I am a neurointensivist who has cared for several gunshot wound victims and am also a new mother of a daughter. I feel these roles provide me with perspectives on reproductive rights and gun control that are likely to be shared with others. In this article, I briefly summarize the policies in the Unites States regarding both of these issues, the dangers in not fully addressing them and the steps we (as neurointensivists and others reading this article) can take to help ensure that evidence-based reproductive rights remain available to all and that our society (and in particular our children) can live without fear of gun violence. While some recent progress has been made regarding both of these issues, much work unfortunately remains. 

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I have recently given birth to my first-born – a daughter. I am also a neurocritical care physician who has taken care of gunshot wound victims. Over the last few months, we’ve lost the abortion rights provided by Roe v Wade¹ and continued to witness repeated episodes of gun violence.² I would argue that both issues are relevant to neurointensivists (and other physicians) and parents alike, and further that we can each do our part to ensure a better tomorrow for future generations.

Growing up in the ‘80s and ‘90s and completing medical school by 2010, I never considered the magnitude of potential infringements on our rights (including women’s rights) that could be possible in the future. We saw important gains in LBGTQ+ rights early in the 21st century. Various contraceptive methods have been in practice for decades. In 2020, we celebrated 100 years of women being afforded the right to vote. We were headed in what I thought was the right direction, especially for future generations—including my daughter.

Though others may have different views, 71% of the US population feel that abortion is a medical issue that exclusively concerns a pregnant person and their doctor.³ Though of course there is a new life at stake, there is also the mother’s life as well, and without a mother there can be no new life. Further, eliminating abortion rights only removes safe abortions in many places but not abortions overall, and there are also now legal risks with self-managed abortions as well as real medical risks to some mothers if required to carry a pregnancy to term.⁴ From a neurocritical care perspective, there may be times when known teratogenic agents are necessary for various conditions (e.g., valproic acid for status epilepticus, cyclophosphamide for autoimmune encephalitis), which could obviously have major implications for unborn children.⁵ In addition, there may be other situations in which critical care physicians feel constrained in the patient-care decisions they are able to make if there are concerns about possible undesirable consequences to fetuses and the potential for liability. In other words, they may feel they have little choice but to abide by the law even if it comes into direct conflict with a patient’s wishes.

However, given the medical complexity surrounding abortions as well as the attitudes of the US population,³ one might argue that abortion should not even be a target of legislation to begin with. Though I’m fortunate to live in a state that permits abortions regardless of the recent Supreme Court decision, I worry about my daughter’s future and what rights may (or may not) await her when she is of child-bearing age. And it should be acknowledged that the Supreme Court decision will most certainly disproportionally affect those of lower income, those with fewer resources, and those living in states that have historically disenfranchised minorities.^4,5

There are some potential bright spots with regard to this issue. In the wake of the Supreme Court decision, several leading medical societies released statements supporting the right to abortion. The American Medical Association (AMA) pledged “to protect the patient-physician relationship” and to “oppose any law or regulation that compromises or criminalizes patient access to safe, evidence-based medical care, including abortion.”⁶ The Neurocritical Care Society (NCS) stated that “Laws that restrict the provision of medical and nursing care based on best scientific evidence is in direct conflict with NCS’s Mission and Vision, especially when these rulings impact those in minority or otherwise underserved populations. NCS will continue to advocate for the right of healthcare providers globally to deliver care based on their training, to act based on the best available evidence without threat of criminalization and to support patients to make healthcare decisions based on this advice.”⁷ On the governmental level, the Biden administration has issued executive orders and guidelines to help protect access to reproductive services,^3,8 though the right to abortion has yet to be codified into law.

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Gun violence also clearly remains problematic in this country and is also of major concern to physicians and parents. It seems not a week goes by that we don’t hear about young lives being taken as a result of firearms, and physicians (including neurointensivists) continue to see gunshot wound victims in our practice settings. I had worked alongside others to help address this at the AMA level a few years ago, including advocating for gun buyback programs and for increasing the age to purchase ammunition and firearms from age 18 to 21. Within the past year, the AMA has continued to release statements in support of curbing gun violence.⁹ Fortunately our country recently seems to have made additional strides in this direction.^10,11 In particular, the Bipartisan Safer Communities Act increases funding for mental health services, expands background checks for individuals less than 21-years-old seeking to purchase a firearm, and prevents those convicted of domestic violence offenses from purchasing firearms for 5 years, among other provisions.¹¹

But even now, without the support of additional legislation, parents are discussing equipping their children with bulletproof outfits, and active shooter drills are being exercised in schools – previously unimaginable scenarios but seemingly necessary given the ongoing gun violence crisis in our country. And despite what some critics may say, gun violence does affect medical professionals, and they can and should work to address it.¹² Having cared for many of these patients myself, many of whom are unfortunately younger victims, I can personally attest to this issue being in physicians’ “lane,” and I’m sure many other neurointensivists would agree.

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Despite these recent advances, reproductive rights and gun control are still not completely secured and assured in this country. I am uneasy about what the future holds for the generation that will include my daughter – to have fewer rights than my mother and I had, and to be potentially exposed to gun violence at school. What a scary predicament for physicians and parents alike.

I’ve always believed in standing up for things when they don’t seem right, and I hope to engender this in my daughter as well. I believe I’m speaking for lots of parents and their children that our nation finds itself in a crisis, and I know I speak for many other physicians regarding the tremendous impact of these issues on both doctors and patients.^4,5,9 The US has seemingly taken steps backwards in its protection of rights and safety. As a mother, I want the best for my daughter, including the assurance that healthcare decisions for women will continue to be made based on the best available scientific evidence, and that gun violence will hopefully be a non-issue throughout her life. As a critical care physician, I worry that we will continue to see and manage young victims of gun violence, and that we may be doing pregnant women (and their unborn children) a disservice with limitations on the medical care we are permitted to provide.

It will require concerted and deliberate action by as many stakeholders as possible to ensure that reproductive decisions remain a decision solely between persons born as female and their doctor, and that guns find a decreased presence in society or, at the very least, are placed only in responsible hands. Physicians need to continue to support medical associations such as the AMA and NCS in their advocacy efforts through participation in meetings, phone calls, and emails. All of us must lobby our governmental leaders (including local members of congress) to support these issues via similar mechanisms as well as by votes and/or potentially financial assistance. We must continue to amplify our voices by utilizing social media such as Facebook and Twitter and any other outlets at our disposal. Guaranteeing that reproductive rights remain available and that our society can live and grow without fear of gun violence is critical: the lives of future generations are at stake.