If politicians wish to play doctor, we should hold them to the same standards: First, do no harm.
Back in medical school, I, like most students, envisioned myself caring for people in their worst moments, providing reliable, compassionate guidance amidst the chaos of illness, and prioritizing not merely longevity, but quality of life.
These days, I cannot do that. I cannot provide ethical, optimal care for my patients now that I am a physician if those in positions of power do not respect my medical training.
Lately, I’ve found myself using the words “obtuse” and “U.S Court of Appeals for the Fifth Circuit” in the same sentence with increasing frequency. To that mix, I offer more: “misogynistic” and “dangerous.”
The latest misadventures from the Fifth Circuit include a ruling in favor of Attorney General Ken Paxton and anti-abortion groups that hospitals receiving Medicare cannot be required to perform emergency abortions to stabilize patients, despite federal guidance.
This grim beginning to 2024 comes on the heels of the Kate Cox fiasco, one that Paxton pursued with a fervor bordering on the fanatic, devoid of empathy and reason. The same day that a lower court granted Cox the right to abortion for an unviable and complicated pregnancy that threatened her health and future fertility, Paxton fought the decision and intimidated physicians and hospitals with a threat that the ruling would not shield them from criminal charges for violating Texas’ abortion laws, should they involve in Cox’s care. He was alarmingly successful.
I worry that anti-abortion zealots will consequently feel emboldened to come out of the woodwork to terrorize women.
If [politicians] can undermine our careful decision-making with brute force and no medical qualifications, then what is the point of our expertise?
In his argument, Paxton belittled the original ruling: “Judge Guerra Gamble is not medically qualified to make this determination.”
To which I say: AG Paxton, neither are you.
I interpret these decisions as overt hubris by Texas politicians who are dictating medical care without adequate training or licensure. Had Paxton been genuinely concerned with medical expertise here, he would have respected the professional opinions of Cox’s physicians and would not need to threaten them with litigation.
These politicians’ control over medical practice is decidedly antithetical to the practice of medicine that I was taught. Our Hippocratic oath is succinctly distilled into the phrase: “First, do no harm.”
I do not see Paxton abiding by that credo—neither in his challenge to the federal guidelines on emergency abortions, nor in his efforts against Cox, nor bullying of patients by weaponizing the legal system against them nor prioritizing personal ideology over scientific evidence are considered good medical care. Denying an emergency abortion to a medically unstable patient who needs one is the exact opposite of preserving life.
The Fifth Circuit’s appalling attempts to control medicine continue with further frivolous barriers to care. The Supreme Court of the United States has agreed to review a decision by the court limiting access to mifepristone and imposing wholly unnecessary burdens for patients who need this medication. These restrictive requirements do nothing to improve patient outcomes or experience with mifepristone—and are entrenched in inflexible and harmful ideology.
The mother is not, in fact, a priority in the eyes of the law.
As physicians, we can follow neither our ethics nor appropriate standard of care if uninformed politicians flagrantly disrespect our training. If they can undermine our careful decision-making with brute force and no medical qualifications, then what is the point of our expertise?
As a psychiatry resident, I have clinical teaching responsibilities. I can see my medical students fearfully considering the extremism creeping into their fields. Despite OB-GYN becoming more competitive, many are reluctant to consider residency in states where ideology infringes upon healthcare.
“I would like to train at an institution that teaches family planning. And I don’t think I’ll apply to [OB-GYN residency] programs in states where there are restrictions or bans on abortion,” said one of my third-years, who is already a valuable asset to the medical team.
If you drive away physicians with the threat of criminal charges when they don’t practice according to your personal beliefs, they will not come to your state. Another casualty of extremism: women’s access to comprehensive reproductive healthcare.
Anti-abortion advocates will inevitably challenge me on this with any number of ludicrous extremes. I cannot count the number of times an infuriated idealogue has sanctimoniously asked me, “So, that means that you’re fine with aborting a perfectly healthy baby up until the day of birth?” or “What’ll you do when a dumb teenager who had sex shows up at 38 weeks wanting to abort?”
No one in medicine with any amount of common sense or decency is advocating murder, and this argument is an egregious misrepresentation and oversimplification of healthcare decisions in which abortion is determined to be the best option for the patient. This misogynistic position suggests that hordes of callous and irresponsible women will casually line up to dispose of infant children, given the opportunity. That is not happening. Nor is Texas’ misrepresentation of federal guidance on emergency abortions and EMTALA happening: that the guidelines strive to turn emergency departments into abortion clinics.
What is happening? A group of politicians are dictating healthcare without medical training and endangering the lives of women. Texas’ decisions seem tantamount to enforcing inferior medical care that harms women, prioritizing personal belief over evidence-based medicine and codifying misogyny into standard of care. This most recent decision by the Fifth Circuit, which allows denial of an emergency abortion to a critically ill pregnant patient, highlights the chilling truth that the life of the mother is not, in fact, a priority in the eyes of the law.
For a group that professes to value life, the politicians of Texas are demonstrating otherwise—with unyielding dedication to preserving an inflexible ideology, enforcing it without nuance or compassion, without firm grounding in scientific evidence, and even at the expense of women’s lives.
I would lose my job very quickly if I practiced medicine this way.
If politicians wish to play doctor, we should hold them to the same standard. The situation has become dire for too many innocent people.
If you recently had an abortion, are seeking an abortion, or need legal support for your pregnancy outcome contact the Repro Legal Helpline at (844) 868-2812 for confidential legal information and advice. If you provide or support abortion care and have questions about your legal rights or have been threatened with legal action related to abortion, contact the Abortion Defense Network.
The views in this piece are the author’s alone.
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