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Some abortions are necessary to save the life of a patient


The states that have moved to ban abortion typically make an exception to preserve the life of the woman. But exactly what that means, what constitutes an endangered life and who decides - that's unclear. Dr. Lisa Harris is an OB-GYN, and she has wrestled with this question over her 24 years in practice. She teaches at the University of Michigan, and she joins us now.

Dr. Harris, welcome to the program.

LISA HARRIS: Thank you so much for having me.

BLOCK: When you think about that question, is there some recognized set of circumstances, some very clear line that would define a life in peril when we're talking about ending a pregnancy and preserving the life of the woman?

HARRIS: There are some situations where it is clear what that means, but in most situations, it's not clear what that means.

BLOCK: And explain what you mean. What would some of those unclear situations be?

HARRIS: Well, maybe if I could explain the clear ones first, it will be easier to explain the unclear ones. Is that OK?

BLOCK: Fair enough.

HARRIS: OK. Every year there are women who would have died within days or even hours from pregnancy complications. Those can be things like someone is hemorrhaging, or someone is septic, meaning they have an infection that may have started in their uterus, but it's spread to their whole body, and their organs are beginning to fail. And for conditions that are not specific to pregnancy but that pregnancy can make worse, it could be things like a massive blood clot in someone's lungs or severe heart failure.

BLOCK: What about the gray areas?

HARRIS: Most pregnant women who will suffer irreparable harm or die in the context of pregnancy are not actually those patients that I just described. They're patients who have a pregnancy-related complication, but they may not be in an acute emergency in that very moment - things called hypertensive disorders of pregnancy, which means high blood pressure conditions in pregnancy, like preeclampsia or eclampsia. People may be OK in the moment, but if their blood pressure can't get under control, they may have a stroke and perish. Or they may have an ectopic pregnancy, and they're stable in the moment that we're seeing them. But if that ectopic pregnancy were to rupture, which is one of the complications, that can be catastrophic. And there are a long list of conditions where someone may be OK in the moment, but they might not be later. Or they may be OK in the moment, and they have a 20% or 40% or 50% chance of dying later, but it's not 100%. Those are the situations in which I'm afraid that physicians will hesitate to act and that women will suffer the consequences of that, including even dying.

BLOCK: Because that's when you're basically trying to calculate risk that, I am sure, is not easily quantifiable of just, you know, what are the chances that this woman will die?

HARRIS: That's exactly right. In medicine, we do things on a person-by-person, case-by-case basis. And with years as a physician, it's really clear to me that there is no one-size-fits-all law or guideline that could possibly meet everybody's needs. And certainly none of the tools that we have available are certain enough to say, you know, this patient qualifies for a legal abortion under a state's ban.

BLOCK: We should clarify that where you are, in Michigan, abortion is still legal, but there is confusion about a 1931 statute that would make providing abortion a felony. That's before the courts now, as I understand it. If the courts in Michigan do uphold that law, what would that mean for you? What steps would you have to take?

HARRIS: Yes. So we're in a situation of great uncertainty here in Michigan. We do have a ban on the books, but currently it cannot be enforced because a judge issued an injunction or blocked enforcement of that law. So here we need to be prepared for that injunction to be lifted and for our ban to come into effect. At the same time, we need to be prepared to see patients from states where there is an active ban right now, and we already are. One main question we have is, who can we still continue to provide care for here in Michigan even if our ban does come into effect?

BLOCK: When you think about these laws and this language about preserving the life of a woman, can you think of a specific case that you have handled as an OB-GYN where it wasn't clear-cut, but you had to make a decision?

HARRIS: Recently, we saw a patient who was pregnant and had had several prior caesarean sections. And in that situation, in a subsequent pregnancy, the placenta can grow into the wall of the uterus. People are at risk of losing their life. They're at risk of needing - they will need a hysterectomy. This patient's priority was to be around and be alive and well to care for the children that she already had. We were able to end her pregnancy. But it's really unclear. If we were in a ban state, I'm not sure we would be able to provide that care. And it was a really complex case and difficult surgery. It would have been absolutely a life-threatening caesarean section later in pregnancy, if that's what had needed to happen. And it's not clear what would have happened to this patient.

BLOCK: I wonder what you would say to the lawmakers who are voting to pass these bans about this language and what they don't understand.

HARRIS: I wish a lawmaker, I wish a judge or justice would just come and spend the day with me and meet the patients for whom I care and look at the complexity and the judgment calls involved in the care that we provide - that abortion ban exceptions that permit abortion to preserve a life are unclear. Doctors won't know what they can do and what they can't do. And the threat of a criminal penalty - that threat means that doctors may hesitate to act. It may mean that they won't act at all. And that will be to the detriment of their patients.

BLOCK: I've been speaking with Dr. Lisa Harris. She's an OB-GYN at the University of Michigan.

Dr. Harris, thanks very much for being with us.

HARRIS: My pleasure. Thank you for having me.

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As special correspondent and guest host of NPR's news programs, Melissa Block brings her signature combination of warmth and incisive reporting. Her work over the decades has earned her journalism's highest honors, and has made her one of NPR's most familiar and beloved voices.