IMPOSSIBLE CHOICES

Hackney discusses how the U.S. Supreme Court’s overturning of Roe v. Wade transformed the world of high-risk obstetrics.

The author, a medical doctor and a professor of reproductive biology at Case Western Reserve University, calmly and systematically lays out the repercussions for patients and physicians after the Supreme Court’s decision in the 2022 case Dobbs v. Jackson Women’s Health Organization. Succinctly noting how “medicine, at its most fundamental, lies at the intersection of facts and choices,” he aims to provide the facts necessary to make what he characterizes as impossible decisions. The ramifications of Roe’s defeat occupy three sections. In the first, he explains what’s involved in high-risk obstetrics, discussing uncertainty factors and elucidating physicians’ quandaries and legal risks in cases in which abortion is criminalized. He also describes decision-paralysis among physicians, examines what medical expertise comprises, and addresses why trust in doctors has eroded. Finally, he questions the differing standards of responsibility for physicians and legislators, asking pointedly, “why is the bar set so much lower for democracy than medicine?” Two subsequent sections examine the impact of Dobbs on the status quo, including specific legal, ethical, and care complications for physicians and patients. Hackney emphatically advocates bodily autonomy and physician empathy, rather than moral judgment, but he’s clear about the moral injury that abortion bans inflict. Writing for an educated audience, but not in abstruse language, Hackney effectively engages readers with moving personal anecdotes that vividly dramatize the issues under discussion, often employing pithy expressions; he notes that “risk is the marriage between what we know and what we do not” and that people can “impose abortion bans or uphold…representative government, but not both.” Hackney unambiguously observes that legislative intrusion into medicine affects everyone, not just those who are pregnant. Although this book will undoubtedly be useful to physicians and patients, many general readers will also feel rage and poignant sympathy; above all, the book seems intended for legislators and judges, since it grapples with the real-world difficulties they’ve created.

A sensitive, wide-ranging, and deeply thoughtful examination of the consequences of abortion bans.