Unclear, draconian abortion bans in several states demand that doctors and nurses cooperate with a system that harms their patients. In some of these cases, non-compliance is the only ethical response.
Every physician takes an oath to do no harm, yet harm is enshrined in law. Patients experiencing miscarriages are being denied standard care. Those seeking abortions face suspicion, interrogation, and, in some cases, prosecution. And the doctors caught in the middle? They either comply with unjust laws or risk their careers and freedom.
Imagine a pregnant woman bleeding heavily as she checks into a hospital. She’s miscarrying, but her doctor hesitates. The doctor doesn’t know if immediate treatment conforms to the
abortion ban in her state. The hospital’s legal department is called, and they call the risk management team. The clock ticks as she continues to bleed. She gets worse.
This is happening today in hospitals in states where abortion is illegal. Too often, this anticipatory compliance is harming our patients. When the law criminalizes care, neutrality is complicity. Our role is not to help law enforcement—it’s to protect our patients.
Sometimes, that means strategic, peaceful non-compliance.
A Brief History of Medical Non-Compliance
The biggest threat to a patient facing criminalization isn’t a nosy neighbor. It isn’t even a prosecutor. It’s us—and it’s nothing new.
Before Griswold v. Connecticut legalized contraception for married couples in 1965, doctors distributed birth control illegally, believing patients deserved the right to control their reproductive futures. During the AIDS crisis, providers treated patients with dignity despite public hysteria and government inaction. Black midwives in the Jim Crow South delivered babies in defiance of racist hospital policies that excluded Black women from care.
These were not acts of rebellion. They were acts of medical integrity.
Complications from Self-Managed Abortions
Researchers have found that the No. 1 way people who use medication for
self-managed abortion end up in legal trouble is through a healthcare provider. A patient comes in seeking help, and we turn them in. Sometimes, it’s intentional—someone sees an early miscarriage and assumes the worst. Other times, it’s bureaucratic, like when hospital policies trigger an automatic report to Child Protective Services (CPS) or the police.
Let’s be clear: we are usually not legally required to report.
No state law mandates reporting self-managed abortion to law enforcement. But that hasn’t stopped hospitals from treating pregnant patients like suspects. A Brookings report documents multiple cases where
digital surveillance—search histories, period tracking apps, even text messages—were used to investigate women for possible abortions.
And where did law enforcement start their investigation? Medical records.
The state doesn’t need to force us to comply. They count on us doing it willingly.
Who Pays the Price for Compliance?
Before abortion bans made headlines, hospitals were already punishing pregnant patients. A ProPublica investigation exposed cases where
miscarrying patients were denied life-saving care because doctors feared violating abortion laws.
All of these patients wanted to be pregnant. Their crime? Needing the same procedures used in abortion care.
We also know who gets turned in the most. Black and Indigenous women, immigrants, and those living in poverty are far more
likely to be reported than white, wealthy patients. Compliance does not keep us “safe” as providers. It keeps us in line with a system that disproportionately punishes the most vulnerable patients we serve.
We do not protect our clinics or ourselves from liability when we comply. We only protect the state’s ability to weaponize medicine against our patients.
What Non-Compliance Looks Like
Non-compliance does not mean recklessness or breaking the law. It means understanding the law and using its limits to protect our patients.
We do not comply in advance. Without a warrant, law enforcement should not be allowed into your clinic, hospital, or records. If they ask, you say no. If they insist, you tell them to come back with legal documentation.
We understand our rights. A Reuters report on
HIPAA-free zones found that while federal law protects patient privacy, hospitals often overreach in compliance with law enforcement. We are not required to answer questions about our patients.
Every receptionist, nurse, and doctor should know the answer when law enforcement calls:
We do not release medical records without a subpoena, answer questions without legal counsel, or discuss our patients with anyone without their consent.
We Are Not the Enemy—Until We Are
I always hear it from providers: “I would never report a patient.” But many of us already have, sometimes without even knowing.
- We follow a hospital policy written to “protect” us from liability, not our patients from criminalization.
- We document a patient’s pregnancy history in detail without considering how it might be used against them.
- We assume a miscarriage is just a miscarriage and that law enforcement won’t ask questions.
I am not asking you to do something radical. I am asking you to do your job as a healer, not as an agent of the state.
If you are uncomfortable with non-compliance, ask yourself: Are you comfortable with the alternative?
Because the alternative is that pregnant people are denied critical care in hospitals that are too afraid to help them. The alternative is criminal records instead of medical records. The alternative is practicing medicine in the service of prosecution, not care.
We do not have to comply, and we must not comply when our patients’ health and security depend on it.
