?[T]here 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 for its insights, but because of who wrote it and where it was published. The authors were Marcia Angell and Michael Greene, and their op-ed on current abortion restrictions appeared in USA Today, the newspaper with the largest circulation in the United States. Dr. Angel, 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.
The significance of the writers? credentials and the place of publication becomes clear when one takes into account the long-standing 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 abortions 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, there was very little training of residents in abortion procedures, and many individual providers experienced sanctions because of their involvement with the abortion issue. I heard numerous stories of academic advancement denied, difficulty in getting research published, and, perhaps most poignant of all, a lack of collegiality with fellow physicians. The memories of ?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 likely tainted with that legacy. In short, a majority of physicians then (as now) supported legal abortion?but gave less support to abortion providers.
Much has changed for the better since 1973 in this respect. The number of training sites has increased considerably. Such technological developments as medication abortion (formerly known as RU-486) and an improved device for manual vacuum aspiration have allowed many more primary-care doctors and, where legally permitted, nurse practitioners, midwives, and physician assistants to offer early abortion care. And perhaps most importantly, organizations such as Medical Students for Choice and Physicians for Reproductive Choice in Health have facilitated collegial contact between numerous clinicians who are or will become abortion providers and clinicians in other fields who, while not performing abortions themselves, firmly support those who do.
The stigma surrounding abortion within medicine may have lessened, but in the larger society it has only worsened, as can be seen from the character and unprecedented number of restrictions proposed in the last year and a half. A number of states have even mandated that abortion providers tell patients misleading or downright untrue facts (for example, that there is a link between abortion and breast cancer or infertility). Some states have passed or proposed laws that shield doctors from lawsuits over withholding information, such as the results of a prenatal diagnosis, that might lead a pregnant woman to seek an abortion.
Drs. Angell and Greene 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 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 that state?s mandated ultrasound law, speaking at rallies and in a video about her opposition to the bill, and other physicians have voiced objection as well.
But the fact that two high-profile physicians at one of the country?s leading medical institutions spoke out in such a widely read newspaper is a particularly welcome sign. It is especially encouraging because neither physician has built a career around abortion.
Angell and Greene mince no words in denouncing the assault on medical ethics that such laws represent, and make clear 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.? They end their piece with a call for the relevant medical professional organizations?too timid until now, in their view?to support their members who are caught in this war on those who serve women.
An earlier version of this ran at RH Reality Check.