Since the U.S. Supreme Court’s overturning of Roe v. Wade in June 2022, a patchwork of laws that ban abortions have been implemented in numerous states, including Missouri, raising concerns about medical care that could impact pregnancies.
One story began circulating on social media, claiming that breast cancer patients from Missouri were no longer being given hormonal therapy treatments or radioactive isotopes in Veterans Affairs (VA) hospitals because of Missouri’s anti-abortion “trigger law” that took effect after Roe was overturned.
We reached out to the person who made these claims on Twitter, and will update this post if we get more information. We have also reached out to representatives from Veterans Affairs and the Veterans Administration’s (VA) St. Louis Health Care System. While no one was able to confirm the details behind the claims, a spokesperson from the VA told us that the care they provide to pregnant veterans has not changed. They gave us the following statement (emphasis ours):
We recognize this is a rapidly evolving landscape, and we are assessing the impact of the Dobbs decision while remaining in close contact with Veterans and their families. The care VA provides to Veterans – including pregnant Veterans – has not changed. Any treatment consistent with VA policy before the Dobbs decision was issued remains lawful now. By regulation, VA does not provide abortion services or travel assistance related to abortion procedures. As the Secretary noted, access to contraception and fertility services is and will remain a critical component of Veteran health care, and VA will continue to deliver reproductive health care operations consistent with our Federal legal authority.
VA hospitals fall under the federal government’s purview but do not provide abortions or abortion-related counseling services.
[…] a condition which, based on reasonable medical judgment, so complicates the medical condition of a pregnant woman as to necessitate the immediate abortion of her pregnancy to avert the death of the pregnant woman or for which a delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function of the pregnant woman.
That definition has many physicians concerned that they cannot intervene and carry out an abortion unless the person’s condition becomes extremely dire. Democratic Missouri state Rep. Sarah Unsicker sent a letter to Missouri Attorney General Eric Schmitt, calling on him to define cases he would not prosecute due to the medical emergency. She asked him to address ectopic pregnancies, miscarriage management, and cancer care in which pregnancy could become dangerous, among other instances. She also noted social media reports about patients being denied radiation therapy for cancer, and wanted clarity around the law.
Doctors around the country are worried that they will spend time defending their medical decisions in courts, where they will face legal consequences. Molly Meegan, chief legal officer for the American College of Obstetricians and Gynecologists, said in a media briefing, “If a doctor can’t tell what the law is at the time they are trying to provide care, it has a terribly chilling effect on the medical care that is provided.”
Around 1 in 1,000 pregnancies can be affected by cancer care, according to a 2020 review by doctors at the University of California at San Francisco (UCSF). While some people can remain pregnant while receiving treatment for cancer, sometimes cancer care can harm a pregnancy.
Harold Burstein, a breast cancer specialist at the Dana-Farber Cancer Institute in Boston told Bloomberg, “Sometimes, that involves discussion of abortion, to enable certain kinds of cancer treatment. Every busy cancer center will see patients like this every year.”
And some treatments cannot take place without terminating the pregnancy. Pelvic radiation for rectal cancer, for example, cannot be done without harming the fetus, according to Katherine Van Loon, a specialist in gastrointestinal cancers at UCSF.
Other cancer treatments, like surgery to remove a tumor, wouldn’t require an abortion, according to Dr. Karen Knudsen, chief executive officer of the American Cancer Society. Stephanie Blank, president of the Society of Gynecologic Oncology, told Insider that chemotherapy and radiation therapy can, in some cases, affect a fetus and raise the risk of miscarriage.
Insider reported on one case from Ohio, where a pregnant cancer patient was turned away from seeking an abortion. Val Haskell, who ran the Women’s Med Center in Dayton, said the woman did not expect to get pregnant and learned about her pregnancy in June, midway through her cancer treatment. Her doctors reportedly ended her medication and cancer treatment, and she was past the six-week threshold in the state when the Supreme Court overturned Roe. According to Haskell, the woman had to cross state lines to Indiana for termination on June 30.
