On June 24, 2022, the U.S. Supreme Court reversed Roe v Wade ending the constitutional right to an abortion to persons with the potential to become pregnant, giving states the authority to decide their own policies. While some people in states across the U.S. will continue to have access to abortion care, there are many states in which abortion rights were removed or limited with trigger ban laws that immediately made abortions illegal after the ruling. Thus, many persons with the potential to become pregnant, especially those at socioeconomic disadvantage, will not have access to therapeutic abortion, irrespective of indication - whether personal choice or clinically based.
This ruling is estimated to affect 36 million women and people who can become pregnant (according to the U.S. Census Bureau).This not only abolishes the right to self-agency but also autonomy. Individuals belonging to marginalized communities (such as low socioeconomic status, people of color, and the LGBTQ+) will be disproportionately affected. The availability of safe reproductive care is imperative for all people who can become pregnant and particularly for those with bleeding or thrombotic disorders. As with any medical or surgical procedure for patients in our community, abortions require careful, transparent monitoring with multispecialty consultation. Patients require input from a Hematology expert to manage factor coverage, anticoagulation and other medical decisions. The potential increase in hidden therapeutic abortions outside of a medical setting puts patients at a high risk of complications, including excessive bleeding and thromboembolism. Furthermore, this abortion ruling effectively dissolves the four pillars of medical ethics for people who can become pregnant and ties the hands of clinicians – as in some states, for a patient in need of an abortion. There will not be an opportunity to abide by the principles of beneficence (doing good), non-maleficence (to do no harm), autonomy (giving the patient the freedom to choose freely, where they are able) and justice (ensuring fairness). This puts the mental health of patients and of practitioners at risk.
On behalf of the Thrombosis and Hemostasis Societies of North America (THSNA), whose mission is to improve the quality of patient care in the fields of thrombosis and hemostasis, we strongly advocate for access to safe and affordable abortion care and uphold the principles of medical ethics and health equity especially for persons diagnosed with medical conditions to whom pregnancies may pose a significant threat to life.
*The Board of Directors of the following organizations support this statement: The American Thrombosis and Hemostasis Network, Anticoagulation Forum, Association of Hemophilia Clinical Directors of Canada, Canadian Pediatric Thrombosis and Hemostasis Network, The Hemophilia Alliance, Hemostasis and Thrombosis Research Society, International Society for Laboratory Hematology, National Blood Clot Alliance, North American Specialized Coagulation Laboratory Association, Sociedad Mexicana de Thrombosis y Hemostasis and Thrombosis Canada.