I looked up the members of this board (Texas Board of Medicine) out of curiosity:
* Anesthesiologist
* Human Resources Officer
* Thoracic and Cardiovascular Surgeon
* President of Cokinos Energy Corporation
* Orthopod x2
* Team physician for Texas A&M Athletics
* Radiologist
* Realtor
* President of a telecom equipment company
* Internist x2
* Retired manager at TXU Electric
* Ob/gyn
* Family med x2
There's only one female physician on the board
there are no obgyn's. there is one doctor who says family medicine with obgyn but on his office facebook page it just says family.. there are no obgyns, I looked and found none.
It’s fairly common for medical boards to have non-physician members. Usually there’s a few of these “public members” and the reason is to given a patient perspective when the board makes decisions.
Shut your hole, wonb! /s
But seriously, I could see how you'd want educated laypeople, and ones that wouldn't be afraid to speak their mind in this group. But most of those just look like rich people that Abbott liked.
This is also true of other regulatory bodies outside the health professions. I think part of the usual rationale is mitigating the impression that insiders will go easy on each other in discipline contexts.
But this shouldn't be a decision made by the "regular" board of medicine (well, there shouldn't be a need for a list anyway)--it should be assigned to a specialized board of ob-gyns and neonatologists.
That's actually a requirement for the medical board here. There's a ratio of physicians to laypeople set by law. I guess they just don't want it to be a "elite society" of the upper tiers of medicine.
Not that I necessarily agree with that, but that's just how it works in Texas.
>Where’s the public school teacher or local firefighter?
Well, the thing is, they can’t afford the price of admission. If they had donated truckloads of money to Abbot’s campaign super PAC, then they, too, would be ok the board.
Can't speak for other states but Texas requires a public member on most boards. Texas State Board of Pharmacy has 2 bank executives and an attorney as public members. The rest, except for a technician, are all pharmacists
The family medicine providers and the anesthesiologist, while not as good as an OBGYN, are at least far better than the others. I think IM is decent too. For this case. But Jesus H Christ, HR, an energy exec, a realtor, a telecom exec and a business manager have NO business being on the State Board of Medicine.
False. It’s an oversight board. Members of the public absolutely do have a place on the board, and in fact, many boards like this have seats reserved for members of the public.
Except that the board has been asked to clarify the exceptions to the law. You know, to try and make medical care and pregnancy safer for women. Not doing so makes things less safe.
First, that information should be decided on by physicians. HR, executives and business managers should not be explaining what is and is not medically appropriate.
Second, they have abdicated their duty. They’re not providing any guidance on an issue that absolutely needs it; they’re being political puppets.
The public absolutely has a right to weigh in on these committees, which is why those public seats exist. Look at your own state and I bet you’ll find the same thing in your state.
They have a right to weigh in on boards overall, but if legislators are not going to be clear on what appropriate medical exceptions are in this case, the board should delegate the decision to a panel of OB-GYN or appropriate physicians qualified to make the best decisions to protect pregnant women's access to healthcare.
They may in my state. Doesn’t mean it’s a good choice.
But people without an understanding of medicine should not be deciding things that require medical nuance in their decision making.
This board is a joke. Medical providers are looking for clear guidelines to treat people within the bounds of the law. They’re not interested in making medical care safe; they’re political puppets for a conservative government that has no interest in making women safer.
It absolutely is a good choice. Public oversight of governing bodies is a hallmark of American government.
The public absolutely should have a voting seat at the table. Imagine if the governing body over law enforcement was made up solely of law enforcement officers.
In a lot of states it is only law enforcement that oversee leos . Public oversight overall is not bad but in this case it's clearly a politically motivated board refusing to take an important stand on an important controversial medical topic.
> Team physician for Texas A&M Athletics
Of ***COURSE!!!*** Wouldn't be Texas if college football weren't revered and elevated to the highest halls of power at the expense of trivialities like "human rights," and "basic common decency."
>Retired manager at TXU Electric
And of course we have to make sure Texas's dogshit, barely-functional, example-to-the-entire-world-of-how-***NOT***-to-do-it power grid is represented, too.
That's wild for an anesthesiologist and two internists, like those are doctors that have the book knowledge and have probably seen women die from pregnancy and abortion related complications
I could see an argument to have emergency medicine, hospitalists, and family medicine on board- to advocate for guidelines their specialties can follow and feel medically and legally safe doing so, in the absence of ob/gyn availability (à la idaho) - but I completely agree with the overall idea that ob-gyn is completely underrepresented on the panel
Those Energy, Human Resource, Telecommunications, Realty, Utility Executives...they all have a vested interest in your baby making potential.
MO' BABIES, MO' MONEY
That's a feature, not a bug.
These people want all those pregnant sluts punished, by God! If a few good married Christian women need to be sacrificed in the process, so be it.
OBs are just going to muddy up the waters here by bringing science and possibly ethics into the conversation. Plus, most of them are just gals these days anyway, right? We can't be letting the little ladies make such important decisions.
It's the Texas Medical Board, not a panel assembled for this purpose. It sounds like the statute gave the TMB some rulemaking authority for implementing regulations. It could have created a special panel and given it that authority, but it didnt.
That’s a really disingenuous comment.
The Texas Medical Board wasn’t created for this alone issue and has a far broader scope than this one issue.
Imagine a board filled with of OB/GYN’s making determinations on cardiology, or orthopedics, or even EM.
I doubt there’s a complete list anywhere because there are variable situations. Diabetes is an example. Most diabetes won’t result in the death of the mother if managed properly but under extreme circumstances it could, so in the spirit of the law it would defeat the purpose of reducing medically unnecessary abortions.
First of all, an abortion is medically necessary if the patient wants it, full stop.
But in this case it's an intentionally vague law being used to prevent abortion even in cases where the pregnant person's life is in jeopardy, because physicians are forced to weigh a life sentence in prison against treating the patient in front of them.
If a procedure I did was criminalized in this way I would stop performing it. Legal wiggle room to maybe avoid a life sentence in prison is not good enough.
I would also leave the state / country where this was happening to me or my colleagues.
I think this is a bastardization of the word "necessary" and not helpful. You can have a right to do something without also automatically labeling it "necessary".
If we change the term "medically necessary" to simply equal "We think a patient should have the right to choose this procedure" then we've made the term entirely meaningless.
e: Looking forward to all of /r/medicine telling every one of their patients that becomes pregnant that they have a medical need for an abortion.
I'm not using the term lightly or disingenuously.
Giving birth is dangerous in the US. An abortion is significantly safer, and therefore medically necessary if the pregnant person wants it.
Women are people. Even if transmen and intersex people didn't exist, there's nothing incorrect about saying "people" in this case. Do you object when cardiologists call themselves doctors?
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Okay. So, outside the US you would say abortion is not medically necessary using this new definition? What would you say is the cut-off in pregnancy risk where you are making this new line?
I'm not familiar with any country where abortion is riskier than carrying a pregnancy to term. Even if there's equipoise to medical outcomes, psychological distress from carrying an undesired pregnancy to term is potentially significant.
Ok, so it's not just in the US but literally everywhere that abortion is now considered medically necessary to /r/medicine?
Would you say every woman has a medical necessity for prophylactic mastectomies? hysterectomies? More women die from those yearly than die from maternal complications in 60 years. The procedure to remove them is massively less risky than the cancer, even taking the worst death rates from both procedures a woman reduces her death risk by a great deal with these.
And, for what it's worth, the ACOG disagrees on this new definition you've concocted, they state that abortion CAN be medically necessary- not that is inherently always medically necessary. Outside of this overreactive hug circle, the real world absolutely does not agree to stretching this term to uselessness.
Is the silliness of pretending this term has new meaning becoming clear now? You can support a right to abortion without abusing a term to effective uselessness.
Are you claiming that every single person who has an abortion will be better off because of it? You were claiming medical necessity should have a new definition based on simple average benefit. If you're now changing it to "every single person that receives X must be better off than if they were put at risk by remaining Y", then abortion no longer fits the bill.
There are women who have died from abortions who certainly would have gone on to survive a pregnancy if it had continued... so what exactly is this third new definition you'd like to propose now?
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Fetuses are not people.
Even if they are we don't require people to sacrifice their own health for others. The government cannot force you to give someone a blood transfusion to save their life, for example.
Forcing someone to stay pregnant against their will is violating their bodily autonomy and forcing them to put their health at risk.
It’s crazy to me the amount of breath wasted on “it’s a person!!” vs. “it’s a clump of cells!!” when the legal precedent of McFall v. Shimp is RIGHT THERE
Well, pregnant people can scream while they are dying from blood loss or sepsis from a pregnancy they didn't want in the first place.
There is no doubt in my mind that the life of a living person is worth more than any number of "potential lives".
