Navigating Loss of Abortion Services — A Large Academic Medical Center Prepares for the Overturn of Roe v. Wade

Lisa H. Harris, M.D., Ph.D.
May 11, 2022, NEJM,  DOI: 10.1056/NEJMp2206246

The intense politicization of abortion in U.S. public discourse obscures its status as a health and health care issue. Medical centers may therefore not be doing the careful preparation needed to manage the health system–wide impact of abortion’s criminalization. What follows is a framework for preparation in a state where abortion will become illegal.

At the University of Michigan, we’ve been actively preparing for the loss of abortion care since the December oral arguments in Dobbs v. Jackson Women’s Health Organization made explicit the Supreme Court’s eagerness to overturn Roe v. Wade. In Michigan, a 1931 law criminalizing abortion will come into effect if Roe is overturned. It’s among the strictest laws in the country, permitting abortion only to “preserve the life” of a pregnant person.


I Got an Illegal Abortion Before Roe v. Wade

She was 15 when she got an illegal abortion in a dirty Detroit warehouse. Now, she’s terrified others will experience something similar.

By Carter Sherman
April 7, 2022

Renee Chelian still doesn’t know who performed her abortion.

In 1966, Chelian was 15 years old and living in the Detroit area when she got pregnant. She had no idea what an abortion was, until her parents asked her if she wanted one. But Chelian soon underwent one—after being blindfolded and taken to a dirty warehouse crowded with women looking for illegal abortions.

Determined to keep pregnant people from facing the kind of uncertainty and danger she did, Chelian eventually become an abortion provider herself. She now runs three abortion clinics around Detroit.


States move to front lines in battle over abortion rights with Supreme Court decision looming


Washington — With the Supreme Court poised to issue a decision in the coming months that could reshape the landscape for abortion care in the country, state lawmakers returning to their capitals this month are moving to the front lines in the fight over reproductive rights.

Republican-led legislatures are preparing to impose more restrictions on abortions or ban the procedure outright, while Democrat-controlled state houses are moving to enshrine the right to an abortion into state law. But the future of abortion access is less predictable in states with divided governance, where activists are pursuing a multi-pronged offensive to protect abortion rights in their states.


Michigan Police Express Sympathy for Anti-Abortion Clinic Blockade


In the early morning of Friday, Aug. 27, 12 fanatical anti-abortion extremists in Sterling Heights, Mich., formed an unyielding blockade in front of the Northland Family Planning Center—known for providing access to abortion, pregnancy tests, treatment for miscarriages, and gynecological care, among other reproductive health care services.

There are three Northland Family Planning Centers located across Michigan—and all have been under siege from anti-choice extremists throughout the summer months.


Abortion Clinic Protests Are Still Happening in the Pandemic: ‘They Accost Patients Face to Face’

Abortion Clinic Protests Are Still Happening in the Pandemic: ‘They Accost Patients Face to Face’
“They don’t social distance. They block, stalk, push, shove, talk, scream. It’s business as usual out there for them.”

by Carter Sherman
May 26 2020

When Kelly Benzin arrived at the Grand Rapids, Michigan, abortion clinic where she works one recent Wednesday morning, everything seemed normal. Even in the midst of the pandemic, the Heritage Clinic for Women had been drawing about five to 15 protesters a day, she said. One was just setting up his chair as Benzin pulled in.

But around 8 a.m., when the clinic officially opened, Benzin realized that about 25 to 35 people had started to gather outside. Soon, they started to approach patients, handing out roses and trying to talk them out of getting abortions.


USA – These 5 States Are the Next Battlegrounds in the Abortion Wars

These 5 States Are the Next Battlegrounds in the Abortion Wars
Abortion rights groups are pouring tens of millions into these states to flip their legislatures in 2020.

by Carter Sherman
Oct 22 2019

When Americans think about the future of abortion, they often think of the Supreme Court decision to legalize abortion nationwide in Roe v. Wade. But over the last decade, the real battle over abortion hasn’t been in Washington, D.C. — it’s played out in statehouses across the country, where legislators have passed restriction after restriction on the procedure.

Now, abortion rights activists believe they have a unique chance to wrest back those state legislatures from abortion opponents. And though Election Day 2020 is still more than a year away, they’re already preparing.


USA – An overlooked consequence of the Supreme Court’s gerrymandering rulings: Stricter abortion laws

An overlooked consequence of the Supreme Court’s gerrymandering rulings: Stricter abortion laws

By Reis Thebault
Oct. 22, 2019

For the next two months, petitioners will swarm Michigan ahead of late-December deadlines. They’ll knock on doors, flock to fairs and hand out pamphlets after church. Every day will be valuable, and every signature will get them a little bit closer to their goal: making it harder for women to get abortions in their home state.

If the volunteer fleet is successful, Michigan will join the list of states that have tightened restrictions on abortion rights this year. But, unlike those other states, which have overwhelmingly conservative governments, Michigan could pass antiabortion laws without the governor’s approval and without the support of a majority of voters.


‘We should be terrified’: What Michigan women should know if abortion becomes illegal

'We should be terrified': What Michigan women should know if abortion becomes illegal
If the Supreme Court overturns the landmark Roe v. Wade decision, Michigan and other states could see a patchwork of abortion laws in the nation.

Kathleen Gray, Detroit Free Press
Aug. 8, 2019

Renee Chelian remembers keeping her head bowed and counting the pairs of shoes of the women sitting around her.

Chelian was 15 and too frightened to take in her surroundings or look at the faces of the many women who sat with her, waiting for an abortion at the Detroit warehouse where the floor was covered in grease stains, and folding chairs and card tables served as the only furniture.


