PIP: The US Supreme Court's decision in Planned Parenthood v. Casey leaves an uncertain future for abortion as a constitutional right. By a vote of 1, Roe v. Wade could be overturned. Without Roe, the states would be free to legislate their own abortion laws, including the outlawing of abortion except when a pregnancy threatens the life or health of the pregnant woman. Psychiatrists could be thrust into the abortion process to certify the threats to life or health on mental health grounds, as they did more than 2 decades ago before Roe. What should psychiatrists' response be? What little empirical data exists reveals almost no basis for individualized determinations of the likelihood of harm if an abortion is denied. There are obvious situations where psychiatry can play a useful role: 1) for women with histories of postpartum depression or psychosis who may be at high risk for a repetition of those conditions, and 2) for women severely mentally disordered who require medications to control their symptoms and are faced with the prospect of decompensation if they terminate their medication to avoid harming the fetus. Some psychiatrists argue that if psychiatric certification provides the only method to obtain abortions, psychiatrists should assist women in whatever way possible, even if that means being dishonest about the likely consequences of a pregnancy, for abortion would be in the longterm psychosocial interest of the woman. In a democratic society, disregarding the laws means disregarding the will of the people. Personal beliefs about social policy also justifies the denial of mental health claims for the psychiatrist who believes that it is in the best interest of the woman to carry the fetus to term. Roe saved psychiatry from this ethical morass; its demise will be unpleasant.