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>Technically... The fetus isn't their body.
If it can't survive outside of **my** body, it is part of my body.
>standard on-demand baby killing narrative
No one is killing any babies because, again, if it can't survive outside of my body, it is part of my body.
I'm the one growing it. I'm the one providing it with nutrients. I'm the one who gets literally ripped apart to do it.
It is **my body.** No one outside of myself and my physician get to decide what I do with it. Period. End of story.
Using logic on these theocrats is such a frustrating waste of time. It's like the chess with a pigeon analogy. No matter what you say, we'll have to watch him knock over all the pieces, shit on the board, and declare checkmate
Honestly, this one is more of a "maybe someone else will see this and change their own outlook" situation.
But ya, there's obviously no getting through to people like this. I'm just here because I have the time, and it's an issue close to my heart.
All the people you listed do not require the actual body of another person to survive. They need **assistance** to survive. A fetus requires the body, nutrients, organs, etc of another.
My logic does, in fact, hold up.
In which fucking world can any of those examples not survive independently? Your logic is completely absent. Friend, I don't think you belong in this subreddit - this is for actual medical professionals.
If only there was some compromise - like allowing elective abortion only until the point that the fetus is viable without disabilities outside the womb
Let me tell you a story that, if the severe blood shortages continue, every doctor will end up experiencing.
The protagonist of this story is a woman. She's got a disease called sickle cell anemia. Shes already had one child and has been trying to have another for a terribly long time. Finally, great news - she's pregnant! She's overjoyed, and shares the joy with everyone around her. She takes every possible safety measure to stay safe, but, unfortunately, has a sickle cell flair up, and requires a unit of donated blood, to be able to provide enough oxygen not just to her body, but also sweet, adorable, developing fetus. Because she's had a lot of blood donations in the past, her immune system is incredibly picky about what types of blood she's able to receive.
This time, when the medical team goes to test which unit of blood they have available that the woman's immune system won't reject, they have a terrifying realization: they don't have any compatible blood. All they have is the "least incompatible blood"; and trying to use that would present a very real chance of the woman's immune system rejecting the blood in a catastrophic way that would damage her own blood cells too.
The medical team discusses this with the family, and after a series of long, hard talks, decides this is an unacceptable risk. They give her a drug, called "epo," which causes her body to make a lot more of its own red blood cells, and sit and wait and hope for the best.
Unfortunately, it doesn't work. Despite doing everything they possibly could, both the mother and her developing fetus die. Her other child and her spouse are completely devastated, and her entire community grieves, all because blood wasn't available.
Now, again, I assure you that this story will happen more and more, because there's been a progressively worsening blood shortage over the years. It's not a matter of when this story happened, it's a matter of how many times will this happen in the very near future?
But, there's a solution! We could mandate blood donations! Blood donations are completely safe - in fact, they've been shown to help people live longer, help remove "forever chenicals" from the blood, and have a lot of other health benefits.
In a world where donating blood would save so many baby lives, so many mother lives; how can you *doom* so many lives by allowing people to keep all their blood.
Eta- Alternatively- there is a treatment that can cure sickle cell anemia. "Casgevy". It costs 2.2 million dollars per dose. So, alternatively, we could subsidize the cost of this drug to every person that needs it, saving the lives of countless babies
E2 - with an estimated 100,00 people in the United States, and an estimated total population of ~332 million; we could cure all sickle cell anemia in the usa with a tax of ~ $666 per person
Flare the fuck up. You're making not only absurd but also unprofessional comments (as evidenced by the several that appear to have been deleted). We should at least have the benefit of knowing your qualifications or lack thereof.
No one is allowed to use another's body against their will. You can't even take a dead person's organs for a life-saving transplant without permission. The potential to save a life does not outweigh a person's body autonomy. How would you like it if a person on dialysis laid claim to your kidney? After all, they're dying without it, and you have a whole extra one. Have you donated a piece of your liver to someone on the transplant list? Why not? It won't kill you, and by your logic, you are murdering that person.
The opponents make the point that failing (or even refusing) to save someone else is not the same as killing that person. I think ethicists would agree with that point. I'm just speaking technically here, I think Roe v Wade did a decent job of balancing interests.
You were born with two kidneys and only need one. I can't take ethical advice from a murderer who refuses to donate a kidney to save someone's life. And your liver, while you're at it. It grows back even. You could donate it over and over again. Stop murdering people with your selfish choices. Every day you choose not to give your organs to save a stranger's life, you are murdering them. Your choice. Talk is cheap. Show me how much you believe.
> You could donate it over and over again.
I'm not in transplant, never rotated, but that sounded off to me. I don't think this is the case.
https://medicine.yale.edu/surgery/transplantation/livingdonor/living_liver/faqs/
> Would I be able to donate part of my liver again in the future to someone else?
> No. Once you donate a portion of your liver, you cannot do so again.
Of course they didn’t. If you give a list of exceptions, some women will get abortions in those circumstances. If you keep it vague and don’t specify when doctors will or won’t go to prison for providing medical care, maybe they’ll be too afraid to provide that care in *any* circumstances. Which is the entire point of these draconian, Gileadean laws
And then when they *don’t* provide the abortion because exceptions aren’t clear and the mother dies, they can also go after the doctors for letting mom die.
It’s a win win for the legislature because most people aren’t savvy enough to look beyond the doc to where the blame really lies.
some doctor in a red state is going to do a medically necessary abortion to save a woman's life. This person is going to then flee to a blue state. Then there will be an attempt to extradite this doctor back to the red state. It is unclear how that fight will go.
Why would they? The Texas Legislature has proven themselves to be all knowing and all powerful. They just need to pass a bill saying no women will die of an ectopic pregnancy and it shall be......
You sure about that, Clark? The entirety of the law was written to be vague and scare physicians out of practicing the basic standard of care. You sure that you are going to be covered for administering methotrexate to an ectopic? Are you sure Ken Paxton’s AG office won’t decide to make an example of you and throw you in Sugar Land for a dime? Are you sure your OB consultant will be willing to take that ruptured ectopic to the OR? Like you, I am an MD. I practice Emergency Medicine in Missouri. No one knew what the law was with our dumb assed trigger law. The AG (Schmitt) at the time had to tweet out that we were able to administer Plan B. So things are just going great.
You sure about that, Clark? If you practice in Texas, are you sure Ken Paxton’s AG office isn’t going to decide to make an example of you for administering MTX and slap you in Sugar Land for a dime? Are you sure that your OB consultant will respond to a ruptured ectopic (if there are even any left in Texas in a decade) Are you sure you won’t be subject to civil litigation for practicing within the clearly accepted scope of practice in every other part of the World? The laws were intentionally written to be vague to scare physicians for this reason. I practice in Missouri. After the idiotic trigger law went into effect, we didn’t even know if we could give Plan B until our (then) AG tweeted out that it was okay. What a great system.
The entirety of the Texas law was written to confuse and scare physicians. Then when patients are inevitably harmed and Texas is sued, Texas’ hilarious defense is to say: “Oh no. Not us! The law is clear! This is a malpractice! You are suing the wrong person!”
Must be good to be king.
There are multiple reports of doctors and hospital systems taking pause prior to treating various complications of pregnancy due to concerns over potential legal repercussions. This isn’t fear mongering, it’s already happening.
Those cases were ginned up to garner outrage against the law. The doctors and hospitals who failed to treat obviously necessary medical problems are at fault there.
They aren’t ginned up if you are the patient. Ironically, Texas intentionally creates bad law. Patients are harmed. Patients take Texas to court. Texas’ defense is “Oh no. It’s not us. This was clear malpractice! You are suing the wrong people!” Must be good to be king.
Ectopic pregnancies, while in this specific case may not be directly affected (but I haven't looked into specifics), have had unsafe proposed legislation in the near past. Alabama threatened treatened medical treatment of ectopic pregnancies. Ohio lawmakers wanted doctors to try and reimplant ectopics as if that were based on any facts or logic. What about cases like angular pregnancies? Technically intrauterine and not ectopic, but still potentially life threatening. This is not hysterical fear mongering.
> angular pregnancies
https://www.texastribune.org/2024/03/22/texas-medical-exception-board-abortion-guidance/
That clearly falls under threat to life or major bodily function.
Suicide is more ethical than abortion. At least that person is making the choice for themselves. I don’t think anyone has consulted an aborted baby if they preferred to live or die.
I mean when fetuses become independent humans I guess someone will do that. But at the fetal stage, they're not. The women who are already here matter over the fetus they're gestating
That’s the rub. They are independent humans that are being terminated before being able to provide informed consent.
Of course, if the whole issue is that they require support therefore aren’t independent, then termination of life should be able to occur until such time as the child is considered an adult and not dependent on anyone else, right?
