US Clinicians Face a “Dual Loyalty” Crisis over Reproductive Health Care

Since the 2022 US Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, clinicians have been struggling to provide routine medical care and to manage situations where well-established standard practices for patient care are in conflict with new state laws that have expanded legal restrictions on sexual and reproductive health care. This dilemma is known as “dual loyalty.” A growing number of states have imposed restrictions on abortion care, including 14 that have introduced abortion bans with limited or no exceptions and severe civil and criminal penalties against clinicians.2 Some states are also considering or passing laws that could restrict gender-affirming care and assisted reproductive technologies such as in vitro fertilization.3 Clinicians in these states are experiencing an expanding array of dual loyalty conflicts as they attempt to practice patient-centered health care.4 Clinicians are being forced to choose between providing evidence-based care or obeying new legal prohibitions when treating pregnant patients, including those facing pregnancy-induced medical emergencies or with severe comorbidities.