DUAL LOYALTY, MEDICAL ETHICS, AND ABORTION BANS

Objectives

We aimed to examine clinicians’ experiences of dual loyalty, defined as conflict between professional duties to a patient and obligations to the interests of a third party such as the state, when providing care under restrictive abortion bans.

Methods

We conducted semi-structured interviews with clinicians providing care in Louisiana a year post-Dobbs v Jackson Women’s Health Organization (May to November 2023) and in Florida (July to August 2024) after the six-week abortion ban went into effect. In this secondary thematic analysis, we examined the code for participants’ responses about experiences of dual loyalty.

Results

We interviewed 30 healthcare workers and trainees in Louisiana and 25 in Florida; the analytic sample contained 48 participants who described an experience of dual loyalty. Participants described having to deny care to patients that they had the knowledge and skills to care for as a primary example of dual loyalty. Many noted that this was necessary to protect the care that they could offer, by complying with the law to not lose their licenses. Participants also described interference with their medical judgment and having to deviate from the standard of care. Several participants highlighted conflicted thoughts about having to break the law to adhere to their medical ethics. Participants often described feeling moral distress from being unable to adhere to medical ethics.

Conclusions

Participants’ experiences of dual loyalty highlight a moral obligation to provide abortion care, which is being negatively impacted by abortion bans. This could be seen as a new form of conscientious objection, where clinicians object to abortion bans as being antithetical to medical ethics.