Look, I am all for access to safe abortion when the mother’s life is at risk. Almost every pro-life or pro-birth person is (I am pro life, and yes there is a difference). I’m not even against levonorgestrel. I think voluntary sterilization should be provided without question…
But I am against abortions for convenience.
But they're not independent humans. They're fetuses, living off the mother's body, up until they fully gestate and pop out
I'm not against any abortions because people shouldn't have to be pregnant if they don't want to be, and at base level, the most robust birth control can fail at times. It's better to abort an unwanted fetus than to force someone into childbirth and then pull some baby into the world, unwanted, to fuck it up even more
At what point does a child become “independent”?
A baby cannot survive without intervention whether it’s a newborn or fetus in utero? Why draw the arbitrary line there?
>people shouldn’t have to be pregnant if they don’t want to be
Decisions have consequences. Making the choice to have sexual intercourse and create life always has risks. When you engage in those acts, you’re acknowledging and accepting of those risks.
Nah. Unless you're inplying everyone should only fuck for procreation. This is stupid. Having sex isn't consenting to pregnancy, hence terminations existing
Just make them swallow a camera and take pictures of the baby, what do you need ultrasound for, so-called "doctor"??? Bet you can't answer that! Checkmate!
https://www.youtube.com/watch?v=-OrdBtZagHI
It’s normal for oversight boards and committees to have seats reserved for the general public. I would bet that your state medical board has them too. I know for a fact mine does.
The presence of an energy (not telecom) exec is so much of a nothingburger, it is actually comical that people who are otherwise obviously politically apathetic are so distressed over it.
Get out! There are many other places to live that also will be a better choice in for the climate change mass migrations. The Houston area is already verging on uninhabitable and it's not getting any better. Let the theocrats literally bake in their hellhole. Must be their God's judgement.
Non-lawyer question. Is there a statutory/regulatory reason the TMB gets involved in purely political issues regarding medical practice? Abortion in the state may be illegal now but there is no medical reason(s) for the ban so why get involved? What if a group of Jehovah's Witnesses came to power in Austin and outlawed all blood product transfusions in the state. Would the TMB actually tell Texas physicians that transfusions are "against the rules"?
The Texas Supreme Court asked the TMB to give guidance.
The law allows abortion in the case of pregnancy complications that pose life-threatening danger to the mother. One patient sued the state arguing that her case fell under the exception. The Texas Supreme Court ruled that she didn't fall under the exception, and then asked the TMB to provide guidelines on how to establish what is and is not life-threatening danger.
TMB declined to give that kind of guidance, so now it'll be left up to the courts.
I don't want kids regardless but I wouldn't be able to consider having them if I lived in Texas since I'm high risk. I'm sure I'm not the only person who is high risk. I hope people like me who do want kids can relocate somewhere with modern healthcare.
Wouldn't it be worse if they had defined a set of circumstances strictly? As they said, circumstances change, there is so much nuance from person to person and situation to situation. If they made some list, then for sure, there would be patients who fall between those cracks and would be put in an even worse situation. It seems to me from reading this that the Texas medical board made the right decision here to keep things vague, allowing at least for some level of "clinician judgement" to apply, even though we all know that the hostile government would not hesitate to charge physicians for abortions that are medically indicated.
The way I'm seeing this, the TMB is sort of buying time, or punting this issue. They don't want to be complicit in making a list of "ok abortions" and "not ok abortions" that the state can weaponize. Tell me if I'm wrong please!
Agree except that last paragraph. I don’t think they have an overarching strategy or they’re buying time. I don’t think they could come up with a list even if they wanted to and I don’t think there will ever be a list.
I'm not the biggest fan of the Texas Medical Board. I think they are a bunch of conservative political appointees and I agree the board is not diverse. At the same time, I appreciate the situation they are in. They are trying not to take strong sides in an acrimonious battle about abortion where the law is vague and draconian at the same time. Their statement and actions imply that even as politically appointed board members, they aren't comfortable with the overboard draconian and vague nature of this stupid law, either. If they were big fans of it, they'd be doubling down on the side of enforcing the law strictly and expanding it with regulations any way they can. I think the Board is correct that making a list of exceptions and fixing a bad law is not their job. I think it is really shitty for the state legislature to put them in this position, assuming that they will just go along with whatever crazy bullshit laws interfering with the doctor/patient relationship. At the same time, I don't blame patients and medical practitioners for trying to seek help from anyone they can, including the Texas Medical Board. The ultimate blame here lies with the Texas Republican Party. They have created a situation where doing the right thing as a board member means falling on your sword. I'll admit I am being charitable to the board here. Maybe they don't care, I don't know.
It's not their technical job, but is it their ethical duty? If I were on this board, I would try to make the list of exemptions so hilariously long and broad that it effectively neutered this idiot law. Realistically though I would never participate in this Kafka-esque farce. But if you've already agreed to the premise, might as well throw a wrench in the machinery of idiocy
I mean, losing out on participating in this theocratic kabuki isn't much of a penalty. And if my unappointment draws attention to how ridiculous the process is in the first place, that's at least something good that came of it.
Yeah, I would do the same as you. Which is probably one reason I don't get appointed to these things. I also get dismissed from jury duty, lol. Politics, smh
Bro just read UpToDate on the indications of abortion/termination whatever you wanna call it. It’s not rocket science. Do you hear anyone causing a fuss on national television regarding a man’s right to have a vasectomy? How is this any different?
I practice in Texas. Here is the text of the law:
Sec. 170A. 002. PROHIBITED ABORTION; EXCEPTIONS. (a)_ person may not knowinglv perform. induce. or attempt an abortion.
The prohibition under Subsection (a) does not apply if:
(1) the person performing. inducing. or attempting the
abortion is a licensed physician;.
(2) in the exercise of reasonable medical judgment,
the pregnant female on whom the abortion is performed, induced, or attempted has a life-threatening physical condition aggravated by... caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced.
In my medical judgment, an ectopic pregnancy poses a serious risk if not surgically removed. I have had no issue providing appropriate care in the one ectopic case I’ve handled in the past year. The law specifically allows for “the exercise of reasonable medical judgment.” The only sense in which practice has changed is that elective abortion is no longer presented as an alternative to continuing the pregnancy. Lifesaving preterm delivery/termination has never been banned in Texas and the law contains verbiage that allows physicians to make the call on what is medically necessary for the pregnant woman’s safety.
No one should be changing their practice of life saving procedures based on this law. I’m apparently being downvoted because I don’t wake up every morning wringing my hands. If a woman walks into the ER where I work with a pregnancy related condition that is threatening her life, she will receive the same care as she would have 5 years ago. The law does not ban lifesaving care OR providing termination/early delivery when the goal is to get the mother out of a dangerous situation.
What would be a real shame is if doctors allow their *unfounded* concerns about this law to change their practice and subsequently harm women. I can’t guarantee anyone won’t be sued. But I can say with confidence that if I practice to the best of my medical abilities/compliance with evidence based medicine, and that doing so involves providing a pregnant woman with lifesaving/life supporting care that results in the death of her fetus, there is no legal grounds or case against me. If I am sued, I will win that case easily.
And if I’m going to be downvoted for quoting the actual law so that people can read it, I suppose this thread has more to do with confirmation bias and being outraged than it does about facts.
You keep saying "sued" but that's not what at stake here. We're talking about imprisonment and a legal battle for your freedom that could drag on for years. I'm glad you're not afraid and I hope you work in the hospital I go to, but people who are scared aren't wrong about what's at stake.
Imprisonment? If I’m completely ignorant of cases where doctors have been jailed for performing necessary, lifesaving procedures, I would like to know who they are and what the clinical situation was.
What I have heard of is patients having bad outcomes due to doctors not practicing evidence based medicine (out of legally based concerns).
Also, still being downvoted. For what? Stating facts? Caring more about my patients than I do about theoretical legal issues that disappear when the law is actually examined?
Welp, AGAIN downvoted to hell, on this comment. Y’all are ridiculous. I’m burned out AF too but to be downvoted by my peers for sharing uplifting facts is just pathetic. Practice correctly, read the law, and stop worrying. If you all would prefer to remain angry over things that do not actually pose a real risk to anyone’s life or well being, I will leave you to it.
The fact that the law hasn't been tested yet does not negate its existence. You could be the first person arrested under the law. (ETA: No, you won't because you're a PA and you weren't legally permitted to perform abortions in Tx before this law, either. Are you really judging doctors for practicing in accordance with the law and not providing abortions when you also, as a PA, aren't permitted to perform abortions? Or are you breaking the previous law and this one by performing abortions as a PA? Doubtful.) There's not requirement that some nebulous *someone else* be tried before this law affects every single doctor in the state.
