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CNN
14 hours ago
- Health
- CNN
Trump administration's guidance on emergency care law adds to ‘chaos,' not clarity, in states with strict abortion laws, some doctors say
Abortion rights Maternal health Women's healthFacebookTweetLink Follow Federal guidance that the Trump administration says is intended to offer clarity is instead leaving health care providers even more confused about whether they can provide an abortion in an emergency, particularly in states with strict abortion laws. This month, the Trump administration rescinded 2022 federal guidance specifying that under the Emergency Medical Treatment and Labor Act, or EMTALA, people should be able to get an abortion if a medical emergency makes it necessary, even in states with laws that restrict such procedures. HHS and the Centers for Medicare & Medicaid Services said they would continue to enforce the federal law, specifying that the policy included emergency medical conditions that placed the health of a pregnant woman or her unborn child in serious jeopardy. Then, in a letter to health care providers last week, US Health and Human Services Secretary Robert F. Kennedy Jr. emphasized that under EMTALA, stabilizing care should be given to a person who is pregnant and having a medical emergency – but it doesn't specify what that care might involve. In the June 13 letter, Kennedy says that it was the 2022 memo that 'created confusion. But that is no more.' Some doctors beg to differ. It's unclear exactly what the recision of the previous guidance meant for emergency care, particularly in states with highly restrictive abortion laws, some doctors said. The latest letter doesn't mention abortion at all — and the absence of specifics is creating more uncertainty. 'I do think this just contributes to all of the chaos that clinicians are having to deal with as they just attempt to take care of the patient in front of them and navigate state laws and federal guidance to provide care for patients,' said Dr. Nisha Verma, a practicing obstetrician-gynecologist and senior adviser for reproductive health policy and advocacy at the American College of Obstetricians and Gynecologists, a professional organization that represents the majority of practitioners in the United States. 'It's not something you want to get wrong, because the consequences are so severe and it feels so scary.' Verma appreciates that the new letter from Kennedy clarifies that EMTALA is still the law of the land, even after the administration rescinded the 2022 guidance. But without a specific mention of abortion, she said, the nation's patchwork of laws makes it difficult for doctors to navigate emergency situations. Some of those state laws could even send doctors to jail if they make the wrong decision about when an emergency necessitates an abortion. 'I think it was helpful to specify abortion is covered under EMTALA' in the 2022 guidance, Verma said. 'I do think that having that language specifically in this really scary, chilling environment was helpful.' Dr. Alison Haddock, an emergency room doctor who is president of American College of Emergency Physicians, said she was happy that Kennedy's letter confirmed that pregnant patients need access to care and that it included examples of common problems like miscarriages, ectopic pregnancies and premature rupture of membranes. 'Those are some of the situations that have been really challenging for our physicians. Noting that those can represent an obstetric emergency where EMTALA would apply is really good to see,' Haddock said. But she added that the Trump administration's guidance does not clear up everything. 'I think physicians are still going to have issues with conflicting state law where they are still going to be left in a gray area of uncertainty about how to balance adhering to EMTALA and adhering to state law, and that's going to leave patients in the same place,' Haddock said. Trips to the emergency room are common for pregnant people, studies show. The majority of emergency providers say they treat pregnant patients in virtually every shift, according to the American College of Obstetricians and Gynecologists, and in some circumstances, treatment to protect a pregnant person's health or life may require an abortion. Pregnancy emergencies don't always happen during standard work hours, Haddock said, and the 'ability to convene the ethics committee at 2 a.m. is very limited, and then it can be a lot of layers to get through at the hospital.' Haddock said her association sent a letter to its members encouraging them to advocate for clearer guidance from their own hospitals. 'Achieving greater clarity on this is really important to make sure physicians feel like they have the protections they need to provide lifesaving medical care,' she added. Specifics have been important when it comes to EMTALA. When it became federal law in 1986, some hospitals refused to care for uninsured women in labor, so in 1989, Congress spelled out that pregnant people who were having contractions had to be given emergency care even if they couldn't pay for it. In 2021, guidance from the Biden administration added more specifics, saying it was a doctor's duty to provide stabilizing treatment that 'preempts any directly conflicting state law or mandate that might otherwise prohibit or prevent such treatment.' However, it wasn't until the 2022 guidance that it was spelled out that an abortion had to be provided when necessary. The Biden administration guidance was meant to eliminate confusion in states with anti-abortion laws that did not include an exception for the life or health of a pregnant person, and it stated that federal law preempted the state statutes in the case of such laws. That memo was issued just weeks after the US Supreme Court overturned Roe v. Wade, the 1973 ruling that gave pregnant people a constitutional right to an abortion. A case before the court last year would have clarified whether federal law requires health care services to provide access to emergency care in every state, regardless of abortion laws, but the high court sent it back to the lower courts. In March, the Trump administration dropped the lawsuit. Some legal experts interpreted that as a signal that the administration would not enforce EMTALA. Even when the 2022 guidance was in place, provider surveys in states that criminalized abortion found that doctors were operating in 'chaos and confusion,' said Payal Shah, director of research, legal and advocacy with the Physicians for Human Rights a Nobel Peace Prize-winning medical and human rights organization. Providers were still having a hard time determining whether EMTALA really would protect them if they had to perform an abortion, even in an emergency situation. 