Today's post is from Carole Joffe, author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients, and the Rest of Us. Joffe is a professor in the Bixby Center for Global Reproductive Health at the University of California, San Francisco (however, the views and opinions expressed here do not necessarily state or reflect those of the Regents of the University of California, UCSF, or the UCSF Medical Center). This post originally appeared at RHRealityCheck.
“…there is now an unprecedented and sweeping legal assault on women’s reproductive rights. New legislation is being introduced, and sometimes passed, in state after state that would roll back access to abortion and contraception, mainly by intruding on the relationship between doctor and patient…..But where are the doctors? They have been strangely silent about this legal assault, even though it directly interferes with medical practice.”
The above statement is important not just because of the insightful words being said, but because of who is writing these words, and where these words are published. The writers are Marcia Angell and Michael Greene, and the piece they wrote on current abortion restrictions appears in USA Today, the newspaper with the largest circulation in the United States. Dr. Angell, a senior lecturer at Harvard Medical School, is the former editor-in-chief of the New England Journal of Medicine; Dr. Greene is professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and chief of obstetrics at Massachusetts General Hospital.
Why do the credentials of the writers, and the place of publication, matter? The significance of these issues becomes clear if one takes into account the longstanding marginalization of abortion — and abortion providers — in the United States. As I learned in researching a book on the first generation of doctors who provided abortion after Roe v Wade, these pioneers acutely felt their isolation from mainstream medicine. Most hospitals did not establish abortion services, most professional organizations did not set guidelines for abortion care, very little training of residents in abortion procedures was taking place, and many individual providers told me of sanctions they experienced because of their involvement with the abortion issue. I heard numerous stories of academic advancement denied, difficulty in getting research published, but perhaps most poignant of all, the lack of colleague-ship they felt with their fellow physicians. As I speculated, the memories of the “back alley abortionists” were still so strong in the period immediately after Roe that even ethical and competent doctors, such as those I interviewed, were tainted with that legacy. In short, a majority of physicians then (as now) have supported legal abortion — but there was less support for the abortion provider.
To be sure, much has changed for the better since 1973 in U.S. medicine with respect to abortion. The number of training sites has considerably improved; such technological developments as medication abortion (formerly known as RU-486) and an improved device for Manual Vacuum Aspiration have brought many primary care doctors and, where legally permitted, nurse practitioners, midwives and physician assistants to offer early abortion care; perhaps most importantly, organizations such as Medical Students for Choice and PRCH (Physicians for Reproductive Choice in Health) have facilitated collegial contact between numerous clinicians who go on to become abortion providers, or who are already doing so, and clinicians in other fields who, while not performing abortions themselves, firmly support those who do.
However, while the stigma surrounding abortion within medicine may have lessened, in the larger society it has only worsened — as we see from the unprecedented number, and character, of the restrictions proposed in the last year and a half. In fact numerous states even mandate that abortion patients be told misleading or downright untrue facts, such as the links between abortion and breast cancer or infertility — while a number of states have passed, or are proposing, laws that shield doctors from lawsuits if they withhold accurate information, such as the results of prenatal diagnosis that might lead a pregnant woman to seek an abortion.
Back to the forceful statement by Drs. Angell and Greene. They are not the only voices within medicine to object to these egregious measures. The Pennsylvania Medical Society and the Wisconsin Medical Society, for example, are on record as opposing restrictive laws in those states because they interfere with the doctor-patient relationship. Dr. Pippa Abston, a pediatrician in Alabama, has become an outspoken critic of Alabama's mandated ultrasound law, speaking at rallies and making a video of her opposition, and others have voiced objection as well. But given the cultural stigma that now surrounds abortion, the fact of two high profile physicians at one of the country’s leading medical institutions, speaking out in such a widely read newspaper, is a particularly welcome blow against the legislative persecution of abortion providers. To me, it is especially encouraging, given the past marginalization of this field that I have described, that the two physician-writers have not themselves built careers around abortion.
Angell and Greene mince no words in denouncing the assault on medical ethics that such laws represent, and make clear their understanding that the stakes in these battles go well beyond abortion care. “Physicians…have ethical commitments to patients that they cannot and should not be required by state law to set aside. Prominent among them is the responsibility to place the welfare of their patients above all other considerations.” But their statement does not only call for the proper treatment for patients. They end their piece with a call for the relevant medical professional organizations — too timid till now, in their view — to support their members who are caught in this war on those who serve women.