Navigating the Dobbs era after the end of Roe

This was supposed to be the golden anniversary. January 22, 2023 would have marked fifty years since the Supreme Court ruled in Roe v. Wade that the Constitution protected the right to an abortion. Instead, this January marked Roe’s undoing when a realigned court found in Dobbs v. Jackson Women’s Health that no such right existed.

In just months since the Dobbs ruling, fourteen states now have a ban on abortion, scrambling the rules of life for 20 million women, who now live without the right to privacy affirmed in Roe and must now live with the state’s interdiction on the most personal of decisions. However, we are not reverting to a pre-Roe era. Alongside these restrictions on women, states are now moving to criminalize physicians who would provide abortion services. Relatively rare prior to Roe v. Wade, punishing physicians as coconspirators is becoming a more common tactic of intimidation to diminish the availability of abortion. Our colleagues throughout the country must now practice with the state’s increasing intrusion into the relationship with their patients—previously privileged and sacrosanct—perhaps because legislators know many physicians see this prohibition as contrary to our duty to our patients.

Civil enforcement measures in states like Idaho allow abortion providers to be sued by immediate or extended family members. Arizona has a law, currently blocked by its Court of Appeals, that carries a prison sentence of two to five years for anyone who assists in an abortion. Although it has no chance of becoming law with a Democratic Senate, the House of Representatives passed a law on January 11, 2023, that would subject abortion providers to criminal penalties. While the fight for reproductive justice casts a shadow on the practice of medicine, it poses a particular peril to our own specialty of Family Medicine. In her essay, Dr. Chris Henneberg, family physician and abortion provider, insightfully connects abortion care with our specialty’s ethos of caring for the whole person: another example of how we provide medical care with an appreciation of our patients as people, rather than their component organ systems.

What does it mean, then, to be a family physician when we may be barred from helping a patient address one of the most meaningful decisions in their life: the question of whether, when and how to become a parent? Treating the whole person is our prime directive as family physicians. It is why we consider the prevention and treatment of disease not as an end, but as an objective serving a vision where patients can live their lives to their fullest potential.

The Dobbs ruling—that the right to an abortion was different from other privacy rights—nonetheless invited the debate over the presumption that decisions between physicians and patients are private and personal. This is likely to add fuel to the fire to efforts to intrude on what family physicians do for their patients. Specialties are partly defined by what skills they bring, so when we are restricted from providing our skills in whole person care, how does that affect the identity of Family Medicine?

What would it mean to be a family physician when we can longer help patients live in bodies that suit their gender? What would it mean to be a family doc if we cannot help patients make choices about their end of life? What is family medicine if addressing gun violence is declared not in our “lane” (e.g., physician gag laws)? In what other ways will our care become a political hot topic and subject to criminalization?

In California, these questions feel far away in our political climate, but we are far from insulated. We care for patients from other states seeking services they cannot obtain elsewhere, and the validity of our state laws is subject to a politically unstable federal government.

In truth, California family docs are on a different front of the same fundamental fight of family physicians throughout the country: maintaining the integrity of how we care for our patients, maintaining the integrity of our relationships with them, and by doing so, maintaining the integrity of our specialty.

Vista Community Clinic has outstanding opportunities for Full-Time and Part-Time Physicians. Join a team of dedicated, motivated and enthusiastic team players who make a difference in the community.

Vista Community Clinic is a federally qualified, not-for-profit healthcare clinic with state-of-the-art clinics. We provide healthcare throughout the Southern California regions of North San Diego, Orange and Riverside Counties.

Our compensation and benefits program includes: Competitive compensation, sign-on bonus, relocation bonus, health, dental, vision, company-paid life, longterm disability, flexible spending accounts , 403(b) retirement plan, malpractice coverage, CME allowance and no oncall hours. We are a NHSC loan repayment eligible organization.

Salary (full-time): $239,000 – $260,000/year

For more information visit www.vcc.org or email hr@vcc.org EEO/AA/M/F/Vet/Disabled

Lauren Simon, MD, MPH, FAAFP, CAFP President