First, Do No Harm: The Detrimental Public Health Effects of Louisiana’s Current Abortion Statute

Comment

PDF available here.

By Emily A. Berthelot[*] 

Introduction

         In 2022, the United States Supreme Court overturned more than forty years of precedent and sent the question of abortion back to the states.[1] Specifically, Louisiana enacted a trigger law in anticipation of overturning Roe v. Wade, making abortion procedures illegal immediately following the Dobbs decision.[2] Louisiana has two exceptions to its current abortion statute.[3] The first is that abortion is legal in the case of a medical emergency to save a pregnant person’s life or to prevent substantial and irreversible impairment of bodily functions.[4] The second exception permits abortion if the pregnancy is “medically futile.”[5]

         Louisiana enacted its current abortion law to protect the health and welfare of its residents[6]. Specifically, the statute is in the “Public Health and Safety Title” of the Louisiana Annotated Statutes.[7] Unfortunately, its provisions have the opposite effect and harm the health of Louisianians. For example, the current statute offers only two exceptions and excludes cases of rape or sexual abuse, which can cause severe emotional harm to the pregnant person.[8] The statute explicitly notes that the exceptions do not include “any emotional, psychological, or mental condition.”[9]

         Additionally, the statute includes provisions that criminally penalize physicians who “violate the provisions” of the Abortion Chapter.[10] However, the practice of medicine requires physicians to make quick, life-altering decisions.[11] Under Louisiana’s current abortion statute, this quick decision involves choosing whether to risk their freedom and medical license to protect their patient or whether the patient’s life is at enough risk to qualify under the broad “medical emergency” exception to the Louisiana abortion statute.[12]

         Additionally, Louisiana’s May 2024 law reclassified misoprostol[13] and mifepristone[14] as Schedule IV drugs,[15] making them controlled substances.[16] With this change in scheduling, mifepristone and misoprostol became nearly impossible to access efficiently.[17] The consequence of labeling these drugs as “abortion-inducing drug” is that their unauthorized prescription and administration can incur criminal penalties.[18] However, these drugs are not only used for abortion procedures.[19] For example, misoprostol is used for intrauterine device (“IUD”) implantations, to prevent postpartum hemorrhages, to treat miscarriages, to induce labor, and more.[20] Where gaining access to misoprostol used to be relatively quick, there are new requirements, adding minutes that could mean the difference between life and death.[21]

         This Comment examines Louisiana’s current abortion statute and explains why it is not a public health law, as it diminishes the public health of Louisianians rather than improving it as intended. Part I outlines the scope of public health laws, including specific subsections on the Tenth Amendment granting a state the police power to enact public health laws, the wholistic[22] approach needed to create a true public health law, and the importance of enacting public health laws focused on improving patient outcomes. Next, Part II outlines the physician-patient relationship, specifically discussing a physician’s duties not to abandon patients, obtain informed consent, and comply with the standard of care. Part III then addresses Louisiana’s current reproductive health landscape, emphasizing that despite over four decades of efforts to implement abortion legislation aimed at “protect[ing] the health of women and children,” Louisiana still exceeds national averages of maternal and infant mortality. Finally, Part IV analyzes Louisiana’s current abortion statute, explains why it is not a public health law, and proposes amendments to improve the health of Louisianans instead of harming it.

I. Public Health Law

         Generally, “[p]ublic health laws are any laws that have important consequences for the health of defined populations.”[23] Public health laws have played a significant role in increasing life expectancy for the last 124 years.[24] Therefore, to understand how a law does not qualify or should not qualify as a public health law, one must first understand the basics of public health law. Subsection A explains where states derive their power to enact public health laws and the scope of such power. Then, Subsection B discusses a wholistic approach to public health law, including the need to utilize physician assistance and medical research throughout drafting and enacting a public health law. Lastly, Subsection C explains how states enact public health laws to help improve patient outcomes.

         A.  State Power to Enact a Public Health Law

       Public health laws “derive from federal and state constitutions; statutes, and other legislative enactments; agency rules and regulations; judicial rulings and case law; and policies of public bodies.”[25] Generally, states have the authority to pass public health laws under the Tenth Amendment, which grants them police powers “for enacting and enforcing laws to promote the health, safety, and general welfare of people in their jurisdictions, which is understood to include public health.”[26] Americans value their privacy and are often reluctant to allow government intrusion into their personal decisions, including their health decisions.[27] Thus, implementing public health laws often requires weighing the need for an intervention to protect public health against the intrusion of “government-imposed requirements.”[28]

         In the landmark case Jacobson v. Massachusetts, the United States Supreme Court addressed the issue of whether a state has the power to enact a statute requiring the vaccination of all residents.[29] The city of Cambridge, Massachusetts, brought a criminal complaint against the plaintiff in this case, Jacobson,[30] for refusing to get the smallpox vaccination.[31] The Massachusetts statute required that all residents, twenty-one and older, be vaccinated or pay a five-dollar fine[32] for noncompliance.[33] Jacobson was ultimately found guilty after appealing his criminal complaint to the Massachusetts Supreme Court.[34] Jacobson then filed a civil suit against the state of Massachusetts, arguing that the statute restrained his liberty and was arbitrary.[35]

         The Court was clear that Massachusetts had the power to enact a law requiring the vaccination of all residents under its police power, which includes “health laws of every description.”[36] However, the Court explicated that this case would be the first to define the limits of a state’s police power.[37] In general, the Court asserted, “the police power of a state must be held to embrace, at least, such reasonable regulations established directly by legislative enactment as will protect the public health and the public safety.”[38] The Court held that if a state uses its police powers to enact a regulation for public health, then the regulation must be reasonable and not arbitrary or oppressive.[39] Thus, the statute should have a rational relationship between the purported public health concern it aims to address and the method it employs to regulate that issue.[40] Further, the state statute cannot violate the rights protected by the United States Constitution or interfere with the exercise of federal power.[41] Therefore, an exercise of police power cannot stand if it is unreasonable or arbitrary, as it exceeds what is reasonably required for the public’s safety. Additionally, it must have a rational relationship between its public health aim and how it attempts to achieve that aim, and it cannot violate a constitutional right.[42]

         Regarding plaintiff-Jacobson’s assertion that the statute infringed upon his individual liberties, the Court was clear that a person’s liberty “may at times, under the pressure of great dangers, be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand.”[43] Thus, the paramount consideration when enacting a public health law is to promote the public’s health and safety, even if that involves implementing restrictions. However, a law is outside the scope of a state’s police powers, and, therefore, not considered a public health law when it attempts to regulate beyond what is reasonably necessary to promote the health and safety of the public.[44]

         The Jacobson Court clarified that it is appropriate for a state to defer to medical experts and those who will be affected by the statute when enacting a public health statute.[45] Further, the Court explained that a state may delegate its police power to a state agency or local government to enact statutes that are in the best interest of public health.[46] Thus, to ensure that a law is not unreasonable or arbitrary as to harm public health, the governing body that enacts the law should consult with medical experts and conduct research on how the law will affect public health.[47] In short, legislatures should conduct a more wholistic approach to enacting public health laws.

         B. The Wholistic Approach to Public Health Law

         The primary goal of public health laws is to promote healthier practices[48] and to establish standards of care that lead to better patient outcomes and “access to quality health services.”[49] Importantly, “[p]ublic health law shares conceptual terrain with the field of law and medicine.”[50] Thus, a medical background is necessary to create a wholistic public health law.

         When a law is enacted to promote public health, its breadth can have long-lasting influence on individual health and health-related outcomes.[51] Additionally, public health laws can affect future generations, empirical studies, healthcare plans, and more.[52] Therefore, “[t]he responsible use of law as a tool for improving public health requires a commitment to the pursuit and consideration of scientific evidence when possible.”[53] The key to understanding that law and health are intrinsically intertwined is appreciating that the law regulates the lives of individuals and is embedded in everyday life.[54] Therefore, when a law governs the health of individuals, it can produce intended and unintended health effects, which require an understanding of those effects before enacting a law.[55]

         A wholistic approach to enacting public health laws requires not only the integration of the law and health research but also collaboration between the community, the media, and businesses.[56] This collaboration ensures that the proper conditions for health are met in every aspect of life.[57] Combining the law with scientific research, socioeconomic research, and media literacy will help legislators reach their ultimate goal—fewer deaths and improved patient outcomes

         C. Enacting Public Health Laws as a Mode of Bettering Patient Outcomes

         As outlined in Jacobson, the overarching theme of public health laws is the health and safety of the public.[58] As a result, the purpose of public health law is to halt bad patient outcomes and promote better health, even if that means facing media backlash or going against an individual’s idea of what is “socially acceptable.” Throughout history, laws have been enacted to improve public health and safety, for example, state laws requiring car seats for children and seatbelts.[59] At first glance, a law requiring car seats for children and seatbelts for adults may seem like purely a traffic issue. However, looking at the law through a wholistic approach, and considering not only the practicality of the law but its effects on health, the community, and businesses, car seat and adult seatbelt laws are the epitome of public health laws because they keep the public safe, and help to prevent car-related deaths for all ages.[60]

         In the 1970s, a Tennessee pediatrician, Robert Sanders, noticed that car accidents were a leading cause of death amongst children in the United States, “killing hundreds of toddlers and infants each year.”[61] Through research, Sanders learned about child safety seats (car seats) and how their use could reduce the deaths of children in traffic incidents.[62] Convinced that children deserved the protection and safety that a car seat could offer, Sanders decided to lobby for a bill that would require the use of car seats for children.[63] While the idea of child safety seems like an issue that everyone would be on board with, the bill faced a lot of backlash from people, including members of the legislature, who had personal reasons for opposing the perspective legislation.[64] Ultimately, the Tennessee Legislature enacted the Tennessee child restraint law to protect the lives of children and deter future adverse outcomes.[65] This law “was effective almost immediately, more than doubling car seat usage within the first few years and reducing childhood traffic fatalities by 70 percent.”[66] Many states quickly followed suit, and by the 1980s, every state had child restraint laws “on the books,” with the primary purpose of protecting the lives of children.[67]

         Child vehicle safety laws paved the way for adult seatbelt laws, with New York leading the cause in 1984.[68] Car manufacturers were the loudest in opposition to adult seatbelt laws, citing heavy requirements and extra costs in the manufacturing process.[69] While car manufacturing companies can often be large campaign donors,[70] and enacting legislation that they directly opposed could adversely affect some state legislatures, every state chose the health and safety of its residents and enacted seatbelt laws.[71]

         Tobacco use is another historical example of public health concerns influencing legislation. The first report of tobacco causing adverse health effects was in 1761, when Dr. John Hill cautioned against the use of snuff,[72] as it was causing swelling and disease-ridden growths in certain extremities.[73] Throughout the early 1900s, researchers were uncovering connections between cancer and tobacco use.[74] Since then, tobacco use has increased, along with the side effects.[75] Tobacco companies were the biggest obstacle to enacting tobacco legislation, focusing their resources on lobbying against the regulation and offering misleading research in congressional hearings that suggested tobacco was not harmful or addictive.[76]

         Due in part to continuing concerns of physicians and researchers who actively cautioned against tobacco use because of its link to cancers and other health concerns, twenty-eight states have laws either restricting or outright prohibiting the use of tobacco through smoking in most public places and workplaces.[77] Even further, twelve states have passed laws restricting the promotion and advertisement of tobacco, including e-cigarettes.[78] Additionally, the Affordable Care Act (ACA) has many requirements to help deter tobacco use.[79] For instance, the ACA allows insurers to charge tobacco users a fifty percent higher rate.[80] Additionally, the ACA requires most insurers to offer coverage of tobacco cessation treatments and Federal and Drug Administration-approved medications.[81] In all, the outcry of researchers and physicians about the dangers of tobacco use outshone the tobacco industry’s concerns. It prompted many states to enact legislation restricting tobacco use to protect the public health of their residents.

