Giving patients complete information about their health care is the foundation of the doctor-patient relationship. As health care providers, we do our best to uphold the medical ethics and standards of care that require us to give patients all the information they need to empower themselves to make informed decisions about their health. A trusting relationship with our patients is not a given — it is a delicate one that must be nurtured.
At the National Medical Association, the largest and oldest national organization representing the interests of more than 30,000 African-American physicians and the patients we serve, we have spent decades attempting to reconcile the mistrust that many African-Americans have for the medical system. We are deeply concerned that a recent proposal by the Trump administration not only violates medical ethics and undermines medical standards of care, but would undo all the progress we have made in developing trusting relationships with our patients.
The Department of Health and Human Services just finished soliciting comments on a proposed “gag” rule on Title X — the nation’s only affordable birth control and reproductive health care program. If this rule is finalized, it would remove the guarantee that Title X patients get full and accurate information about their care from their medical providers; would prohibit providers from referring their patients for safe and legal abortions; and would make it impossible for patients to get birth control from reproductive health care providers like Planned Parenthood.
The damage this proposal would do goes even deeper: It strikes at the very core of the ethical principles we hold as health care providers. By forcing a provider to withhold necessary information about abortion that is essential to a patient’s ability to make informed medical decisions and prohibiting a provider from referring a patient to a clinic for an abortion, this directive breaches the bedrock principles of modern medical practice.
In both sickness and health, patients turn to health care professionals for guidance and support. We cannot afford to reverse the progress made in building lasting, trusting relationships and embolden racist and biased medical practices.
The field of medicine has a dark history with its treatment and care of African-Americans due to decades of secret experiments, misinformation, and the segregated delivery of services that have created deep roots of mistrust in many African-American communities. When we don’t care enough about people to share with them all of the information they need because they are poor, women, black, or part of another minority group, we have failed as medical providers and as a society.
Title X has made high-quality preventive health care affordable and more easily accessible to every person, regardless of background. It serves about 4 million people each year, more than half of whom are women of color. Like other policies being advanced by the Trump-Pence administration, this proposal would have dire and disproportionate consequences for women of color and others who already face significant health challenges due to systemic inequities.
Right now, the U.S. is at a 30-year low for unintended pregnancies, and a historic low for teenage pregnancies. Both are largely due to expanded access to birth control. This proposal would prevent millions of people from getting birth control and preventive care at Planned Parenthood and other health centers, and would force Title X providers to increase their already overburdened caseloads by an average of 70 percent.
Let’s be clear: The Trump administration’s proposal would be a radical departure from the way health care has operated in America until now. The Reagan administration attempted to implement something similar in the 1980s, but it was blocked in the courts and retracted by the Clinton administration in the 1990s after an intense outcry from the medical community.
We are already seeing a similar outcry from providers today, and the National Medical Association is proud to stand with the American Medical Association, the American Nurses Association, the American College of Obstetricians and Gynecologists, the American College of Physicians, and thousands of providers across the country in opposing this intrusive, dangerous proposal.
The field of medicine has made great strides because of a renewed commitment to transparency, honesty, and expanded autonomy for people to make informed decisions about their health. To continue this progress, we cannot support poorly devised rules like the Trump administration’s gag rule on Title X that would violate medical ethics, strip away freedoms, and ultimately destroy trusted patient-provider relationships. Instead, we have a responsibility to do right by our patients, and that means doing everything in our power to stop this dangerous rule.
Doris Browne, M.D., is president of the National Medical Association.