The American Journal of Obstetrics and Gynecology (AJOG) published a letter in its September 2013 edition signed by 100 OB medical school professors calling for more abortion training of physicians and more abortions performed in hospitals. Time magazine promptly picked up on the letter noting increased State regulation of abortion clinics to comply with other surgical center expectations as well as for the abortionist to maintain admitting privileges. This recent development of increased standard of care for women has OB professors concerned?
Before we dive into the detail it is important to clarify who it is that is making the statement. 100 physicians who teach obstetrics at 77 medical schools. It does not appear that they represent the official position of the medical school nor the official position of the 200 obstetrical programs in the U.S. Nor were they representing the actual position of the of 33,000 physician strong obstetrical community. At best the letter and the physicians who signed it represent 38% of the medical schools and a .003% of the OB docs in the U.S. But somehow Time Magazine scooped the story before the letter was even printed and AJOG provided no meaningful peer context in support of their radical abortion position and unfounded statements appearing in the letter.
The letter was said to be a companion piece to a similar letter written in 1972 just before the Supreme Court made the determination on the Roe vs Wade case. The purpose of that letter as well as the most recent one was to “express their concern for women’s health in a new legal and medical era of reproductive control and to define the responsibilities of academic obstetrician-gynecologists.” The problem they say now, is that while medicine has progressed, specifically in the area of women’s reproductive health and ‘family planning,’ America has been in the throes of a political regression.
Does this letter and its 1972 counterpart really just promote educating more medical students on abortion and more hospitals performing them? Knowing that the vast majority of Ob/Gyns do not perform abortions and that medical standard of care is determined by what most physicians do and most patients expect then what would make this small group of professors push their political agenda so aggressively as if is is accepted medical standard of care? What would make AJOG print the letter without the appropriate peer positions knowing full well neither the physicians nor the medical schools represent the majority opinion of OBs on abortion practice?
To answer that question we must look at the two ideas these medical professors did not address and which would be absolutely toxic to their abortion agenda in the teaching environment: 1) the purpose of medicine and 2) medical ethics. The policy director for NARAL, Donna Crane, hit the nail on the head during the Time Magazine interview when she said, “There are definitely instances . . . where the medical community steps up and says that there are medical principles at stake.” Unfortunately for Donna this is obviously not one of those instances. This was. But I am sure we all would like to know exactly to what ‘medical principles’ she is referring. The Hippocratic tradition with the principle of not providing a woman with an abortive remedy? How about the principles of beneficence, non-maleficence, or true patient autonomy with fully informed consent devoid of coercive fear tactics like false time pressure?
If you know the purpose of medicine then it becomes obvious how medicine (and the physician) should act toward the patient. If one would like to use medicine to accomplish a political agenda, say population control, it would have to take control of medicine first and those that deliver medical care. Roe vs Wade struck at the heart of the purpose of medicine and permitted physicians to act in ways that run counter to traditional medical ethics in women’s health.
What is the traditional purpose of medicine? To act for the benefit of the patient by healing and maintaining health. An important caveat to mention here is that the Obstetrician is trained to treat that pregnant woman as two patients. To what purpose is the ‘new legal and medical era’ given? Roe reoriented the purpose of medicine from the individual woman to the population group called ‘women of child bearing age.’ And now a governmental body has set medical policy according to a population objective. This new population medicine dynamic set the stage for Obamacare. Population groups are now being identified with government bureaucrats setting health ‘objectives’ for these various groups. These health objectives will be incentivized by health insurance mandates and ‘outcome-based’ care according to certain policy algorithms. And now the physician will be expected or at least strongly pressured to provide or withhold patient care according to these objectives. In the end the doctor/patient relationship becomes subservient to the dictates of the State. And medical ethics in patient care is a memory of a presumably outdated and bygone era suitable only for stodgy old men with their antiquated morality who only ever wanted to dominate women. As the author of the most recent letter Philip Darney was quoted by Time saying, “we have a whole new generation of young women who are replacing the old men, and they have a very different view about their relationships with their patients.”
If only Dr. Darney, presumably a man, had clarified how these new doctors view their relationship with their patients. Bottom line, these elitist academic professors don’t talk about the purpose of medicine because to do so would reveal their inhumane view of people in order to justify and satisfy their sick need for control over both medicine and the population. They don’t train their medical students in medical ethics because to do so would create critically thinking physicians who would never stand by and let political power co-opt the medical profession and trump patient care.
If the behavior of clinical medicine is not governed by the good care of the individual patient then it will be governed by the bad ideas of the politically powerful.