Physicians occupy an unusual position in society. We are subject to the law, but also to a code of ethics that in some cases conflicts with the law. This code focuses on the unique relationship between physician and patient, on the responsibility of the physician to serve the patient in a way informed by the best medical knowledge. It’s not so hard to imagine situations where ethics and law might conflict: military interrogations, state executions. Most of these examples feature doctors choosing to violate basic ethical precepts.
There are also situations where doctors fail to provide reasonable care. No doctor can be required to provide a particular service to a particular person; that would be a violation of the freedoms of the doctor. But a doctor who cannot provide basic standard-of-care medicine cannot be a doctor. Analogous to pharmacists who refuse to fill prescriptions for birth control, doctors who cannot fulfill their basic duties should seek a new career.
Currently, however, we are being confronted by a new attack on the autonomy of physicians and patients. The spread of new abortion laws across the country has put doctors in the position of violating their ethics or giving up practice. Doctors who are brave enough to provide abortions are already at risk, already face barriers including mortal danger. Most deliver these services despite the danger because they know it’s needed, and that if they won’t do it, no professional will step up. I can only imagine the pain a doctor feels when she is asked to injure her patient by being forced to lie about abortion, by being forced to perform unnecessary procedures such as ultrasounds, or to risk being shut down, forcing abortion underground. What’s best for their patients, delivering flawed care or no care?
Let’s clarify a few issues here. While unnecessary transvaginal ultrasounds are essentially rape, other unnecessary ultrasounds are little better. No patient should be forced to undergo any procedure they do not wish to. When I care for a Jehovah’s Witness, I have an understanding with them: they know I fear for their health if they should need a transfusion, but they know I won’t force them. I also will not deny them other care, such as a referral for a potentially bloody surgery, simply because they refuse transfusion. The patient’s autonomy must be respected as far as possible (and there are limits; I won’t, for example, provide an overdose for a patient).
In the case of abortions, where time is essential and providers may not be easy to find, delays in care are unconscionable. To enforce a waiting period violates the doctor’s ethical duty to provide appropriate, timely care and to avoid causing the patient unnecessary grief. The law forces us to violate our ethics. To force us to perform ultrasounds, transvaginal or otherwise, is battery. No procedure can be performed on a patient without their informed consent. To make another important procedure contingent on an unnecessary one is a clear violation of medical ethics. Abortions can be safely performed without sonography, and should be unless their is compelling medical reason to perform one—with the patient’s consent. To say that a woman can always refuse the ultrasound as long as they refuse the abortion is an immoral argument, one which removes all autonomy from the patient, and forces a doctor to make unreasonable choices.
Doctors are notoriously poor organizers. We generally operate independently. The AMA represents less than thirty percent of American doctors. When it comes to protecting ourselves and our patients, we are often on our own. When it comes to the latest abortion bills we cannot afford to remain apart. We must all speak out against this violation of our ethics and our patients’ rights. How this might work isn’t clear, but perhaps we need target certain states, one at a time. When one provider is shut down for honoring their patients’ rights, another must be willing to step up, and another. There is a nationwide shortage of abortion providers so this probably isn’t realistic, but even so, we must try, we must advocate for our patients, we must defend them from the depravities of those who would violate their basic right to ethical, respectful care.