         As evidenced above, even with the presence of competing interests, public safety is threaded throughout public health law. Physicians are best positioned to lead discussions focused on the central goal of improving patient outcomes. A pediatric physician voiced his concerns about the death of children in traffic accidents, leading to the enactment of public health laws requiring car seats, subsequently paving the way for public health laws requiring the use of adult seat belts.[82] Further, in 1761, Dr. Hill was the first to caution his patients on the use of tobacco; numerous physicians and researchers later accompanied Dr. Hill,[83] warning about the side effects of tobacco, culminating in states enacting public health laws restricting the use of tobacco. Physicians are the first to notice the trends that are adversely affecting their patients, and advocate on their behalf.[84] Therefore, public health laws should seek to facilitate and encourage the physician-patient relationship to better aid physicians in analyzing and pinpointing issues that affect public health and, ultimately, produce better patient outcomes and fewer deaths.

II. The Physician-Patient Relationship

         Before becoming a practicing physician, a prospective physician must recite the Hippocratic Oath, including the language “primum non nocere,” which translates to “First, Do No Harm.”[85] While this seems like a steadfast requirement for the practice of medicine, the oath to “do no harm” is in constant conflict with physicians as they balance what is best for their patient and what the law requires them to do.[86] Adding the boundary of the law to the physician-patient relationship not only potentially puts the patient’s life in danger but also forces the physician to put their career on the line to provide, in some cases, basic care.[87]

         The baseline for a good physician-patient relationship is that the patient is willing to put their trust in the hands of the physician, and the physician acts in compliance with that trust and in the patient’s best interest.[88] Without a mutually trustworthy physician-patient relationship, the lives of patients and physicians suffer immensely.[89]

         Generally, the physician-patient relationship is defined as “a consensual relationship in which the patient knowingly seeks the physician’s assistance and in which the physician knowingly accepts the person as a patient.”[90] The relationship of a physician and patient is often described as a fiduciary duty, meaning it is “one of the highest degree involving every element of trust, confidence and good faith.”[91] Thus, the formation of the physician-patient relationship prompts four duties that physicians should abide by.[92] Specifically, those duties are “not to abandon a patient, . . . to obtain informed consent to treatment, . . . to keep treatment information confidential, and . . . to comply with the medical standard of care.”[93] Therefore, this Section will discuss and explain the duty not to abandon the patient, the duty to obtain informed consent, and the duty to comply with the medical standard of care, and the effects on both the patient and physician if these duties are breached. The three duties mentioned above are thoroughly discussed in this Section because they are at odds with the current restrictions of Louisiana’s abortion law and are the most likely to be breached due to those restrictions.[94]

         A. Duty Not to Abandon the Patient

        Upon formation of a physician-patient relationship, a physician has a duty not to abandon their patient.[95] Put simply, a patient is abandoned when there is a “unilateral termination of the physician-patient relationship without providing adequate notice for the patient to obtain substitute medical care.”[96] A physician’s abandonment of a patient can be intentional or unintentional.[97] For instance, arbitrarily refusing to see a patient after a relationship has been formed is intentional abandonment.[98] To the contrary, unintentional abandonment can look like a myriad of things, including not responding to a patient’s concerns for a prolonged period, failing to follow up with a patient, or miscommunicating with the patient regarding services that the physician offers or coverage of those services.[99]

         Physician abandonment most often occurs when the patient is having a medical crisis and needs continuing or substantial care, but is left either completely without the care, or without adequate care for their specific needs.[100] The potential effect of abandonment on the patient is the worsening of the patient’s injuries or mental state due to lack of care in a timely or adequate manner.[101] The effect of abandonment on physicians is a potential lawsuit against the physician for negligence due to the abandonment, which can result in a physician losing their license or suffering a financial detriment.[102]

         Overall, the duty of a physician is not to abandon their patient, ensuring that the patient will receive the care they need and deserve when they put their trust in their physician.[103] Furthermore, when the physician enters a physician-patient relationship, they invite the patient to place their trust and care in them.[104] Therefore, the duty not to abandon is not akin to medical malpractice, where the physician has offered some care, but it lacked the quality needed to meet the standard of care; it is where the patient is desperate for that care, but the physician does not fulfill their duty.[105]

         B. Duty to Obtain Informed Consent

        As Justice Cardozo opined in Schloendorff v. Society of New York Hospital, “[e]very human being of adult years and sound mind has a right to determine what shall be done with [their] own body.”[106] The ability to accurately comprehend the care a patient signs up for is highly underappreciated.[107] Informed consent is not simply a piece of paper that a patient signs before undergoing a procedure or receiving some form of care. Rather, informed consent encompasses a wholistic approach to medicine that requires the physician to see the patient as a person and address all of their needs and concerns to ensure that the patient can accurately decide how they want to address their health.[108] The doctrine of informed consent requires not only that the physician inform the patient about the care they are about to receive, but also educate them on the “risks, benefits, and alternatives of a given procedure or intervention.”[109]

         The purpose of informed consent is to ensure that patients are fully involved in their care and are aware of all the potential benefits and harms that may arise from it.[110] Therefore, physicians need to be aware of the potential barriers to achieving informed consent and know how to face them.[111] For instance, a patient can lack the ability to fully comprehend the physician’s suggestions or potential care plan.[112] However, lacking comprehension does not always mean mental infirmity or medical impairment; instead, it can arise when there are “varying levels of health literacy.”[113] For example, a physician can explain a health plan in terms they believe are easy to comprehend, but include medical jargon that a patient lacks the proper medical background to fully understand.[114] In such a case, the patient may agree to the physician’s health plan because they think the physician has more knowledge and would not lead them astray.[115] While this may be true, the patient does not fully understand the potential impact the health plan may have on their body or mental health; thus, they did not truly consent to the care.[116]

         Physicians must exercise extreme caution when explaining their care plans or procedures to patients, ensuring that patients are fully aware of all the risks and benefits.[117] Therefore, physicians should not downplay certain risks or let their own biases influence physician-patient discussions, as they can sway patients in a direction that may not align with their wishes.[118] Further, physicians should emphasize the patient’s control over the decision-making process and their freedom to inquire about complex medical explanations that they don’t understand.[119]

         Breaching the duty of informed consent can have detrimental effects on both the patient and the physician.[120] For instance, the patient could agree to undergo a medical treatment or procedure that they do not fully understand, leaving them to grapple with side effects they are unprepared for. Take, for example, a gallbladder removal procedure.[121] On the surface, the procedure is routine for physicians, and they may explain the pre- and post-operative care to the patient without considering that the patient may not have accurately understood their role in the care. However, a routine procedure, like a gallbladder removal, may be the first time a patient has had any surgery, or they may not know anyone who has ever had their gallbladder removed, so they are not aware of the routine procedure that must take place to ensure a quick and healthy recovery.[122] If a patient misunderstands that they cannot return to their everyday activities, such as driving or going to work, and may weaken easily when attempting to do so, they may attempt to return to “normal” too quickly, worsening their symptoms and prolonging their recovery.[123] Thus, if the patient is not fully aware of all that their care plan entails, they lack informed consent, which can cause more harm to themselves.[124]

         If a patient lacks informed consent, the physician may be at risk for liability, including being sued for negligence or battery.[125] Criminal battery is “the unauthorized touching of another person that causes harm.”[126] Thus, if a physician were to perform a procedure on a patient that they did not consent to, or did not fully understand enough to give their informed consent, the physician could be held criminally liable for a battery upon the patient, and could also be held civilly liable for the tort of battery upon the patient.[127]

         The importance of informed consent cannot be overstated. A physician obtaining informed consent to treat their patient is an essential duty because it not only ensures the patient’s safety but also sets them up to receive the most beneficial outcome for their health. Additionally, the duty to obtain informed consent allows physicians to take extra time with their patients and speak with them about their concerns and fears, increasing favorable patient outcomes and decreasing physician liability.[128]

         C. Duty to Comply with the Medical Standard of Care

         When referencing a physician’s duty to comply with the medical standard of care, the standard in question is a legal threshold that protects patients when physicians fail to meet their specific needs.[129] In turn, the legal standard of care protects physicians who comply with its requirements, even if, unfortunately, the patient has a bad outcome.[130] In general, most physicians have a duty to comply with the national standard of care, which is, “the level and type of care that a reasonably competent healthcare professional, with training and experience, would have provided under similar circumstances.”[131] Although physicians are held to a standard that can seem uniform and strictly empirical, “[the] standard of care is sensitive to time, place, and person.”[132] Meaning, each patient has their own specific set of needs that need to be considered when determining their health plan.[133]

         In the practice of medicine, the standard of care is often referred to as “best practice.”[134] Best practice translates to the “treatments and practices that are appropriate for a specific disease that are both accepted by medical authorities and widely used by healthcare professionals.”[135]  The standard of care is a spectrum ranging from unacceptable medical care to the best care a patient can receive.[136] Thus, a breach of the standard of care can look like a myriad of things, from misdiagnosing a patient and failing to order appropriate medical tests to errors in surgeries that can leave patients with serious long-term effects.[137]

