In recent history, the world has witnessed a trend towards liberalization of abortion laws driven by an increasing understanding of the negative personal and public health consequences of criminalizing abortion. By contrast, several countries have recently implemented restrictive reproductive laws, joining the 112 countries where access to abortion care is banned completely or with narrow exceptions. On June 24, 2022, the US Supreme Court ruling in Dobbs v Jackson Women's Health Organization overturned its landmark decisions in Roe v Wade that established abortion until the point of viability of the fetus as a constitutional right. After Roe v Wade having been overturned, it is projected that many women in the USA will be prevented from accessing safe abortion care. Importantly, abortion bans not only impose constraints on patient autonomy, they also restrict physicians' ability to practice evidence-based medicine, which will negatively impact psychiatric care. It is therefore crucial for the practicing psychiatrist to be familiar with this new legal landscape. In this Personal View, we aim to provide a topical overview to help clinicians gain a clear understanding of legal, clinical, and ethical responsibilities, focusing on the USA. We also discuss the reality that psychiatrists might be called upon to determine medical necessity for an abortion on psychiatric grounds, which is new for most US psychiatrists. We predict that psychiatrists will be confronted with very difficult situations in which lawful and ethical conduct might be incongruent, and that abortion bans will result in greater numbers of patients needing psychiatric care from a system that is ill-prepared for additional demands.

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罗伊诉韦德案后精神病学：堕胎禁令下精神病学的法律、临床和伦理挑战


在近代史上，由于人们越来越了解将堕胎定为犯罪对个人和公共健康造成的负面影响，世界见证了堕胎法自由化的趋势。相比之下，一些国家最近实施了限制性生殖法律，加入了完全禁止或极少数例外情况禁止获得堕胎护理的 112 个国家行列。 2022 年 6 月 24 日，美国最高法院在多布斯诉杰克逊妇女健康组织案中的裁决推翻了其在罗伊诉韦德案中的里程碑式判决，该判决将胎儿存活前的堕胎视为一项宪法权利。罗伊诉韦德案被推翻后，预计美国许多妇女将无法获得安全的堕胎护理。重要的是，堕胎禁令不仅限制了患者的自主权，还限制了医生实践循证医学的能力，这将对精神科护理产生负面影响。因此，执业精神科医生熟悉这一新的法律环境至关重要。在本个人观点中，我们旨在提供主题概述，以帮助临床医生清楚地了解法律、临床和道德责任，重点关注美国。我们还讨论了这样一个现实，即精神科医生可能会被要求根据精神病学理由确定堕胎的医学必要性，这对大多数美国精神科医生来说都是新鲜事。我们预测，精神科医生将面临非常困难的情况，其中合法和道德行为可能不一致，而堕胎禁令将导致更多的患者需要从一个没有为额外需求做好准备的系统中获得精神科护理。