Document Type

Working Paper

Publication Date

2024

Abstract

Following the Supreme Court's decision in Dobbs v. Jackson Women's Health Organization and a series of restrictive state laws post-Dobbs, physicians in many states now face difficult choices between evidence-based practice and criminal penalties. Previously, when deciding whether to provide abortion care, concern for the health of the patient was paramount. Now, fear of criminal penalties drives decision-making for physicians practicing in many areas of the country, including our home state: Missouri. For certain life-threatening complications, termination of pregnancy is warranted, but since Dobbs, physicians have been delaying these potentially lifesaving procedures for fear of criminal repercussions. Behavioral research on decision-making under constraints has revealed predictable patterns of human cognition, including motivated reasoning, risk aversion, and decision paralysis. These features of human reasoning lead physicians in abortion-restricted states to err on the side of inaction, delaying or eschewing vital abortion care rather than risking criminal charges. This paper will identify the characteristics of these treatment situations that interact rational and biased patterns of human reasoning, making distorted decision-making all but inevitable. Exploring such difficult decisions through a behavioral lens allows us to offer a path forward: by targeting and minimizing the sources of uncertainty and anxiety for practitioners, we hope to clear the way for more predictable, evidence-based practices. To this end, we advocate reliance on clear and consistent protocols and workflows aimed at eliminating uncertainty on the part of both the physician and the institution.

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