'Criminalization causes fear, and then clinicians feel paralyzed,' Shah said. 'They don't feel like they have the authority to make decisions about reproductive health care in line with their medical judgment and medical ethics and pregnant patients' preferences. Instead, it becomes a legal decision.' After the Dobbs decision removed the federal right to an abortion in 2022, some women died after doctors told them it would be a 'crime' to intervene in a miscarriage or they couldn't access timely medical care. Idaho's strict abortion law has led some doctors to tell pregnant patients that they should consider buying 'life flight insurance' in case a local hospital wouldn't be able to take care of a pregnancy complication. Rescinding the 2022 guidance will probably make stories like these more common, several experts said. 'Rescinding this guidance serves no purpose other than to try to strengthen or deepen that confusion,' Shah said. 'This is an attempt to gaslight the American public and to say that criminalization of abortion is working. Criminalization is not working, and that is something the evidence really shows.' Alexa Kolbi-Molinas, deputy director of the ACLU's Reproductive Freedom Project, interprets the new HHS letter to mean the law does require emergency abortion care, but she added that the administration's actions on the matter 'have been reckless at best and outright dangerous at worst.' 'The Trump administration is scrambling to clean up a mess entirely of its own making,' Kolbi-Molinas said in an email. 'The law has been clear for forty years: pregnant patients who go to a hospital in medical crisis must receive health- and lifesaving care, regardless of state law. If the administration had not rescinded the previous guidance reaffirming hospitals' obligations to provide this care earlier this month, there would have been no need to issue Friday's letter.' HHS did not respond to direct questions about what 'stabilizing care' meant and whether its interpretation of EMTALA included abortion as stabilizing care. Instead, a spokesperson for the agency sent a link to a June 4 message on X from Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services. 'Don't believe the spin and fearmongering of the fake news,' the post said. 'The Biden Administration created confusion, but EMTALA is clear and the law has not changed: women will receive care for miscarriage, ectopic pregnancy, and medical emergencies in all fifty states- this has not and will never change in the Trump Administration.' 'To me, this question remains: Why won't they use the word 'abortion' if they really believe that abortion is sometimes part of emergency medical care for pregnant people? They won't do it,' said Rebecca Hart Holder, president of Reproductive Equity Now. 'If the Trump administration or Secretary Kennedy truly intended to reassure providers that abortion in the case of a medical emergency, is protected under EMTALA, they would have used those words explicitly as a qualifying example of emergency medical care,' Hart Holder added. 'I think it's a fair assumption to make that even more people are going to die when they're in emergency situations.' In the wake of Dobbs, the Kennedy letter presents another potential problem, said reproductive law expert Rolonda Donelson. 'In the letter, he mentions that EMTALA requires caring for the pregnant woman and their unborn child. Pre-Dobbs, that might not have meant much, but post-Dobbs, with the rise in fetal personhood in state abortion bans, it raises questions on whether the providers in these emergency departments have any duty to the unborn fetus and whether they can provide this emergency stabilizing care when it conflicts with their state abortion ban,' said Donelson, the Huber Reproductive Health Equity Legal Fellow at the National Partnership for Women & Families. 'This guidance does not provide any clarification. It increases chaos and confusion among patients, providers and everyone on whether they can go into an emergency department if they're experiencing a medical emergency and receive an abortion as necessary stabilizing care.' In March, concerned that even more clarity was needed, 88 lawmakers reintroduced a resolution that affirmed EMTALA protects access to emergency abortion care. But even if such a bill were to make its way through Congress, it's unclear whether Trump would sign it. In the absence of additional legislation, legal experts say, the confusion will continue placing an unfair burden on doctors and patients. 'It's unrealistic to have doctors who should be saving patient lives and doing all of those important things to try and also be lawyers and policy advocates and figure out the nitty gritty of what these things mean,' Donelson said. But it's important for patients to know, she said, that they should go to an emergency room if they are experiencing a medical emergency. 'The last thing I would want is a pregant person who is experiencing a medical emergency to think that they won't be able to get care at a hospital and forgo going and then something bad happen to them.'
