The most obvious implication as discussed above is that in some states, risk to the health of the mother (which includes mental health) is a qualifying reason for abortion and so psychiatrists may once again become arbiters of whether women can get abortions and there are complex ethical ramifications of that. Sally Satel (who herself is a republican and part of the conservative American Enterprise Institute)
wrote about this recently in the NYT. However many states have rewritten their laws to be more stringent than in the pre-Roe either with no exceptions for health of the mother, incest or rape. I suspect many others will exclude exceptions for the health of the mother (and explicitly mental health) in the next few months as state legislatures revisit their abortion laws.
There has long been tensions within organized psychiatry about how much psychiatrists should be at the forefront of social issues. While psychiatrists do lean liberal, there is obviously a wide range of viewpoints within the field (and this particular forum seems to skew to the right). Some people think that physicians and our professional organizations should stay out of political and social issues. Whereas others see sociopolitical issues as directly relevant to our work as physicians, believe activism is a part of being a physician, and believe we have a moral imperative to enter the fray and opine on such issues. Black and other minority physicians and younger physicians are more likely to want physicians and organized medicine to speak out on such issues. The flip side is being seen as partisan is not a good look for the legitimacy of the profession, one that many people continue to look upon with suspicion and disdain.
Somewhat peripherally, women who have miscarriages and stillbirths attributed to their behavior have been charged with manslaughter. In general, fetuses do not have any rights, but laws meant to protect women from domestic violence are now being used to criminalize women with substance use disorders themselves. This has even happened in
supposedly liberal california (off the coasts large parts of the state are solidly red and there is a large evangelical community). I think this has implications for both clinical and forensic psychiatrists.
In some states, if fetuses are given more rights and a patient sees a psychiatrist and discusses abortion, there could be a duty for the psychiatrist to protect the fetus. This would likely be established in case law, but could be enshrined by state legislators as well. What this would mean in practice is that psychotherapists (including psychiatrists) could have a duty to report women who are thinking of having abortions in order to protect the life of the fetus. In states where they put a bounty on anyone who aids and abets a woman having an abortion, psychiatrists could also potentially be sued as well.
