September 9, 2021, 3:40 p.m. — The physician-patient relationship is under siege in parts of our country. As of Sept. 1, every private citizen in Texas can play lawyer against any physician who offers — or even discusses with their patients — abortion care. And in other states, a few non-physicians have been playing doctor in court, chasing human access to an unproven remedy.
Family physicians are used to feeling the earth move under our feet with the shifting of administrations and political agendas. These latest rumblings, though, feel more seismic and pack real destructive force. While change is always present in our health care system, the patient-physician relationship has until recently remained sacred and was seldom threatened or unduly influenced. The sanctity of the patient-physician relationship feels under attack by those seeking political gain, not improvements to health. That’s why it’s imperative for us to speak up now.
Let’s start with Texas, where the law known as S.B. 8 took effect last week after the U.S. Supreme Court refused to block it. It bans abortions as early as six weeks into pregnancy — well before most patients seek medical confirmation that they are pregnant.
Let me be clear: S.B. 8 delivers no public health benefit and has no medical justification. Its outlawing of a safe and sometimes essential element of a woman’s health care endangers the physical and psychological health of patients and their families, and severely compromises the patient-physician relationship. The law unethically limits clinicians’ counsel and healing powers, and affects every patient of any practice under legal threat.
And that threat will be constant. Twelve other states have passed similarly restrictive laws. What sets this one apart is that it will be enforced not by Texas officials, but rather by private citizens and only by private citizens. Because the state doesn’t enforce the law, it can’t be sued over it.
Why would private citizens want this responsibility? Because S.B. 8 offers them both a powerful incentive and a lot of cover to essentially intimidate women and clinicians, including family physicians. S.B. 8 promises at least $10,000 plus attorney’s fees to anyone who wins a lawsuit against a practice that “engages in conduct that aids and abets” an abortion — or even, the law says, “intends” to. Those successful in fending off such an attack, on the other hand, get no remuneration for their legal costs.
This goes far beyond nuisance. The law deputizes citizens in a culture war with grave medical and public health consequences. It poses an existential threat to medical practices and seems certain to strand some family medicine patients in the country’s second-most populous state without proximate high-quality care.
Restricting abortion without addressing social determinants of health and inequities ultimately worsens health disparities, including maternal and infant mortality, especially for the patients of color whom S.B. 8 will disproportionately affect. Data collected in Texas show that the majority of the 53,000 abortions administered there in 2020 involved Hispanic and Black women.
Last week, we joined our fellow medical organizations in the Group of Six to decry Texas’ law. We believe S.B. 8 endangers patients and clinicians, and puts those of us who provide necessary medical care — or even offer evidence-based information — at risk. S.B. 8 virtually eliminates women’s access to evidence-based, comprehensive reproductive care and information and denies women their right to make decisions about their own health. That’s wrong.
“We strongly urge the courts to act swiftly to strike down this law and any similar legislation,” our statement said.
The AAFP, alongside the American College of Obstetricians and Gynecologists, the AMA and other medical societies, has also signed onto an amicus brief objecting to a six-week ban in the state where I practice, South Carolina. That law, another so-called “heartbeat bill” — the term is misleading and clinically inaccurate — was blocked this past spring before it could take effect, pending court challenges including the one we’ve joined.
Additionally, the Academy this summer joined several other medical organizations calling for passage of the Women’s Health Protection Act (S. 1975/H.R. 3755), which would safeguard the patient-physician relationship and preserve the ability of physicians to provide evidence-based care to their patients.
These things are always important, but the work to protect them is more urgent than ever before. The letter of support noted that legislators increasingly overstep “the proper limits of their role in the health care of Americans to dictate the nature and content of patients’ interactions with their physicians.”
This overstepping isn’t limited to women’s health.
A Medpage Today article last week reported glaring examples of this overreach involving inappropriate, potentially hazardous efforts (including one in Ohio, my home state, that it took a second court to halt) to get judges to order that ivermectin be given to COVID-19 patients. Ivermectin, an antiparasitic drug that the FDA hasn’t OK’d for use in any COVID-19 prevention or treatment, remains outside the bounds of evidence-based medicine for the uses judges are being asked to consider. So, yes, it’s more than reproductive health that needs legislative protection.
I don’t have to tell you all the reasons why a judge overruling a physician’s evidence-based care and setting aside the caution of scientists sets an extraordinarily dangerous precedent. What we’re talking about here is absurd. There are patients who would go to court to demand that doctors be forced to wield an antiparasitic drug against a viral infection rather than heed evidence-based medical care — including staggeringly effective vaccines. (Right-to-try laws have a place in our health care system; appropriate application of such statute isn’t what’s going on here.) But it’s also tragic because there are people who would go to court to prevent women in their community from receiving safe, evidence-based, potentially lifesaving care.
Whatever else these troubling scenarios share in common, they ultimately touch all family physicians. The trust our patients place in us, which we work constantly to earn and keep, must not be undermined by statutes or court rulings that hobble our ability to deliver comprehensive care or encourage intimidation. Such interference threatens our specialty equally, regardless of our personal convictions about abortion.
For these reasons, the AAFP will push back against any such intrusion into the physician-patient relationship, as we and our Group of Six partners have codified in our Joint Principles for Protecting the Patient-Physician Relationship and referred to in an April statement opposing criminalization of physicians and physician services.
The Academy will also continue to advocate for family physicians, amplifying our longstanding policies opposing any governmental interference in the confidential relationship between patient and physician, including those related to criminalizing medical care, reproductive decision-making and reproductive services.
I am deeply concerned about the ways in which recent legislative and legal interference will affect patients and the family physicians who care for them. These examples, and others that could be on the horizon, make me worry for the personal safety of family physicians nationwide. The AAFP shares these concerns, and we will do everything we can to protect the rights of our members and the health of their patients.
Ada Stewart, M.D., is president of the AAFP.