Post-abortion care after fetal demise is no legally riskier than miscarriage management.

Emergency physicians frequently provide care to people engaged in legally risky or prohibited activity such as sex work or use of illegal substances; self-managed abortion is no exception in states where abortion is criminalized or illegal. Providing care to someone experiencing a complication of self-managed abortion after fetal demise is no legally riskier for emergency physicians than treating someone experiencing a complication of miscarriage. In fact, providing treatment after a self-managed abortion with pills is identical to post-miscarriage treatment. Providing treatment prior to fetal demise is a more legally complicated question which will depend on the wording of the abortion laws in your state.

Generally, self-managed abortion is not something emergency physicians need to report to authorities and doing so is likely a HIPAA violation.

Emergency physicians are mandated by law to report certain incidents, such as some injuries and vital statistics information like fetal deaths. Currently, there is no law in any state that requires an explicit report of self-managed abortion or of the intention to self-manage. In fact, recently released HIPAA guidance makes clear that in the absence of an explicit law requiring a report, reporting a self-managed abortion to law enforcement is an unpermitted breach of protected health information.³ In most states, emergency physicians are still obligated to report to public health authorities abortions that they themselves perform or abortion complications they treat. This may include self-managed abortion in some states. Emergency physicians may also be required to report injuries they treat arising from unsafe methods of self-managed abortion, such as injuries from sharp objects or assault. However, in the vast majority of these cases where a physician is not mandated to report, disclosing a self-managed abortion to law enforcement is unnecessary and could harm the patient by contributing to criminalization.² Mandatory reporting is fraught with racial and class bias.⁴ Emergency physicians should consider and take steps to mitigate potential harms associated with mandatory reporting, such as ensuring a patient is aware of what the emergency physician is required by law to report.

Providing stabilizing care is required under EMTALA.

Some physicians have expressed concerns that state laws banning abortion have the potential to restrict a physician’s ability to offer stabilizing care in a medical emergency. The federal government recently released guidance clarifying that “[e]mergency medical conditions involving pregnant patients may include, but are not limited to, ectopic pregnancy, complications of pregnancy loss, or emergent hypertensive disorders, such as preeclampsia with severe features.”⁵ More guidance is needed to determine the extent of EMTALA protections for physician actions. However, it is clear that EMTALA preempts state laws restricting the ability of physicians to provide stabilizing care in an emergency situation, including abortion care.