A new reality for U.S. doctors as they navigate exceptions to shifting abortion laws

In 2012, Savita Halappanavar sought treatment at a hospital in Galway, Ireland; she was 17 weeks pregnant, in pain and miscarrying. 

Her repeated requests for an abortion were ignored because of the presence of a fetal heartbeat, according to her husband. She died of septicemia — or blood poisoning by bacteria — 2½ days later.

Halappanavar's death is viewed as a pivotal moment in the abortion debate in Ireland, leading the country toward overturning its constitutional ban on abortion in a referendum six years later. 

Pregnancy and the process of giving birth can be traumatic and carries inherent risks — everything from excessive bleeding to vaginal and other forms of tearing, cardiovascular problems and death.

The maternal mortality rate stands at eight per 100,000 in Canada, compared with 24 per 100,000 in the United States — a far higher mortality risk than that of a legal abortion procedure. 

Doctors in the U.S. are now pointing to Halappanavar's death as an illustration of the thorny legal and ethical challenges ahead — as well as the potentially fatal consequences — following the overturning of Roe v. Wade.

According to Dr. Louise King, an expert in bioethics at Harvard Medical School, in many states, doctors will be left with the impossible task of trying to determine precisely when an intervention should be deemed medically necessary, as it was in the case of Halappanavar.

But if they act too quickly, she said, they could face the prospect of prosecution or fines under new or pending legislation, as roughly half of American states are expected to outlaw or severely limit abortion. 

"It's complete absurdity, because it leaves [physicians] in these situations where they have no real choice," said King, who is also an obstetrician and gynecologist at Brigham and Women's Hospital in Boston.

"Broadly speaking, it removes an important option … from all persons who are pregnant in the United States, in states in which abortion is restricted."

In Missouri, for instance, there is an exception for a "medical emergency," while in Michigan, a law already in place only allows abortions "necessary to preserve the life" of a pregnant person. (That law is on hold pending a court injunction.) 

Physicians say the specifics of these exceptions remain unclear. 

Dr. Lisa Harris, an ob-gyn and associate chair at the University of Michigan, outlined her concerns in a widely circulated essay published in the New England Journal of Medicine earlier this year. It was then cited in the dissenting Supreme Court opinion on Dobbs v. Jackson Women's Health, the case that led to the overturning of Roe v. Wade. 

"What does the risk of death have to be, and how imminent must it be?" she wrote.