         Breaching the standard of care can put patients’ lives in danger and expose physicians to liability. A patient who feels they received substandard medical care can file a medical malpractice action against the physician.[138] The duties of a physician discussed above are closely tied to the obligation to meet the standard of care. A breach of any of these duties may serve as evidence that a physician failed to meet that standard, potentially resulting in liability.[139] For instance, if a physician fails to obtain informed consent from a patient for their treatment plan and still proceeds, the physician is not acting in best practice and can be sued for medical malpractice.[140]

         A physician’s duty to comply with the standard of care not only gives patients a legal recourse to be made whole if they are harmed, but it also protects patients by providing a guideline for acceptable care by physicians. Consider the gallbladder removal procedure discussed in the previous Section.[141] The “best practice” is to use a cholecystectomy procedure because it involves robotic surgery that uses very small incisions to minimize recovery time and pain to the patient.[142] Now, issues can arise, and if the surgeon has to make a larger incision due to an emergency, that is perfectly acceptable and within the applicable standard of care.[143] However, if there was no justified reason, and the physician arbitrarily elects not to use the cholecystectomy procedure, and instead, makes a larger incision, or performs open surgery on the patient, the physician would not be complying with the standard of care for gallbladder removals, and the patient can suffer more pain and a longer recovery time.[144] In which case, the physician would be open to liability for failing to comply with the standard of care, which can be proved by offering evidence showing the “best practice” for gallbladder removal.[145] Thus, the baseline of the duty to comply with the standard of care is to protect patients and hold physicians accountable by setting an objective threshold.[146]

         At the core of a physician’s duties is the trust between patient and physician.[147] The duties discussed above aim to put the patient and physician on even footing; with the patient understanding, consenting, and trusting the physician’s plan, and the physician acting in accordance with best practices and in the patient’s best interest.[148] A breakdown in the physician-patient relationship, or a breach in one of the physician's duties, can lead to poor patient outcomes and expose physicians to liability.[149] Therefore, a legal statute claiming to protect public health is not a public health law if it causes a breakdown in communication between patients and physicians, thereby facilitating a breach in their duties to patients.

III.  Louisiana’s Current Reproductive Health Landscape

         Since the holding of the seminal case Roe v. Wade,[150] Louisiana has passed 89 abortion restrictions.[151] Some of the restrictions included an abortion ban at 15 weeks,[152] followed by another ban as early as 6 weeks.[153] The bans were either struck down by the Supreme Court[154] or placed on hold and labeled as a trigger law, for if, or when, the Supreme Court overturned Roe v. Wade.[155] Louisiana has passed numerous pieces of legislation that restrict or ban abortion in as many scenarios as possible and has spent millions defending its proposed laws in courts,[156] only to ignore the true issue—the health of women.[157] The current abortion law was drafted in 2006 as a trigger law, anticipating the overturning of Roe v. Wade, and declares the intention of protecting the “health, safety, and welfare of women.”[158] Unfortunately, Louisiana’s current reproductive health landscape and the health of women and children do not reflect the current statute’s intention.[159] Thus, this Section discusses Louisiana’s current reproductive health landscape and emphasizes the need for comprehensive care that does not further limit the needs of women.

         Louisiana’s healthcare system ranks as one of the worst-performing in the United States.[160] Louisiana’s inadequate healthcare system, coupled with its astronomically high poverty rate,[161] has left many Louisianians vulnerable and without access to proper healthcare.[162] Additionally, about fifteen percent of the Louisiana population lives in rural areas, which further restricts their access to healthcare.[163] More than 300,000 Louisiana women live in contraceptive deserts, limiting their access to contraceptive care.[164] The lack of adequate contraceptive care and Louisiana’s refusal to require comprehensive and medically accurate[165] sex education in schools[166] have led to higher rates of sexually transmitted infections, unintended pregnancies, and teen and adolescent births.[167]

         Louisiana is not equipped to handle its high pregnancy rate and cannot provide equitable access to reproductive care.[168] According to the 2023 March of Dimes report on Louisiana, 26.6% of the parishes in Louisiana are “maternity care deserts,”[169] compared to 32.6% of maternity care deserts across the United States.[170] Meaning, Louisiana comprises a significant percentage of maternity care deserts in the United States.[171] Importantly, 16.2% of Louisiana women received “inadequate prenatal care,” surpassing the United States average of 14.8%.[172] Additionally, 12.1% of Louisiana women have no hospitals that are equipped to handle births within 30 minutes of them, once again surpassing the national average of only 9.7%.[173]

         Louisiana’s grim outlook on reproductive care did not stop its rising birth rate.[174] Unfortunately, with inadequate access to good reproductive care comes more birth-related issues. Women who have chronic health conditions have a 49% higher likelihood of having a preterm birth.[175] Sadly, Louisiana surpasses the national average once again, with 78.1% of parishes having a high rate of chronic health conditions and pre-term birth.[176] The national average on chronic health conditions and pre-term births further translates to 42.5% of Louisiana women having chronic health conditions compared to 37.8% of women in the United States.[177]

         As evidenced above, Louisiana’s lack of adequate reproductive care and overall healthcare led to a rise in preterm births and infant mortality.[178] Preterm births are “defined as babies born before 37 weeks,” and are the “leading cause of infant mortality and can lead to health problems throughout life.”[179] Louisiana received an “F” in the 2024 March of Dimes Report Card for preterm birth and infant mortality.[180] The data importantly pointed out that Louisiana’s pre-term birth rate is 13.4%, which has increased since 2022 and once again surpasses the national average.[181] As a result of the high pre-term birth rate, Louisiana’s infant mortality rate is 7.4% with the biggest impact on Black women,[182] whose infant mortality rate is 1.5 times the national  rate.[183]

         The statistical data above illustrate the current reproductive healthcare crisis in Louisiana and emphasize the need for a statute that protects the health of women and children.[184] Unfortunately, Louisiana’s current abortion statute does neither.[185] The legislative intent of Louisiana’s current abortion statute makes it out to be a public health law.[186] It states that “[t]he provisions of this Chapter that regulate the practice of abortion are enacted to provide for the health, safety, and welfare of women.”[187] However, the statute and its current restrictions put the lives of women and children at further risk and should be amended to meet the goal it set out to accomplish.

IV.  Analysis and Suggestions

         This Section first discusses how Louisiana’s current abortion statute harms the physician-patient relationship and forces physicians to breach their duties designed to protect patients. It then asserts that the provisions of the current statute are arbitrary, unreasonable, and not rationally related to the protection of public health. Therefore, the current statute is outside of the scope of Louisiana’s police powers. Finally, it offers suggestions on how to amend the statute to make it a public health law that supports the health and safety of Louisiana citizens.

         A. The Current Statute Harms the Physician-Patient Relationship and Causes Physicians to Breach Their Duties.

         The physician-patient relationship is the cornerstone of good medical practice because it provides a foundation of trust and open communication between the patient and physician.[188] During the existence of a good physician-patient relationship, the physician should allow the patient to freely express their medical concerns and symptoms. The physician should then use their medical training and knowledge to accurately advise them on their diagnosis and health plan, followed by the patient’s informed consent to that plan.[189] However, if the physician is forced to balance compliance with the law and avoiding criminal penalties with treating their patient, the physician-patient relationship starts to crack, and trust is lost in both directions. This ultimately leaves the physician vulnerable to liability, and the patient vulnerable to harm.[190] Louisiana Revised Statutes § 40:1061 states a blanket prohibition on abortion.[191] Specifically, it states that:

No person may knowingly administer to, prescribe for, or procure for, or sell to any pregnant woman any medicine, drug, or other substance with the specific intent of causing or abetting the termination of the life of an unborn human being. No person may knowingly use or employ any instrument or procedure upon a pregnant woman with the specific intent of causing or abetting the termination of the life of an unborn human being.[192]

         Importantly, the next provision states that “[a]ny person in violation of this Section shall be prosecuted pursuant to the effective provisions of R.S. 14:87.7….”[193] Title 14 of the Louisiana Revised Statutes pertains to criminal law.[194]  Specifically, La. R.S. § 14:87.7 explains the criminal penalties that physicians will face if they “commit the crime of abortion.”[195] Namely, that they will “be imprisoned at hard labor for not less than one year nor more than ten years and shall be fined not less than ten thousand dollars nor more than one hundred thousand dollars.”[196] Louisiana considers a crime that carries a sentence “at hard labor” for any number of years a felony.[197] Thus, if a physician violates La. R.S. § 40:1061, the state would charge them with a felony and sentence them not less than one year, but up to ten years in a state prison and fine not less than ten thousand dollars, but up to one hundred thousand dollars.[198] Further, physicians could face civil penalties under La. R.S. § 40:1061.29, which states:

Whoever violates the provisions of this Chapter shall be subject to a civil fine of one thousand dollars per incidence or occurrence. In addition to any other authority granted by the constitution and laws of this state, the attorney general shall have the authority to pursue the civil fines provided for in this Section.[199]

        The provision further asserts that if a physician fails to comply with “the provisions of this Chapter,” that failure will be used as the basis of a potential civil suit brought by the woman.[200] Further, the violation will “be admissible in a civil suit as prima facie evidence of a failure to comply with the requirements of this Chapter.”[201] The provisions also provide a basis “for professional disciplinary action,” under La. R.S. § 37:1261, which grants the Louisiana Legislature the right to protect “against unprofessional, improper, unauthorized, and unqualified practice of medicine and from unprofessional conduct of persons licensed to practice medicine, surgery, and midwifery.”[202] Thus, physicians could face harsh civil and professional penalties on top of criminal penalties for violation of the current abortion statute.

      Louisiana offers two exceptions to its current abortion statute. The first exception is to “perform a medical procedure necessary in reasonable medical judgment to prevent the death or substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ of a pregnant woman.”[203] The second exception is if the pregnancy is medically futile.[204] Meaning that “in reasonable medical judgment, the unborn child has a profound and irremediable congenital or chromosomal anomaly that is incompatible with sustaining life after birth.”[205] Currently, there are no exceptions for rape or sexual abuse in Louisiana.[206]

       The criminalization of physicians and the harsh civil and professional penalties under La. R.S. § 40:1061 puts physicians in extremely difficult situations because the nuance of medicine and the vagueness of the statute.[207] Further, when physicians are subject to criminal penalties for attempting to practice medicine to the best of their ability, they are forced to make decisions that could cause them to breach their duties as physicians.[208] Louisiana’s current abortion statute forces physicians to breach their duties of obtaining informed consent, not abandoning their patient, and complying with the standard of care.

