Dean's Update
June 24, 2022 - Aron Sousa, MD
Friends,
Today, the U.S. Supreme Court released its opinion reversing the 1973 Roe v. Wade decision that had made abortion legal, if not universally accessible, in the U.S. The new ruling makes the legality of abortion an issue of state law, and for Michigan revives a 1931 law that prohibits abortion. That statute makes it illegal to perform abortions or to provide or prescribe medications that lead to miscarriages or abortions “except to preserve the life of the mother.”
Emergency contraception (levonorgestrel and ulipristal acetate) does not end a pregnancy but prevents one, and so should, in theory, remain legal and available under the 1931 Michigan law. But no one really knows how the legislation will be interpreted. Mifepristone, also known as RU-486, is an oral medication that can be used for ending a pregnancy, and it is sure to be illegal when the current Michigan law takes effect.
There is currently a court injunction against the 1931 law preventing its immediate implementation. Without additional legislation or court action, when the injunction ends, women in Michigan will no longer be able to legally access this part of health care unless their lives are in danger. How to define whether a woman’s life is in danger is not at all clear in the statute. Health care providers who run afoul of a prosecutor’s office would be subject to felony prosecution.
Many medical societies view abortion as health care and these groups are generally opposed to legal limitations on decisions that patients make with their care providers. As an example, the American College of Physicians’ policy on abortion is “to protect patient health, privacy and autonomy and the patient-physician relationship, from government interference.” As a few of many examples, the American College of Obstetricians and Gynecologists, American Academy of Family Physicians, American Medical Association, American Association of Medical Colleges, and the American Public Health Association all have similar positions.
The College of Human Medicine as an entity does not take positions on political issues, but people in the college may. And, like most people in Michigan and America, the views of the people of the college are likely to be more complicated and subtle (and thoughtful) than many of our political leaders, who tend to see the issue as an all-or-none phenomenon.
As an example, after the leak of the Supreme Court draft decision in May, I had a conversation with a college colleague who comes to the abortion discussion from a different position than I do. I’ll admit I approached the conversation with trepidation. My colleague and I have an excellent working relationship, which means a great deal to me, and talking about such a polarizing topic was a little scary for its potential to harm our friendship. I want my colleagues to be comfortable in the college, while many of us advocate for one position or another.
As it turned out, my colleague and I had a good conversation about abortion in which it became clear neither of us were as far from each other as we might have thought before we spoke. We were both worried about the extremism in the 1931 law. And, although we don’t agree on the topic, we thought there was probably a middle ground to be found.
Although polls vary in their specifics, most people have complex views of abortion. Relatively small percentages of people think abortion should always be legal or illegal. These polls show most people think there are times abortion should be legal and some limits to when abortion should be legal, as was the case under Roe. And, most people in this country support access to abortion.
While the college will not have a formal position on this court decision, we will have to address the implications of it. In concert with the leadership of the university, I am committed to “reproductive health care as a basic human right.” The college will continue to educate students and residents about all aspects of reproductive care. We will do our best to give patients the very best reproductive care we can.
Fundamentally, this decision will worsen health inequities. Certainly, access to health reproductive choices will now be limited by geography and resources in fundamental ways. At a more basic level, this is a decision that creates new health inequity about the agency and autonomy of all women and whether they have the fundamental right to control their bodies. I continue my commitment to the work our students, staff, and faculty do to increase health equity.
I am also personally convinced this issue is special because of the long-standing oppression of women in our society stretching from chattel status through denial of property and voting rights to pervasive sexual harassment and domestic violence mostly impacting women to the limits on educational and occupational opportunities so many women have experienced. Context matters. That is not a college position; as I said, the college has no position, but this is how I think about the issue.
On another personal note, I was a clinic defender in medical school when there were protesters at a local Planned Parenthood clinic in Bloomington, Indiana. And in my family, we have good reason to believe that one of my great grandmothers died in California of a botched home abortion; I can only imagine her desperation.
This is a very important health issue for our students, our staff, our faculty, and our patients. We will listen to each other, we will be civil to each other, and we respect each other’s position. I am committed to a culture in which everyone will be able to work and study at the College of Human Medicine.
Serving the people with you,
Aron
Aron Sousa, MD
Dean