Imagine a 9-week pregnant patient who comes to the emergency department with vaginal bleeding and abdominal cramping. Like nearly a quarter of pregnancies, she is experiencing early pregnancy loss, also referred to as spontaneous abortion or miscarriage. As she continues to bleed, she becomes progressively tachycardic and hypotensive, entering hemorrhagic shock, requiring an emergent procedure in order to preserve her health and save her life.  

Now imagine she lives in a state with laws that restrict clinicians from performing abortion care, even in emergency scenarios. Although this patient’s pregnancy is nonviable, because dilation and curettage can also be used in abortion care, in certain states this may fall under the abortion ban. Abortion is completely illegal, regardless of gestation age, in fourteen states, including Idaho, North and South Dakota, Indiana, and most of the South, with exceptions only if the patient’s life is threatened. Few have exceptions for threat to the patient’s health, though the definition of “health” varies and can be arbitrary. In these cases, she would either have to be transported to another state where abortion care is not criminalized (one Idaho hospital had to airlift 6 patients in just the first three months of 2024) or wait until she is quite literally near death to be treated.  

This is the situation at hand as the Supreme Court, as well as several lower courts across the nation, considers the right to emergency abortion care – in particular, whether the Emergency Medical Treatment and Labor Act, or EMTALA, protects patients in these scenarios. EMTALA mandates that any patient who comes to an emergency department experiencing an emergency medical condition must be treated and stabilized, which may involve an abortion. 

On April 24, 2024, the highest court in the nation heard oral arguments on the consolidated cases Idaho v. United States and Moyle v. United States, which argue that state restrictions on emergency abortion care can override EMTALA. As emergency medicine residents at George Washington University, we had the unique opportunity to participate in the rally outside the Supreme Court which is right in our backyard here in Washington DC. Showing up en masse in our white coats along with our medical school’s OB-GYN residents and fellows, we came together to advocate for continued access to emergency abortion care; to advocate for our patients. It was an unprecedented experience in place of our usual weekly didactics, which felt all the more impactful to have our entire program, including faculty and leadership, declare that this is an important effort worth learning about and spending time on.