The Abortion Pill and the Hypocritical Oath

The sham nature of the Alliance for Hippocratic Medicine, and its cynical appropriation of the concept of “do no harm,” makes it the perfect representative of the anti-abortion movement.

Erin Hawley, (in blue) a Missouri attorney and Alliance Defending Freedom’s senior counsel, departs the Supreme Court following oral arguments in the case of FDA v. Alliance for Hippocratic Medicine on March 26, 2024. (Anna Rose Layden / Getty Images)

The lead plaintiff in the mifepristone case heard before the Supreme Court this week is a shadowy organization calling itself the Alliance for Hippocratic Medicine (AHM). The group’s name is clearly intended to evoke the Hippocratic oath, popularly understood as the commitment of doctors to “first do no harm.”

AHM has existed for less than two years, having been incorporated immediately after the Supreme Court’s July 2022 ruling in Dobbs. It is headquartered in Amarillo, Texas, for no apparent reason other than the fact that the city is located within the sole jurisdiction of Judge Matthew Kacsmaryk, the Trump-appointed U.S. district judge revered among reactionary conservatives for his reliably ideology-driven decisions. As Melissa Gira Grant reports in The New Republic, AHM “stated that it did not anticipate raising more than $50,000 annually for the next three years.” 

It is clear that such a newly formed organization with such limited funds is not the actual force behind the ambitious lawsuit that aimed to have mifepristone taken entirely off the market.

The case’s real engine is the Alliance Defending Freedom (ADF), the extremely well-funded, theocratic Christian legal advocacy group whose agenda is largely aimed at rolling back civil rights protections for historically marginalized communities. ADF authored the Mississippi anti-abortion bill that triggered the Supreme Court’s rejection of a constitutional right against forced birth in Dobbs; Erin Hawley, ADF’s senior counsel (and wife of Sen. Josh Hawley), represented AHM in Monday’s oral arguments.

The AHM is likely no more than a fly-by-night operation whose sole purpose is to lend credibility to the anti-abortion cause by invoking the authority of physicians and the “Hippocratic” practice of medicine. Like the Physicians Ad Hoc Committee for Truth—which was created to push for a federal ban on the intact dilation and extraction abortion method and disappeared immediately after the ban was passed—the AHM will probably exist only as long as the mifepristone litigation does.  

How the Alliance for Hippocratic Medicine Furthers the Anti-Choice Movement

But it is precisely the sham nature of the Alliance for Hippocratic Medicine, and its cynical appropriation of the concept of harm, that makes it the perfect representative of the anti-choice movement. The group claims to follow the principles of the “essential Hippocratic oath,” a modified version of the Hippocratic oath created and endorsed solely by anti-abortion religious organizations with medical affiliations. Adherents to this bespoke oath promise “in the presence of the Almighty” to “not help a woman obtain an abortion” and to “maintain the utmost respect for human life from the moment of fertilization until the moment of natural death, carefully guarding my role as a healer.” 

The anti-abortion stance has a referent in the original ancient Greek text of the oath often attributed to Hippocrates, which includes the promise not to “give to a woman a pessary to cause abortion.” Historians debate whether this principle was a categorical rejection of abortion or simply a rejection of a specific method of abortion, but significantly, this aspect of the oath—along with many other peculiarities, such as swearing the oath to “Apollo Healer” and other Greek gods and promising to give the oath taker’s teacher money if he needs it—is not included in modern medical ethics codes.

Indeed, the denial of abortion care can clearly be viewed as violating the four fundamental principles “widely recognized as guides to practice: beneficence, nonmaleficence, respect for autonomy, and justice” by  “supersed[ing] the needs, values, and preferences of the woman seeking care.” 

To claim, as the Alliance for Hippocratic Medicine does, that forcing a woman or child to give birth against her will, even if childbirth will seriously injure or even kill her, honors the principle of “do no harm” is perverse, but also very revealing. It makes clear that the “harm” that AHM and other anti-abortion ideologues care about is wholly imaginary.

They do not care about the actual, flesh-and-blood harm to the fragile bodies of 10-year-old rape victims, or the harm to broken-hearted expectant mothers forced to carry dead fetuses in their bodies for weeks, or the harm to any of the women and girls denied the choice to decide for themselves whether to make the life-changing, irrevocable, physically risky decision to become mothers.

No, the only harm they care about is the speculative, religiously-grounded harm to “potential life,” and the incredibly attenuated possible harm to members of the (male-dominated) medical profession that someday, in some way, they might possibly play some passive role in the provision of emergency services to a woman experiencing incredibly rare complications of a medication abortion. The solution they demand on the basis of this vanishingly remote possibility of harm to a tiny group of religious zealots who also happen to be medical professionals is that no woman or girl anywhere in the United States should be allowed to access a safe and effective medication without extensive restrictions. 

To claim that forcing a woman or child to give birth against her will—even if childbirth will seriously injure or even kill her—honors the principle of ‘do no harm’ is perverse.

As Amanda Marcotte trenchantly observes, unvarnished regressive misogyny is a “bad look,” and the modern anti-abortion movement has accordingly attempted to wrap itself in the mantle of concern for women’s health. This is a tactic most effectively deployed by women spokespeople like Hawley, who “loves to wax poetic in public about how she wants a culture ‘that values women’s lives.’” But this was a particularly difficult sell in the mifepristone oral arguments, which Hawley mostly devoted to “maudlin complaint about anti-abortion doctors who were afraid that, one day, they may have a patient show up at an emergency room with an incomplete abortion.”

Understanding the Hippocratic Oath

It is a quirk of English pronunciation that leads many to associate the Hippocratic oath with the similar-sounding concept of hypocrisy. The two are unrelated in fact; the Hippocratic oath is named for the Greek physician Hippocrates, while the word “hypocrisy” derives from the Greek word hypokrisis, meaning “acting on the stage; pretense.”

The negative connotation of the word has its origins in the New Testament: “In the book of Mark, hypocrite is the word Jesus uses to describe those who trumpet their faith,” and Christianity helped established the definition of “hypocrite” that is known today: “One who falsely professes to be virtuously or religiously inclined; one who pretends to have feelings of beliefs of a higher order than his real ones; hence, generally, a dissembler, pretender.”

It is ironic, then, that the invocation of the Hippocratic oath to advance a theocratic, forced-birth agenda happens to indeed be an act of profound hypocrisy: a grotesque pantomime of concern for women’s welfare by those utterly hostile to it.

The one heartening sign is that the mask seems to be slipping. As many legal commentators noted following oral argument in Alliance for Hippocratic Medicine v. U.S. Food and Drug Administration, the Supreme Court, including several of its conservative members, did not seem to be particularly sympathetic to AHM’s position.

It is possible that even this Supreme Court—which has repeatedly sided with imaginary, speculative or attenuated harms over actual, documented, real-life harms, including in cases such as NYSRPA v. Bruen, Dobbs v. Jackson Women’s Health Organization,Counterman v. Colorado, and 303 Creative LLC v. Elenis—may have hit a limit to its tolerance for hypocritical spectacle.

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Dr. Mary Anne Franks is the Eugene L. and Barbara A. Bernard professor in intellectual property, technology and civil rights law at George Washington Law School and the president and legislative and tech policy director of the nonprofit organization Cyber Civil Rights Initiative. Her areas of expertise include First and Second Amendment law, criminal law, family law, and the intersection of civil rights and technology. She is the author of the award-winning book, The Cult of the Constitution: Our Deadly Devotion to Guns and Free Speech (Stanford Press, 2019). Her second book, Fearless Speech (Bold Type Books) is expected in 2024.