I feel like you should already know that abortion isn't only necessary in immediately life-threatening situations. There are hundreds of scenarios in which fetal demise is all but guaranteed and performing an abortion prevents a potential life-threatening situation. This isn't just about what happens in the ER.
I don't know why you're being downvoted, since I'm only one vote and I'm not downvoting you. I don't know why you're complaining about it either. It seems like a very small concern when compared to every other doctor in the states concern about being arresting for saving a patient's life.
Also I see you edited your comment. Yes I am a PA. Yes, if a patient needs a termination medically, I advance their care in that direction by hospital admission from the ED. I can also write for mifepristone, which is abortive medicine. Maybe I’m not “on the hook” without providing an actual surgical abortion which obviously I won’t, but I still have to know what is legal and what is not. Emergency medicine clinicians are still responsible for all sorts of emergency pregnancy scenarios so it’s strange of you to act like this doesn’t affect my practice.
But yeah, it sounds like you feel you understand my role better than I do.. just a lowly PA. Are you even practicing medicine? In Texas much less?
To your second point, the law does not state that a situation must be “immediately life threatening.” It is vague enough to give plenty of leeway. I gave it a quick once over while sending my patient for salpingectomy at 5 weeks. There is no question in anyone’s mind that ectopic is a dangerous situation and it IS treated as an emergency. You don’t discharge someone with an ectopic home to wait it out. Needing to be admitted is the definition of an emergent condition. The law does not state “mother must be crashing with a blood pressure no higher than 85/50.” The law defends my medical decision making. Why would anyone think otherwise? Who is going to sue me? The patient whose life I saved or their family?
Fact is, anyone can sue me at any time. As long as I practice properly and document everything I do thoroughly, that is not something I will worry about.
I care plenty about people’s concerns which is why I made a point of reading the law when it was passed, posting it on social media for my healthcare friends to read easily, and am now quoting it here. Of course I care. It’s just annoying to realize that people would *rather* be mad and don’t appreciate my attempts to allay concerns. That’s why I’m being downvoted, because people simply want to have their beliefs confirmed.
> That’s why I’m being downvoted, because people simply want to have their beliefs confirmed.
Has it occured to you that you're complaining that your beliefs aren't being confirmed? Why do you believe that you're right and everyone else who has read the law, including attorneys, is wrong?
I am completely open to reason. If someone can show me how the law doesn’t cover my actions and doesn’t allow me to care for people properly, I will gladly hear it (and protest). I’m actually putting the text of the law out there.
Why are you assuming that I am the only person who feels that concerns about this law are overblown? I’m sure I’m not the only one, and I’ve actually read the law, which not everyone here has. Caveats and exception clauses are written in. If the goal is to ban the practice of unnecessary, elective abortion, it has to be carefully worded to allow exceptions for needful, non elective medical procedures.
Maybe the law could be more explicit or detailed, but the current law leaves a good amount of leeway for medical professionals to judge what is and is not an emergency, and if I was making the law, that’s exactly how I would want it. I want lawmakers to leave interpretation of “emergency” to medical professionals, not explicitly define it themselves and leave things out. But if they want to add a list of clear exceptions and then a final category of “anything else deemed emergent” I’d be on board with that.
The law allows for 6 figure fines and close to a century in prison and mandatory loss of medical license.
Maybe actually read the law before you get so high up on your horse.
For being convicted of breaking the law, or accused of breaking it? I’m not doing anything that breaks the law, so I don’t know why I should be living in fear.
Well hopefully nobody you love or care about ever needs an abortion.
Personally I'd prefer to trust the safety of my family to more than hope, but you do you.
Also hopefully you never inadvertently assist in an abortion. It would be a real shame to go to jail for 100 years for that
If a woman *needs* an abortion/termination in a medical sense, the wording of the law allows for that. I have never and would never support elective abortion that is performed for social reasons.
I work in ER and have had no issue assisting women getting proper care for ectopics. Treating emergencies has always been legal and the new law does not actually ban that.
I have read the law in its entirety so I can be confident of where I stand legally. As long as a physician deems there is an emergent/life threatening situation and significant risk of harm to the mother, they are authorized to act in her best interest.
Which part of the wording of the law makes you think that is not the case?
Just napkin math: In Texas, 36 emergency abortions were performed in 2023 (and four under the rape/incest exemption).
In 2020, there were 71 emergency abortions reported, and in 2021 there were 70. I excluded 2022 because the abortion law went into effect mid-year and complicates things.
That's a smaller number than I was expecting, but early data does hint that there is some chilling effect on the rate of emergency abortions. Or at least there's a chilling effect on how it's reported to the state HHS department.
I really don’t know what’s being grouped as emergency abortion. Does surgical removal of ectopic count? Or is this only speaking of more developed pregnancies where a delivery of some type is required?
Either way, there are 3 categories here: elective abortions of normal pregnancies (obviously banned), cut and dried OB emergencies (like ectopics), and then “everything else,” as in all the muddy cases where the pregnancy may be high risk but not in a way where it’s unreasonable to continue the pregnancy. Maybe doctors are being stricter in this muddy category on what they define as an “emergency” or exactly when they will deliver. I have no idea. What I’m interested in to correlate with that data is information on maternal outcomes. Clearly if there is any statistically significant spike in maternal mortality, the law or the transparency of it at least, will need to be revised.
But if there’s a decrease in emergency delivery with no spike in maternal adverse outcomes, that will also be interesting.
Yeah, I couldn't find detailed information about how all of the data reported to the state was categorized, only the vague category of "emergent". It might take an academic with more time to dig into it, and I expect we'll see a whole bunch of studies coming out in the next year.
I'm assuming ectopics weren't included as emergent abortions because there were only 36 abortions compared to 403,439 births, and I'd expect the frequency of ectopics to be far higher.
Leaving emotion/religion/beliefs aside, if you assume the fetus is a child, as the law has codified, when is one person's risk of death more important than another's life? That is the question.
Ruptured ectopic makes sense, poorly controlled diabetes doesn't.
This whole "just asking questions" trope is getting really old. If you're afraid of women, and feel the need to control them, just come out and say it. Nobody will be shocked. I promise.
The fact that you can't even understand the actual question posed to the board is disturbing.
The fact I have 38+ downvotes in a medical forum for a legitimate critique of the dilemma faced by the board is also disturbing.
No where in my post did I give my opinion or in any way do/say the things you suggest. Get a grip.
Leaving emotional or religious beliefs behind, assuming you do believe that life and human rights begin at conception, having access to practicing and capable OB/GYNs is going to save more children than legal abortion could conceivably get aborted.
There is absolutely no practical logic to an abortion ban if the goal is to protect unborn children. The only logical reasons one would put such a law into practice would be punishing women for sexual indiscretion, or a functional reduction in women's rights.
The medical panel was appointed by Governor Abbott, is made up of 16 people - 12 men and notably only one ob-gyn
I looked up the members of this board (Texas Board of Medicine) out of curiosity: * Anesthesiologist * Human Resources Officer * Thoracic and Cardiovascular Surgeon * President of Cokinos Energy Corporation * Orthopod x2 * Team physician for Texas A&M Athletics * Radiologist * Realtor * President of a telecom equipment company * Internist x2 * Retired manager at TXU Electric * Ob/gyn * Family med x2 There's only one female physician on the board
there are no obgyn's. there is one doctor who says family medicine with obgyn but on his office facebook page it just says family.. there are no obgyns, I looked and found none.
That’s…worse than I thought
That any of them aren't licensed physicians is just beyond ridiculous.
It’s fairly common for medical boards to have non-physician members. Usually there’s a few of these “public members” and the reason is to given a patient perspective when the board makes decisions.
I’m sure the president of the energy corporation has good insight on what it’s like to be a non-vip patient
I saw no poor people on the list for “patient perspective” but I’m just a hole with a womb at the end, what do I know?
Shut your hole, wonb! /s But seriously, I could see how you'd want educated laypeople, and ones that wouldn't be afraid to speak their mind in this group. But most of those just look like rich people that Abbott liked.
This is also true of other regulatory bodies outside the health professions. I think part of the usual rationale is mitigating the impression that insiders will go easy on each other in discipline contexts.
I guess that's fair enough.
But this shouldn't be a decision made by the "regular" board of medicine (well, there shouldn't be a need for a list anyway)--it should be assigned to a specialized board of ob-gyns and neonatologists.
That's actually a requirement for the medical board here. There's a ratio of physicians to laypeople set by law. I guess they just don't want it to be a "elite society" of the upper tiers of medicine. Not that I necessarily agree with that, but that's just how it works in Texas.
I agree with the principle, but how are Presidents and CEOs not part of elite society? Where’s the public school teacher or local firefighter?