CBS News
3 days ago
- Politics
- CBS News
U.K. parliament poised to decriminalize abortion in England and Wales as crime bill amendment passes easily
London — British lawmakers voted Tuesday to decriminalize abortion in England and Wales after a lawmaker argued it was cruel to prosecute women for ending a pregnancy. The House of Commons approved an amendment to a broader crime bill that would prevent women from being criminally punished under an antiquated law. Tonia Antoniazzi, the Labour Party member of Parliament who introduced one of the amendments, said the change was needed because police have investigated more than 100 women for suspected illegal abortions over the past five years, including some who suffered natural miscarriages and stillbirths. "This piece of legislation will only take women out of the criminal justice system because they are vulnerable and they need our help," she said. "Just what public interest is this serving? This is not justice, it is cruelty and it has got to end." The amendment passed 379-137. The House of Commons will now need to pass the crime bill, which is expected, before it goes to the House of Lords, where it can be delayed but not blocked. Protesters from the "Abortion Rights" group gather near the U.K. Parliament in London, where lawmakers were voting on an amendment to decriminalize abortion, June 17, 2025. Alishia Abodunde/Getty Under current law, doctors can legally carry out abortions in England, Scotland and Wales up to 24 weeks, and beyond that under special circumstances, such as when the life of the mother is in danger. Abortion in Northern Ireland was decriminalized in 2019. There is no specific law in Scotland barring abortions, and the country is generally viewed as more lenient in its approach to enforcing other laws that could apply in abortion cases, though rights advocates continue to call for a domestic law specifically decriminalizing the act. Changes in the law implemented during the COVID-19 pandemic allow women to receive abortion pills through the mail and terminate their own pregnancies at home within the first 10 weeks in England and Wales. That has led to a handful of widely publicized cases in which women were prosecuted for illegally obtaining abortion pills and using them to end their own pregnancies after 24 weeks or more. Anti-abortion groups opposed the measures, arguing it would open the door to abortion on demand at any stage of pregnancy. "Unborn babies will have any remaining protection stripped away, and women will be left at the mercy of abusers," said Alithea Williams, public policy manager for the Society for the Protection of Unborn Children, which describes itself as the U.K.'s biggest pro-life campaign group. The debate came after recent prosecutions have galvanized support to repeal parts of the 1861 Offences Against the Person Act. In one case, a mother of three was sentenced to more than two years in prison in 2023 for medically inducing an abortion about eight months into her pregnancy. Carla Foster, 45, was released about a month later by an appeals court that reduced her sentence. Judge Victoria Sharp said that case called for "compassion, not punishment" and there was no useful purpose in jailing her. Last month, a jury acquitted Nicola Packer on a charge of unlawfully self-administering poison or a noxious thing with intent to procure a miscarriage. Packer, who took abortion medicine when she was about 26 weeks pregnant, testified that she did not know she had been pregnant more than 10 weeks. Supporters of the bill said it was a landmark reform that would keep women from going to prison for ending their pregnancy. "At a time when we're seeing rollbacks on reproductive rights, most notably in the United States, this crucial milestone in the fight for reproductive rights sends a powerful message that our lawmakers are standing up for women," said Louise McCudden of MSI Reproductive Choices. A second amendment that would have gone even further than Antoniazzi's proposal, barring the prosecution of medical professionals and others who help women abort their fetuses, did not get to a vote. A competing Conservative measure that would have required an in-person appointment for a pregnant woman to get abortion pills was defeated.
