Column: Where are the doctors?

Women's reproductive rights were hard-won decades ago, and while there have been encroachments and threats to them over the years, they have generally been supported by the law. And women have availed themselves of those rights in large numbers.

By Brendan Hoffman, Getty Images

Abortion legislation: Five states require doctors to tell women that a link might exist between abortion and breast cancer, though studies have not found any such link.

By Brendan Hoffman, Getty Images

Abortion legislation: Five states require doctors to tell women that a link might exist between abortion and breast cancer, though studies have not found any such link.

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Since the choice to terminate an unwanted pregnancy was established by the U.S. Supreme Court in 1973 in Roe v. Wade, almost one in three women have had abortions. The legality of contraception was established even earlier, in 1965, in Griswold v. Connecticut, and tens of millions of women use some form of artificial contraception.

But 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.

Women have reacted strongly, as evidenced by a growing disaffection among female voters with the Republican Party and its candidates; there is now a double-digit "gender gap." But where are the doctors? They have been strangely silent about this legal assault, even though it directly interferes with medical practice.

A lengthening list

Consider some of the new laws:

•Nine states require doctors to perform ultrasound examinations on women seeking an abortion, and to encourage women to view the images. (This requirement was justified by Alabama Sen. Clay Scofield in his deeply patronizing comment, "This bill just allows them to see the child inside of them, so it's not just out of sight, out of mind.") Three of these states also require women to listen to a description of the fetus.

•Counseling is now mandated in 35 states to dissuade women from having abortions.

•Five states require doctors to tell women that a link might exist between abortion and breast cancer, despite the fact that careful studies have not found any such link.

•Similarly, eight states require doctors to tell women that abortion could cause psychological problems, despite evidence to the contrary.

•Arizona is considering a bill that would hold doctors harmless from lawsuits if they intentionally withhold information from a woman, such as the presence of major fetal abnormalities, because they believe the information might cause the woman to seek an abortion.

In short, legislatures are ordering doctors to lie about the medical evidence, the patient's condition and their own medical judgment.

Even more regressive than obstructing the right to abortion is the recent effort to block access to contraception. The current attempt to turn the clock back nearly a half-century is cloaked in high-flown rhetoric about the rights of employers and insurers to deny coverage for contraception if it violates their conscience (it also saves them money).

But employers and insurers are not doctors, and should not be permitted to decline to pay for a category of medical services that they disapprove of. Appealing to conscience does not change the fact that employers and insurers, regardless of their own beliefs, do not belong in decisions about what constitutes good medical care.

Legislators vs. physicians

The unspoken assumption by state legislators seems to be that doctors will, of course, acquiesce with these new laws, that they are simply neutral agents who will comply with whatever the state orders. Physicians, however, 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. In light of this, requiring doctors to perform procedures that are not medically indicated, or to provide false information about medical evidence, doesn't just violate women's rights. It also leaves doctors with an untenable dilemma: Violate state law, or betray their professional obligations to patients.

Physicians, both as individuals and as a profession, should stand with their patients. They should make it clear that they will not perform procedures, such as ultrasound examinations, unless they are medically indicated and desired by their patients. And they should refuse to provide inaccurate information about the consequences of abortion, or to follow any other prepared script in counseling their patients, particularly when it involves treating women like children.

Such acts of civil disobedience by individual doctors should be only the starting point. The profession as a whole, as represented by its professional organizations, needs to become involved, so that physicians are not left to fend for themselves.

It is time for the American Medical Association and, particularly, the American College of Obstetricians and Gynecologists to take a public position on behalf of the patients they are pledged to serve, and to support their members in doing so.

Marcia Angell, MD, is senior lecturer in social medicine at Harvard Medical School and a former editor in chief of The New England Journal of Medicine. Michael Greene, MD, is professor of obstetrics, gynecology and reproductive biology at Harvard Medical School and chief of obstetrics at Massachusetts General Hospital.

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