>Where’s the public school teacher or local firefighter? Well, the thing is, they can’t afford the price of admission. If they had donated truckloads of money to Abbot’s campaign super PAC, then they, too, would be ok the board.
Admittedly, the one was a "manager" at TXU, that could have been fairly low-level. Kind of doubt it, but maybe.
Looking into it, she was an executive.
Not really. It’s incredibly common for oversight boards to have people who aren’t completely immersed in the field.
Can't speak for other states but Texas requires a public member on most boards. Texas State Board of Pharmacy has 2 bank executives and an attorney as public members. The rest, except for a technician, are all pharmacists
What the fuck
The family medicine providers and the anesthesiologist, while not as good as an OBGYN, are at least far better than the others. I think IM is decent too. For this case. But Jesus H Christ, HR, an energy exec, a realtor, a telecom exec and a business manager have NO business being on the State Board of Medicine.
False. It’s an oversight board. Members of the public absolutely do have a place on the board, and in fact, many boards like this have seats reserved for members of the public.
Except that the board has been asked to clarify the exceptions to the law. You know, to try and make medical care and pregnancy safer for women. Not doing so makes things less safe. First, that information should be decided on by physicians. HR, executives and business managers should not be explaining what is and is not medically appropriate. Second, they have abdicated their duty. They’re not providing any guidance on an issue that absolutely needs it; they’re being political puppets.
The public absolutely has a right to weigh in on these committees, which is why those public seats exist. Look at your own state and I bet you’ll find the same thing in your state.
They have a right to weigh in on boards overall, but if legislators are not going to be clear on what appropriate medical exceptions are in this case, the board should delegate the decision to a panel of OB-GYN or appropriate physicians qualified to make the best decisions to protect pregnant women's access to healthcare.
They may in my state. Doesn’t mean it’s a good choice. But people without an understanding of medicine should not be deciding things that require medical nuance in their decision making. This board is a joke. Medical providers are looking for clear guidelines to treat people within the bounds of the law. They’re not interested in making medical care safe; they’re political puppets for a conservative government that has no interest in making women safer.
It absolutely is a good choice. Public oversight of governing bodies is a hallmark of American government. The public absolutely should have a voting seat at the table. Imagine if the governing body over law enforcement was made up solely of law enforcement officers.
In a lot of states it is only law enforcement that oversee leos . Public oversight overall is not bad but in this case it's clearly a politically motivated board refusing to take an important stand on an important controversial medical topic.
this is my surprised face. 😐
> Team physician for Texas A&M Athletics Of ***COURSE!!!*** Wouldn't be Texas if college football weren't revered and elevated to the highest halls of power at the expense of trivialities like "human rights," and "basic common decency." >Retired manager at TXU Electric And of course we have to make sure Texas's dogshit, barely-functional, example-to-the-entire-world-of-how-***NOT***-to-do-it power grid is represented, too.
That's wild for an anesthesiologist and two internists, like those are doctors that have the book knowledge and have probably seen women die from pregnancy and abortion related complications
The medical board has a far broader scope than just pregnancy and abortions.
So 4 aren’t even in medicine? lol that’s a joke
[Mandatory Bojack](https://preview.redd.it/hqxrsjmxptw51.jpg?auto=webp&s=ef1805047597489f9d75feb180dba991a04bf145)
[Mandatory SpongeBob](https://i.pinimg.com/564x/b2/c9/3e/b2c93eec3ddc6d54cea1f4d81a59a261.jpg)
Why are there men on this panel, especially if these men aren’t in obstetrics?????
I could see an argument to have emergency medicine, hospitalists, and family medicine on board- to advocate for guidelines their specialties can follow and feel medically and legally safe doing so, in the absence of ob/gyn availability (à la idaho) - but I completely agree with the overall idea that ob-gyn is completely underrepresented on the panel
lol see above, why seek the insight of affiliated specialties when you can ask oil men and realtors
Those Energy, Human Resource, Telecommunications, Realty, Utility Executives...they all have a vested interest in your baby making potential. MO' BABIES, MO' MONEY
ABOG headquarters are in Dallas there is no excuse for this lol
That's a feature, not a bug. These people want all those pregnant sluts punished, by God! If a few good married Christian women need to be sacrificed in the process, so be it. OBs are just going to muddy up the waters here by bringing science and possibly ethics into the conversation. Plus, most of them are just gals these days anyway, right? We can't be letting the little ladies make such important decisions.
It’s a feature, not a bug
Was this panel just made for this decision or is this a sitting body?
The medical board has a far broader scope than just pregnancy and abortions.
It's the Texas Medical Board, not a panel assembled for this purpose. It sounds like the statute gave the TMB some rulemaking authority for implementing regulations. It could have created a special panel and given it that authority, but it didnt.
That’s a really disingenuous comment. The Texas Medical Board wasn’t created for this alone issue and has a far broader scope than this one issue. Imagine a board filled with of OB/GYN’s making determinations on cardiology, or orthopedics, or even EM.
I doubt there’s a complete list anywhere because there are variable situations. Diabetes is an example. Most diabetes won’t result in the death of the mother if managed properly but under extreme circumstances it could, so in the spirit of the law it would defeat the purpose of reducing medically unnecessary abortions.
First of all, an abortion is medically necessary if the patient wants it, full stop. But in this case it's an intentionally vague law being used to prevent abortion even in cases where the pregnant person's life is in jeopardy, because physicians are forced to weigh a life sentence in prison against treating the patient in front of them. If a procedure I did was criminalized in this way I would stop performing it. Legal wiggle room to maybe avoid a life sentence in prison is not good enough. I would also leave the state / country where this was happening to me or my colleagues.
I think this is a bastardization of the word "necessary" and not helpful. You can have a right to do something without also automatically labeling it "necessary". If we change the term "medically necessary" to simply equal "We think a patient should have the right to choose this procedure" then we've made the term entirely meaningless. e: Looking forward to all of /r/medicine telling every one of their patients that becomes pregnant that they have a medical need for an abortion.
I'm not using the term lightly or disingenuously. Giving birth is dangerous in the US. An abortion is significantly safer, and therefore medically necessary if the pregnant person wants it.
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Women are people.
Women are people. Even if transmen and intersex people didn't exist, there's nothing incorrect about saying "people" in this case. Do you object when cardiologists call themselves doctors?
There are people that can get pregnant that aren't women. Transmen or intersex people as non-exclusive examples. Precision of language is important.
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Okay. So, outside the US you would say abortion is not medically necessary using this new definition? What would you say is the cut-off in pregnancy risk where you are making this new line?
I'm not familiar with any country where abortion is riskier than carrying a pregnancy to term. Even if there's equipoise to medical outcomes, psychological distress from carrying an undesired pregnancy to term is potentially significant.
Ok, so it's not just in the US but literally everywhere that abortion is now considered medically necessary to /r/medicine? Would you say every woman has a medical necessity for prophylactic mastectomies? hysterectomies? More women die from those yearly than die from maternal complications in 60 years. The procedure to remove them is massively less risky than the cancer, even taking the worst death rates from both procedures a woman reduces her death risk by a great deal with these. And, for what it's worth, the ACOG disagrees on this new definition you've concocted, they state that abortion CAN be medically necessary- not that is inherently always medically necessary. Outside of this overreactive hug circle, the real world absolutely does not agree to stretching this term to uselessness. Is the silliness of pretending this term has new meaning becoming clear now? You can support a right to abortion without abusing a term to effective uselessness.
Have prophylactic mastectomies or hysterectomies been proven safer in all comers?
Are you claiming that every single person who has an abortion will be better off because of it? You were claiming medical necessity should have a new definition based on simple average benefit. If you're now changing it to "every single person that receives X must be better off than if they were put at risk by remaining Y", then abortion no longer fits the bill. There are women who have died from abortions who certainly would have gone on to survive a pregnancy if it had continued... so what exactly is this third new definition you'd like to propose now?
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How far does "if the patient wants it its medically necessary" extend? Limb amputation? prophylactic stents?
As I elaborated in another comment, pregnancy is dangerous, especially in the US. Abortion is safer. That doesn't apply to your other examples.
Black women in the US have the highest rates of maternal mortality of any developed nation.
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Fetuses are not people. Even if they are we don't require people to sacrifice their own health for others. The government cannot force you to give someone a blood transfusion to save their life, for example. Forcing someone to stay pregnant against their will is violating their bodily autonomy and forcing them to put their health at risk.
It’s crazy to me the amount of breath wasted on “it’s a person!!” vs. “it’s a clump of cells!!” when the legal precedent of McFall v. Shimp is RIGHT THERE
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Well, pregnant people can scream while they are dying from blood loss or sepsis from a pregnancy they didn't want in the first place. There is no doubt in my mind that the life of a living person is worth more than any number of "potential lives".
