Moral Injury of a Practicing OBGYN

Karla Van Keulen, M.D.

         The cell phone goes off at 2:34 AM—an Emergency Room patient needs my assistance. She is a 22-year-old who is orthostatic, minimally responsive, and has heavy vaginal bleeding. I then find out that she had found an abortion pill online and taken it to terminate her pregnancy, which was her first, without having a medical evaluation. When I see the patient at 3:04 AM the operating team is enroute and blood products have been ordered. Then she is rushed to the operating room. She has an emergency dilation and curettage at 3:45 AM, loses approximately another liter of blood, and receives a blood transfusion. The emergency operation was successful, but during the patient’s follow-up appointment she shares that she regrets taking the abortion pill and wishes she knew the risks involved beforehand. She also would like to be pregnant again but sadly may never be able to. With the abortion pill more readily available online, emergencies like this one are the tragic reality for many women and OBGYNs.

Medicine has changed significantly in the thirty-two years of my medical career. We have seen some incredible successes and achievements that truly make medicine more effective and that have saved many lives. The age of viability for unborn infants is now about twenty-two weeks; we now have better treatment for chronic illnesses; and we are now able to perform more minimally invasive surgeries. These are just a few medical advancements that have impacted the world of obstetrics and gynecology.

However, there is an ugly side of this medical field that has become more apparent in recent years and which I did not fully recognize until the Covid-19 pandemic. Around that time, I began to realize that organized medicine is failing to state the truth and that many organizations, such as The American College of Obstetricians and Gynecologists and the American Academy of Pediatricians, are deliberately silencing any opposing views.[1] Medical students and professionals are being pressured and even required to support abortion and to use politically correct terms, such as referring to women as “birthing persons.” I am grateful for the leadership of organizations such as American Association of Pro-Life OBGYNs, the American College of Pediatricians, The Catholic Medical Association, and the Christian Medical & Dental Associations, which all provide a consistently ethical voice in our culture today.[2] However, I have resigned from both the American College of Obstetricians and Gynecologists and the American Medical Association, since unfortunately neither organization is interested in having discussions with medical professionals who have a different opinion on controversial topics.

         Another of my patients found out that she was pregnant while taking a weight loss drug. She was out of town and went to the nearest Planned Parenthood center, where she was told that she must have an abortion because the drug would most likely cause the baby to be malformed. They gave her an abortion pill and inserted a Nexplanon to prevent future pregnancies at the same time. Several weeks later, the patient came to my office, explained the situation, and said that she still felt pregnant. An ultrasound showed that she indeed still had a live, intrauterine, ten-week pregnancy. She and her husband were overjoyed to hear the news, as they had wanted to keep the baby but felt coerced into getting an abortion. The baby was saved because Nexplanon is a progesterone device, and thus it reversed the process of the abortion pill. She delivered a healthy, full-term baby, without any medical complications for either mother or child. Organized medicine, however, including ACOG and AMA, does not acknowledge that APR treatment works.

         Many medical professionals these days are concerned about “burn-out” for doctors, but no one talks about how abortion pills contribute to this problem and to the moral injury of doctors.[3] The emergency calls for women who took a pill without ever seeing a medical professional, just like my first patient, is skyrocketing. The complications from the abortion pill include, but are not limited to, vaginal bleeding, infection, and retained products of conception. Many women need surgical management of these complications, and on-call OB/GYNs have to manage these complications without having an established relationship with the patient. A recent study highlighted the true complication rate of abortion pills, showing how high the risk is for women, who are so often lied to about the true risk of chemical abortion.[4]

         I grieve for the women who have been misled, pressured, or coerced into taking abortion pills. I am distressed that organized medicine is supporting the pill when it is clearly not safe. I grieve for the babies that do not stand a chance. I grieve for the loss to families and to our society. And I grieve for my fellow OBGYNs who are suffering from moral injury when caring for patients who experience complications from the abortion pill which they took without any medical guidance. It is a serious weight on medical professionals to be forced to accept the consequences of an action which not only goes against their moral and ethical convictions but is also so seriously harming their patients. I hope and pray that the consequences and risks of abortion procedures on both doctors and patients will become more widely acknowledged, and I am sincerely thankful for the work of pro-life organizations in spreading this knowledge.

Karla Van Keulen, M.D. is a practicing OBGYN. She graduated from Southern Illinois School of Medicine in 1993 and completed her Obstetric-Gynecology residency at Columbus-Cabrini Hospital in Chicago in 1997. She has been in private practice with Medical Arts LTD in Moline Illinois since 1997. She has been a member of CMA since 1998. and is a member of Thomas Aquinas Guild in the Quad Cities. Her practice has been NFP only since 1999. She is passionate about offering life-affirming obstetrical care and educating women on respecting their reproductive system.

[1] Louttit C. The origins and proliferation of unfounded comparisons regarding the safety of mifepristone [Internet]. Charlotte Lozier Institute; 2025 May 24^th [Cited 2025 Jul 8^th]. Available from https://www.mdpi.com/2673-6284/14/2/39.

[2] Telemedicine chemical abortion: a catholic medical association policy with recommendations [Internet]. Catholic Medical Association; 2025 Jun 11^th [Cited 2025 Jul 8^th]. Available from: https://www.cathmed.org/wp-content/uploads/2025/06/Catholic-Medical-Association-Telemedicine-Chemical-Abortion-Policy-Statement.pdf.

[3] Moral injury is defined as the distress that arises when an individual’s deeply held moral beliefs or values are violated by their own actions, the actions of others, or by failing to prevent harmful actions.

Moral distress and moral injury in healthcare [Internet]. Christian Medical and Dental Associations; spring 2023 [Cited 2025 Jul 9^th]. Available from https://cmda.org/article/moral-distress-and-moral-injury-in-healthcare/.

[4] Hall JB and Anderson RT. The Abortion pill harms women: insurance data reveals one in ten patients experiences a serious adverse event [Internet]. Ethics & Public Policy Center; 2025 Apr. 28^th [Cited 2025 Jul 8^th]. Available from: https://eppc.org/publication/insurance-data-reveals-one-in-ten-patients-experiences-a-serious-adverse-event/.

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