This article was featured in the One Story to Read Today newsletter. . “I’m standing in front of doctors who know exactly what to do and how to help and they’re refusing to do it.” Another woman whose water broke early went into labor en route to Portland, her doctor told me, and delivered her fetus hundreds of miles from home. Her baby did not survive, and she was left to figure out how to get back to Idaho by herself—a medical transport is only a one-way ride. Another became infected and turned septic in the hours it took her to get to Salt Lake City. She had to go to the ICU, says Lauren Theilen, an MFM at the Utah hospital where she was taken. Other patients were sick when they left Idaho and even sicker when they arrived somewhere else.
Where exactly was that line between a patient who could be transferred versus one who needed care immediately, then and there? “I have sometimes wondered if I’m being selfish,” says Stacy Seyb, a longtime MFM at St. Luke’s, by putting patients through medical transfer to avoid legal sanction. But no doctor works alone in today’s hospitals. When one of the first legally ambiguous cases came up, Seyb saw the unease in the eyes of his team: the nurses, the techs, the anesthesiologists, the residents—all the people who normally assist in an emergency abortion. If he did something legally risky, they would also be exposed. Idaho’s law threatens to revoke the license of any health-care professional who assists in an abortion. He came to feel that there was no good option to protect both his team and his patients, but that an out-of-state transfer was often the least terrible one. In Portland or Seattle or Salt Lake City, health-care providers do not have to weigh their own interests against their patients’.
In April, when the Supreme Court heard the Idaho case, the media seized upon the dramatic image of women being airlifted out of state for emergency abortions. Justice Elena Kagan made a point of asking about it in oral arguments. In a press conference afterward, Idaho’s attorney general, Raúl Labrador, pushed back on the idea that airlifts were happening, citing unnamed doctors who said they didn’t know of any such instances. If women were being airlifted, he said, it was unnecessary, because emergency abortions were already allowed to save the life of the mother. “I would hate to think,” he added, “that St. Luke’s or any other hospital is trying to do something like this just to make a political statement.” (St. Luke’s had filed an amicus brief with the Court in support of the federal government.)
Labrador’s comments echoed accusations from national anti-abortion groups that doctors and others who support abortion rights are sowing confusion in order to “sabotage” the laws. When Moon, the chair of the Idaho Republican Party, had rallied lawmakers against any health exceptions back in 2023, she’d also evoked the specter of “doctors educated in some of the farthest Left academic institutions in our country.” (Neither Labrador nor Moon responded to my requests for an interview.)
It is true that doctors tend to support abortion access. But in Idaho, many of the ob-gyns critical of the ban are not at all pro-abortion. Maria Palmquist grew up speaking at Right to Life rallies, as the eldest of eight in a Catholic family. She still doesn’t believe in “abortion for birth control,” she told me, but medical school had opened her eyes to the tragic ways a pregnancy can go wrong. Lately, she’s been sending articles to family members, to show that some women with dangerous pregnancies need abortions “so they can have future children.”
Kim Cox, the doctor who told me about a patient who had a relatively healthy child after PPROM at 16 weeks, practices in heavily Mormon eastern Idaho. Cox said that “electively terminating” at any point in a pregnancy is “offensive to me and offensive to God.” But he also told me about a recent patient whose water had broken at 19 weeks and who wanted a termination that he was prepared to provide—until he realized it was legally dicey. He thought the dangers of such cases were serious enough that women should be able to decide how much risk they wanted to tolerate. Because, I ventured, they might already have a kid at home? “Or 10 kids at home.”
Megan Kasper, an ob-gyn in Nampa, Idaho, who considers herself pro-life, told me she “never dreamed” that she would live to see Roe v. Wade overturned. But Idaho’s law went too far even for her. If doctors are forced to wait until death is a real possibility for an expecting mother, she said, “there’s going to be a certain number of those that you don’t pull back from the brink.” She thought the law needed an exception for the health of the mother.
In the two-plus years since the end of Roe, no doctor has yet been prosecuted in Idaho or any other state for performing an abortion—but who wants to test the law by being the first? Doctors are risk-averse. They’re rule followers, Kasper told me, a sentiment I heard over and over again: “I want to follow the rules.” “We tend to be rule followers.” “Very good rule followers.” Kasper said she thought that, in some cases, doctors have been more hesitant to treat patients or more willing to transfer them than was necessary. But if the law is not meant to be as restrictive as it reads to doctors, she said, then legislators should simply change it. “Put it in writing.” Make it clear.