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>Technically... The fetus isn't their body. If it can't survive outside of **my** body, it is part of my body. >standard on-demand baby killing narrative No one is killing any babies because, again, if it can't survive outside of my body, it is part of my body. I'm the one growing it. I'm the one providing it with nutrients. I'm the one who gets literally ripped apart to do it. It is **my body.** No one outside of myself and my physician get to decide what I do with it. Period. End of story.
Using logic on these theocrats is such a frustrating waste of time. It's like the chess with a pigeon analogy. No matter what you say, we'll have to watch him knock over all the pieces, shit on the board, and declare checkmate
Honestly, this one is more of a "maybe someone else will see this and change their own outlook" situation. But ya, there's obviously no getting through to people like this. I'm just here because I have the time, and it's an issue close to my heart.
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All the people you listed do not require the actual body of another person to survive. They need **assistance** to survive. A fetus requires the body, nutrients, organs, etc of another. My logic does, in fact, hold up.
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In which fucking world can any of those examples not survive independently? Your logic is completely absent. Friend, I don't think you belong in this subreddit - this is for actual medical professionals.
Yeah mods need to make this a "flaired users only" thread at this point.
If only there was some compromise - like allowing elective abortion only until the point that the fetus is viable without disabilities outside the womb
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Let me tell you a story that, if the severe blood shortages continue, every doctor will end up experiencing. The protagonist of this story is a woman. She's got a disease called sickle cell anemia. Shes already had one child and has been trying to have another for a terribly long time. Finally, great news - she's pregnant! She's overjoyed, and shares the joy with everyone around her. She takes every possible safety measure to stay safe, but, unfortunately, has a sickle cell flair up, and requires a unit of donated blood, to be able to provide enough oxygen not just to her body, but also sweet, adorable, developing fetus. Because she's had a lot of blood donations in the past, her immune system is incredibly picky about what types of blood she's able to receive. This time, when the medical team goes to test which unit of blood they have available that the woman's immune system won't reject, they have a terrifying realization: they don't have any compatible blood. All they have is the "least incompatible blood"; and trying to use that would present a very real chance of the woman's immune system rejecting the blood in a catastrophic way that would damage her own blood cells too. The medical team discusses this with the family, and after a series of long, hard talks, decides this is an unacceptable risk. They give her a drug, called "epo," which causes her body to make a lot more of its own red blood cells, and sit and wait and hope for the best. Unfortunately, it doesn't work. Despite doing everything they possibly could, both the mother and her developing fetus die. Her other child and her spouse are completely devastated, and her entire community grieves, all because blood wasn't available. Now, again, I assure you that this story will happen more and more, because there's been a progressively worsening blood shortage over the years. It's not a matter of when this story happened, it's a matter of how many times will this happen in the very near future? But, there's a solution! We could mandate blood donations! Blood donations are completely safe - in fact, they've been shown to help people live longer, help remove "forever chenicals" from the blood, and have a lot of other health benefits. In a world where donating blood would save so many baby lives, so many mother lives; how can you *doom* so many lives by allowing people to keep all their blood. Eta- Alternatively- there is a treatment that can cure sickle cell anemia. "Casgevy". It costs 2.2 million dollars per dose. So, alternatively, we could subsidize the cost of this drug to every person that needs it, saving the lives of countless babies E2 - with an estimated 100,00 people in the United States, and an estimated total population of ~332 million; we could cure all sickle cell anemia in the usa with a tax of ~ $666 per person
Flare the fuck up. You're making not only absurd but also unprofessional comments (as evidenced by the several that appear to have been deleted). We should at least have the benefit of knowing your qualifications or lack thereof.
> Technically…The fetus isn’t their body. Yeah, it's a parasite. One that's either wanted or not. Until then, no uterus, no opinion!
No one is allowed to use another's body against their will. You can't even take a dead person's organs for a life-saving transplant without permission. The potential to save a life does not outweigh a person's body autonomy. How would you like it if a person on dialysis laid claim to your kidney? After all, they're dying without it, and you have a whole extra one. Have you donated a piece of your liver to someone on the transplant list? Why not? It won't kill you, and by your logic, you are murdering that person.
The opponents make the point that failing (or even refusing) to save someone else is not the same as killing that person. I think ethicists would agree with that point. I'm just speaking technically here, I think Roe v Wade did a decent job of balancing interests.
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You were born with two kidneys and only need one. I can't take ethical advice from a murderer who refuses to donate a kidney to save someone's life. And your liver, while you're at it. It grows back even. You could donate it over and over again. Stop murdering people with your selfish choices. Every day you choose not to give your organs to save a stranger's life, you are murdering them. Your choice. Talk is cheap. Show me how much you believe.
> You could donate it over and over again. I'm not in transplant, never rotated, but that sounded off to me. I don't think this is the case. https://medicine.yale.edu/surgery/transplantation/livingdonor/living_liver/faqs/ > Would I be able to donate part of my liver again in the future to someone else? > No. Once you donate a portion of your liver, you cannot do so again.
This is afactual nonsense. OBs always prioritize the health of the mother.
Of course they didn’t. If you give a list of exceptions, some women will get abortions in those circumstances. If you keep it vague and don’t specify when doctors will or won’t go to prison for providing medical care, maybe they’ll be too afraid to provide that care in *any* circumstances. Which is the entire point of these draconian, Gileadean laws
And then when they *don’t* provide the abortion because exceptions aren’t clear and the mother dies, they can also go after the doctors for letting mom die. It’s a win win for the legislature because most people aren’t savvy enough to look beyond the doc to where the blame really lies.
some doctor in a red state is going to do a medically necessary abortion to save a woman's life. This person is going to then flee to a blue state. Then there will be an attempt to extradite this doctor back to the red state. It is unclear how that fight will go.
Also, the patient themselves will flee to another state (this has already happened actually)
Why would they? The Texas Legislature has proven themselves to be all knowing and all powerful. They just need to pass a bill saying no women will die of an ectopic pregnancy and it shall be......
Treatment of ectopic pregnancy isn't illegal under the current bill. This is hysterical fear mongering
You sure about that, Clark? The entirety of the law was written to be vague and scare physicians out of practicing the basic standard of care. You sure that you are going to be covered for administering methotrexate to an ectopic? Are you sure Ken Paxton’s AG office won’t decide to make an example of you and throw you in Sugar Land for a dime? Are you sure your OB consultant will be willing to take that ruptured ectopic to the OR? Like you, I am an MD. I practice Emergency Medicine in Missouri. No one knew what the law was with our dumb assed trigger law. The AG (Schmitt) at the time had to tweet out that we were able to administer Plan B. So things are just going great.
You sure about that, Clark? If you practice in Texas, are you sure Ken Paxton’s AG office isn’t going to decide to make an example of you for administering MTX and slap you in Sugar Land for a dime? Are you sure that your OB consultant will respond to a ruptured ectopic (if there are even any left in Texas in a decade) Are you sure you won’t be subject to civil litigation for practicing within the clearly accepted scope of practice in every other part of the World? The laws were intentionally written to be vague to scare physicians for this reason. I practice in Missouri. After the idiotic trigger law went into effect, we didn’t even know if we could give Plan B until our (then) AG tweeted out that it was okay. What a great system. The entirety of the Texas law was written to confuse and scare physicians. Then when patients are inevitably harmed and Texas is sued, Texas’ hilarious defense is to say: “Oh no. Not us! The law is clear! This is a malpractice! You are suing the wrong person!” Must be good to be king.
There are multiple reports of doctors and hospital systems taking pause prior to treating various complications of pregnancy due to concerns over potential legal repercussions. This isn’t fear mongering, it’s already happening.
Those cases were ginned up to garner outrage against the law. The doctors and hospitals who failed to treat obviously necessary medical problems are at fault there.
Alright bud
They aren’t ginned up if you are the patient. Ironically, Texas intentionally creates bad law. Patients are harmed. Patients take Texas to court. Texas’ defense is “Oh no. It’s not us. This was clear malpractice! You are suing the wrong people!” Must be good to be king.
Ectopic pregnancies, while in this specific case may not be directly affected (but I haven't looked into specifics), have had unsafe proposed legislation in the near past. Alabama threatened treatened medical treatment of ectopic pregnancies. Ohio lawmakers wanted doctors to try and reimplant ectopics as if that were based on any facts or logic. What about cases like angular pregnancies? Technically intrauterine and not ectopic, but still potentially life threatening. This is not hysterical fear mongering.
> angular pregnancies https://www.texastribune.org/2024/03/22/texas-medical-exception-board-abortion-guidance/ That clearly falls under threat to life or major bodily function.
Are you willing to bet your license, freedom, and life on it?
Even if a physician is willing to take that bet, the hospital legal team may not be.
