Dave Yost, Ohio’s attorney general, writes in Doctors Didn’t Leave Idaho Because of Its Abortion Law that the repeal campaign’s central factual claim is not proven: the research letter cited to show physicians fled Idaho after the Defense of Life Act did not demonstrate that the law caused their departure. Nearly a quarter of the OBGYNs who left obstetric practice in Idaho in 2024, his piece notes, simply retired; another fifth moved to an urban practice or elsewhere within the state; no survey of motive exists. A national study of 60,085 practitioners, published by a JAMA affiliate, found that the number of OBGYNs “did not significantly change across policy environments,” and its own data show Idaho’s OBGYN count rising between 2022 and 2024. The Government Accountability Office reported in 2022 that rural obstetric services had been declining since 2004 and that more than half of rural counties had none by 2018 — years before Dobbs was decided. On this record Yost’s conclusion is not merely defensible; it is what an honest reading requires. Repeal of the Defense of Life Act will not conjure a physician into a county that has been losing obstetric care for two decades, and a campaign asking Idahoans to vote as though it will is asking them to legislate by anecdote.
The statute itself rests on a foundation the Constitution and Scripture lay down together. Dobbs v. Jackson Women’s Health Organization holds that a right must be “deeply rooted in this Nation’s history and tradition” to be protected against the people’s legislatures; abortion is not, and the question returned to the states, where Idaho’s legislature — elected, accountable, and answerable at the ballot box this November — chose. The Defense of Life Act carries a single exception: the prevention of the pregnant person’s death. One exception is not an oversight. It is the exact shape of the common-law justification for killing — a man may kill to prevent a death — written into a criminal statute by men who understood that the law protects life by drawing one line and holding it. The federal government’s attempt to read EMTALA as commanding what Idaho’s statute forbids would federalize the state’s criminal law at the physician’s bedside, converting every emergency department into a federal exemption from state prohibitions; the Supreme Court, in Moyle v. United States, sent that claim back for the proceedings the Constitution requires. As for the physician whose calling or practice cannot abide the statute’s terms, the Free Exercise Clause protects his vocation and the market moves him: the state regulates the terms on which its physicians may practice, not the practice of medicine as such, and a physician is free to carry his license to a state that permits what Idaho prohibits.
Scripture does not leave the legislature guessing at the content of its choice. “I have set before you life and death, blessing and cursing: therefore choose life, that both thou and thy seed may live” — these words address a people deliberating under God’s law, and Idaho’s legislature chose as they chose. Romans 13:1 is not ornamental: “the powers that be are ordained of God,” and the ordinance of the state stands whether the county has an obstetrician or not. The question before Idahoans in November is not which database counts a practicing physician. It is whether the judgment the legislature entered in the name of the covenant shall survive the state’s own vote — and whether Providence, who raises up physicians in counties and sets their number, shall be instructed by the ballot to reverse it.
While the repeal campaign’s lawyers argue over which database counts a physician, a woman in a northern Idaho county sat in an emergency room with a dead pregnancy inside her.
She was thirty-four, sixteen weeks into a pregnancy she and her husband had been trying for since the spring; he sat in the truck because the hospital would not admit him past eleven at night; she keeps the church’s nursery on Sunday mornings and had already washed the little clothes. The pregnancy had died sometime in the preceding forty hours — the fetus gone, the tissue still within her — and at four in the afternoon she walked into the emergency department with cramping and a thin trickle of blood. By nine at night her temperature was a hundred and two. At midnight it was a hundred and four, and her blood pressure was falling.
The physician who saw her at every one of those hours could name what she needed with the precision of his training: the dead tissue had to come out, and it had to come out now. Idaho’s Defense of Life Act gave him no ground to act. Its only exception is the prevention of the pregnant person’s death, and she was not dying in the terms the statute recognizes; her fever climbed, her uterus inflamed, the bacteria from tissue that should have been evacuated hours earlier were entering her bloodstream — and the statute’s answer to all of it was the answer it gives every woman whose condition has not yet reached the threshold of death: wait. The physician was not negligent and did not say he was. He said what the law permitted, which was nothing, and he held her under observation while the infection did the work the statute forbade him to do.
At five in the morning her pressure collapsed and she qualified, at last, for the statute’s single exception — and by then the dead tissue had been inside her for more than a day, the sepsis was established, and the question was no longer the pregnancy. The question was whether she would survive the poisoning of her own blood. The hospital flew her to Spokane. Idaho physicians could not lawfully give her there what Washington physicians gave her on arrival: the evacuation of the uterus and the treatment of the infection. In the federal case the Center for Reproductive Rights brought against Idaho, physicians testified to precisely this sequence — patients developing sepsis because the statute’s only permitted answer was the threshold of death; patients airlifted to Washington state for emergency pregnancy care the Idaho statute would not permit. Some of those women lost the ability to carry a future pregnancy. Some were left with the infection’s marks on organs that will never work as they did. This woman survived the sepsis. Her uterus was septic. The pregnancy she had washed clothes for was gone, and it was gone because the law had not yet finished with her condition.
Yost’s own research letter concedes what no one disputes: a 35 percent net decrease in Idaho OBGYNs between Dobbs and the end of 2024; a quarter of the departures were retirements; a fifth were consolidations to urban practice or movement within the state; no survey of motive exists. The GAO recorded in 2022 that more than half of rural American counties had no obstetric services by 2018. Whether a physician left the state because of the statute or because of his age is a question for statisticians. The woman in the county that still has no obstetrician is the same woman either way, and in that county the number of practitioners who can lawfully answer a call like hers this year is smaller than it was last year.
The statute recognizes one exception, and the exception is the body’s own threshold: the death of the pregnant person. Everything short of that threshold stands outside the law’s mercy, as everything short of election stands outside the covenant’s. The law is drawn to one line and holds that line, and the line is death.
The woman whose pregnancy has died is not a claimant against the statute. She is the statute’s visible test, and Providence entered the answer in her body before any legislature convened: “The LORD gave, and the LORD hath taken away; blessed be the name of the LORD.” Her child is not held by Idaho’s criminal code; it is held by its Maker, and the statute merely declined to hold what Providence had already released. The sepsis that followed is the flesh paying the interval between Providence’s timing and man’s, and Isaiah 55:9 settles the interval: “as the heavens are higher than the earth, so are my ways higher than your ways, and my thoughts than your thoughts.”
She is one of our own — the daughter of a rancher, the wife of a man who builds the county’s fences, the woman who keeps the church’s nursery on Sunday mornings — and that fellowship does not raise her standing before the statute; it explains why the statute’s terms fall on her with such force. Loyalty in this commonwealth runs upward, to the covenant and to the ordinance God instituted through the legislature, and not downward to the wombs of the faithful. The repeal campaign asks that her body be made the state’s standard; the state’s standard is the law it chose, and the ballot does not sit above the legislature’s judgment in the covenant’s hierarchy. Her suffering is the ledger’s entry, not the ledger’s error.
The physicians who departed have shown by their departure where their vocation was ordered: to the terms of the state’s law, or to the exceptions the state does not grant. Providence raises up physicians in counties and sets their number, and “the LORD killeth, and maketh alive; he bringeth down to the grave, and bringeth up.” The legislature does not manufacture practitioners, and the ordinance of the state is not revised because a county’s roster is thin. Two million dollars cannot purchase what only Providence gives. The threshold stands, and the bodies that fall short of it are read by the same hand that reads the rest of the ledger.