Patients experiencing pregnancy complications have died after being denied emergency medical treatment in states with restrictive abortion laws even where the laws ostensibly allow pregnancy termination when necessary to save a patient’s life. For patients experiencing miscarriage, premature rupture of membranes, placental abruption, severe hypertensive disorders, ectopic pregnancy, and other conditions, a treating physician’s decision about whether their condition qualifies as an emergency under state law can mean the difference between life and death. Physicians who treat obstetric emergencies report being torn between delivering evidence-based care and protecting themselves from criminal prosecution. This article frames physician decision-making about emergency abortion within the larger institutional context in which those decisions arise, providing a taxonomy of the myriad hospital policies that impact physicians who treat obstetric emergencies. It evaluates these institutional procedures’ efficacy with respect to the dual goals of protecting pregnant patients’ health and limiting providers’ exposure to legal risk. The article concludes that the optimal institutional approach grants full deference to physicians’ clinical judgment while also providing robust institutional support in the form of comprehensive legal guidance and guaranteed legal representation for physicians who are prosecuted for making good faith medical judgments. It calls upon hospitals to re-commit to their primary mission of providing high quality patient care, and to dedicate resources to supporting physicians who deliver evidence-based care despite unrelenting legal and political pressures.
