Many doctors hoped that last week's Supreme Court decision on emergency care for pregnant women would give them the clarity they needed to do their work.

It has not.

Shortly after the court announced its decision, political commentator Ruth Marcus sent the following text message: “Don't let the Idaho abortion case confuse you. This is not a victory for pregnant women. It is likely only a temporary reprieve, and that applies only to some.”

For now, pregnant women in Idaho will no longer have to be flown out of the state by helicopter for appropriate treatment if they come to the emergency room with a life-threatening pregnancy complication such as severe bleeding, impending kidney failure or an ectopic pregnancy.

But instead of issuing a final ruling, the Supreme Court sent the case back to the lower courts. It also lifted a stay of a lower court ruling allowing emergency abortions in Idaho hospitals for now when necessary to protect the mother's health.

Justice Ketanji Brown Jackson strongly objected to the court's handling of the case, reading portions of her dissent: “Today's decision is not a victory for pregnant patients in Idaho. It is a delay,” she wrote. “While this court dithers and the country waits, pregnant people with medical emergencies remain in a precarious position as their doctors are left in the dark about what the law requires. This court had a chance to bring clarity and certainty to this tragic situation, and we squandered it.”

Contradictory laws

In states where abortion is virtually banned, emergency physicians and gynecologists who treat women with pregnancy complications face a dilemma: they must meet the requirements of their training and professional ethics and fear that they will face criminal prosecution if they take such measures.

In a previous comment, I noted that the Emergency Medical Treatment and Labor Act (also known as EMTALA) entitles patients treated for an emergency to receive stabilizing treatment, regardless of their ability to pay. Hospitals that do not comply with EMTALA risk losing Medicare funds. Nearly four decades later, EMTALA still protects emergency room patients from being denied necessary treatment.

When the Supreme Court overturned Roe v. Wade, several states quickly imposed a near-total ban on abortion. Idaho's ban, for example, allows only emergency abortions to prevent the death of a pregnant woman. It makes no exceptions for abortions to prevent serious harm to a woman's health, such as loss of fertility.

Citing EMTALA, the Biden administration sued Idaho for failing to protect women seeking emergency care due to severe pregnancy complications.

In a column, Ruth Marcus explained what happened next: “A district court tentatively agreed with the Biden administration, saying that EMTALA preempts state law in the narrow cases of serious threats to maternal health. An all-Trump-appointed panel of the U.S. Court of Appeals for the 9th Circuit disagreed; [then] the appeals court sided with the district court. So Idaho appealed to the Supreme Court before the case was fully heard.”

The opinion of the doctors

Dismayed, several of our nation's leading medical and public health organizations, including the American Medical Association, the American College of Obstetricians and Gynecologists, the American College of Emergency Physicians, and the Society for Maternal-Fetal Medicine, filed a forceful amicus curiae brief asserting that EMTALA is critical to protecting the health and lives of pregnant women:

“Idaho's law prohibits medical personnel from providing emergency care as it has been defined and practiced for decades. It eliminates the essence of emergency medicine – the immediate provision of stabilizing and often life-saving treatment – and replaces it with a ruthless wait-and-see approach that will prove fatal for many patients.”

Unfortunately, the doctors' opinion did not convince the Supreme Court to make a final decision.

Shortly after the court announced it would send the case back to the lower courts, the American College of Emergency Physicians issued a press release titled “Emergency physicians must be able to treat pregnant patients without fear of criminalization.”

What's next

The Supreme Court will not revisit the issue until after the upcoming presidential election. At that time, it could revisit the Idaho case or take up a related case from Texas. Alternatively, if Donald Trump wins back the White House, he could order the Justice Department to drop both cases. In either case, that is unlikely to end the matter.

Texas and Idaho argue that abortion is not protected by EMTALA because it is not explicitly mentioned in the law. In January last year, US Federal Law 5^th The Circuit Court of Appeals – widely considered the most conservative in the country – agreed, finding that EMTALA “does not mandate any particular type of medical treatment, let alone abortion.”

If the Supreme Court agrees with the Fifth Circuit's reasoning, other emergency room treatment practices could also be challenged in court, such as administering antibiotics to an infected intravenous drug user, providing oxygen to an immigrant child with severe asthma, or providing emergency dialysis to an uninsured patient with acute kidney failure.

Rather than prescribing specific treatments, EMTALA requires that every patient who comes to an emergency room receive a screening to determine if an emergency exists and that doctors act promptly if so. to the best of our professional judgmentto stabilize the patient's condition. This standard has proven itself for almost 40 years.

When the Supreme Court decided to hear United States v. Idaho, the stakes were high. Today, the stakes are even higher.