In the wake of the COVID-19 pandemic and the overturning of Roe v. Wade, physicians and nurses across the country have faced ethical dilemmas, grappling with feeling restricted in their ability to provide the best care, according to Mara Buchbinder.
“The pandemic manifested a rise in anti-physician sentiment, in opposition to science, with scuttles over vaccines, masks, and other public health measures. Social media really fueled these trends, making more work for physicians to disentangle science and fiction,” said Buchbinder, chair of the department of social medicine at the University of North Carolina, Chapel Hill.
On April 3, Buchbinder and Nancy Berlinger, an author and researcher at the Hastings Institute, presented their research as a part of a series of talks co-sponsored by the Boston College philosophy department and the LaBrecque Medical Ethics Lecture Committee.
The lecture discussed how health care providers are navigating moral distress and burnout, with Buchbinder focusing on obstetrician gynecologists (OBGYNS) and Berlinger focusing on family caregivers.
“I think that understanding what happened in the aftermath of the Dobbs decisions really requires understanding several cultural and political shifts that preceded it, creating a strain in the physician-patient relationship,” Buchbinder said.
Buchbinder’s 2024 study included interviews with 54 physicians, the majority of whom were women, from 13 states that had enacted full abortion bans.
“Fifty of the 54 participants in our study reported worries about practicing in this uncertain legal climate, and their fears centered on the potential for criminal prosecution, loss of medical license, loss of income, and, to a lesser extent, fines or incarceration,” Buchbinder said. “They repeatedly wondered, ‘Is this the case that is going to make me a felon?’”
Buchbinder’s study found that OB-GYNs practicing in areas where abortion laws were ambiguous faced restrictions in their ability to fully counsel patients on all pregnancy options. She noted that many were unable to provide medically necessary abortion care until the mother’s condition became dire.
“‘I’m a single mom, I’m the only breadwinner, and I have to be there for my kids,” Buchbinder said, quoting an OB-GYN. “‘I can’t go to jail, right? I told myself that I’m not going to do abortion. I’m not going to skirt around the law about this. The neighboring state is not that far away. I can get patients to where they need to be, but the one thing I am totally willing to go to jail for is my right to counsel my patients, and I’m not going to stop doing that.’”
Berlinger also discussed the burnout family members experience when caring for older relatives, particularly those with dementia.
“I thought, ‘No, this is broader, and includes people who are perhaps family caregivers,’” Berlinger said. “For example, you can feel these things even if they are not occurring in a professional school. They may be occurring in a familial duty, or something that is expected of you, and you feel like you’re letting somebody else down or you’re letting yourself down.”
Both Buchbinder and Berlinger emphasized the moral distress faced by physicians and caregivers and called for increased support to help them cope.
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