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The termination of an ectopic pregnancy is not an abortion

The termination of an ectopic pregnancy is not an abortion We read with interest the article by Samuels‐Kalow et al. that points out, “State laws criminalizing abortion after 6 weeks and only for lifesaving or medical emergencies has created ambiguity in how these laws will be adjudicated, resulting in clinician fear of legal ramifications when managing ectopic pregnancies.”1 While we agree with the authors’ statement, it is important to clarify that the termination of an ectopic pregnancy by medical or surgical means is not an abortion. As defined by the Centers for Disease Control and Prevention (CDC), an abortion is “… an intervention […] that is intended to terminate a suspected or known ongoing intrauterine pregnancy and that does not result in a live birth.”2 The position of the American College of Obstetrics and Gynecology also reflects this usage. Since an ectopic pregnancy is definitionally extrauterine and never viable, use of the term “abortion” to define its termination is incorrect.This is more than a semantic problem. The delayed care of patients with ectopic pregnancies has already caused real‐world harm across multiple U.S. regions since the ruling in Dobbs v. Jackson.3–5 Adopting the correct medical terminology would help reassure emergency clinicians that no conflict exists between recent “trigger laws” and the management of this emergent medical condition which is rightfully protected under the legal obligations outlined in the Emergency Medicine Treatment and Labor Act.Were this proper usage universally recognized, it would be a step forward in reassuring patients their treatment for an ectopic pregnancy would not be withheld until their clinical condition progressed to a life‐threatening state. Likewise, physicians would not need to fear they would be legally required to withhold care in a manner they believed to be ethically reprehensible or constitutive of medical malpractice.It has been recognized that the emergency medicine scope of procedural and medical practice may expand due to Dobbs, particularly in states with poor access to reproductive care. As the authors note, “The extent to which future laws will render standard of care practices illegal is unknown.” As we consider this new legal and medical landscape, precision in our employment of terms as a field and advocacy for the congruence of the definition of abortion in written law will help disambiguate the increasingly complex landscape of emergency reproductive care.REFERENCESSamuels‐Kalow ME, Agrawal P, Rodriguez G, et al. Post‐roe emergency medicine: policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med. 2022;29(12):1414‐1421. doi:10.1111/acem.14609How does CDC define abortion? CDCs Abortion Surveillance System FAQs. Centers for Disease Control and Prevention 2022. Accessed January 28, 2023. https://www.cdc.gov/reproductivehealth/data_stats/abortion.htmGoldhill O. ‘A scary time’: fear of prosecution forces doctors to choose between protecting themselves or their patients. Stat News. 2022. Accessed December 15, 2022. https://www.statnews.com/2022/07/05/a‐scary‐time‐fear‐of‐prosecution‐forces‐doctors‐to‐choose‐between‐protecting‐themselves‐or‐their‐patients/Muñoz ND, Uribe MR. How treatment of ectopic pregnancy fits into post‐roe medical care. Politifact the Poynter Institute. 2022. Accessed December 15, 2022. https://www.politifact.com/article/2022/jun/30/how‐treatment‐ectopic‐pregnancy‐fits‐post‐roe‐medi/Walker C. Treatments for ectopic pregnancies in Missouri are delayed due to “trigger law”. Truthout. 2022. Accessed December 15, 2022. https://truthout.org/articles/treatments‐for‐ectopic‐pregnancies‐in‐missouri‐are‐delayed‐due‐to‐trigger‐law/ http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Academic Emergency Medicine Wiley

The termination of an ectopic pregnancy is not an abortion

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Publisher
Wiley
Copyright
© 2023 Society for Academic Emergency Medicine
ISSN
1069-6563
eISSN
1553-2712
DOI
10.1111/acem.14712
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Abstract

We read with interest the article by Samuels‐Kalow et al. that points out, “State laws criminalizing abortion after 6 weeks and only for lifesaving or medical emergencies has created ambiguity in how these laws will be adjudicated, resulting in clinician fear of legal ramifications when managing ectopic pregnancies.”1 While we agree with the authors’ statement, it is important to clarify that the termination of an ectopic pregnancy by medical or surgical means is not an abortion. As defined by the Centers for Disease Control and Prevention (CDC), an abortion is “… an intervention […] that is intended to terminate a suspected or known ongoing intrauterine pregnancy and that does not result in a live birth.”2 The position of the American College of Obstetrics and Gynecology also reflects this usage. Since an ectopic pregnancy is definitionally extrauterine and never viable, use of the term “abortion” to define its termination is incorrect.This is more than a semantic problem. The delayed care of patients with ectopic pregnancies has already caused real‐world harm across multiple U.S. regions since the ruling in Dobbs v. Jackson.3–5 Adopting the correct medical terminology would help reassure emergency clinicians that no conflict exists between recent “trigger laws” and the management of this emergent medical condition which is rightfully protected under the legal obligations outlined in the Emergency Medicine Treatment and Labor Act.Were this proper usage universally recognized, it would be a step forward in reassuring patients their treatment for an ectopic pregnancy would not be withheld until their clinical condition progressed to a life‐threatening state. Likewise, physicians would not need to fear they would be legally required to withhold care in a manner they believed to be ethically reprehensible or constitutive of medical malpractice.It has been recognized that the emergency medicine scope of procedural and medical practice may expand due to Dobbs, particularly in states with poor access to reproductive care. As the authors note, “The extent to which future laws will render standard of care practices illegal is unknown.” As we consider this new legal and medical landscape, precision in our employment of terms as a field and advocacy for the congruence of the definition of abortion in written law will help disambiguate the increasingly complex landscape of emergency reproductive care.REFERENCESSamuels‐Kalow ME, Agrawal P, Rodriguez G, et al. Post‐roe emergency medicine: policy, clinical, training, and individual implications for emergency clinicians. Acad Emerg Med. 2022;29(12):1414‐1421. doi:10.1111/acem.14609How does CDC define abortion? CDCs Abortion Surveillance System FAQs. Centers for Disease Control and Prevention 2022. Accessed January 28, 2023. https://www.cdc.gov/reproductivehealth/data_stats/abortion.htmGoldhill O. ‘A scary time’: fear of prosecution forces doctors to choose between protecting themselves or their patients. Stat News. 2022. Accessed December 15, 2022. https://www.statnews.com/2022/07/05/a‐scary‐time‐fear‐of‐prosecution‐forces‐doctors‐to‐choose‐between‐protecting‐themselves‐or‐their‐patients/Muñoz ND, Uribe MR. How treatment of ectopic pregnancy fits into post‐roe medical care. Politifact the Poynter Institute. 2022. Accessed December 15, 2022. https://www.politifact.com/article/2022/jun/30/how‐treatment‐ectopic‐pregnancy‐fits‐post‐roe‐medi/Walker C. Treatments for ectopic pregnancies in Missouri are delayed due to “trigger law”. Truthout. 2022. Accessed December 15, 2022. https://truthout.org/articles/treatments‐for‐ectopic‐pregnancies‐in‐missouri‐are‐delayed‐due‐to‐trigger‐law/

Journal

Academic Emergency Medicine – Wiley

Published: Mar 4, 2023

References

  • Post‐roe emergency medicine: policy, clinical, training, and individual implications for emergency clinicians
    Samuels‐Kalow, ME; Agrawal, P; Rodriguez, G
  • ‘A scary time’: fear of prosecution forces doctors to choose between protecting themselves or their patients
    Goldhill, O