Intrusions into medicine jeopardize patients and public health

Jack Resneck Jr., MD , Former President

AMA News Wire

Intrusions into medicine jeopardize patients and public health

May 9, 2024

In the nearly two years since the U.S. Supreme Court dealt a devastating blow to reproductive health and patient autonomy in the Dobbs decision, state and federal courts have increasingly become battlegrounds for reckless assaults on public health.

Decisions in several cases now pending at the highest levels of our judicial system have the potential to further threaten access to reproductive health services, criminalize safe and evidence-based medical care, jeopardize the nation’s drug approval process, undermine the patient-physician relationship and abet the unchecked spread of medical misinformation. Our profession’s ethical obligations to our patients are being undermined as courts consider interfering in some of the most difficult and personal decisions patients and physicians make together.

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The AMA continues to respond to these threats in the courts and elsewhere, pushing back against dangerous legislative and judicial interference that compromises the ability of patients to receive medical care rooted in evidence-based science. Our AMA House of Delegates, comprising physicians representing every state, specialty, practice setting, and political stripe, has been unambiguous in passing a raft of policies directing us to stand strong against attempts by government or other third parties to dictate the type of care patients can receive—and to protect physicians from criminal or civil penalties for providing care based on their best medical judgment.

The cases in question, including several heard during the current term of the U.S. Supreme Court, pose varied threats to physicians, patients and public health. Consider Murthy v. Missouri, for example, which was argued before the nation’s highest court on March 18. The issue is whether the government has a compelling public interest in countering medical misinformation and disinformation that is spread through social media and other means.

While we have no interest in policing open debate about real science, which has been a cornerstone of our profession, we do believe that a compelling interest exists in curtailing harmful misinformation that puts lives at risk. As outlined in the amicus brief (PDF) we joined in this case, physicians and other health professionals are trusted messengers that patients rightfully rely upon for accurate, timely, evidence-based medical guidance. We take an oath to protect the health and well-being of patients, and in doing so share the responsibility to help them separate fact from fiction. Abdicating that responsibility puts our patients in danger.

The nation’s highest court heard arguments March 26 on whether to reimpose limits on mifepristone, part of a two-drug protocol for medication abortion and miscarriage management. Mifepristone is an exceptionally safe and effective drug backed by hundreds of studies and used by millions of women. It was approved by the Food and Drug Administration (FDA) more than two decades ago but is now being challenged in a lawsuit brought by a group of physicians who had never used or prescribed it wrongly claiming that it poses serious safety concerns.

The AMA joined 15 other leading medical societies in an amicus brief (PDF) filed in this case, asserting that reimposing outdated limits on mifepristone would have devastating effects health consequences for people living in states where abortion remains legal, jeopardize public health, and significantly worsen inequities in maternal health. The AMA also believes that, should the ideologically driven lawsuit against mifepristone succeed, the FDA’s entire drug approval process would be upended and chaos would ensue  as additional legal challenges are brought against other FDA-approved drugs.

In another case involving reproductive health care, the Supreme Court heard arguments April 24 involving the potential for criminal prosecution of physicians and other health care professionals who must end a pregnancy during an emergency for the health of a pregnant woman. This case is based on a law enacted by the Idaho State Legislature in 2022, not long after the Dobbs decision.

The Idaho Defense of Life Act makes it a crime, punishable by up to five years in prison, for anyone who performs or assists in an abortion. In its wake, almost one-fourth of Idaho obstetricians have made the difficult choice to stop practicing or leave the state entirely, and pregnant women whose lives are in danger must be packed up in ambulances or helicopters to flee the state for needed care.

The U.S. Department of Justice filed a legal challenge to that measure in August 2022, a few weeks before the law was set to take effect, citing a conflict with the federal Emergency Medical Treatment and Labor Act (EMTALA). A provision of EMTALA requires hospitals that receive federal funding to provide stabilizing emergency treatment—which can sometimes include abortion—to patients experiencing a medical emergency. We agree that this obligation exists even if a state has passed a law banning abortion—doctors cannot be required by a state to sit on their hands and withhold emergency care when a septic patient begins to lose kidney function, or when a hemorrhaging patient faces a chance of dying.

After a district court concluded that the Idaho law violated the supremacy clause of the Constitution and a panel of the 9th Circuit subsequently stayed the resulting injunction, the justices agreed to take the case.

The public knows that speed is everything in a health emergency, and that it is dangerous and wrong to prohibit physicians from protecting the health of a pregnant patient when terminating a pregnancy is required. A delay of even a few minutes in these situations can lead to a devastating outcome, but Idaho’s law forces physicians to postpone and deny care until a patient’s medical condition deteriorates to the point of crossing a nonexistent bright line that state officials lacking medical expertise would dependably agree is life-threatening. AMA policy specifies that these government intrusions into medicine are a violation of human rights.

The AMA will continue to vigorously oppose any legislative or judicial foray into the practice of medicine, particularly those that undermine the basic medical principle that clinical assessments are determinations to be made by physicians—not politicians or courts. Physicians work each day to decipher fact from fiction in our care of patients, and our nation must not allow political or ideological interference that compromises patient access to safe, evidence-based medical care.

Physicians must be allowed to bring their training, knowledge of science, and experience to bear in helping patients decide on a course of treatment through shared decision-making and informed consent. Barring physicians from doing so undermines the practice of medicine, the well-being of patients and the health of our nation.