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Cutting Title X funding promotes unethical medical practices

Cutting Title X funding promotes unethical medical practices
© Francis Rivera

Ever since the seminal 1957 decision of Salgo v. Stanford, U.S. courts and the health profession have recognized that there is a duty for providers to disclose not only the risks of treatments, but also their alternatives. This is essential to respecting dignity, autonomy and freedom of choice for patients.

The Trump-Pence administration rejects these quintessentially American values and is substituting instead a regime that actively hides information from patients and silences their nurses and physicians.

The Title X Family Planning Program is the nation’s program for affordable birth control and other family planning health care, such as STD testing and treatment. It does not fund the performance of abortions.

 

But the Trump-Pence administration now asserts that any provider who offers a referral for abortion to a patient would be ineligible for funding. In a feat of absurdity second only to Joseph Heller's infamous Catch-22, if a woman has already decided to have an abortion and asks for a referral, a health-care provider would not be allowed to respond. Instead the provider will at best be able to give her a general list of providers who offer prenatal care, with no indication of which provide abortions – yet the list will include those that will not perform the service she specifically requests.

Informed consent is a bedrock principle of medical ethics. The American Medical Association's own code says physicians must explain the "burdens, risks, and expected benefits of all options..." [emphasis mine]. In its statement opposing Trump’s Title X changes, the American Nurses Association said "As the most honest and ethical profession, nurses must guard against any erosive policy that hinders patients from making meaningful, informed decisions about their own health, or that blocks access to care" [emphasis theirs].

Even the 1982 report by the President's Commission for the Study of Ethical Problems in Medicine and in Biomedical and Behavioral Research, commissioned by Ronald Reagan when he was considering a similar rule, states that “a physician is obliged to mention all alternative treatments, including those he or she does not provide or favor, so long as they are supported by respectable medical opinion.”

The administration may argue that it is within the discretion of the federal government whether to fund a particular program. But that public funding does not extend to silencing providers who are meeting their ethical obligations when they offer critically important information to patients. Health care providers have a duty to provide a comprehensive, accurate and unbiased evaluation of a patient’s condition and available treatment options, so that the patient can decide for herself how to proceed.

Likewise, the patient relies on the health care provider to practice medicine in line with the latest recommendations and best practices and to tell her the truth about her medical condition and treatment options — even if that information may be hard to swallow. To require a provider to withhold information, and to actively mislead a patient through a lie of omission, is unethical. It flies in the face of fundamental medical ethics and standard of care — full stop.

It is clear that the changes to Title X are aimed squarely at Planned Parenthood health centers, which have been the subject of sustained attacks since the earliest days of this administration. Equally clear is that this administration will stop at nothing in its attack, leaving ethics, science, and patient care in its wake.

Whether or not you support Planned Parenthood or the legality of abortion, we can all agree that the ethical standards of medicine are the same, whether in a private practice, a hospital or a clinic. If any aspect of our health care system fails to adhere to ethical standards around informed consent, it also fails to meet patient care.

When state and federal governments substitute a political agenda for medical information, mischief follows. We have already seen states, under the guise of informed consent, single out abortion from all other medical procedures and try to force physicians to provide inaccurate or misleading information about the risks of abortion, all in an effort to make it more difficult for women to access a legal health service that they have already decided that they need.

Other states continue to impose unduly burdensome and medically unnecessary requirements on physicians and clinics, despite a Supreme Court decision holding them to be an unconstitutional interference with women's rights. And it is women, particularly women of color and women with low incomes, who are harmed.

The administration claims that they are merely trying to make sure Title X family planning dollars are not used for abortions, but federal law already does that. So, what then, is the point of this proposed rule? It is aimed at blocking women’s access to safe abortion, despite its legality under state and federal law.

And in its effort to turn back the clock on reproductive health, and to prevent providers from fulfilling their duty to inform patients of available options, the Trump-Pence administration will not only destroy the trust patients have in their providers, but it will be undermining the entire medical profession by legally mandating medical malpractice.

R. Alta Charo is the Warren P. Knowles professor of law and Bioethics at the University of Wisconsin Law School.