         First, the current abortion statute forces physicians to breach their duty to obtain informed consent from the patient they are treating. The doctrine of informed consent requires not only that the physician inform the patient about the care they are about to receive, but also educates them on the “risks, benefits, and alternatives of a given procedure or intervention.”[209] La. R.S. § 40:1061 states that “[n]o person may knowingly administer to, prescribe for, or procure for, or sell to any pregnant woman any medicine, drug, or other substance with the specific intent of causing or abetting the termination of the life of an unborn human being.”[210] The statute forces physicians to withhold information from their patients regarding all of their options for them to make an educated decision about what is best for their reproductive health.

         It is essential for physicians to explain to patients all of their options because “[a]ccess to information is critical to safeguarding patients’ rights to informed consent and reproductive rights.”[211] Forcing physicians to withhold information about patient care not only causes them to breach their duty to obtain informed consent, but also puts them in direct violation of the American Medical Association’s (“AMA”) Code of Medical Ethics.[212] Specifically, the AMA Code of Medical Ethics states that “[e]xcept in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable.”[213] If patients are not equipped with all the necessary information regarding their care, they cannot truly consent, and continuing that care breaches the physician’s duty to obtain informed consent.[214]

         Next, Louisiana’s current abortion statute forces physicians to breach their duty not to abandon their patients. For instance, a physician breaches their duty to not abandon their patient if the patient is having a medical crisis and is in need of continuing or substantial care, but the physician either leaves them completely without the care, or without adequate care for their specific needs.[215] Since Louisiana’s abortion statute went into effect, numerous physicians “relayed an account in which they and/or their colleagues delayed abortion care until complications worsened to the point where the patient’s life was irrefutably at risk.”[216] The delay of care until “the patient’s life was irrefutably at risk” was due to the fact that the physician could not administer an abortion unless the patient fell under the exception to “prevent the death or substantial risk of death due to a physical condition, or to prevent the serious, permanent impairment of a life-sustaining organ.”[217] A physician who leaves their patient without adequate care because they have no other recourse but to let their condition worsen until they fit into a narrow exception of a law is a breach of a physician’s duty not to abandon their patient.

         Unfortunately, physicians have no choice but to breach their duty not to abandon their patient because if they treat the patient, they will have to perform an abortion and could face criminal penalties for doing so too soon.[218] The vague provisions of the statute and the lack of case law interpreting it have left lawyers with little to no guidance on how to advise their physician-clients, which has caused additional delays in care and harm to patients.[219] The Louisiana Board of Medical Examiners advised its members to speak with a lawyer before they perform any care that could lead to an abortion.[220] Since lawyers have a duty to protect their clients’ interests, they will likely advise them to be extremely cautious, even if it causes harm to the patient. In fact,

Dr. Valerie Williams, a New Orleans obstetrician and gynecologist, wrote that a hospital attorney prevented her from performing an abortion on a patient whose water broke before the fetus was viable. It forced the patient to spend hours in labor, and she ultimately lost more than a liter of blood.[221] 

Thus, lawyers are essentially left to advise their physician-clients to breach their duty not to abandon their patient to avoid criminal liability.

         Lastly, Louisiana’s current abortion statute causes physicians to breach their duty to comply with the standard of care. In medicine, the standard of care encompasses both a legal and a medical definition.[222] Physicians have certain guidelines they must follow for the specific care that the patient needs, often referred to as “best practice.”[223] In the legal sense, if the physicians breach the applicable standard of care, it can be used as evidence against them if the patient decides to seek legal action.[224]

         Since the enactment of Louisiana’s current abortion statute, physicians have reported an increase in “medical procedures and treatments that do not meet the standard of care—heightening risk to patients—and which could have been avoided if they had been able to provide abortion care.”[225] Consider, for instance, preterm premature rupture of membranes (PPROM), a life-threatening complication where the amniotic sac breaks before 37 weeks and increases the risk of infection.[226] The standard of care in PPROM cases that would not result in a viable pregnancy is a “common abortion procedure,” called dilation and evacuation.[227] However, physicians have been legally advised to perform a cesarean section, a riskier and more invasive surgery with far more documented complications, to remain in compliance with the law and not subject the patient to more pain by waiting for them to fit into a vague exception.[228] Thus, Louisiana’s current abortion statute forces physicians to breach their duty to comply with the standard of care by making them perform riskier procedures that are not the standard for the patient’s specific needs, essentially putting the patient’s life in danger.

         Louisiana’s current abortion statute forces physicians to breach their duties of care, which in turn, places patients in harm’s way.[229] A physician who breaches their duties also loses the trust of their patients and chips away at the physician-patient relationship.[230] In the wake of the enforcement of Louisiana’s abortion statute, one physician commented,

Well, I’m hopeful that [my patients] still trust me, but it’s hard to be trusting when you are told that I have to send you here or you have to go there. These are options, but I can’t help you. You are on your own ... This is not the physician I trained to be and how I have practiced for more than 20 years, not how I saw or see my role, not to walk with my patients through their whole journey.[231]

The breakdown in the physician-patient relationship caused by Louisiana’s abortion statute has had detrimental consequences on the health of patients and is only exacerbated by its overly strict provisions that only harm the health of Louisianans.

         B. The Current Statute is Outside the Scope of Louisiana’s Police Powers.

         The Tenth Amendment of the United States Constitution grants states powers to “enact[ ] and enforc[e] laws to promote the health, safety, and general welfare of people in their jurisdictions, which is understood to include public health.”[232] Specifically, the Jacobson court held that “the police power of a state must be held to embrace, at least, such reasonable regulations established directly by legislative enactment as will protect the public health and the public safety.”[233] Additionally, the statute must be reasonable and cannot be so arbitrary or oppressive as to have an adverse effect on the public health of the residents of the state.[234] Thus, the statute should have a rational relationship between the purported public health situation it attempts to regulate and how it attempts to regulate that situation, and should not infringe on any constitutionally protected rights.[235] The Jacobson court also held that it is appropriate for a state to defer to medical experts and those who the statute will directly affect in order to determine its effect on public health.[236]

         Louisiana’s current abortion statute is arbitrary and oppressive, and its near-total abortion ban is not rationally related to preserving the “health, safety, and welfare of women.”[237] The criminalization of physicians who perform an abortion unless the patient falls into one of the two incredibly vague exceptions has caused delayed care to patients and put their lives in more danger.[238] Further, physicians are forced to deviate from the standard of care to perform riskier procedures with more complications that can result in longer recovery times, and even death.[239]

         The current statute limits a woman’s choice to receive timely reproductive care, many of whom have reported “life-threatening pregnancy complications, including eclampsia and infections, compared to those who received requested abortion care.”[240] The current statute does not protect women who do not fall into the narrow exceptions and forces them to experience a deterioration in their health to be cared for by a physician.[241] The statute does not have exceptions in the case of rape or sexual abuse, and specifically notes that the exceptions do not include “any emotional, psychological, or mental condition.”[242] Thus, the near-total ban, with two very limited exceptions, is overly oppressive and adversely affects the public health outcomes of Louisiana residents.

         Further, the Louisiana Legislature did not consult physicians when enacting this statute, nor did it attempt to gather medically accurate information to determine how it would affect the health of Louisiana citizens.[243] The legislature has also continuously ignored the outcry of physicians who have expressed the adverse health effects that the current statute has had on the public.[244] While this is not a requirement, if the Legislature had done so, it would have gained a better understanding of the issues that could arise for physicians and patients when enacting a statute that harms public health as opposed to supporting it.

         Louisiana already has the highest maternal mortality rate in the country, with “58.1 deaths per 100,000 births.”[245] The current abortion statute threatens to increase that number because it forces physicians to delay care and perform unnecessary procedures to comply with the oppressive provisions.[246] Thus, Louisiana’s current abortion statute is arbitrary and oppressive because it harms public health, and its oppressive provisions are not rationally related to protecting the health and safety of women. In fact, it has the opposite effect. Therefore, Louisiana’s current abortion statute is not within Louisiana’s police powers allotted by the Tenth Amendment and should be amended to reflect a statute that promotes the public health and safety of Louisianians, as was its original purpose.

         C. Suggestions 

         Louisiana’s current abortion statute is not a public health law because its oppressive provisions are not rationally related to the public health of Louisianians, and it causes more harm to the public health than it aims to help.[247]  The best course of action is to amend the statute and edit the current provisions so that they truly benefit the public health of Louisiana residents. In adding and editing these provisions, the Louisiana Legislature should consult physicians who specialize in reproductive health, emergency medicine, and any other physicians who treat those most affected by the oppressive provisions of this statute. If the Louisiana Legislature does not seek to amend and add provisions to its current abortion statute that protect the public health of its residents, the maternal mortality rate will continue to rise,[248] and the public health of Louisiana residents will continue to decrease.

         First, the Louisiana Legislature should remove La. R.S. § 14:87.7, which criminalizes physicians who commit the “crime of abortion.”[249] As discussed above, because of the provision that criminalizes physicians, they are forced to breach their duties of care, which delays care and causes adverse health risks to women. It also erodes the physician-patient relationship, leading to an increase in adverse patient outcomes and prolonged health consequences for patients. Further, the Louisiana Legislature should lessen the number of civil penalties imposed on physicians who violate the statute. Physicians are already faced with numerous uncertainties when treating a patient, including what treatment plan to pursue, how the patient will respond to the proposed treatment plan, and what complications could arise from the treatment plan. All the concerns are patient-centered and focused on finding the best possible outcome for the patient. A physician should not have to weigh their proposed criminal and civil liability against the care they need to provide for their patient.

         If the Louisiana Legislature decides they still must impose a penalty on a physician who violates the amended statute, it should be strictly civil and subject to review before it is imposed. For instance, under La. R.S. § 40:1237.2, a plaintiff cannot commence a medical malpractice action against a physician “in any court before the claimant’s complaint has been presented to a state medical review panel.”[250] If, under “normal” medical malpractice circumstances, a claim must be evaluated before a medical review panel to determine if the physician breached the applicable standard of care, the physician should have the right to have their proposed violation evaluated by a medical review panel to determine if they should be penalized or not. The medical review panel consists of three physicians and an attorney chairman.[251] The three physicians should include those with reproductive health or emergency medicine backgrounds who understand the nuances and potential complications of reproductive care.

