Clinical and legal confusions surrounding maternal-fetal conflict in emergency medicine

Abstract: In the post-Roe care context, the Emergency Medicine Treatment and Labor Act (EMTALA) has become a flashpoint in the controversy over abortion. As a federal law that codifies the right of patients to receive stabilizing emergency medical treatment, abortion advocates have argued that the management of certain pregnancy conditions are protected under EMTALA, even in states with trigger laws that outlaw abortion. However, the “unborn child” provision within the law has been cited by abortion oppositionists and lawmakers as conferring equal protection to the fetus and the mother. This generates a legal and ethical conflict for emergency clinicians tasked with interpreting these ambiguities in the setting of medical extremis. In response to these concerns, we emphasize the asymmetry of the relationship between fetal interests and maternal health in emergency settings. Namely, we argue that while the mother’s health may depend on the termination of a pregnancy, there is no legitimate sense in which the health of the fetus can be effectively separated from the health of the mother in extremis. Accordingly, we reposition fetal viability as constitutively informed by the enmeshment between mother and child in pregnancy and assert that this consideration must be accommodated in any application of the “unborn child” provision of EMTALA. Consequently, we reject the management of a pregnant patient in extremis as an instance of maternal fetal conflict and defend the clinician’s legal obligation to terminate pregnancies that threaten the life of the mother in emergency settings.

Joel Rowe, MD – Attending Physician, Emergency Medicine, Icahn School of Medicine at Mount Sinai