U.S.: Appeals Court Won’t Hold Catholic Hospital Responsible for Denial of Care

Safe Abortion:

Sep 9, 2016, Rewire
Jessica Mason Pieklo

On Thursday the Sixth Circuit Court of Appeals dismissed the case of Tamesha Means, a Michigan woman who had argued a Catholic-affiliated hospital was negligent in following religious directives in treating her miscarriage.

In 2010, when Tamesha Means showed up at Mercy Health Partners in Muskegon, Michigan, while having a miscarriage, she had every reason to expect the hospital doctors and staff would treat her emergency medical condition. Instead, the Catholic-affiliated health-care entity turned her away twice, effectively telling her to just “wait and see” what would happen.

Means filed suit against Mercy Health Partners and the United Conference of Catholic Bishops (USCCB) in 2013. On Thursday, the Sixth Circuit Court of Appeals ruled that she had failed to state a viable legal claim.

Thursday’s ruling is a narrow one. It does not prevent other patients who have faced similar denials of care from Catholic-affiliated health care facilities from suing based on those denials. But it does suggest those claims will be very difficult to win.

Means’ case is, in some ways, the perfect example of conservative federal courts’ reluctance to second-guess the medical decisions made at religiously affiliated hospitals. When Means first showed up at Mercy, the only hospital in her county, she was 18 weeks pregnant. Her water had broken, and she was beginning to miscarry. Doctors and staff at Mercy Health—which is operated by Trinity Health, a multi-billion dollar network of Catholic-run hospitals—told Means there was no medical care they could offer her. That was because treatment would mean the termination of her pregnancy: a violation of Catholic directives preventing any care resulting in the death of a fetus, even a non-viable one.

So instead, they sent Means home.

Means came back the next day, in pain and this time bleeding vaginally. As detailed in court documents, doctors and staff at Mercy again told Means the only thing they could do was to wait and see how the miscarriage progressed.

Means returned to Mercy Health a third time just days later. Now, she was suffering from a significant infection from her untreated miscarriage. This time, instead of telling Means to just wait it out, hospital staff gave Means some aspirin to treat her fever and prepared to send her home yet again. But before the hospital discharge process for Means was complete, she started to deliver her dying fetus. It wasn’t until then that the hospital agreed to admit her; she delivered a baby who died within hours of birth.

Means eventually sued, claiming the Catholic directives followed by the hospital amount to the provision of negligent care.

These “Ethical and Religious Directives” are not the same thing as professional standards of care, which dictate when a hospital or doctor has committed an act of medical negligence. Rather, they are expressions of religious beliefs. Still, Mercy deferred to them as a defense for its actions, saying its doctors and staff did nothing wrong in relying on those directives, rather than medical standards, when they turned away Means and refused to treat her.

And both a lower court and, now, the Sixth Circuit Court of Appeals have ruled Means’ case could not go forward. This was, in part, because the court felt it was not its job to judge the directives and decide whether or not following them amounted to negligence in the delivery of health care by Mercy and its doctors and staff.

Part of these decisions rests in a legal doctrine dating back more than 100 years called “ecclesiastical abstention.” Both the federal district court and the court of appeals ruled in part that this doctrine prevents courts from reviewing cases like Means’.

According to the doctrine of ecclesiastical abstention, civil courts should be limited in their role in deciding matters of religious controversy. The idea behind the ecclesiastical abstention doctrine is that courts should not settle what would amount to disputes about religious doctrine, which Catholic-affiliated hospitals like Mercy claim their refusal to provide health care to patients like Means amounts to. Specifically in Means’ case, the defendants claimed the directives offer “a statement of the Roman Catholic Church’s moral and religious postures as it relates to health care issues” and are in place “to provide authoritative guidance on certain moral issues that face Catholic health care today.” That means, the bishops and Mercy argued, that interpreting the directives in the context of whether or not carrying out those directives amounts to medical malpractice means interpreting Catholic theology. And according to the bishops and Mercy Health, that is exactly the kind of thing which the ecclesiastical abstention doctrine prohibits.

Thursday’s ruling did not decide definitively whether or not the directives are insulated from judicial review in cases of medical negligence. Instead the court ruled that the USCCB could not be sued in Michigan in this case. According to the court, USCCB’s action of publishing the directives does not “create a substantial connection” between USCCB and Michigan hospitals sufficient to justify bringing the bishops into court to respond to claims like Means’.

But the court used topsy-turvy logic to justify refusing to allow Means to sue the USCCB. According to the court, “Michigan—like every state—does have Catholic hospitals, and USCCB does intend the Directives to be implemented by all Catholic healthcare institutions. USCCB may even have known that Trinity Health is a Catholic hospital network operating in Michigan,” the court wrote. But this is not a “substantial connection” enough that USCCB could expect to be sued when following those directives results in medical negligence, according to the court. Similarly, Mercy cannot be sued in this case for following those national directives.

Approximately one in six hospital beds in the United States are in a facility where health-care delivery is governed by the Catholic directives. In some states, more than 40 percent of all beds fall into that category, with those hospitals routinely refusing to provide comprehensive reproductive health care to patients. As Means’ case illustrates, some patients’ only choice is to seek care at a Catholic-affiliated hospital. If courts are unwilling to hold those institutions accountable for delivering to their patients shoddy and substandard care, in part on the grounds that those hospitals have a religious imperative that courts cannot second-guess, where does that leave patients like Means, whose lives are being put at risk in the name of religiously driven health care?

Source: Rewire