Q&A: ACP vows to continue fight against Title X gag rule
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The 9th U.S. Circuit Court of Appeals has decided in a 7-4 ruling to uphold the Title X gag rule that prohibits certain family planning discussions between physicians and patients, according to the AMA.
The gag rule bans health care providers from referring women for abortions as a method of family planning and denies federal funding for programs and facilities that do not comply with the rule. The ruling rescinds three injunctions previously issued by federal courts in Oregon, Washington and California.
The 11 Circuit judges heard oral arguments on Sept. 23, 2019, regarding a lawsuit originally filed by the AMA and other health care organizations that was later consolidated with additional lawsuits that include 20 states, the District of Columbia and individual health care providers, according to the AMA.
Circuit Judge Sandra S. Ikuta argued in the majority opinion that “there is no ‘gag’ on abortion counseling” because the rule only prohibits physicians from “promoting or encouraging” abortions — not from discussing the risks or adverse events associated with abortions.
In a statement, AMA President Patrice A. Harris, MD, said the organization is “disappointment by — and strongly disagrees with — the reasoning behind” the court’s decision to enforce the gag rule.
“The judges failed to properly take into consideration the AMA’s legal arguments or the decision’s impact on either health care or the patient-physician relationship,” she wrote. “It is unconscionable that the government is telling physicians that they can treat this underserved population only if they promise not to discuss or make referrals for all treatment options.”
ACP President Robert McLean, MD, also released a statement expressing disappointment. Healio Primary Care spoke with McLean about how the gag rule interferes with the patient-physician relationship, advice for physicians who will be impacted by the gag rule and how ACP is supporting efforts against the ruling. – by Stephanie Viguers
Q: How does the gag rule contradict the Code of Medical Ethics? What are the downstream consequences of this rule?
A: The gag rule restricts the counsel that a physician can give to a patient. The AMA’s Code of Medical Ethics specifically states: “Physicians can best contribute to a mutually respectful alliance with patients by serving as their patients’ advocates and by respecting patients’ rights,” and further, one of the specific patient rights is “to receive information from their physicians and to have opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits and costs of forgoing treatment.” The gag rule places limits on information that can be discussed. This directly interferes with the sacrosanct patient-physician relationship which underlies the delivery of health care to our patients. Any gag rule of patient-physician discussions around women’s health or any other topics pertinent to one’s health is simply inappropriate and wrong.
This policy also conflicts with ACP’s public and ethics policies. ACP believes that laws and regulations should not mandate the content of what physicians may or may not say to patients or mandate the provision or withholding of information or care that, in the physician’s clinical judgment and based on clinical evidence and the norms of the profession, are not necessary or appropriate for a particular patient at the time of a patient encounter. These laws may interfere with the relationship between physicians and patients or make access to reproductive health care services or abortion extremely difficult or impossible. Physicians may personally choose not to provide certain reproductive services or information about these services if it conflicts with their moral or personal standards. However, they still have a duty to inform patients about care options and alternatives or refer them for information (so that patient rights are not constrained) and provide information that is evidence-based and free of personal bias.
The above position is from our policy on interference in the patient-physician relationship.
Also relevant is our policy paper on women’s health. This language can be found under position 3 of the paper: “ACP believes that a woman has the right to make her own decisions, in consultation with her physician or health care professional, on matters affecting her individual health. Reproductive decision-making rights should be based on the ethical principle of respect for patient autonomy ... ACP opposes regulation of reproductive health care services that is not focused on patient safety or based in accepted science.”
Q: What advice do you have for physicians who are forced to choose between complying with the gag rule or closing their clinics because they will be denied federal funding?
A: The ACP and other leading physician organizations will continue to fight this gag rule. Physicians treating patients know that they must follow ethical principles of patient beneficence.
Q: How is ACP supporting efforts against the gag rule?
A: ACP has joined AMA and other organizations in amicus briefs to the courts as this case has continued. ACP opposes any restrictions that interfere with the patient-physician relationship. We will continue to fight against this or any other regulations that would prevent the physician from using sound medical judgement to counsel patients.
References:
AMA. U.S. appeals court upholds Title X gag rule on physicians. https://www.ama-assn.org/delivering-care/patient-support-advocacy/us-appeals-court-upholds-title-x-gag-rule-physicians. Accessed Feb. 27, 2020.
United States Courts for the 9th Circuit. En Banc Opinion. http://cdn.ca9.uscourts.gov/datastore/general/2020/02/24/19-15974_opinion.pdf. Accessed Feb. 27, 2020.
Disclosure: McLean reports he is president of the ACP.