When the Supreme Court issued the Dobbs decision on June 24, 2022, it overturned 48 years of precedent and ended federal protection of abortion. In the three and a half years since then, state laws about abortion have changed rapidly, leaving doctors confused about what treatment options for pregnant people are legal.
As state abortion bans create a "chilling effect" that leaves clinicians paralyzed by legal fear, Brown’s AIM Lab is stepping in to provide a practical roadmap for emergency care and maternal health. The lab brings together medical and legal experts, working together to answer the questions that doctors are facing all over the country.
In this interview, Dr. Dara Kass and Professor Liz Tobin-Tyler share how they are moving past the political noise to improve the public health crises on the ground, offering a harm reduction approach that protects both doctors and patients while training a new generation of advocates to value the lives of pregnant people in every state.
What are you hearing from physicians about what it's like to be in this legal limbo?
Kass: I spent a lot of time talking with doctors in different states about what is actually legal where they practice—that’s really where this new collaboration between doctors and lawyers begins. Take ectopic pregnancy, for example, which is a pregnancy that implants outside the uterus and cannot continue. There is no state in the U.S. where treating an ectopic pregnancy is illegal. And yet, we’re seeing doctors delay care. We’ve seen this in the data, and we actually published a paper a few months ago showing that clinicians are waiting for more evidence—another ultrasound, more definitive findings—because they’re worried that, in some hypothetical scenario, an attorney general might later say, “I don’t agree with your care and I’m going to charge you with a crime.”
The reality is that no emergency physician anywhere in the United States has been charged with a crime for providing necessary care to a pregnant patient in the E.R., including care that involves pregnancy termination, such as treatment for ectopic pregnancy or miscarriage. We need to keep reminding doctors that the care they’re obligated to provide in emergency settings is very often not illegal.
Tobin-Tyler: Part of the challenge is that lawyers, especially hospital legal counsel in states with abortion bans, tend to be extremely risk-averse. Their training is focused on protecting the hospital from liability, which is very different from thinking about how to best take care of the patient.
When you look at this from a medical malpractice perspective, there’s a clear standard of care that clinicians are expected to meet. So the real questions become: What is the standard of care here? What would an OB-GYN do in this situation, especially in an emergency? What does the patient actually need, and what do we need to do to protect her life and well-being?
And the answer is that providing that care is not impossible, even in states with abortion bans. That’s really how we frame the work we want to do—as a form of harm reduction.
What are the goals of the AIM Lab?
Tobin-Tyler: AIM stands for Advancing Impact in Maternal and Reproductive Health. The goal of the lab is to address the issues happening on the ground right now that have the greatest impact on pregnant people and mothers, especially given the horrific statistics we see around maternal mortality and morbidity. At the same time, more people are becoming pregnant when they don’t want to be and are facing serious consequences as a result.
We want to use the lab as a space to synthesize the existing research and evidence on these issues that are directly shaping people’s outcomes every single day, but also to turn that work into policy and practice changes that actually affect what happens on the ground.
Some of that will take the form of academic papers that clearly establish the evidence base, but a big part of it is also about producing practical, on-the-ground guidance. Dara has already done terrific work in emergency care settings, and we really want to build on and expand that.
So while our long-term goal is to change policy, our immediate focus is on three core areas: emergency care, intimate partner violence and homicide, and substance use disorders during pregnancy.
So it sounds like this isn't just about abortion; it's about taking care of a person who is pregnant in that vulnerable time.
Tobin-Tyler: Absolutely. I think what this really comes down to is that our current policies and practices don’t value the lives of pregnant people. What we want to do is to clearly show that we do care about them, and that when people are experiencing health consequences they should never have to endure, their lives matter.
That’s honestly one of the things that inspires me most about this work. Right now, there are so many forces telling mothers and women that their lives aren’t that valuable. And this work is about pushing back against that and affirming, in very concrete ways, that they are.