments in the UW School of Medicine Department of Family Medicine. The Department of Family Medicine provides support to FMRN faculty such as learning collaboration, residency program consultations, faculty development, administrative support and regional marketing. Abortion care is taught in some FMRN family medicine residency programs, where allowed by state law and the supporting hospital system. The university’s legal counsel do not provide legal advice to the FMRN family medicine residency programs or to participating faculty for their independent clinical practice. The University does not provide professional liability for the independent clinical practices of these faculty.
Mental Health Resources
Are mental health resources available to me to help me process all of this?
Yes. Resources for faculty and staff are available at the SoM Employee Mental Health Resources