"Shield laws" declare that, for purposes of reproductive health care, the law of the jurisdiction in which the clinician practices governs when state laws conflict. In 2024, approximately 100,000 pregnant people living in states that criminalize abortion provision received pills for a medication abortion from a clinician living in one of the eight states with these laws. One of these clinicians is New York's Margaret Carpenter, who was criminally charged in Louisiana and fined and enjoined in Texas. Carpenter's case testing shield laws, which is likely to go to the U.S. Supreme Court, should be framed as a "right to travel case" because telemedicine should be understood as a modern version of travel. If the Supreme Court ultimately accepts Louisiana and Texas's likely argument that it's a narrow "state regulation of medicine" case, the Court will be limiting the constitutional right to travel to people who have the money and time to physically travel for medical care, and withholding it from people who need the same care but who can afford to access it only through virtual travel.

This Viewpoint discusses how abortion and in vitro fertilization (IVF) are comparable practices because they are family-building medical interventions; therefore, abortion access should be as important as IVF access.

OBJECTIVE:To examine patient, physician, and operating room (OR) staff perceptions at an academic institution following the introduction of an explicit, written consent form for medical student participation in the pelvic examination under anesthesia (EUA). METHODS:The study was performed at one urban academic medical center between May 2021 and May 2023. Thirty-one individuals including patients, OR staff, and physicians were interviewed to better understand their perspectives regarding an initiative to explicitly consent patients for the student pelvic EUA. Northwestern University Institutional Review Board approval was obtained. RESULTS:Patients appreciated being asked to explicitly consent to or refuse the student pelvic EUA and having a dedicated consent form left them with a positive feeling about the hospital and their healthcare providers. OR staff and physicians agreed that the student pelvic EUA is necessary, and almost all supported an explicit consent form. Physicians did not find the additional consent form burdensome and noted only a modest decline in learning opportunities. CONCLUSION:Patients and healthcare providers agreed that requiring explicit written consent for the student pelvic EUA respected patient autonomy, improved healthcare quality, and caused minimal disruption to medical education. Our data support the use of an explicit written consent form as standard practice.

Adoption is often framed as an alternative to abortion. However, many women feel that pregnancy and birth made them a mother and that this new identity is not erased by the fact they are not raising that child. This article argues that involuntary adoption occurs when legislative coercion deprives a pregnant person of a realistic abortion option, forcing them into this position of being a parent who is not parenting. The article also argues that the moral seriousness of motherhood begins at conception, not because embryos are the moral equivalent of babies, but because that's when the pregnant person becomes a "potential mother" who must make a new set of decisions in response to her status. The reversal of Roe v. Wade has made narrative insight into the dynamics of pre-Roe adoption critical. Therefore, this article offers the stories of a 1969 birth mother's journey from being a teenager who relinquished her birth daughter to becoming a physician working in abortion care and of a 1965 adoptee's effort to reach out to her birthparents at age fifty-four as texts for ethical analysis.

Surrogacy raises complex social and ethical issues related to autonomy, informed consent, potential exploitation, and the welfare of all parties involved. In this article, FIGO advocates for ethically sound surrogacy practices that prioritize voluntary and informed consent, safeguard the well-being of surrogates, uphold the rights and responsibilities of intended parents, and place the welfare of the child at the center of all decisions. FIGO discourages surrogacy arrangements in which a woman agrees in advance to surrender a child to whom she is genetically related ("traditional surrogacy") and supports surrogacy arrangements in which a woman agrees in advance to surrender a child to whom she is not genetically related ("gestational surrogacy") provided they align with core ethical principles. FIGO also emphasizes the importance of adhering to international ethical standards, particularly in the context of cross-border surrogacy arrangements.

( N Engl J Med . 2025;393(4):313-315. doi: 10.1056/NEJMp2507544) Katie Watson, JD, examines the legal and ethical complexities surrounding cases where pregnant individuals are declared brain-dead. The discussion is framed around the recent case of Adriana Smith in Georgia and the earlier case of Marlise Muñoz in Texas. Smith, who was 8 to 9 weeks pregnant, was declared brain-dead in February 2025. Her mother was reportedly told that Georgia’s 6-week abortion ban made it illegal to withdraw life support. Watson clarifies that this interpretation was incorrect, emphasizing that refusing or discontinuing medical treatment does not meet Georgia’s statutory definition of abortion. The removal of life support in such cases is an “act of omission,” distinct from the “act of commission” that characterizes abortion procedures. US Supreme Court precedents, Cruzan v. Director, Missouri Department of Health , Washington v. Glucksberg , and Vacco v. Quill, reinforce the legal distinction between withdrawing life-sustaining treatment and committing homicide or suicide.

Importance:Recent changes in the legal landscape in the United States have affected access to abortion, and this restricted access has profound effects on both physical and mental health of reproductive-aged women and their families. Observations:Denial of abortion care has substantial consequences for the mental health of pregnant individuals and their children. We review rates of mental health symptoms and disorders in abortion-seeking individuals, those who are denied care, and those who are subject to laws restricting care. We also cover how these effects are experienced by those in marginalized communities, including rural populations and those of limited financial resources, and how resulting distress affects children born to those denied abortions. Finally, we review the current and shifting legal landscape and how it affects clinicians aiming to care for those experiencing mental health sequelae from the denial of abortion care. Conclusions and Relevance:There is an urgent need for research on strategies to manage psychiatric disorders associated with restricted reproductive health services. The health of the mother is a critical element in fetal and infant well-being. Individuals who are forced to continue an unwanted pregnancy deserve the social and resource support required to deliver healthy infants who can be raised in an environment that allows the family to thrive.