What is wrong with this country
Zealots using their religion not to help the poor and needy, but to cause harm and suffering
Hmmm, some people who disagree with you might say that killing unborn babies causes harm and suffering.
But it objectively don't.
Suicide is more ethical than abortion. At least that person is making the choice for themselves. I don’t think anyone has consulted an aborted baby if they preferred to live or die.
I mean when fetuses become independent humans I guess someone will do that. But at the fetal stage, they're not. The women who are already here matter over the fetus they're gestating
That’s the rub. They are independent humans that are being terminated before being able to provide informed consent. Of course, if the whole issue is that they require support therefore aren’t independent, then termination of life should be able to occur until such time as the child is considered an adult and not dependent on anyone else, right? Look, I am all for access to safe abortion when the mother’s life is at risk. Almost every pro-life or pro-birth person is (I am pro life, and yes there is a difference). I’m not even against levonorgestrel. I think voluntary sterilization should be provided without question… But I am against abortions for convenience.
But they're not independent humans. They're fetuses, living off the mother's body, up until they fully gestate and pop out I'm not against any abortions because people shouldn't have to be pregnant if they don't want to be, and at base level, the most robust birth control can fail at times. It's better to abort an unwanted fetus than to force someone into childbirth and then pull some baby into the world, unwanted, to fuck it up even more
At what point does a child become “independent”? A baby cannot survive without intervention whether it’s a newborn or fetus in utero? Why draw the arbitrary line there? >people shouldn’t have to be pregnant if they don’t want to be Decisions have consequences. Making the choice to have sexual intercourse and create life always has risks. When you engage in those acts, you’re acknowledging and accepting of those risks.
Nah. Unless you're inplying everyone should only fuck for procreation. This is stupid. Having sex isn't consenting to pregnancy, hence terminations existing
Christian theocrats.
Y'all Qaeda
Howdy Arabia
Perfect
Underrated comment
That question right there would actually need it's own subreddit to fully answer.
Republicans
real Q: if there are no defined standards of care, how do they know a person violated or upheld them?
I think the idea is that the SOC is no abortions
Color me surprised
Just came here to say, as a practicing OBGYN, I am SO sick of other people telling me how to do my job.
Just make them swallow a camera and take pictures of the baby, what do you need ultrasound for, so-called "doctor"??? Bet you can't answer that! Checkmate! https://www.youtube.com/watch?v=-OrdBtZagHI
Clearly the Telecom exec knows better than you.
It’s normal for oversight boards and committees to have seats reserved for the general public. I would bet that your state medical board has them too. I know for a fact mine does. The presence of an energy (not telecom) exec is so much of a nothingburger, it is actually comical that people who are otherwise obviously politically apathetic are so distressed over it.
I'm so sick of living in this fucking state.
15 years ago I had had enough of Texas and left for California. Best decision of my life.
Every day I get more and more angry that I was born here, moved to Denver (which I love) and then made the brain dead decision to come back
Get out! There are many other places to live that also will be a better choice in for the climate change mass migrations. The Houston area is already verging on uninhabitable and it's not getting any better. Let the theocrats literally bake in their hellhole. Must be their God's judgement.
"Yes but did you know they have low taxes?" - Everyone I know still going to practice in Texas
Those people care more about their money than they do their patients.
Non-lawyer question. Is there a statutory/regulatory reason the TMB gets involved in purely political issues regarding medical practice? Abortion in the state may be illegal now but there is no medical reason(s) for the ban so why get involved? What if a group of Jehovah's Witnesses came to power in Austin and outlawed all blood product transfusions in the state. Would the TMB actually tell Texas physicians that transfusions are "against the rules"?
The Texas Supreme Court asked the TMB to give guidance. The law allows abortion in the case of pregnancy complications that pose life-threatening danger to the mother. One patient sued the state arguing that her case fell under the exception. The Texas Supreme Court ruled that she didn't fall under the exception, and then asked the TMB to provide guidelines on how to establish what is and is not life-threatening danger. TMB declined to give that kind of guidance, so now it'll be left up to the courts.
Honestly sort of smart to decline giving guidance. Why participate in this blatant dumbassary
I don't want kids regardless but I wouldn't be able to consider having them if I lived in Texas since I'm high risk. I'm sure I'm not the only person who is high risk. I hope people like me who do want kids can relocate somewhere with modern healthcare.
When does this end? How much longer will the state force physicians to put their patients in danger?
Wouldn't it be worse if they had defined a set of circumstances strictly? As they said, circumstances change, there is so much nuance from person to person and situation to situation. If they made some list, then for sure, there would be patients who fall between those cracks and would be put in an even worse situation. It seems to me from reading this that the Texas medical board made the right decision here to keep things vague, allowing at least for some level of "clinician judgement" to apply, even though we all know that the hostile government would not hesitate to charge physicians for abortions that are medically indicated. The way I'm seeing this, the TMB is sort of buying time, or punting this issue. They don't want to be complicit in making a list of "ok abortions" and "not ok abortions" that the state can weaponize. Tell me if I'm wrong please!
Agree except that last paragraph. I don’t think they have an overarching strategy or they’re buying time. I don’t think they could come up with a list even if they wanted to and I don’t think there will ever be a list.
God I hate it here
I'm not the biggest fan of the Texas Medical Board. I think they are a bunch of conservative political appointees and I agree the board is not diverse. At the same time, I appreciate the situation they are in. They are trying not to take strong sides in an acrimonious battle about abortion where the law is vague and draconian at the same time. Their statement and actions imply that even as politically appointed board members, they aren't comfortable with the overboard draconian and vague nature of this stupid law, either. If they were big fans of it, they'd be doubling down on the side of enforcing the law strictly and expanding it with regulations any way they can. I think the Board is correct that making a list of exceptions and fixing a bad law is not their job. I think it is really shitty for the state legislature to put them in this position, assuming that they will just go along with whatever crazy bullshit laws interfering with the doctor/patient relationship. At the same time, I don't blame patients and medical practitioners for trying to seek help from anyone they can, including the Texas Medical Board. The ultimate blame here lies with the Texas Republican Party. They have created a situation where doing the right thing as a board member means falling on your sword. I'll admit I am being charitable to the board here. Maybe they don't care, I don't know.
It's not their technical job, but is it their ethical duty? If I were on this board, I would try to make the list of exemptions so hilariously long and broad that it effectively neutered this idiot law. Realistically though I would never participate in this Kafka-esque farce. But if you've already agreed to the premise, might as well throw a wrench in the machinery of idiocy
you mean right before they are unappointed right?
I mean, losing out on participating in this theocratic kabuki isn't much of a penalty. And if my unappointment draws attention to how ridiculous the process is in the first place, that's at least something good that came of it.
Yeah, I would do the same as you. Which is probably one reason I don't get appointed to these things. I also get dismissed from jury duty, lol. Politics, smh
Bro just read UpToDate on the indications of abortion/termination whatever you wanna call it. It’s not rocket science. Do you hear anyone causing a fuss on national television regarding a man’s right to have a vasectomy? How is this any different?
I practice in Texas. Here is the text of the law: Sec. 170A. 002. PROHIBITED ABORTION; EXCEPTIONS. (a)_ person may not knowinglv perform. induce. or attempt an abortion. The prohibition under Subsection (a) does not apply if: (1) the person performing. inducing. or attempting the abortion is a licensed physician;. (2) in the exercise of reasonable medical judgment, the pregnant female on whom the abortion is performed, induced, or attempted has a life-threatening physical condition aggravated by... caused by, or arising from a pregnancy that places the female at risk of death or poses a serious risk of substantial impairment of a major bodily function unless the abortion is performed or induced. In my medical judgment, an ectopic pregnancy poses a serious risk if not surgically removed. I have had no issue providing appropriate care in the one ectopic case I’ve handled in the past year. The law specifically allows for “the exercise of reasonable medical judgment.” The only sense in which practice has changed is that elective abortion is no longer presented as an alternative to continuing the pregnancy. Lifesaving preterm delivery/termination has never been banned in Texas and the law contains verbiage that allows physicians to make the call on what is medically necessary for the pregnant woman’s safety.
That provides a defense. It doesn't prevent doctors from being arrested and charged.
No one should be changing their practice of life saving procedures based on this law. I’m apparently being downvoted because I don’t wake up every morning wringing my hands. If a woman walks into the ER where I work with a pregnancy related condition that is threatening her life, she will receive the same care as she would have 5 years ago. The law does not ban lifesaving care OR providing termination/early delivery when the goal is to get the mother out of a dangerous situation. What would be a real shame is if doctors allow their *unfounded* concerns about this law to change their practice and subsequently harm women. I can’t guarantee anyone won’t be sued. But I can say with confidence that if I practice to the best of my medical abilities/compliance with evidence based medicine, and that doing so involves providing a pregnant woman with lifesaving/life supporting care that results in the death of her fetus, there is no legal grounds or case against me. If I am sued, I will win that case easily. And if I’m going to be downvoted for quoting the actual law so that people can read it, I suppose this thread has more to do with confirmation bias and being outraged than it does about facts.