         Finally, the Louisiana Legislature should consult physicians who specialize in reproductive health and can educate them on all the risks, benefits, and complications that the current statute provides. The Louisiana Legislature should listen and revise the statute to ensure that it is medically accurate and supports the public health and safety of Louisiana residents. For instance, a near-total ban with narrow exceptions has caused delays in care[252], higher maternal mortality rates[253], and worsened the public health of Louisianans.[254] Thus, the Louisiana Legislature should expand the number of exceptions offered and add provisions that are medically accurate and consider the nuances of reproductive health when drafting them.

Conclusion

         A public health law should not be so arbitrary or oppressive that it harms the public health of the community that it aims to help, and bears no rational relationship between that public health aim and the restrictions it imposes.[255] Louisiana’s current abortion statute is not a public health law because its oppressive provisions, such as the criminalization of physicians, are not rationally related to protecting the public health of Louisiana citizens. In fact, the current abortion statute causes more harm to the public health of Louisiana, by forcing physicians to breach their duties of care, further delaying life-saving care to women, and causing prolonged health risks, and in some cases even death.[256] The Louisiana Legislature should amend the current statute to decriminalize physicians. It should focus on addressing the current reproductive crisis in Louisiana by adding provisions that are medically accurate and aim to promote the health of women.

         If the Louisiana Legislature does not amend its current abortion statute, the public health of Louisiana residents will suffer immensely. Further, physicians will have no choice but to provide inadequate care which will force many to leave the medical profession altogether, thereby exacerbating the growing physician shortage in this country. The Louisiana Legislature should rethink the current provisions of the abortion statute and amend them so that they align with their purported intent— to protect the “health, safety, and welfare of women.”[257]

Footnotes

[*] J.D. Candidate 2026 Loyola University New Orleans College of Law; B.A. 2022, University of New Orleans. I extend my deepest gratitude to Dr. Jennifer Avegno for her invaluable guidance in the research for this Comment. I am also grateful to Molly Payne and Alex Medina for their thoughtful assistance during the editing process, and to my parents for their unwavering support in all that I do. Finally, I dedicate this Comment to those experiencing the harmful effects of Louisiana’s current abortion statute, with the hope that this work contributes to greater awareness and meaningful change in the law.

[1] See Dobbs v. Jackson Women's Health Org., 597 U.S. 215 (2022).

[2] Louisiana was one of only 13 states to have a trigger law in place for the overturning of Roe v. Wade. Additionally, Louisiana’s trigger law is the second oldest, having been enacted in 2006, following close behind South Dakota, whose trigger law was enacted in 2005. Elizabeth Nash & Isabel Guarnieri, 13 States Have Abortion Trigger Bans – Here’s What Happens When Roe Is Overturned, Guttmacher (Jun. 2022), https://www.guttmacher.org/article/2022/06/13-states-have-abortion-trigger-bans-heres-what-happens-when-roe-overturned.

[3] Know Your State's Abortion Laws: A guide for Medical Professionals, Alliance Def. Network (Jan. 2024), https://abortiondefensenetwork.org/wp-content/uploads/2024/01/Louisiana_ADN-Know-Your-State_Feb-2024.pdf.

[4] A medical emergency is defined as “the existence of any physical condition, not including any emotional, psychological, or mental condition, which a reasonably prudent physician, with knowledge of the case and treatment possibilities with respect to the medical conditions involved, would determine necessitates the immediate abortion of the pregnancy to avert the pregnant woman's death or to avert substantial and irreversible impairment of a major bodily function arising from continued pregnancy.” La. Rev. Stat. Ann. § 40:1061.10 (LexisNexis, Lexis Advance through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session).

[5] A medically futile pregnancy “means that, in reasonable medical judgment as certified by two physicians, the unborn child has a profound and irremediable congenital or chromosomal anomaly that is incompatible with sustaining life after birth.” La. Rev. Stat. Ann. § 14:87.1 (LexisNexis, Lexis Advance through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session).

[6] La. Rev. Stat. Ann. § 40:1061.1 is entitled “Legislative intent; construction of abortion provisions law regulating abortion, and states that “[t]he provisions of this Chapter that regulate the practice of abortion are enacted to provide for the health, safety, and welfare of women.”

[7] La. Rev. Stat. Ann. § 40:1061 (LexisNexis, Lexis Advance through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session).

[8] Id; see Violence and Pregnancy, Ctr. for Disease Control  (Dec. 5, 2024), https://www.cdc.gov/intimate-partner-violence/about/violence-and-pregnancy.html.

[9] La. Rev. Stat. Ann. § 40:1061.10.

[10] La. Rev. Stat. Ann. § 40:1061.29 (LexisNexis, Lexis Advance through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session).

[11] See generally Lift La. et al., Criminalized Care: How Louisiana's Abortion Bans Endanger Patients and Clinicians, Physicians for Hum. Rts. (Mar. 19, 2024), https://phr.org/our-work/resources/louisiana-abortion-bans/.

[12] Id.

[13] The original intended use for Misoprostol was to “reduce[] stomach acid and help[] protect the stomach lining from damage that can be caused by taking aspirin or a nonsteroidal anti-inflammatory drug.” Carmen Pope, Misoprostol, DRUGS.COM, https://www.drugs.com/misoprostol.html (last visited Oct. 21, 2025). However, misoprostol is also used in conjunction with mifepristone “to end an early pregnancy (medical abortion).” Id.

[14] While one of mifepristone’s primary uses is to be used together with misoprostol to induce an abortion, it is also used to control high blood pressure that is caused by high cortisol levels “in patients with Cushing's syndrome who also have type 2 diabetes and have failed surgery or who cannot have surgery.” Mifepristone (oral route), Mayo Clinic, https://www.mayoclinic.org/drugs-supplements/mifepristone-oral-route/description/drg-20067123 (last visited Oct. 21, 2025).

[15] Misoprostol and mifepristone being labeled as “Schedule IV drugs” means they are now controlled substances in Louisiana. Even further, a “Controlled substance" means a controlled dangerous substance as defined and covered by the Uniform Controlled Dangerous Substances. La. Rev. Stat. Ann. § 9:2800.62 (LexisNexis, Lexis Advance through Act 33 of the 2025 Regular Session).

[16] La. Rev. Stat. Ann. § 40:964 (LexisNexis, Lexis Advance through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session).

[17] Berkeley Lovelace Jr., Louisiana’s new abortion pill law may delay lifesaving care for women, doctors say, NBC (Sep. 30, 2024, at 12:26 PM), https://www.nbcnews.com/health/health-news/louisianas-new-abortion-pill-law-may-delay-lifesaving-care-women-docto-rcna172673.

[18] Specifically, the current statute states that “[a]ny person who knowingly performs an abortion by means of an abortion-inducing drug in violation of this Section shall be imprisoned at hard labor for not less than one nor more than five years, fined not less than five thousand nor more than fifty thousand dollars, or both.” La. Rev. Stat. Ann. § 14:87.9 (LexisNexis, Lexis Advance through Act 33 of the 2025 Regular Session).

[19] Pope, supra note 13.

[20]  Id; Marissa Krugh et al., Misoprostol, Nat’l Libr. of Med (Dec. 11, 2024), https://www.ncbi.nlm.nih.gov/books/NBK539873/#:~:text=Misoprostol%20is%20a%20synthetic%20prostaglandin%20E1%20analog,receptors%20on%20parietal%20cells%20in%20the%20stomach.

[21] In an interview with Dr. Jen Avegno, she stated that “During labor, misoprostol is typically kept at the patient’s bedside, [Dr. Avegno] said. Under the new state law, the medication must be stored in a locked cabinet, potentially on a different floor of the hospital, and will require a nurse to order the drug, enter a code and retrieve it, she said. ‘Even if that adds a few minutes — which it will — in the setting of a life-threatening hemorrhage, minutes are really important.’” Lovelace Jr., supra note 17.

[22] I chose the “wholistic” spelling as opposed to “holistic,” because I wanted to emphasize the need for public health laws to include research on the entirety of the situation, including emotional its impacts. Holistic felt more like a vocabulary word compared to what the true meaning of a “wholistic” approach to health law would entail.

[23]  Richard A. Goodman et al., Law and Public Health at CDC, CDC (Dec. 22, 2006), https://www.cdc.gov/mmwr/preview/mmwrhtml/su5502a11.htm.

[24] See e.g., Jason D. Buxbaum et al., Contributions of Public Health, Pharmaceuticals, And Other Medical Care To US Expectancy Changes, 1990-2015, 39 Health Affairs 1546, 1546 (2020), https://www.healthaffairs.org/doi/10.1377/hlthaff.2020.00284; Brietta R. Clark et al., Clark, Fuse Brown, Gatter, McCuskey, and Pendo's Health Law: Cases, Materials and Problems 1478 (9th ed. 2022).

[25] Goodman et al., supra note 23.

[26] Josh Michaud et al., U.S. Public Health, KFF, https://www.kff.org/health-policy-101-u-s-public-health/?entry=table-of-contents-what-is-public-health (last visited Oct. 21, 2025).

[27] See Clark et al., supra note 24, at 1501-1505.

[28] Id. at 1477.

[29] Jacobson v. Massachusetts, 197 U.S. 11, 22 (1905).

[30] Henning Jacobson was a was a 50-year-old minister from Sweden. Interestingly, he based his contention with the Massachusetts statute on the fact that he had a bad reaction to a smallpox vaccination when he was a child in Sweden, which resulted in him struggling with a bad rash for many years. Peter S. Canellos & Joel Lau, The Surprisingly Strong Supreme Court Precedent Supporting Vaccine Mandates, POLITICO (Sep. 8, 2021, at 5:00 AM), https://www.politico.com/news/magazine/2021/09/08/vaccine-mandate-strong-supreme-court-precedent-510280.

[31] Jacobson, 197 U.S. at 13.

[32] Id. at 12.

[33] Id. (stating that the “[t]he Revised Laws of that Commonwealth, c. 75, § 137, provide that "the board of health of a city or town if, in its opinion, it is necessary for the public health or safety shall require and enforce the vaccination and revaccination of all the inhabitants thereof and shall provide them with the means of free vaccination. Whoever, being over twenty-one years of age and not under guardianship, refuses or neglects to comply with such requirement shall forfeit five dollars").