She does wonder what it would mean to test the law. Kasper has a somewhat unusual background for a doctor. She was homeschooled, back when it was still illegal in some states, and her parents routinely sent money to legal-defense funds for other homeschoolers. “I grew up in a family whose values were It’s okay to take risks to do the right thing,” she told me. She still believes that. “There’s a little bit of my rebel side that’s like, Cool, Raúl Labrador, you want to throw me in jail? You have at it.” Prosecuting “one of the most pro-life OBs” would prove, wouldn’t it, just how extreme Idaho had become on abortion.
When I visited Boise in June, doctors were on edge; the Supreme Court’s decision on emergency abortions was expected at any moment. On my last day in town, the Court accidentally published the decision early: The case was going to be dismissed, meaning it would return to the lower court. The injunction allowing emergency abortions would, in the meantime, be reinstated.
As the details trickled out, I caught up with Thomson, who was, for the moment, relieved. She had an overnight shift that evening, and the tight coil of tension that had been lodged inside her loosened with the knowledge that EMTALA would soon be back in place, once the Court formally issued its decision. Doctors at St. Luke’s also felt they could stop airlifting patients out of state for emergency abortions.
But Thomson grew frustrated when she realized that this was far from the definitive ruling she had hoped for. The decision was really a nondecision. In dismissing the case, the Court did not actually resolve the conflict between federal and state law, though the Court signaled openness to hearing the case again after another lower-court decision. The dismissal also left in place a separate injunction, from a federal appeals court, that had blocked enforcement of EMTALA in Texas, meaning that women in a far larger and more populous state would still be denied emergency abortions. This case, too, has been appealed to the Supreme Court.
Moreover, the federal emergency-treatment law has teeth only if an administration chooses to enforce it, by fining hospitals or excluding them from Medicare and Medicaid when they fail to comply. The Biden administration has issued guidance that says it may sanction hospitals and doctors refusing to provide emergency abortion care, and as vice president, Kamala Harris has been a particularly vocal advocate for abortion access. A Trump administration could simply decide not to enforce the rule—a proposal that is outlined explicitly in Project 2025, the Heritage Foundation’s blueprint for a second Trump term. If the emergency-treatment law is a mere “Band-Aid,” as multiple doctors put it to me, it is one that can be easily torn off.
EMTALA is also limited in scope. It covers only patients who show up at an ER, and only those with emergency pregnancy complications. It would not apply to women in Idaho whose pregnancies are made more dangerous by a range of serious but not yet urgent conditions (to say nothing of the women who might want to end a pregnancy for any number of nonmedical reasons). It would not apply to the woman carrying triplets who, as an MFM recounted to me, wanted a reduction to twins because the third fetus had no skull and thus could not live. She had to go out of state to have the procedure—tantamount to an abortion for just one fetus—which made the pregnancy safer for her and the remaining babies. And it did not apply when Kayla Smith, already grieving for her unborn son, worried about preeclampsia. Her family ultimately left Idaho for Washington, so she could have another child in a safer state; her younger daughter was born in late 2023.
Smith has joined a lawsuit filed by the Center for Reproductive Rights challenging the limited scope of exceptions under Idaho’s ban. A group in Idaho is also planning a ballot initiative that will put the question of abortion to voters—but not until 2026. In the meantime, doctors still want Idaho to add medical exceptions to the law. After the disappointingly narrow exceptions the state legislature passed in 2023, it did nothing more in its 2024 session. A hearing that Thomson was slated to speak at this spring got canceled, last minute, by Republicans, who control the legislature.
Still, Thomson told me she was set on staying in Idaho. She and her husband had moved their family here 11 years ago because they wanted their four kids to “feel like they’re from somewhere.” Having grown up in a Navy family, she’d moved every few years during her own childhood before joining the military for medical school and continuing to move every few years as a military doctor. When her son was just 14 months old, she deployed to Iraq. She got her job in Idaho after that. When she and her husband bought their house, she told him this was the house she planned to live in for the rest of her life.
In the past two years, she’d seriously wavered on that decision for the first time. The moral distress of practicing under the ban had sent her to see a counselor. “I was in a war zone,” she told me, “and I didn’t see a counselor.” This past fall, she came up with a backup plan: If she had to, she could stop practicing in Idaho and become a traveling doctor, seeing patients in other states.
But then she thought about all the women in Idaho who couldn’t afford to leave the state for care. And she thought of her kids, especially her three girls, who would soon no longer be girls. The eldest is 20, the same age as a patient whose baby she had recently delivered. “This could be my daughter,” Thomson thought. If everyone like her left, she wondered, who would take care of her daughters?
This article appears in the October 2024 print edition with the headline “What Abortion Bans Do to Doctors.”
