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And this is where the Sophie's Choice comes in.
Because you are absolutely right. Nobody wants to have to explain that to someone in immediate need.
But what about his other patients? What about the high risk pregnancies that he's been carefully monitoring for the past several months? Will any of them even be able to find another doctor that knows about whatever specific condition they have? What happens if you're one of the only, if not the only OB/GYN in an underserved rural area? What happens when other doctors in the area close up shop out of fear of being the next one prosecuted?
There is no good answer. That's the whole point. The doctor has to choose between saving the one vs. saving the many.
I don't think they want to be left on the ER bleeding out either. In theory, that means coming together as a community to reject this horrific policy. In practice, it appears to be looking the other way and feeling #Blessed that you're not the one doing the suffering.
I actually heard about a surgeon out in Beaumont, TX who used to race his Lamborghini up and down I-35. That section of the road is swarming with police, but any time he got clocked the police would pull him over and politely give him a warning. That's because he had a reputation for saving lives - particularly cop lives - any time they'd get injured on the job and wheeled in to the ER.
If you're the only doctor in town who can safely deliver a baby (and you don't suck at your job) you are going to enjoy not an insignificant amount of political clout. You're absolutely the person who is in the best position to defiantly act against this kind of law, because you've got the leverage by being the person with the skills to do the job.
But if you're not willing to stand up, why on earth would you expect anyone else to do it?
The good answer is to save the life in front of you and go on from there.
This is 100% correct and exactly what's happening. And that's because deep-red states are giving people no other options. Sure, the doctor could take a stand and say "I'm saving this woman's life because it's the right thing to do, laws be damned!". And he could very well save the life of that theoretical patient bleeding out. What you don't seem to get is that this doesn't magically lead to a situation where he keeps seeing other patients. Now, these doctors face jail time and being stripped of their licenses, denying countless women and their babies the services that they need to live as well. It ends up leading to underserved rural communities even more underserved, creating a downward spiral of problems due to a lack of even basic prenatal care because doctors don't want the legal risks that come with caring for pregnant patients.
It's already happening in Idaho. It ends up being a net negative to everybody. This is what doctors have to consider; save the one, or save the many?
Again, this is already happening in Idaho, and the results that are being reported contradict your example. Doctors are leaving in droves because of the restrictive laws in the state. The ones that remain aren't being given preferential treatment because of the services they provide. The government of Idaho is actively trying to run the ones that are remaining out of the state as well.
Heck, did you see how abortion providers were treated in red states before Roe was tossed out? They don't get treated with some kind of preferential treatment. No, they're under constant death threats and are barely protected by a government that actively wanted them gone in the first place. They've always been about as welcome in those states as a Nazi in a synagogue.
You don't think they would if they could? You again continue to ignore the costs associated with making that choice.
Tell that to the family of every woman that suffers as a result of not getting the care they need once he's gone.
And for the record -- at no point are you wrong. In fact, I'd be making some of the exact same arguments you're making right now if our positions were reversed. That's the whole point I've been trying to make. There are no good options. The government and the Supreme Court has put doctors and patients in a position where no matter what they pick, everybody loses. Whether or not they make the 'right' choice is up for debate, but you can't blame doctors for understanding the reality of the situation and trying to minimize the losses in the long run as much as possible. It may be awkward for him to have to explain that to one patient now, but if he doesn't, several other doctors will have to give that explanation to patients who are affected by him being gone later.
It's an age old thought experiment, being played out in real time, with real people. Do you sacrifice the one to save the many?
I think they would rather avoid an immediate conflict with their own managers and the more zealous members of the community than to take any amount of personal risk to their careers. And, as a result, they are leaving an uncountable number of people to suffer and die, because they no longer have any confidence in the American medical system.
The costs associated with not making the choice rack up every time good people refuse to act.
If we're serious about delivering care to every woman that needs it, we can expand Medicaid to cover everyone without insurance and have the DOJ step in to provide legal aid to any doctor caught in the legal crossfire.
This isn't just a problem of doctors. Its a political problem as well. But the doctors are the people on the front lines. If they are too terrified to even make the attempt to deliver services to people in need, no woman is safe and the volume of untreated patients will continue to balloon.
So much so that its practically a joke.
But the solution to the trolley problem is to stop the trolley, not to console yourself by driving down a track where you can't see as many people.
You're agreeing that this is a political problem, but you're still putting the impetus and responsibility on the physician in that situation. If we're using the trolley problem as an example, the person holding the switch to choose between the 5 people in harm's way, or actively switching it to one person who currently isn't in harm's way....the switch just changes the track direction. That person doesn't have access to brakes, or a "derail" option. The physician in that situation has to choose between actively leaving one person in harm's way, or allowing many people to suffer down the line.
Personally, I don't have kids, I'm not going to have kids, and it's just me and my husband. I don't have a whole family of lives to ruin by getting into legal trouble by running afoul of this, but I don't blame the physicians who do have a lot to lose. Also, I know enough about the legal system and how medical documentation and coding work to make it tough for the hypothetical prosecutor to pin things on me. Hell, I'm still a student and I'm thinking up ways to play this horrible game they've set up, and I think some of my solutions will be pretty clever if I ever have to use them. I will not be sharing any of those ideas, but I have quite a few of them.
The physician who engages with these laws becomes a political actor. Medical centers don't have a political commissar sitting around enforcing the party line, they've got civilian staff and administration. The choice they make in enacting or ignoring these laws is a political one.
The physician makes the choice of who to save in the moment, and then private administrators, local law enforcement, and courts decide how many people suffer down the line.
More power to you. But whatever you do (or refuse to do) is as political a decision as anything your bosses and local government enact above you.
Well, time to Godwin's Law this discussion I guess.
What you're suggesting is an expectation for physicians to do something akin to actively defying the Nazi regime to hide/evacuate/personally protect vulnerable people who the Nazis are trying to round up. The people in Nazi Germany who put their lives and livelihoods on the line to help shield people from the concentration camps are unequivocally heroes in every sense of the word.
It is unreasonable to expect, much less demand true heroism from people who are trying to live their lives. Right now, the penalties for performing an illegal abortion in Texas are loss of your medical license and a minimum of 5 years' imprisonment, and maximum of 99 years' imprisonment, as well as a $100,000 fine per instance. (They are very generous though, in that if the fetus miraculously survives, it's only a second degree felony that carries a mandatory sentence of 2 to 20 years).
You are effectively insisting that physicians put in this position must put their entire profession, career, livelihood, and potentially even their life on the line in the hopes that the politically selected prosecutor elects to not pursue charges. That's a hell of a gamble without even beginning to consider the impact of the loss of a physician would have on their community.
This is a political problem with a political solution, but despite my own intentions and moral convictions, I would never presume to insist that another physician puts everything on the line to stand up to the modern Nazi party. (because, let's be honest, that's what the GOP is now.)