[34] Id. at 39.

[35] Id. at 26.

[36] Jacobson, 197 U.S. at 25.

[37] Id.

[38] Id.

[39] Id. at 28.

[40] Id.

[41] Jacobson, 197 U.S. at 25.

[42] See id.

[43] Id. at 29.

[44] Id. at 28 (stating that “[w]e say necessities of the case, because it might be that an acknowledged power of a local community to protect itself against an epidemic threatening the safety of all, might be exercised in particular circumstances and in reference to particular persons in such an arbitrary, unreasonable manner, or might go so far beyond what was reasonably required for the safety of the public, as to authorize or compel the courts to interfere for the protection of such persons.”).

[45] Id. at 25.

[46] Id. at 38.

[47] See Jacobson, 197 U.S. at 23.

[48] Staff Writer, What is Public Health Law, MPH ONLINE, https://www.mphonline.org/public-health-law-definition/#:~:text=The%20general%20goal%20of%20Public,immunization%20rates%2C%20and%20dental%20hygiene (last visited Oct. 21, 2025).

[49] What Is Health Law – And Why Does It Matter, Am. Pub. Univ. (May 16, 2023), https://www.apu.apus.edu/area-of-study/security-and-global-studies/resources/what-is-health-law/#:~:text=Health%20law%20directly%20impacts%20health,patients%20in%20the%20healthcare%20system.

[50]  Lawrence O. Gostin, A Theory and Definition of Public Health Law, in Public Health Law Power, Duty, Restraint 3 (Georgetown Univ. O’Neill Inst. for Nat’l & Glob. Health L. Scholarship, 2d. ed. 2008).

[51] Id. Health-related outcomes refer to the improvement or decline in health outcomes based on the enactment of the statute. For example, the enactment of child restraint laws improved the health of children, by declining the number of deaths that occurred due to the lack of safety in a vehicle.

[52] Scott Burris et al., Making the Case for Laws That Improve Health: A Framework for Public Health Law Research, 88 The Milbank Q. 169, 170 (2010), https://pmc.ncbi.nlm.nih.gov/articles/PMC2980343/.

[53] Id.

[54] Id. at 73-75.

[55] Id.

[56] See Gostin, supra note 50, at 4.

[57] Id.

[58] See Jacobson, 197 U.S. at 25.

[59] See Erica Westly, The History of seat-belt laws shows public health doesn’t have to be partisan, the Wash. post (Feb. 10, 2022), https://www.washingtonpost.com/outlook/2022/02/10/history-seat-belt-laws-shows-public-health-doesnt-have-be-partisan/.

[60] Id.

[61] Id.

[62] Id.

[63] Id.

[64] Westly, supra note 59 (stating that “[i]n an oral history conducted by the American Academy of Pediatrics in 2004, [Sanders] recalled one state representative who refused to support the legislation unless a “babes in arms” amendment — allowing parents to hold infants in their laps — was added. The representative had fond memories of watching his son and daughter-in-law drive up to his house with their newborn child in the front seat and didn’t want to deprive other families of that experience. It took the deaths of several infants in accidents while sitting in their caretakers’ laps to get the amendment removed”).

[65] Id. Dakota Elliott, Child Passenger Protection Act of 1977: How Tennessee “Immunized” the Automobile Epidemic, The Tenn. Historic Soc’y (Feb. 2, 2022), https://tennesseehistory.org/child-passenger-protection-act-of-1977-how-tennessee-immunized-the-automobile-epidemic/.

[66] Id.

[67] Id.

[68] Id.

[69] See Westly, supra note 59.

[70] Auto Manufacturers Summary, OPEN SECRETS, https://www.opensecrets.org/industries/indus?ind=T2100 (last visited Oct. 21, 2025).

[71] See Westly, supra note 59.

[72] Snuff is “[a] type of smokeless tobacco that is made of finely ground or shredded tobacco leaves. It may have different scents and flavors and may be moist or dry. Moist snuff tobacco is placed in the mouth, usually between the cheek and gum or behind the upper or lower lip. Dry snuff tobacco is inhaled through the nose.” Snuff Tobacco, Nat’l Cancer Inst., https://www.cancer.gov/publications/dictionaries/cancer-terms/def/snuff-tobacco (last visited Oct. 21, 2025).

[73] Time Line of Tobacco Events, Nat’l Libr. of Med., https://www.ncbi.nlm.nih.gov/books/NBK222369/ (last visited Oct. 21, 2025).

[74] Id.

[75] Id.

[76] Id.

[77] See State Legislated Actions on Tobacco Issues, Am. Lung Ass’n, https://www.lung.org/policy-advocacy/tobacco/slati/slati-overview#:~:text=Twelve%20states%20and%20the%20District,down%20advertising%20restrictions%20in%20Massachusetts (last visited Oct. 21, 2025) (stating that “28 states - Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kansas, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, South Dakota, Utah, Vermont, Washington and Wisconsin - and the District of Columbia prohibit smoking in almost all public places and workplaces, including restaurants and bars. Twenty of these states and the District of Columbia have fully included e-cigarettes in their laws.”).

[78] Id.

[79] Tobacco Cessation and the Affordable Care Act, Am. Lung Ass’n, https://www.lung.org/policy-advocacy/tobacco/cessation/tobacco-cessation-and-aca (last visited Oct. 21, 2025).

[80] Tobacco Control and Legal Consortium, Pub. Health L. Ctr., https://publichealthlawcenter.org/sites/default/files/tclc-fs-aca-&-tobacco-control-2014_0.pdf.

[81] Id.

[82] Westly, supra note 59.

[83]  Time Line of Tobacco Events, supra note 73.

[84] The Future of Public Health: Nine Trends You Should Know About, Regis (May 29, 2024), https://www.regiscollege.edu/blog/public-health/public-health-trends#:~:text=According%20to%20an%20American%20Medical,an%20impact%20on%20more%20people.%E2%80%9D.

[85] Nilo Tabrizy & Dr. Allison Linton, ‘Do No Harm’: OB-GYNs Weigh the Legal Impact of Abortion Bans, N.Y. TIMES (Sep. 10, 2022), https://www.nytimes.com/video/us/100000008489880/abortion-bans-maternal-health.html?searchResultPosition=14; Gary Schwartz, Hippocrates Revisted, Einstein J. Biol. Med. 21, 33 (2004), https://einsteinmed.edu/uploadedFiles/EJBM/21Schwartz33.pdf. ,

[86] Tabrizy & Linton, supra note 85 (“We take this oath to do no harm and I feel like the law if forcing me to not practice that oath.”).

[87] Id.

[88] See Nathaniel Scharping, What Makes a Good Doctor-Patient Relationship, CSL, https://www.csl.com/we-are-csl/vita-original-stories/2023/what-makes-a-good-doctor-patient-relationship (last visited Oct. 21, 2025).

[89] Id.

[90] Fallon E Chipidza et al., Impact of the Doctor-Patient Relationship, Psychiatrist.com (Oct. 22, 2015), https://www.psychiatrist.com/pcc/impact-doctor-patient-relationship/.

[91] Clark et al., supra note 24, at 121.

[92] Id.

[93] Id. (stating that “[b]ecause of the special nature of this doctor-patient relationship, each of the duties identified [] requires conduct that goes beyond what the law demands in most other common relationships.”).

[94] See infra Part V.A.

[95] Clark et al., supra note 24, at 130.

[96] Saendy Jung & Rachel H. McDowell, Abandonment, Nat’l Libr. of Med. (Oct. 3, 2022), https://www.ncbi.nlm.nih.gov/books/NBK563285/#:~:text=Abandonment%20is%20considered%20a%20breach,to%20obtain%20substitute%20medical%20care. 

[97] Id.

[98] Id.

[99] Id. (stating “a patient can be inadvertently abandoned, for example, if the physician takes an extended vacation or sabbatical without notifying the patient or arranging emergency coverage. Additionally, being unresponsive to patients' questions in an email or phone call, failure to follow up with a patient after surgery, or after the patient has started a new medication can be considered inadvertent abandonment.”).

[100]Anjelica Cappellino, J.D., Patient Abandonment Cases: What You Need To Know, Expert Inst. (Nov. 20, 2024), https://www.expertinstitute.com/resources/insights/patient-abandonment-cases-what-you-need-to-know/.

[101] Id.

[102] Clark et al., supra note 24, at 134 (“[w]hile stated differently in various jurisdictions, the elements of an abandonment claim are (1) a duty to treat the plaintiff, (2) a breach of that duty by withdrawing from care or failing to provide necessary care in a timely manner, which (3) is the proximate cause of (4) compensable injury to the plaintiff.”)..

[103] Do Doctors Have a Responsibility to Provide Care to Any and All Patients?, Rourke & Blumenthal (Nov. 30, 2021), https://www.randbllp.com/blog/2021/november/do-doctors-have-a-responsibility-to-provide-care/.

[104] Id.

[105] See id.

[106] Schloendorff v. Soc'y of N.Y. Hosp., 105 N.E. 92, 93 (N.Y. 1914).

[107] See Clark et al., supra note 24, at 136-37.

[108] Id. at 136 (stating that “Professor Alexander Capron has argued that the doctrine can serve six salutary functions. Informed consent can: 1) protect individual autonomy; 2) protect the patient’s status as a human being; 3) avoid fraud or duress; 4) encourage doctors to carefully consider their decisions; 5) foster rational decision-making by the patient; and 6) involve the public generally in medicine”).

[109] Parth Shah et al., Informed Consent, Nat’l Lib. of Med. (Nov. 24, 2024), https://www.ncbi.nlm.nih.gov/books/NBK430827/.

[110] Id.

[111] Id.

[112] Id.

[113] Id. (stating that “varying levels of health literacy often result in patients agreeing to procedures or treatments without fully understanding the risks, benefits, or alternatives. Even when information is provided, it may not be communicated in a way that matches the patient's cognitive needs. This mismatch can lead to situations where consent is not truly informed, undermining patient autonomy and trust.”).

[114] Shah et al., supra note 109.

[115] Id.

[116] Id.

[117] Id.

[118] Id.

[119] Shah et al., supra note 109.

[120] Id.

