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American Medical Association President Dr. Jack Resneck recently recounted how doctors around the country are facing difficulties practicing medicine in states that ban abortion.

Nicole Xu for NPR


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Nicole Xu for NPR


American Medical Association President Dr. Jack Resneck recently recounted how doctors around the country are facing difficulties practicing medicine in states that ban abortion.

Nicole Xu for NPR

Since Roe v. Wade was overturned, 13 states have banned abortion except in the case of a medical emergency or serious health risk for the pregnant patient. But deciding what cases qualify for a medical exception can be a difficult judgement call for doctors.

News reports and court affidavits have documented how health care workers sometimes deny women abortion procedures in emergency situations – including NPR’s story of a woman who was initially not treated for her miscarriage at an Ohio ER, though she’d been bleeding profusely for hours.

In Missouri, hospital doctors told a woman whose water broke at 18 weeks that “current Missouri law supersedes our medical judgment” and so she could not receive an abortion procedure even though she was at risk of infection, according to a report in the Springfield News-Leader.

That hospital is now under investigation for violating a federal law that requires doctors to treat and stabilize patients during a medical emergency.

And a survey by the Texas Policy Evaluation Project found clinicians sometimes avoided standard abortion procedures, opting instead for “hysterotomy, a surgical incision into the uterus, because it might not be construed as an abortion.”

“That’s just nuts,” Dr. Matthew Wynia says. He’s a physician who directs the Center for Bioethics and Humanities at the University of Colorado. “[A hysterotomy is] much more dangerous, much more risky – the woman may never have another pregnancy now because you’re trying to avoid being accused of having conducted an abortion.”

Reports like these prompted Wynia to publish an editorial in the New England Journal of Medicine in September, calling for physicians and leading medical institutions to take a stand against these laws through “professional civil disobedience.” The way he sees it, no doctor should opt to do a procedure that may harm their patient – or delay or deny care – because of the fear of prosecution.

“I have seen some very disturbing quotes from health professionals essentially saying, ‘Look, it’s the law. We have to live within the law,'” he says. “If the law is wrong and causing you to be involved in harming patients, you do not have to live [within] that law.”

These issues have raised a growing debate in medicine about what to do in the face of laws that many doctors feel force them into ethical quandaries.

Medical organizations raise the issue

At the American Medical Association’s November meeting, president Dr. Jack Resneck gave an address to the organization’s legislative body, and recounted how doctors around the country have run into difficulty practicing medicine in states that ban abortion.

“I never imagined colleagues would find

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3 min read

Humans have an elegant and intricate system of internal processes that help our bodies keep time, with exposure to sunlight, caffeine and meal timing all playing a role. But that doesn’t account for “precision waking.”

Sarah Mosquera/NPR


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Sarah Mosquera/NPR


Humans have an elegant and intricate system of internal processes that help our bodies keep time, with exposure to sunlight, caffeine and meal timing all playing a role. But that doesn’t account for “precision waking.”

Sarah Mosquera/NPR

Maybe this happens to you sometimes, too:

You go to bed with some morning obligation on your mind, maybe a flight to catch or an important meeting. The next morning, you wake up on your own and discover you’ve beat your alarm clock by just a minute or two.

What’s going on here? Is it pure luck? Or perhaps you possess some uncanny ability to wake up precisely on time without help?

It turns out many people have come to Dr. Robert Stickgold over the years wondering about this phenomenon.

“This is one of those questions in the study of sleep where everybody in the field seems to agree that’s what’s obviously true couldn’t be,” says Stickgold, who’s a cognitive neuroscientist at Harvard Medical School and Beth Israel Deaconess Medical Center.

Stickgold even remembers bringing it up to his mentor when he was just starting out in the field — only to be greeted with a dubious look and a far from satisfactory explanation. “I can assure you that all of us sleep researchers say ‘balderdash, that’s impossible,’ ” he says.

And yet Stickgold still believes there is something to it. “This kind of precision waking is reported by hundreds and thousands of people,'” he says, including himself. “I can wake up at 7:59 and turn off the alarm clock before my wife wakes up.” At least, sometimes.

