The overturn of Roe v Wade wasn’t the only decision with health effects.

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In the December 2021 issue of AJN, Caroline Dorsen and colleagues wrote a Viewpoint, “Why Nurses Should Care About the Supreme Court.” In it, they note:

“The court decides cases every year that have direct implications for our patients, our role as health care providers, and our profession. They decide cases that speak to our common humanity and affect the systems that influence health disparities. And we should all care about that.”

This certainly rang true for decisions recently handed down by the Supreme Court.

Other health consequences of the Dobbs case.

While much of the attention on the recent Supreme Court rulings has focused on the overturn of Roe v. Wade (in Dobbs v. Jackson Women’s Health Organization) and the effects that it will have for millions of women on their access to and choice of reproductive health care, we are starting to see many other potential effects of that decision.

An article at MedPage Today describes concerns that physicians may not choose obstetrics as a career because of worries over prosecution—what if a court doesn’t agree with their management of miscarriages or disagrees with their judgment that a mother’s life was in danger? Nurse midwives and women’s health NPs could face similar dilemmas, as might nurses staffing women’s health services. In addition, what does this mean for the future of medication-induced abortion and the “morning-after pill,” or even birth control? (For a look at the long history of abortion laws in the United States, see this recent post.)

The implications of this ruling are still wider: patients with autoimmune diseases like rheumatoid arthritis who depend on the drug methotrexate are already meeting reluctance from pharmacies or prescribers in making this essential drug available—simply because methotrexate also has an off-label use as a treatment for ectopic pregnancies.

Other recent SCOTUS decisions with public health implications.

In New York State Rifle & Pistol Association Inc. v. Bruen, the court supported the plaintiff’s claim that a New York State law tightly restricting the right to carry concealed firearms violated the rights of citizens to carry a firearm for self-defense in public. This ruling on June 23 came at a time of unprecedent mass shootings—there has been at least one mass shooting each week in 2022; a recent analysis published in the New England Journal of Medicine notes that firearms have surpassed motor vehicle injuries as the leading cause of death in youth ages one to 19. A Kaiser Family Foundation article notes that the United States is “the only country among its peers in which guns are the leading cause of death among children,” accounting for 4,357 deaths in 2020 (the latest data available). The next highest country is Canada, with 48 deaths. One wonders what loosening United States gun laws will yield for the future.

Removing limits on polluters even as climate change accelerates.

The Supreme Court’s October 2021 decision, West Virginia v. Environmental Protection Agency, concerned whether the Environmental Protection Agency (EPA) overstepped its authority under the Clean Air Act by setting caps on carbon dioxide emissions from coal-fired power companies. In the decision, which will have far-reaching effects on the energy industry, the court said, “it is not plausible that Congress gave EPA the authority to adopt on its own such a regulatory scheme… A decision of such magnitude and consequence rests with Congress itself…”

Science affirms the connections among carbon emissions, global warming, and climate change—everywhere on the planet, the effects are being felt from more severe weather events, rising sea levels, and increasing heat, drought, and wildfires. (See this report on the health effect of climate change in AJN‘s April issue, as well as AJN‘s Environmental Health and Issues topical collection.)

In addition, this Supreme Court decision limiting the EPA’s ability to regulate harmful industry practices has the potential to cast into doubt other regulations, not only by the EPA but by other agencies as well. For example, might industry-wide OSHA (Occupational Safety and Health Administration) regulations that protect worker safety also be in jeopardy?

People think of the “trickle-down effect” mostly in terms of economic policy, but it’s obvious that it applies to recent Supreme Court rulings that will affect us all. We need to pay attention.