Missouri doctors could be found guilty of a class B felony if they carried out abortions, resulting in five to 15 years in prison, or revokation or suspension of their medical licenses. Lisa Larson-Bunnell, a healthcare regulatory attorney with a Missouri hospital, told the Missouri Independent that the confusing statute could mean doctors delaying life-saving care if they don’t think a patient is near enough to possible death. Larson-Burnell said experts are also wondering about whether people diagnosed with cancer during pregnancy can have an abortion in order to receive radiation treatment or chemotherapy. So far there are no clear answers.
Katy Liu, a family medicine doctor in St. Louis, argued that if a woman got an aggressive cancer early in her pregnancy, it would not run afoul of the law or her own beliefs to carry out an abortion. While it would not be an immediate medical emergency, Liu argued it would still be permissible under the abortion ban. But not everyone feels that way.
Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri, said in a virtual town hall: “In order for doctors to avoid prison time, instead of treating a patient before their health condition becomes life-threatening, doctors are now contemplating how sick is sick enough before I can provide life-saving care […] Care will be delayed and people will suffer unnecessary harm as doctors wait for permission from hospital lawyers to tell them that they can proceed.”
Overall, abortion restrictions are curtailing the medical options available to patients in such circumstances, whether opting to terminate the pregnancy or waiting to treat the cancer later on.
While a representative from the VA told us that their care practices have not changed, we have been unable to confirm independently if cancer patients at a particular VA hospital were denied radiation treatments due to the changing laws. Until we receive more information, we rate this claim as “Unproven.”
Guenot, Marianne. “Pregnant Cancer Patients May Die Because Doctors Fear Treating Them Could Now Count as Illegal Abortion, Experts Say.” Business Insider, https://www.businessinsider.com/abortion-cancer-care-after-roe-overturn-experts-warn-2022-6. Accessed 6 July 2022.
Langreth, Robert, and Ike Swetlitz. “Abortion Bans Will Impact Doctors’ Treatment of Cancer, Miscarriage.” Bloomberg, 24 June 2022, https://www.bloomberg.com/news/articles/2022-06-24/overturning-roe-can-impact-therapy-for-cancer-miscarriage#xj4y7vzkg. Accessed 6 July 2022.
Munz, Michele. “Concerns Mount over ‘Medical Emergency’ Exception in Missouri’s Abortion Ban.” St. Louis Post-Dispatch, 2 July 2022. https://www.stltoday.com/lifestyles/health-med-fit/health/concerns-mount-over-medical-emergency-exception-in-missouri-s-abortion-ban/article_62de4b3b-87fc-55dd-b13f-81f18299186f.html. Accessed 6 July 2022.
“Title XII PUBLIC HEALTH AND WELFARE: Chapter 188.” Revisor of Missouri, 28 Aug. 2019. https://revisor.mo.gov/main/OneSection.aspx?section=188.015&bid=47547. Accessed 6 July 2022.
“VA Women’s Health Services.” Veterans Affairs, 15 Feb. 2022, https://www.va.gov/health-care/health-needs-conditions/womens-health-needs/. Accessed 6 July 2022.
Weinberg, Tessa, et al. “Missouri Doctors Fear Vague Emergency Exception to Abortion Ban Puts Patients at Risk • Missouri Independent.” Missouri Independent, 2 July 2022, https://missouriindependent.com/2022/07/02/missouri-doctors-fear-vague-emergency-exception-to-abortion-ban-puts-patients-at-risk/. Accessed 6 July 2022.
“Where Is Abortion Legal or Banned? A State-by-State Guide After Roe v. Wade Reversal.” Snopes.Com, https://www.snopes.com/news/2022/07/06/us-abortion-law-state-by-state__trashed/. Accessed 6 July 2022. Accessed 6 July 2022.