Of course, it’s well known that humans have an elegant and intricate system of internal processes that help our bodies keep time. Somewhat shaped by our exposure to sunlight, caffeine, meals, exercise and other factors, these processes regulate our circadian rhythms throughout the roughly 24-hour cycle of day and night, and this affects when we go to bed and wake up.

If you are getting enough sleep and your lifestyle is aligned with your circadian rhythms, you should typically wake up around the same time every morning, adjusting for seasonal differences, says Philip Gehrman, a sleep scientist at the University of Pennsylvania.

But that still doesn’t adequately explain this phenomenon of waking up precisely a few minutes before your alarm, especially when it’s a time that deviates from your normal schedule.

“I hear this all the time,” he says. “I think it’s that anxiety about being late that’s contributing.”

Scientists get curious — with mixed results

Actually, some scientists have looked into this enigma over the years with, admittedly, mixed results.

For example, one tiny, 15-person study from 1979 found that, over the course of two nights, the subjects were able

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Culturally responsive therapy is a growing trend, as therapists of color try to make counseling more inclusive.

Cambodian American Eden Teng was was born in a refugee camp on the border of Thailand and Cambodia just a few years after the Cambodian genocide. She moved to the U.S. with her mom and aunt when she was 6.

Teng attributes much of her own resilience in transitioning to the U.S. to her exuberant mom, who wore whatever she wanted and wasn’t afraid to defy social norms — even when it was embarrassing for a teenage Teng.

But when she was growing up, Teng also witnessed the negative impacts of historical, racial and intergenerational trauma on her mom’s wellbeing. Teng often felt confused by the way her mom’s emotions could spiral out of control for seemingly no reason, or why why she had so many health problems.

When Teng first encountered psychology in college, she realized that her mother’s past was directly connected to her emotional and physical health. (Scientists are learning that stress and trauma are sometimes linked to chronic illnesses, like hypertension, diabetes and kidney disease.)

It was this realization that compelled Teng to become a therapist; in 2018 she began her graduate studies in Seattle.

But when COVID-19 hit and the Black Lives Matter movement came into full force, with communities of color having a more public conversation about their struggles in the U.S., Teng says she started feeling differently about her training and the profession she’d be entering. She began to notice how dealing with certain issues, including race and immigration, were not given priority in her clinical training — even though she knew how important they are in shaping a life.

“I didn’t feel represented, and I felt that so much of my family’s history just didn’t feel like it was considered,” she says, adding that she was studying under teachers who were predominantly white. “I just felt silenced in my own history [and] my own experience in the work that I was doing.”

Teng’s graduate program isn’t the only one like this. Therapy is a predominantly white field in the U.S. — 80% of psychologists, 63% of counselors and 59% of social workers are white, according to Data USA, a website that constructs visualizations of public federal data.

Many of the founding ideas, techniques and schools of practice of therapy were developed by white scholars or practitioners. As a result, the field has marginalized the experiences of people of color, therapists and patients say. Microaggressions are also pervasive in psychological practice, researchers note, and many immigrants report not attending therapy because of language barriers, a lack of insurance and high costs.

That’s why Teng wanted to take a new approach. For her, that meant joining a growing movement of other counselors hoping to transform the practice of therapy, to make it more accessible and relevant to people of color and — ultimately — to help them find healing.

Embracing a practice of ‘decolonizing therapy’

Teng was initially inspired by people like Dr. Jennifer Mullan, who refer to this work

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3 min read

Allison Case is a family medicine physician who is licensed to practice in both Indiana and New Mexico. Via telehealth appointments, she’s used her dual license in the past to help some women who have driven from Texas to New Mexico, where abortion is legal, to get their prescription for abortion medication. Then came Indiana’s abortion ban.

Farah Yousry/ Side Effects Public Media


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Farah Yousry/ Side Effects Public Media

Allison Case, a family medicine physician, spends much of her time working in a hospital where she delivers babies and provides reproductive health care services, including abortions.

Case lives and works in Indiana, where a ban on most abortions took effect for a week in late September until a judge temporarily halted the ban. The state has since appealed the judge’s order and asked the Indiana’s high court to take up the case. Meanwhile, Case is also licensed to practice in New Mexico, a state where abortion remains legal.