[121] I use the example of the gallbladder removal procedure in this Section and in others because it is an extremely common and routine procedure that encompasses all the duties a physician must meet. Gallbladder FAQs at Advanced Surgical Associates, Atlantic Health, https://ahs.atlantichealth.org/locations/atlantic-medical-group/advanced-surgical-associates/services/general-surgery/gallbladder-surgery-faq.html#:~:text=What%20is%20gallbladder%20surgery?,the%20removal%20of%20the%20gallbladder (last visited Oct. 21, 2025).

[122] Recovering from Gallbladder Removal, NHS (July 3, 2025), https://www.nhs.uk/conditions/gallbladder-removal/recovery/.

[123] Id.

[124] See Shah et al., supra note 109.

[125] Andra DelMonico, Can You Sue for Lack of Informed Consent, SuperLawyers (May 9, 2025), https://www.superlawyers.com/resources/medical-malpractice/can-you-sue-for-lack-of-informed-consent/#:~:text=Potential%20Criminal%20Charges,another%20person%20that%20causes%20harm.

[126] Id.

[127] Id.

[128] Shah et al., supra note 109.

[129] Donna Vanderpool, The Standard of Care, Nat’l Lib. of Med., https://pmc.ncbi.nlm.nih.gov/articles/PMC8667701/#:~:text=ANSWER%3A,carry%20significant%20consequences%20for%20clinicians (last visited Oct. 21, 2025).

[130] The Law Offices of David Henderson, Medical Malpractice vs. Bad Medical Outcome: How to Know the Difference, Law Offices of David Henderson (Oct. 14, 2024), https://www.henderson-law.com/blog/2024/october/medical-malpractice-vs-bad-medical-outcome-how-t/#:~:text=What%20Is%20Medical%20Malpractice?,have%20provided%20under%20similar%20circumstances.

[131] Id.

[132] Allison Grady, The Importance of Standard of Care and Documentation, AMA J. Ethics 756, 757 (Nov. 2005), https://journalofethics.ama-assn.org/article/importance-standard-care-and-documentation/2005-11.

[133] Id.

[134] Trisha Torrey, Understanding Standard of Care for Patients, Very Well HEALTH (Sep. 4, 2025), https://www.verywellhealth.com/standard-of-care-2615208.

[135] Id.

[136] Id.

[137] Id. (stating that some examples of medical care the breaches the standard of care and can lead to a medical malpractice suit are “[f]ailing to diagnose or misdiagnosing a disease that turns out to be serious, [f]ailing to order or perform the appropriate medical tests[,] [p]rescribing treatments or medications incorrectly or inappropriately[,] [f]ailing to obtain informed consent before a procedure, particularly surgery[, and] [s]urgical mistakes, including anesthesia errors or unnecessary surgery”).

[138] Vanderpool, supra note 129 (stating that “[t]o prevail in a malpractice case, the plaintiff must prove all four of the following elements: Duty: The clinician owed a duty to meet the standard of care to the plaintiff patient. Negligence: The clinician did not meet the standard of care. Harm: The plaintiff suffered some type of harm—physical, emotional, and/or financial. Causation: The plaintiff’s harm was caused by the defendant clinician’s failure to meet the standard of care”).

[139] Torrey, supra note 134.

[140] Id.

[141] See supra Part II.B.

[142] Cholecystectomy (Gallbladder Removal), Cleveland Clinic (July 24, 2025), https://my.clevelandclinic.org/health/procedures/21614-gallbladder-removal (stating that a “[c]holecystectomy is a common procedure with a typically easy recovery.” It’s also one of the first procedures that’s become routinely performed using minimally invasive surgery techniques.).

[143] See id.

[144] See id.

[145] See id.

[146] Grady, supra note 132.

[147] Tyler Johnson, The Importance of Physician-Patient Relationships Communication and Trust in Health Care, Duke Ctr. for Personalized Health Care (Mar. 11, 2019), https://personalizedhealth.duke.edu/blog/importance-physician-patient-relationships-communication-and-trust-health-care#:~:text=Birkh%C3%A4uer%20et%20al%2C%202017,their%20overall%20satisfaction%20with%20care.&text=Studies%20have%20also%20shown%20that,patient%20continuing%20with%20their%20provider.&text=Trust%20extends%20to%20many%20different,related%20to%20their%20health%20concerns.

[148] Id. (stating that “[c]ollaborative decision making enables physicians and patients to work as partners in order to achieve a mutual health goal”).

[149] Id.

[150] “Inherent in the Due Process Clause of the Fourteenth Amendment is a fundamental ‘right to privacy’ that protects a pregnant woman’s choice whether to have an abortion. However, this right is balanced against the government’s interests in protecting women's health and protecting ‘the potentiality of human life.’… In the first trimester of pregnancy, the state may not regulate the abortion decision; only the pregnant woman and her attending physician can make that decision. In the second trimester, the state may impose regulations on abortion that are reasonably related to maternal health. In the third trimester, once the fetus reaches the point of ‘viability,’ a state may regulate abortions or prohibit them entirely, so long as the laws contain exceptions for cases when abortion is necessary to save the life or health of the mother.” Roe v. Wade, Oyez, https://www.oyez.org/cases/1971/70-18 (last visited Apr. 1, 2025).

[151] Elizabeth Nash, Louisiana Has Passed 89 Abortion Restrictions Since Roe: It’s About Control, Not Health, Guttmacher (Feb. 11, 2020), https://www.guttmacher.org/article/2020/02/louisiana-has-passed-89-abortion-restrictions-roe-its-about-control-not-health (stating that “[t]he state with the second-highest total is Indiana, with 63 restrictions, and Oklahoma is in third place with 60.”).

[152] The 2018 bill set to ban abortion at 15 weeks and also criminalized coerced abortion, which is a law that is still in effect today. Abortion in Louisiana, Ctr. for Reprod. Rts., https://reproductiverights.org/case/scotus-june-medical-services/abortion-in-louisiana/#:~:text=Louisiana%20has%20a%20%E2%80%9Ctrigger%E2%80%9D%20abortion,after%206%20weeks%20in%202019 (last visited Oct. 21, 2025); see also La. Rev. Stat. Ann.  § 14:87.6 (LexisNexis, Lexis through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session).

[153] The 2019 bill labeled the “heartbeat” bill “‘prohibit[ed] the abortion of an unborn human being with a detectable heartbeat,’ which can occur as early as six weeks into a pregnancy, before many women know they’re pregnant.” Caroline Kelly, Louisiana governor signs ‘heartbeat’ abortion bill into law, CNN (May 30, 2019, at 8:01 PM), https://www.cnn.com/2019/05/30/politics/louisiana-governor-signs-abortion-bill/index.html.

[154] Nash, supra note 151.

[155] Louisiana: After Roe Fell—Abortion Laws by State, Ctr. for Reprod. Rts., https://reproductiverights.org/maps/state/louisiana/ (last visited Oct. 21, 2025).

[156] Mark Ballard, Taxpayers will spend millions defending Louisiana anti-abortion laws twice ruled unconstitutional, HoumaToday (Mar. 16, 2021, at 2:32 PM), https://www.houmatoday.com/story/news/2021/03/16/taxpayers-spend-millions-defending-louisiana-anti-abortion-laws-twice-ruled-unconstitutional/4721590001/ (stating that “a review of publicly available records from the federal court and state government suggests taxpayers will be asked to pony up at least $8 million to perhaps more than $10 million just to pay the lawyers on both sides in June Medical Services, a case in which the Supreme Court twice killed the law that required physicians performing the legal pregnancy-ending procedure have admitting privileges at nearby hospitals.”).

[157] See infra Part III.A.

[158] La. Rev. Stat. Ann.  § 40:1061.1.

[159] See infra Part III.A.

[160] Lift La. et al., supra note 11, at 14.

[161] Louisiana’s official poverty rate is 18.6%, “making Louisiana the second-poorest state in the nation. An estimated 829,565 people, including 255,159 children, live[] in poverty.” Census 2022 Poverty, Income and Health Insurance in Louisiana, La. Budget Project, https://www.labudget.org/wp-content/uploads/2023/11/Census-2022-2023.pdf?ref=floodlightnews.org#:~:text=The%20overall%20poverty%20rate%20in,federal%20poverty%20line%20last%20year (last visited Oct. 21, 2025).

[162] Lift La. et al., supra note 11, at 14.

[163] Id. at 13.

[164] Id. Those living in rural areas have restricted access to healthcare because of limited physicians who specialize in chronic illnesses, and limited access to healthcare in general. For instance, hospital closures are more prominent in rural areas, requiring some residents to travel hours to the nearest hospital. Additionally, those in rural areas often lack insurance coverage and the ability to pay for out-of-pocket medical expenses. Why Health Care Is Harder to Access in Rural America, Gov’t Accountability Off. (Mar. 16, 2023), https://www.gao.gov/blog/why-health-care-harder-access-rural-america.

[165] In general, Louisiana schools are not required to have sex education courses. If a school elects to have a sex education course, they must follow La. Rev. Stat. Ann. § 17:24.4, which states that the court must emphasize abstinence from sexual activity outside of marriage. La. Rev. Stat. Ann. § 17:24.4 (LexisNexis, Lexis Advance through the 2024 First, Second, Third Extraordinary with exceptions to Acts 1 and 12, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary Session, Second Extraordinary and The Constitution, Civil Code, Code of Civil Procedure, Code of Criminal Procedure, Children's Code, Code of Evidence, and Revised Statutes Titles 2 to 4, 6, 8, 9, 11 to 19, 22 to 34, 38 to 40, 42 to 50, 52, and 56 of the Regular Session); see State Sex Education Policies and Requirements at a Glance, Sex Educ. Collaborative, https://sexeducationcollaborative.org/states/louisiana (last visited Oct. 21, 2025).

[166] See Louisiana: State Sex Education Policies and Requirements at a Glance, Sex Educ. Collaborative, https://sexeducationcollaborative.org/states/louisiana (last visited Jan. 22, 2026).

[167] In 2022, the percentage of teen and adolescent births in Louisiana was 23.6%. Teen Birth Rate (Age 15 to 19) In Louisiana, Kids Count Data Ctr., https://datacenter.aecf.org/data/tables/1561-teen-birth-rate-age-15-to-19#detailed/2/any/false/1095,2048,574,1729,37,871,870,573,869,36/any/3329,7826 (last visited Oct. 21, 2025).

[168] Where You Live Matters: Maternity Care Access in Louisiana, March of Dimes, https://www.marchofdimes.org/peristats/reports/louisiana/maternity-care-deserts (last visited Oct. 21, 2025).