The Guardian
01-06-2025
- General
- The Guardian
Exit poll in Polish presidential run-off puts candidates neck and neck
An exit poll in Poland's crucial presidential run-off suggested the race is too close to call, giving a slight lead to the liberal contender, Rafał Trzaskowski, but with the difference between the two candidates within the margin of error. The poll by Ipsos Poland, released at 9pm local time (8pm BST) on Sunday as polls closed, put Trzaskowski, backed by the current government led by Donald Tusk, on 50.3%, with the rightwing contender Karol Nawrocki on 49.7%. The poll's margin of error was 2%. Despite the slim margin offered by the poll, Trzaskowski immediately appeared on stage in Warsaw to claim victory. 'We've won!' he announced to cheers from the crowd, before giving a victory speech thanking his family and supporters. In a speech at his own campaign headquarters, Nawrocki did not concede, saying he remained confident he would win when all the votes were counted. During a bitterly fought and often bad-tempered campaign, the two men have offered very different visions of Poland, and the result of the race will have enormous implications for the country's political future, given the president's ability to veto government legislation. Trzaskowski is the pro-European, progressive mayor of Warsaw, who supports the liberalisation of abortion laws and the introduction of civil partnerships for LGBT couples. Nawrocki, a historian and former amateur boxer, has firmly rejected these moves and would likely veto any moves to implement them if elected. The run-off came after neither candidate achieved more than 50% of votes in a crowded first-round vote two weeks ago. The winner will replace the outgoing president, Andrzej Duda, who will step down in August after completing two terms. Duda is a political ally of the rightwing Law and Justice (PiS) party, which ruled Poland until Tusk's coalition won parliamentary elections in late 2023. Tusk's time as prime minister has been marked by difficulties bringing his broad coalition into line, but also by having an ideologically opposed president in office. While the presidential role is largely ceremonial, it does have some influence over foreign and defence policy, as well as the critical power to veto new legislation. This can only be overturned with a 60% majority in parliament, which Tusk's government does not have. Trzaskowski would smooth the way for Tusk to govern with intent, while a Nawrocki win would prolong the current deadlock, making it difficult for the government to pass any major reforms before the 2027 parliamentary election. 'Tusk knows the stakes and that if Nawrocki wins, he's got a lame-duck administration for the next couple of years. And it will be worse than with Duda as Nawrocki will come in fresh, with a new mandate from what effectively turned into a referendum on the government,' Prof Aleks Szczerbiak, who teaches east and central European politics at the University of Sussex, said. Trzaskowski, the Oxford-educated mayor of Warsaw since 2018, who previously held ministerial posts and served in the European parliament, has sought to project himself as a safe pair of hands to work with the government on implementing progressive reforms. However, he has had to defend himself against suggestions he is out-of-touch and elitist, and against allegations about foreign funding for online advertising promoting his candidacy. Sign up to This is Europe The most pressing stories and debates for Europeans – from identity to economics to the environment after newsletter promotion Nawrocki, a historian and former museum director, has been head of the Institute of National Remembrance, a state research body often accused of peddling a politicised version of history, since 2021. During the campaign, a number of scandals about his alleged past conduct were aired in the media. In the final days of the campaign, both candidates sought to court voters of candidates knocked out in the first round and mobilise their supporters. 'This election could be decided by single votes,' Nawrocki told a rally of supporters last week. Trzaskowski also said every vote would be crucial. 'Encourage everyone, so that as many Poles as possible vote in the presidential election,' he told a rally on Friday. A high turnout in the parliamentary vote in 2023, especially among younger urban Poles, was seen as crucial to securing victory for Tusk's coalition.