Before Indiana’s abortion ban took effect, Case would use her days off to provide reproductive health services, including abortion care, via telemedicine through a clinic that serves patients in New Mexico. Many of them travel from neighboring Texas, where abortion is banned.

Some travel solo, she says, and others have their children with them.

“Some people are [staying in] hotels, others might have family or friends they can stay with, some are just sleeping in their cars,” Case says. “It’s really awful.”

During a telemedicine appointment, doctors, nurses or other qualified health professionals review the medical history of the patient and ensure eligibility for a medication abortion. They give the patient information about how the two pills work, how to take them, what to look out for as the body expels the pregnancy, and when to seek medical attention in the rare instance of complications. The medications are then mailed to the patient, who must provide a mailing address in a state where abortion is legal.

In the U.S., more than a dozen states severely restrict access to abortion, and almost as many have such laws in the works. Across the country, since Roe v. Wade was overturned, clinics that do provide abortions have seen an increase in demand. Many clinics rely on help from physicians out of state, like Case, who are able to alleviate some of the pressure and keep wait times down by providing services via telemedicine.

But as more states move to restrict abortion, these providers are finding themselves navigating an increasingly complicated legal landscape.

Is abortion by telemedicine legal? Experts differ

Medication abortions work for most people who are under 11 weeks pregnant, and research suggests medication abortion via telemedicine is safe and effective. Yet many states have enacted legislation to ban or limit access to telehealth abortions.

But it’s not always clear what that means for doctors like Case who are physically located in a state with abortion restrictions but have a license that enables them to provide care via telehealth

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2 min read

Jeni Rae Peters and daughter embrace at their home in Rapid City, S.D. In 2020, Peters was diagnosed with stage 2 breast cancer. After treatment, Peters estimates that her medical bills exceeded $30,000.

Dawnee LeBeau for NPR


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Dawnee LeBeau for NPR


Jeni Rae Peters and daughter embrace at their home in Rapid City, S.D. In 2020, Peters was diagnosed with stage 2 breast cancer. After treatment, Peters estimates that her medical bills exceeded $30,000.

Dawnee LeBeau for NPR

RAPID CITY, S.D. ― Jeni Rae Peters would make promises to herself as she lay awake nights after being diagnosed with breast cancer two years ago.

“My kids had lost so much,” said Peters, a single mom and mental health counselor. She had just adopted two girls and was fostering four other children. “I swore I wouldn’t force them to have yet another parent.”

Multiple surgeries, radiation, and chemotherapy controlled the cancer. But, despite having insurance, Peters was left with more than $30,000 of debt, threats from bill collectors, and more anxious nights thinking of her kids.

“Do I pull them out of day care? Do I stop their schooling and tutoring? Do I not help them with college?” Peters asked herself. “My doctor saved my life, but my medical bills are stealing from my children’s lives.”

Cancer kills about 600,000 people in the U.S. every year, making it a leading cause of death. Many more survive it, because of breakthroughs in medicines and therapies.

But the high costs of modern-day care have left millions with a devastating financial burden. That’s forced patients and their families to make gut-wrenching sacrifices even as they confront a grave illness, according to a KHN-NPR investigation of America’s sprawling medical debt problem. The project shows few suffer more than those with cancer.

About two-thirds of adults with health care debt who’ve had cancer themselves or in their family have cut spending on food, clothing, or other household basics, a poll conducted by KFF (Kaiser Family Foundation) for this project found. About 1 in 4 have declared bankruptcy or lost their home to eviction or foreclosure.

Other research shows that patients from minority communities are more likely to experience financial hardships caused by cancer than white patients, reinforcing racial disparities that shadow the U.S. health care system.

“It’s crippling,” said Dr. Veena Shankaran, a University of Washington oncologist who began studying the financial impact of cancer after seeing patients ruined by medical bills. “Even if someone survives the cancer, they often can’t shake the debt.”

Shankaran found that cancer patients were 71% more likely than Americans without the disease to have bills in collections, face tax liens and mortgage foreclosure, or experience other financial setbacks. Analyzing bankruptcy records and cancer registries in Washington state, Shankaran and other researchers also discovered that cancer patients were 2½ times more likely to declare bankruptcy than those without the disease.

And cancer patients who went bankrupt were more likely to die than those who did not.

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