Doctors warn exceptions to Iowa’s new abortion law impractical

DES MOINES — New abortion restrictions poised to go into effect in Iowa allow an abortion to proceed 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 real-life medical emergencies, doctors in Iowa are saying.

Doctors say the new law could force them to consider legal and professional ramifications while making potential life-or-death medical decisions involving pregnant women.

“The law is still going to 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 spent decades training, and nobody wants to lose their license over saving someone’s life,” Turner said. “I also don’t think in the moment that someone’s life was in jeopardy that I should be stopped and waste precious seconds worrying about whether I’m going to break the law or lose my license.”

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

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

The law contains some exceptions. Doctors will be allowed to perform abortions if they believe the woman’s life or health is endangered, or if the pregnancy is the result of rape or incest.

However, doctors say those exceptions are too vague and will be difficult to apply while providing medical care.

“The exceptions in this bill will be exceedingly difficult to access for both patients and physicians,” said Dr. Emily Boevers, an OB/GYN in Waverly and co-founder of Iowans for Health Liberty.

“Accessing exceptions in cases of rape and incest rely on the ability of those victims to access medical care and legal options,” she said. “This also puts trained physicians who are health care experts in a position of having to document, having to seek non-medical details from patients, and having to break the relationship of trust with our patients by acting as legal interpreters of the law and as enforcers of a criminal ban.”

Doctors’ concerns are not unique to Iowa. A 2023 report from KFF, a health policy and advocacy organization, determined that, “In practice, health and life exceptions to bans have often proven to be unworkable, except in the most extreme circumstances, and have sometimes prevented physicians from practicing evidence-based medicine.”

Status of law

The new restrictions in Iowa have not yet gone into effect.

The Iowa Supreme Court upheld the law’s constitutionality on June 28, but the high court must respond to plaintiffs’ request for a rehearing before the lower court can remove the legal injunction that temporarily halted the law’s implementation.

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

Until the new restrictions go into effect, abortion is legal in Iowa until roughly the 20th week of pregnancy.

Potential punishments

The new law states that any doctor who performs an abortion after cardiac activity can be detected can be subject to punishment by the Iowa Board of Medicine, the state panel that regulates doctors in Iowa.

The law does not specify what punishments doctors should face, but rather leaves that to the medicine board’s discretion.

Rules adopted by the board to implement the law also do not outline how the board would determine non-compliance or specific penalties physicians would face for violating the law.

More generally, existing administrative rules lay out the extent of the punishment the Board of Medicine can impose on physicians and licensees who violate board rules and state laws.

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

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

“When you ask for a consultant, you want it to be another doctor, not a lawyer to find out whether you can give the care that you believe is the best interest of your patient,” Scott said.

Under the law, women cannot be punished for having an abortion.

The Gazette asked the Iowa Medicine Board about doctors’ concerns with the new law, and a spokeswoman for the Iowa Department of Inspections, Licensing and Appeals — the state agency that houses the medicine board — responded with a statement.

“The administrative rules went through a number of public hearings, including two hearings at the Capitol at the Administrative Rules Review Committee, and reviewed written comments as well. The board worked very hard to address any concerns to draft rules to comply with the passed legislation,” the statement said.

Exception: medical emergency or woman’s life

The new law states doctors cannot perform an abortion after cardiac activity can be detected unless, “in the physician’s reasonable medical judgment, a medical emergency or fetal heartbeat exception exists.”

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 possibilities with respect to the medical conditions involved.”

The law refers to the definition of “medical emergency” already in state code, which defines the phrase as when the pregnant woman’s “life is endangered by a physical disorder, physical illness, or physical injury, including a life-endangering physical condition caused by or arising from the pregnancy, or when continuation of the pregnancy will create a serious risk of substantial and irreversible impairment of a major bodily function of the pregnant woman.”

When the Iowa Medicine Board crafted rules to implement the law, it did not provide specific guidance for how badly a pregnant woman’s health would have to decline before doctors can intervene.

The result, doctors say, is an exception that will be difficult to apply in high-pressure medical situations.

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

“And now we’re putting (doctors) in a position of having to guess or make the best educated decision.”

Exception: rape or incest

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

However, the law requires the rape to have been reported to law enforcement or a health facility within 45 days of the assault and requires an incestual act to have been similarly reported within 140 days.

Advocates for survivors of sexual abuse and domestic violence have said that victims often are afraid to come forward with details of their attacks. And victims of such attacks often are not aware they are pregnant for many weeks.

“That exception for incest is especially cruel because it doesn’t work in reality,” said Turner, the Des Moines OB/GYN. “And it was put in there to seem like an exception, but it’s not because, in my experience, most children don’t know they’re pregnant until their teacher or their caregiver notices something’s going on or something’s different. And by that time, that pregnancy is so far along.”

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Doctors: Law violates relationship with patients

Doctors said from their viewpoint, the law breaks down the relationship between doctor and patient. One doctor described it simply by saying pregnancy is “too complicated to legislate.”

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

“I really, truly wish that since our government has decided to join me in the exam room in limiting the options available to patients, that they could be there when we counsel patients about life-threatening, life-limiting complications, anomalies of early pregnancy,” Boevers said.

“I really wish the government could be there when my patients are developing sepsis, and (I am) having to make a decision about how long I let them become sick before we intervene and try to save their life.

“I hope that our governor will be available by telephone to take the calls, wondering if we’ve passed that line where patients are deathly ill, and we can perform lifesaving care for (those patients).”

Tom Barton of The Gazette contributed to this report.

Comments: (515) 355-1300, erin.murphy@thegazette.com

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