Discharge “against medical advice” (AMA) in the obstetric population is overall under-studied but disproportionally affects marginalized populations and is associated with worse perinatal outcomes. Reasons for discharges AMA are not well understood. The objective of this study is to identify the obstacles that prevent obstetric patients from accepting recommended care and highlight the structural reasons behind AMA discharges. Electronic health records of patients admitted to antepartum, peripartum, or postpartum services between 2008 and 2018 who left “AMA” were reviewed. Progress notes from clinicians and social workers were extracted and analyzed. Reasons behind discharge were categorized using qualitative thematic analysis. Fifty-seven (0.12

( N Engl J Med . 2024;390(6);563–567. doi: 10.1056/NEJMms2312012.) In 1965, Ms R. traveled from Denver to have a legal abortion in Japan due to concerns about an illegal US abortion being unsafe. Today, more than 80% of women who get abortions are 11 weeks pregnant or less, and as such, may legally take abortion medication (mifepristone and misoprostol pills) at home. However, options will become much more limited if the Supreme Court decides in favor of antiabortion physicians who have sued the Food and Drug Administration (FDA) to revoke its approval and regulation of mifepristone.

The June 24, 2022 US Supreme Court decision in Dobbs v Jackson Women’s Health Organization resulted in an expansive restriction on abortion access that had been constitutionally guaranteed for nearly half a century. Currently, 14 states have implemented complete bans on abortion with very limited exceptions, and an additional 7 states have implemented abortion bans at 6 to 18 weeks’ gestation. It has been well demonstrated that restrictive policies disproportionately limit abortion access for minoritized people and people of low socioeconomic status; the financial and geographic barriers of these post- Dobbs restrictions will only exacerbate this disparity. Proponents of abortion restrictions, who identify as pro-life, assert that these policies are essential to protect children, women, and families. We examine whether the protection of these groups extends past conception by evaluating the association between state abortion legislation and state-based policies and programs designed to provide medical and social support for children, women, and families. We found that states with the most restrictive post- Dobbs abortion policies in fact have the least comprehensive and inclusive public infrastructure to support these groups. We suggest further opportunities for advocacy. ( Am J Public Health. 2024;114(10):1043–1050. https://doi.org/10.2105/AJPH.2024.307792 )

Click to increase image sizeClick to decrease image sizeThis article refers to:Ethics Considerations Regarding Artificial Womb Technology for the Fetonate DISCLOSURE STATEMENTNo potential conflict of interest was reported by the author(s).Additional informationFundingThe author(s) reported there is no funding associated with the work featured in this article.

Some new state bans on abortion provision include medical exceptions, but it is hard to know how to interpret them. How can physicians use the clinical judgment these statutes authorize to maximum patient benefit?

59% of abortion patients are already mothers, yet only one qualitative study considers how desires around family formation or family preservation might influence pregnant people's abortion decision-making. In addition, existing studies of reasons for abortion obtain data with surveys and interviews. In this study, we examine spontaneous, anonymous notebook entries written by patients in the pre- and post-procedure waiting room of an abortion clinic. This novel data offers a new way to learn more about how abortions patients understand their abortion decision, and how they communicate about it to other abortion patients. Sixteen notebooks containing 394 entries written by people sitting in the pre- and post-procedure waiting and recovery room of Abortion Clinic X over the course of seven years were transcribed, and a content analysis using inductive thematic coding was conducted. The dominant theme that emerged was “maternal reasoning.” Half of the Clinic X abortion patients who offered narratives communicate that their existing children or potential children will be better off as a result of their abortion. In an overlapping category, approximately one quarter of the writers framed themselves as being in a mother-child relationship with the embryo or fetus they were carrying. These data suggest that many abortion patients understand their decision to end a pregnancy as part of family formation and preservation. These data should not be used to fuel a politics of sympathy, but they could support a politics of solidarity that advances reproductive rights.

Psychosocial counseling is the foundation of genetic counseling. Genetic counseling students are required to receive in‐depth training on psychosocial counseling techniques. In other medical disciplines, “medical improv,” an educational method derived from improvisational theatre, has been used to allow trainees to practice clinical skills without also having to focus on medical knowledge they've not yet mastered. The present study aims to investigate the acceptability of medical improv as an educational tool for genetic counseling students. Fourteen genetic counseling students and new genetic counselors completed a 2‐hr medical improv workshop and participated in follow‐up interviews to discuss the workshop. Participants’ responses to the intervention were positive, with 92.9% of participants responding that they would recommend medical improv training to other genetic counseling students. Participants described the medical improv workshop as helping build psychosocial skills in a safe environment, which may facilitate the use of more advanced counseling skills in clinical situations. By training students to practice psychosocial skills and building students’ confidence, medical improv may help genetic counseling students and genetic counselors be more effective in challenging clinical situations, and to feel more comfortable in experimenting with new ideas and psychosocial techniques in their clinical practice.