In 2013, there have already been bills introduced in the US Congress and in the states that would:
- prohibit Title X family planning funds from going to clinics that provide abortions or prohibit funds from going to other entities that perform abortions (US Congress)
- repeal the Affordable Care Act, including the insurance protections and preventive services provisions that ACOG supports (US Congress)
- ban medical abortion (Mississippi)
- require women to undergo transvaginal ultrasound before having an abortion (Michigan)
- prohibit abortion after detection of a fetal heartbeat (at least three states: Arkansas, North Dakota, and Wyoming).
Few, if any, of these proposals are based on medical science. In fact, many of them run contrary to science and good patient-care principles. And although most of these efforts focus on reducing access to reproductive health care, including abortions, legislative interference is an issue of concern to physicians of all specialties, regardless of individual positions on life and choice.
What the medical community is doing
The American Medical Association (AMA) has made clear, consistent with the direction of its House of Delegates, that it fully opposes political interference in the patient-physician relationship. In 2012, the AMA unveiled its “Protect the sanctity of the patient-physician relationship” campaign with a panel that included Dr. Erin Tracy, chair of the Massachusetts Section of ACOG; Dr. Tim Bartholow, chief medical officer of the Wisconsin Medical Society; and Dr. H. Garry Gardner, chair of the American Academy of Pediatrics’ (AAP) Council on Injury, Violence, and Poison Prevention Executive Committee.
The AMA’s campaign is designed to educate physicians and to work with state medical societies and specialties to “articulate a compelling and comprehensive legal foundation to oppose legislation that encroaches on the sanctity of the patient-physician relationship.”
ACOG’s leadership has directly and forcefully pushed back on legislative encroachment. In 2012, ACOG Executive Vice President Hal C. Lawrence III, MD, and the executive leadership of the American Academy of Family Physicians (AAFP), AAP, the American College of Physicians, and the American College of Surgeons issued a joint statement that was published in the New England Journal of Medicine against legislative interference in the exam room.2
In addition, ACOG President James T. Breeden, MD, has written eight oped pieces, letters to the editor, and other public statements in venues with far and important reach, including the New York Times, USA Today, and Capitol Hill dailies (see the box). ACOG has also issued “Rapid Responses” to counter inaccurate statements about women’s health made in the media or on the campaign trail by state or national politicians.
In a paid ad message to the National Conference on State Legislatures (NCSL), which the NCSL refused to run, Dr. Breeden said, in part:
- Because we stand firmly for access to needed care, we also stand firmly against legislative interference with the patient-physician relationship. There’s only room for two people in our exam rooms: the patient and the caregiver. Lawmakers get in the way of good patient care when they try to force women to undergo transvaginal ultrasounds or other unnecessary medical procedures; when they try to close health clinics for specious reasons; or when they try to tell women that legislators know best.
Lawmakers can and do play a vitally productive and important role in ensuring public health. Lawmakers should not, however, attempt to define, mandate, or prohibit medical practices or require doctors to read a government script to their patients.
As ObGyns visit with state and federal legislators this year, our message is simple: Partnership with lawmakers, yes. Legislative interference, no.
Our campaign makes the point that there are a number of legitimate roles that state and federal governments play in public health. We welcome opportunities to partner with legislators on important women’s health-care needs. We draw the line at legislative interference of all stripes.
ACOG’s response to legislative interference
Here are just a few examples of ACOG’s many statements on behalf of women’s reproductive health
USA Today – Letter to the editor – May 21, 2012
“Politicians should not be legislating the practice of medicine or the doctor-patient relationship. We all need to speak up and take action when legislators pretend they know what’s best for women and their physicians.” —ACOG President James T. Breeden, MD
New York Times – Letter to the editor – June 4, 2012
“Politicians were not elected to, nor should they, legislate the practice of medicine or dictate the parameters of the doctor-patient relationship. Our message to politicians is unequivocal: Get out of our exam rooms.” —ACOG President James T. Breeden, MD
“Universal access to contraception could be a lifesaver” – Las Vegas Review Journal – July 22, 2012
“Contraception is a basic and essential element of women’s preventive health care and a basic public health necessity.” —ACOG President James T. Breeden, MD
ACOG Rapid Response to Rep. Todd Akin’s August 19, 2012 statement on “legitimate rape” – Issued August 20, 2012
“Absolutely no veracity to the claim … A woman who is raped has no control over ovulation, fertilization, or implantation of a fertilized egg. To suggest otherwise contradicts basic biological truths.”
ACOG Rapid Response to Rep. Joe Walsh’s October 18, 2012, statement that “Technology has advanced to the point that abortions are never needed to save the health or life of a mother” – Issued October 19, 2012
“Abortions are necessary in a number of circumstances to save the life of a woman or to preserve her health.”