The Supreme Court overturned Roe v. Wade, ending protections for the right to abortions under federal law, in a ruling issued Friday.
The 6-3 decision upholds a Mississippi statute that bans abortions after 15 weeks of pregnancy, which has become the model for similar laws in other states.
The ruling wipes away nearly 50 years of precedent by eliminating a constitutional right to abortion before a pregnancy is considered viable. The decision overrides the landmark Roe v. Wade and Planned Parenthood v. Casey rulings that protected federal abortion rights.
The outcome has seemed certain since last month, when Politico published a draft opinion penned by Justice Samuel Alito, who authored the final decision issued Friday.
"The Constitution does not prohibit the citizens of each state from regulating or prohibiting abortion. Roe and Casey arrogated that authority. We now overrule those decisions and return that authority to the people and their elected representatives," Alito wrote.
"Roe's defenders characterize the abortion right as similar to the rights recognized in past decisions involving matters such as intimate sexual relations, contraception and marriage, but abortion is fundamentally different, as both Roe and Casey acknowledged, because it destroys what those decisions called 'fetal life' and what the law now before us describes as an 'unborn human being,'" Alito wrote.
The historic ruling sets the stage for vastly different abortion laws among the states and greatly reduced, or nonexistent, access to abortion care across a large swath of the nation.
The decision has major implications for the healthcare system that will play out for years. Providers warn of a overcrowded abortion clinics in states where the procedure remains legal, harmful consequences from unsafe practices in states that outlaw abortion and legal risks for healthcare providers.
The [American Medical Association] condemns the high court's interpretation in this case," AMA President Dr. Jack Resneck, Jr. said in a statement. "We will always have physicians' backs and defend the practice of medicine, we will fight to protect the patient-physician relationship, and we will oppose any law or regulation that compromises or criminalizes patient access to safe, evidence-based medical care, including abortion. As the health of millions of patients hangs in the balance, this is a fight we will not give up."
Physicians are now left to decide between not properly caring for patients who need or want abortions and performing them and risking their medical licenses or even criminal charges, Dr. Theresa Rohr-Kirchgraber, president of the American Medical Women's Association, said prior to the ruling.
Seventeen states have laws that dictate prison sentences for doctors who provide abortions past gestational limits. In Oklahoma, physicians who perform abortions could face up to 10 years in prison and $100,000 fines.
"That's really an untenable position for people to be in," Rohr-Kirchgraber said. Patients who experience miscarriages and need follow-up care that could be labeled abortions are in jeopardy for adverse outcomes, for example, she said.
Chief Justice John Roberts and Justices Clarence Thomas, Neil Gorsuch, Alito, Brett Kavanaugh and Amy Coney Barrett made up the majority. Justices Stephen Breyer, Sonia Sotomayor and Elena Kagan dissented.
"Across a vast array of circumstances, a state will be able to impose its moral choice on a woman and coerce her to give birth to a child," the dissenting justices wrote. "Whatever the exact scope of the coming laws, one result of today's decision is certain: the curtailment of women's rights, and of their status as free and equal citizens," they wrote.
"It's heart-wrenching, intensely frustrating and a violation of my oath and duty to care," Dr. Jen Villavicencio, lead for equity transformation at the American College of Obstetricians and Gynecologists, said in a statement in advance of the decision. The Supreme Court ruling will have "disastrous consequences and will absolutely cost lives," she said.
"Instead of being able to dedicate all of my expertise, mental energy and attention to treating my patient in front of me, I have to also think about whether or not I will face consequences, some criminal, for offering the most appropriate, individualized and evidence-based care," Villavicencio said.
This ruling makes it harder for providers to counsel pregnant patients on their options, which should be explained in an unbiased manner regardless of personal or religious beliefs, Dr. Mary Romano, co-chair of the advocacy committee for the North American Society for Pediatric and Adolescent Gynecology, said before the court issued its ruling.
"It is a basic human right as a person to be able to control when and how you reproduce," Romano said. "Anything we do to limit people's control of their own reproductive health is detrimental, whether it's limiting access to the types of contraception you can get, or limiting access to termination of pregnancy."
Patients seeking comprehensive reproductive healthcare already face many obstacles, Romano said. "There's access to competent providers, issues of confidentiality and there may be financial barriers," she said.
The American College of Obstetricians and Gynecologists will help its members refer patients seeking abortions to alternate providers, Villavicencio said.
"This means finding ways to advance healthcare professionals' education and training to provide abortion care and connecting patients with referrals," Villavicencio said. "An expanded network of clinicians across medical specialties will be essential to help patients access needed abortion care regardless of where they live."
In states where abortion is outlawed, medical students and residents won't be trained on care related to terminating pregnancies, which will lead to subpar care, Rohr-Kirchgraber said.