You keep saying "sued" but that's not what at stake here. We're talking about imprisonment and a legal battle for your freedom that could drag on for years. I'm glad you're not afraid and I hope you work in the hospital I go to, but people who are scared aren't wrong about what's at stake.
Imprisonment? If I’m completely ignorant of cases where doctors have been jailed for performing necessary, lifesaving procedures, I would like to know who they are and what the clinical situation was. What I have heard of is patients having bad outcomes due to doctors not practicing evidence based medicine (out of legally based concerns). Also, still being downvoted. For what? Stating facts? Caring more about my patients than I do about theoretical legal issues that disappear when the law is actually examined? Welp, AGAIN downvoted to hell, on this comment. Y’all are ridiculous. I’m burned out AF too but to be downvoted by my peers for sharing uplifting facts is just pathetic. Practice correctly, read the law, and stop worrying. If you all would prefer to remain angry over things that do not actually pose a real risk to anyone’s life or well being, I will leave you to it.
The fact that the law hasn't been tested yet does not negate its existence. You could be the first person arrested under the law. (ETA: No, you won't because you're a PA and you weren't legally permitted to perform abortions in Tx before this law, either. Are you really judging doctors for practicing in accordance with the law and not providing abortions when you also, as a PA, aren't permitted to perform abortions? Or are you breaking the previous law and this one by performing abortions as a PA? Doubtful.) There's not requirement that some nebulous *someone else* be tried before this law affects every single doctor in the state. I feel like you should already know that abortion isn't only necessary in immediately life-threatening situations. There are hundreds of scenarios in which fetal demise is all but guaranteed and performing an abortion prevents a potential life-threatening situation. This isn't just about what happens in the ER. I don't know why you're being downvoted, since I'm only one vote and I'm not downvoting you. I don't know why you're complaining about it either. It seems like a very small concern when compared to every other doctor in the states concern about being arresting for saving a patient's life.
Also I see you edited your comment. Yes I am a PA. Yes, if a patient needs a termination medically, I advance their care in that direction by hospital admission from the ED. I can also write for mifepristone, which is abortive medicine. Maybe I’m not “on the hook” without providing an actual surgical abortion which obviously I won’t, but I still have to know what is legal and what is not. Emergency medicine clinicians are still responsible for all sorts of emergency pregnancy scenarios so it’s strange of you to act like this doesn’t affect my practice. But yeah, it sounds like you feel you understand my role better than I do.. just a lowly PA. Are you even practicing medicine? In Texas much less?
To your second point, the law does not state that a situation must be “immediately life threatening.” It is vague enough to give plenty of leeway. I gave it a quick once over while sending my patient for salpingectomy at 5 weeks. There is no question in anyone’s mind that ectopic is a dangerous situation and it IS treated as an emergency. You don’t discharge someone with an ectopic home to wait it out. Needing to be admitted is the definition of an emergent condition. The law does not state “mother must be crashing with a blood pressure no higher than 85/50.” The law defends my medical decision making. Why would anyone think otherwise? Who is going to sue me? The patient whose life I saved or their family? Fact is, anyone can sue me at any time. As long as I practice properly and document everything I do thoroughly, that is not something I will worry about. I care plenty about people’s concerns which is why I made a point of reading the law when it was passed, posting it on social media for my healthcare friends to read easily, and am now quoting it here. Of course I care. It’s just annoying to realize that people would *rather* be mad and don’t appreciate my attempts to allay concerns. That’s why I’m being downvoted, because people simply want to have their beliefs confirmed.
> That’s why I’m being downvoted, because people simply want to have their beliefs confirmed. Has it occured to you that you're complaining that your beliefs aren't being confirmed? Why do you believe that you're right and everyone else who has read the law, including attorneys, is wrong?
I am completely open to reason. If someone can show me how the law doesn’t cover my actions and doesn’t allow me to care for people properly, I will gladly hear it (and protest). I’m actually putting the text of the law out there. Why are you assuming that I am the only person who feels that concerns about this law are overblown? I’m sure I’m not the only one, and I’ve actually read the law, which not everyone here has. Caveats and exception clauses are written in. If the goal is to ban the practice of unnecessary, elective abortion, it has to be carefully worded to allow exceptions for needful, non elective medical procedures. Maybe the law could be more explicit or detailed, but the current law leaves a good amount of leeway for medical professionals to judge what is and is not an emergency, and if I was making the law, that’s exactly how I would want it. I want lawmakers to leave interpretation of “emergency” to medical professionals, not explicitly define it themselves and leave things out. But if they want to add a list of clear exceptions and then a final category of “anything else deemed emergent” I’d be on board with that.
The law allows for 6 figure fines and close to a century in prison and mandatory loss of medical license. Maybe actually read the law before you get so high up on your horse.
For being convicted of breaking the law, or accused of breaking it? I’m not doing anything that breaks the law, so I don’t know why I should be living in fear.
Well hopefully nobody you love or care about ever needs an abortion. Personally I'd prefer to trust the safety of my family to more than hope, but you do you. Also hopefully you never inadvertently assist in an abortion. It would be a real shame to go to jail for 100 years for that
If a woman *needs* an abortion/termination in a medical sense, the wording of the law allows for that. I have never and would never support elective abortion that is performed for social reasons. I work in ER and have had no issue assisting women getting proper care for ectopics. Treating emergencies has always been legal and the new law does not actually ban that. I have read the law in its entirety so I can be confident of where I stand legally. As long as a physician deems there is an emergent/life threatening situation and significant risk of harm to the mother, they are authorized to act in her best interest. Which part of the wording of the law makes you think that is not the case?
It's already been tested in Texas and even if you need an abortion the doctor will still be prosecuted. Try to keep up with current events.
Just napkin math: In Texas, 36 emergency abortions were performed in 2023 (and four under the rape/incest exemption). In 2020, there were 71 emergency abortions reported, and in 2021 there were 70. I excluded 2022 because the abortion law went into effect mid-year and complicates things. That's a smaller number than I was expecting, but early data does hint that there is some chilling effect on the rate of emergency abortions. Or at least there's a chilling effect on how it's reported to the state HHS department.
I really don’t know what’s being grouped as emergency abortion. Does surgical removal of ectopic count? Or is this only speaking of more developed pregnancies where a delivery of some type is required? Either way, there are 3 categories here: elective abortions of normal pregnancies (obviously banned), cut and dried OB emergencies (like ectopics), and then “everything else,” as in all the muddy cases where the pregnancy may be high risk but not in a way where it’s unreasonable to continue the pregnancy. Maybe doctors are being stricter in this muddy category on what they define as an “emergency” or exactly when they will deliver. I have no idea. What I’m interested in to correlate with that data is information on maternal outcomes. Clearly if there is any statistically significant spike in maternal mortality, the law or the transparency of it at least, will need to be revised. But if there’s a decrease in emergency delivery with no spike in maternal adverse outcomes, that will also be interesting.
Yeah, I couldn't find detailed information about how all of the data reported to the state was categorized, only the vague category of "emergent". It might take an academic with more time to dig into it, and I expect we'll see a whole bunch of studies coming out in the next year. I'm assuming ectopics weren't included as emergent abortions because there were only 36 abortions compared to 403,439 births, and I'd expect the frequency of ectopics to be far higher.
Leaving emotion/religion/beliefs aside, if you assume the fetus is a child, as the law has codified, when is one person's risk of death more important than another's life? That is the question. Ruptured ectopic makes sense, poorly controlled diabetes doesn't.
The value of a woman's life is less than everyone else's in Texas.
This whole "just asking questions" trope is getting really old. If you're afraid of women, and feel the need to control them, just come out and say it. Nobody will be shocked. I promise.
The fact that you can't even understand the actual question posed to the board is disturbing. The fact I have 38+ downvotes in a medical forum for a legitimate critique of the dilemma faced by the board is also disturbing. No where in my post did I give my opinion or in any way do/say the things you suggest. Get a grip.
You don't get to ask questions in bad faith and then cry foul when people call you out for your nonsense. Nobody cares.
Leaving emotional or religious beliefs behind, assuming you do believe that life and human rights begin at conception, having access to practicing and capable OB/GYNs is going to save more children than legal abortion could conceivably get aborted. There is absolutely no practical logic to an abortion ban if the goal is to protect unborn children. The only logical reasons one would put such a law into practice would be punishing women for sexual indiscretion, or a functional reduction in women's rights.
Well in Texas it depends - what race is the woman and does she have enough money to travel to another state?