Doctors warn exceptions to Iowa’s new abortion law are impractical

DES MOINES — New abortion restrictions coming into effect in Iowa will allow abortions to be performed if a woman’s life is at stake. But that exception and others in the law will be difficult, if not impossible, to apply in true medical emergencies, Iowa doctors say.

Doctors say the new law could force them to consider legal and professional consequences when making medical decisions that could affect the lives of pregnant women.

“The law will still have a chilling effect,” said Dr. Francesca Turner, an obstetrics and gynecology physician in Des Moines and co-founder of the advocacy group Iowans for Health Liberty.

“We’ve been training for decades, and no one wants to lose their license for saving someone’s life,” Turner said. “I also don’t think that when someone’s life is in danger, I should be pulled over and waste precious seconds worrying about whether I’m going to break the law or lose my license.”

Iowa’s new law bans abortions once cardiac activity can be detected, which is typically around the sixth week of pregnancy — often before a woman knows she’s pregnant. Abortion rights advocates say the law will effectively ban the vast majority of abortions in Iowa.

The new law, House File 732, was passed last year by Republican state lawmakers and signed into law by Republican Gov. Kim Reynolds. It is commonly known as the fetal heartbeat law, a medical misconception. Doctors say that what is detected by an ultrasound at six weeks is not a beating heart, but electrical impulses.

The law does have some exceptions. Doctors can perform abortions if they believe the woman’s life or health is in danger, or if the pregnancy is the result of rape or incest.

However, doctors say these exceptions are too vague and difficult to apply in medical care.

“The exemptions in this bill will be extremely difficult for both patients and physicians to access,” said Dr. Emily Boevers, an obstetrician-gynecologist in Waverly and co-founder of Iowans for Health Liberty.

“Obtaining exceptions in cases of rape and incest is dependent on the ability of victims to access medical care and legal options,” she said. “It also places trained physicians who are experts in health care in a position where they have to document, request non-medical details from patients, and break the trust relationship with our patients by acting as legal interpreters of the law and enforcers of a criminal prohibition.”

Doctors’ concerns aren’t unique to Iowa. A 2023 report from KFF, a health policy and advocacy organization, found that “in practice, health and life exceptions to bans have often proven unworkable in all but the most extreme circumstances, and have sometimes prevented doctors from practicing evidence-based medicine.”

Status of the law

The new restrictions in Iowa are not yet in effect.

The Iowa Supreme Court upheld the constitutionality of the law on June 28, but the high court must still respond to the plaintiffs’ request for a new hearing before the lower court can vacate the injunction that temporarily halted the law’s operation.

As of Friday afternoon, the Supreme Court had not yet responded to the request for review.

Until the new restrictions take effect, abortion is legal in Iowa until approximately the 20th week of pregnancy.

Possible punishments

The new law states that any doctor who performs an abortion after cardiac activity is detected could be disciplined by the Iowa Board of Medicine, the state body that regulates doctors in Iowa.

The law does not specify what punishments doctors should receive, but leaves that to the discretion of the medical board.

The rules the board adopted to implement the law also do not specify how the board would determine noncompliance or what specific penalties doctors would face if they violate the law.

More generally, existing administrative rules determine the extent of the penalty the Board of Medicine may impose on physicians and licensees who violate the Board’s rules and state law.

The board may revoke, suspend or restrict a person’s license, place a person on probation or require additional education or training. The board may also impose a fine of up to $10,000 and issue a citation and warning.

“When you’re taking care of a patient, you don’t want to think, ‘Am I going to lose my license? Am I going to go to jail? Am I going to get in trouble?’ You want to take care of the patient,” Dr. Bruce Scott, president of the American Medical Association, said recently in Iowa.

“When you ask for an advisor, you want it to be another doctor, not an attorney, figuring out whether you can provide the care that you think is best for your patient,” Scott said.

By law, women cannot be punished for having an abortion.

The Gazette asked the Iowa Medicine Board about physicians’ concerns about the new law, and a spokeswoman for the Iowa Department of Inspections, Licensing and Appeals (the state agency that oversees the Medicine Board) responded with a statement.

“The administrative rules went through a series of public hearings, including two hearings at the Capitol before the Administrative Rules Review Committee, and also reviewed written comments. The administration worked diligently to address any concerns in order to draft rules that comply with the law that was passed,” the statement said.

Exception: Medical Emergency or Woman’s Life

The new law states that doctors may not perform an abortion after cardiac activity has been detected unless, in the doctor’s reasonable medical judgment, there is a medical emergency or an exception to the fetal heart rate.

The law defines “reasonable medical judgment” as “a medical judgment made by a reasonably prudent physician who is knowledgeable about the case and the treatment options for the medical conditions involved.”

The law references the definition of “medical emergency” already in the state code, which defines the phrase as when “the life of the pregnant woman is in danger because of a physical disorder, physical illness, or physical injury, including a life-threatening physical condition caused by or resulting from the pregnancy, or when continued pregnancy would pose a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”

When the Iowa Medicine Board drafted rules to implement the law, no specific guidance was given on how serious a pregnant woman’s health must be before doctors could intervene.

According to doctors, the result is an exception that is difficult to apply in high-pressure medical situations.

“You would never want to put people who are practicing in the position of saying, ‘I want to wait until they’re literally dying to save their life,'” said Christina Taylor, chief medical officer at McFarland Clinic in Ames and board chair of the Iowa Medical Society. “That goes against everything we believe about saving the life of the person in front of me,

“And now we’re putting (doctors) in a position where they have to gamble or make the best informed decision.”

Exception: rape or incest

The new law also allows doctors to perform an abortion if the pregnancy is the result of rape or incest.

However, the law requires that rape be reported to the police or a health facility within 45 days of the attack. Incest must be reported within 140 days.

Advocates for survivors of sexual abuse and domestic violence have said that victims are often afraid to share details about their attacks. And victims of such attacks often do not know they are pregnant for weeks.

“That exception for incest is especially cruel because it doesn’t work in practice,” said Turner, the obstetrician-gynecologist in Des Moines. “And it was put in there to seem like an exception, but it’s not, because in my experience, most kids don’t know they’re pregnant until their teacher or caregiver notices that something’s wrong or something’s different. And by then, the pregnancy is far along.”

Doctors: Law violates relationship with patients

Doctors said that from their perspective, the law breaks the doctor-patient relationship. One doctor described it simply by saying that pregnancy is “too complicated to legalize.”

Boevers, the Waverly OB/GYN, said she will continue to provide her patients with the best care she can under the new law. But she expressed frustration about how the new restrictions will affect that care.

“I really hope that our government, now that they have decided to work with me to limit the options for patients, can be there when we advise patients about life-threatening, life-limiting complications and abnormalities in early pregnancy,” Boevers said.

“I really wish the government was there when my patients develop sepsis and I have to make a decision about how long I’m going to let them get sick before we intervene and try to save their lives.

“I hope our governor is available on the phone to take those calls and ask himself if we have crossed the line where patients are terminally ill and we can provide life-saving care to (those patients).”

Tom Barton of The Gazette contributed to this report.

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