[169] “Maternity care deserts are counties across the U.S. in which access to maternity care services is limited or absent, either through lack of services or barriers to a woman's ability to access that care within counties. Specifically, a maternity care desert is any county without a hospital or birth center offering obstetric care and without any obstetric clinicians.” Maternity Care Desert, March of Dimes, https://www.marchofdimes.org/peristats/data?top=23 (last visited Oct. 21, 2025).

[170] Where You Live Matters: Maternity Care Access in Louisiana, supra note 168.

[171] Id.

[172] Id.

[173] Id.

[174] Louisiana’s birth rate is “61.8 births per 1,000 women 15-44 years of age.” Louisiana: Key Health Indicators, CDC, https://restoredcdc.org/www.cdc.gov/nchs/pressroom/states/louisiana/la.htm (last visited Oct. 21, 2025).

[175] Where You Live Matters: Maternity Care Access in Louisiana, supra note 168.

[176] Id.

[177] Id.

[178] LA. REV. STAT. ANN. § 40:1061.1.

[179] Rosemary Westwood, ‘Rock bottom’: Louisiana earns ‘F’ grade for infant health in new report, WWNO (Nov. 15, 2024, at 1:58 PM), https://www.wwno.org/public-health/2024-11-15/rock-bottom-louisiana-earns-f-grade-for-infant-health-in-new-report.

[180] 2024 March of Dimes Report Card: The state of maternal and infant health for American families, MARCH OF DIMES, https://www.marchofdimes.org/sites/default/files/2024-11/2024_MOD_Report_Card_and_Policy_Actions_Booklet_V1.pdf (last visited Oct. 21, 2025).

[181] Id.

[182] This Comment will not discuss the racial disparity in reproductive care in Louisiana, but it is an important topic to get educated on. In 2020, the Louisiana Department of Health released a study stating that black “women accounted for 62% of all pregnancy-associated deaths.” See LDH releases 2020 maternal mortality report, LA. DEP’T of HEALTH (Apr. 10, 2024), https://ldh.la.gov/news/MMR2020.

[183] 2024 March of Dimes Report Card: The state of maternal and infant health for American families, supra note 180.

[184] See id.

[185] Westwood, supra note 179.

[186] LA. REV. STAT. ANN. § 40:1061.1.

[187] Id.

[188] See Grady, supra note 132.

[189] Id.

[190] Id.

[191] La. Rev. Stat. Ann. § 40:1061(C).

[192] Id.

[193] La. Rev. Stat. Ann. § 40:1061(D).

[194] La. Rev. Stat. Ann. § 14:87.7 (LexisNexis, Lexis Advance through Act 33 of the 2025 Regular Session).

[195] Id.

[196] Id.

[197] E.A. Gjelten, Louisiana Felony Crimes and Sentences, Crim. Def. Law. (July 23, 2024), https://www.criminaldefenselawyer.com/resources/criminal-defense/state-felony-laws/louisiana-felony-class.htm.

[198] La. Rev. Stat. Ann. § 14:87.7.

[199] La. Rev. Stat. Ann. § 40:1061.29.

[200] Id.

[201] Id.

[202] La. Rev. Stat. Ann. § 37:1261 (LexisNexis, Lexis Advance through the 2024 First Extraordinary, Second Extraordinary, Third Extraordinary, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary, Second Extraordinary, Third Extraordinary, and Regular Sessions).

[203] La. Rev. Stat. Ann. § 40:1061(F).

[204] La. Rev. Stat. Ann. § 40:1061.1.2 (LexisNexis, Lexis Advance through the 2024 First Extraordinary, Second Extraordinary, Third Extraordinary, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary, Second Extraordinary, Third Extraordinary, and Regular Sessions).

[205] Id. The Louisiana Department of Health has listed the following conditions as a “medically futile” pregnancy: “[A]chondrogenesis, anencephaly, acardia, body stalk anomaly, campomelic dysplasia, craniorachischisis, dysencephalia splanchnocystica (Meckel-Gruber syndrome), ectopia cordis, Exencephaly, gestational trophoblastic neoplasia holoprosencephaly, hydrops fetalis, iniencephaly, perinatal hypophosphatasia, osteogenesis imperfecta (type 2), renal agenesis (bilateral), short rib polydactyly syndrome, sirenomelia, thanatophoric dysplasia, triploidy, trisomy 13, trisomy 16 (full), trisomy 18, trisomy 22, A profound and irremediable congenital or chromosomal anomaly existing in the unborn child that is incompatible with sustaining life after birth in reasonable medical judgment as certified by two physicians that are licensed to practice in the State of Louisiana.” List of Conditions that shall deem an unborn child “medically futile”, La. Dep’t of Health, https://ldh.la.gov/assets/oph/Rulemaking/er/LDH_ER_List_of_Conditions_that_Shall_Deem_an_Unborn_Child_Medically_Futile_CLV_Signed_and_Dated_1_August_2022.pdf (last visited Oct. 21, 2025).

[206] La. Rev. Stat. Ann. § 40:1061(F).

[207] Importantly, the statute does not criminalize women who receive abortions, stating that “[t]his Section does not apply to a pregnant female upon whom an abortion is committed or performed in violation of this Section, and the pregnant female shall not be held responsible for the criminal consequences of any violation of this Section.” La. Rev. Stat. Ann. § 14:87.7(D).

[208] See Lift La. et al., supra note 11, at 23.

[209] Shah et al., supra note 109.

[210] La. Rev. Stat. Ann. § 40:1061(C) (emphasis added).

[211] Lift La. et al., supra note 11, at 42.

[212] Id. at 45.

[213] AMA Code of Medical Ethics: Opinion 2.1.3 Withholding Information from Patients, Am. Med. Ass’n, https://code-medical-ethics.ama-assn.org/ethics-opinions/withholding-information-patients (last visited Oct. 21, 2025).

[214] Shah et al., supra note 109.

[215] Do Doctors Have a Responsibility to Provide Care to Any and All Patients?, supra note 103.

[216] Lift La. et al., supra note 11, at 24.

[217] Id.; La. Rev. Stat. Ann. § 40:1061(F).

[218] La. Rev. Stat. Ann § 40:1061 (D).

[219] See Piper Hutchinson, State board to Louisiana doctors on abortion: Talk to a lawyer, La. Illuminator, (July 28, 2022, at 1:35 PM), https://lailluminator.com/briefs/state-board-to-louisiana-doctors-on-abortion-talk-to-a-lawyer/.

[220] Id.

[221] Id.

[222] Torrey, supra note 134.

[223] Id.

[224] Id.

[225] Lift La. et al., supra note 11, at 22.

[226] PPROM Facts, The PPROM Found. (May 25, 2025), https://www.aapprom.org/community/ppromfacts.

[227] Lift La. et al., supra note 11, at 23.

[228] A non-viable pregnancy due to PPROM is not listed a medically futile pregnancy and therefore does not fall into that exception; Id. (stating that “[o]ne emergency medicine physician recounted a situation where a colleague performed a c-section on a patient with PPROM at 20 weeks’ gestation, a condition that would not result in a viable pregnancy: She ended up having to take this person for c-section to preserve the appearance of not doing an abortion, even though this is not a viable pregnancy. What that means is now this person has had a c-section, right? And that means that she’s at higher risk for any future pregnancies. She can no longer deliver vaginally ... [T]he appropriate thing to do, again would be a D&E … without subjecting the patient to this unnecessary abdominal surgery. But my colleague didn’t feel like she could do that while remaining in compliance with the law or appearing to remain in compliance with the law.”).

[229] See supra Part V.A.

[230] Grady, supra note 132.

[231] Lift La. et al., supra note 11, at 31.

[232] Michaud, supra note 26.

[233] Jacobson, 197 U.S. at 25.

[234] Id. at 28.

[235] Id.

[236] Id. at 23.

[237] La. Rev. Stat. Ann. § 40:1061.1(B)(2).

[238] See supra Part V.A.

[239] See Lift La. et al., supra note 11, at 15.

[240] Id. at 43.

[241] La. Rev. Stat. Ann. § 40:1061; see Lift La. et al., supra note 11, at 13.

[242] La. Rev. Stat. Ann. § 40:1061.10(4)(a).

[243] Julie O’Donogue, Louisiana health department declines to answer doctors’ questions on abortion law, La. ILLUMINATOR (Nov. 1, 2022, at 6:41 PM), https://lailluminator.com/2022/11/01/louisiana-health-department-declines-to-answer-doctors-questions-on-abortion-law/#:~:text=By:%20Julie%20O'Donoghue%20%2D,1%2C%202022%206:41%20pm&text=The%20Louisiana%20Department%20of%20Health,at%20risk%20for%20criminal%20charges.

[244] See id.

[245] Tanya Rawal, Louisiana’s abortion law, maternal mortality rate a double burden to sexual assault survivor, La. Illuminator, (Aug. 21, 2022, at 4:42 PM), https://lailluminator.com/2022/08/21/louisianas-maternal-mortality-rate-at-risk-of-rising-higher-with-abortion-law/.

[246] Lift La. et al., supra note 11, at 22-23.

[247] See supra Part V.

[248] See, e.g., Amanda Jean Stevenson, The Pregnancy-Related Mortality Impact of a Total Abortion Ban in the United States: A Research Note on Increased Deaths Due to Remaining Pregnant, 58 Demography 2019, 2019-2028 (2021), https://doi.org/10.1215%2F00703370-9585908; Summer Sherburne Hawkins et al., Impact of State-Level Changes on Maternal Mortality: A Population-Based, Quasi-Experimental Study,

 58 Am. J. of Preventive Med. 165, 165-174 (2020), https://doi.org/10.1016/j.amepre.2019.09.012.

[249] La. Rev. Stat. Ann. § 14:87.7(C).

[250] La. Rev. Stat. Ann. § 40:1237.2(B)(1)(a)(i) (LexisNexis, Lexis Advance through the 2024 First Extraordinary, Second Extraordinary, Third Extraordinary, and Regular Sessions. Revisions of the Louisiana State Law Institute now current through 2024 First Extraordinary, Second Extraordinary, Third Extraordinary, and Regular Sessions).

[251] Id.

[252] See supra Part V.A.

[253] Stevenson, supra note 248.

[254] See Lift La. et al., supra note 11.

[255] Jacobson, 197 U.S. at 25.

[256] See Lift La. et al., supra note 11.

[257] La. Rev. Stat. Ann. § 40:1061.1.