We allow the legal system to contaminate evidence based guidelines

The American Congress of Obstetricians and Gynecologists (ACOG) issued a recently regarding legislative interference and health care decisions. Specifically, the release states that: “Government should not interfere with the patient-physician relationship without a substantial public health justification.”

The full Statement of Policy was approved by ACOG’s Executive Board. Some recent examples of government interference include mandatory age requirements for Plan B, transvaginal ultrasounds before abortion, prohibiting doctors from asking about firearms, and laws that force doctors to lie to women about a link between suicide, breast cancer, and abortion. These laws are in direct violation of evidence based medicine and are therefore, quite simply, public health hazards. Yes, mandated public health hazards.

According to ACOG President Jeanne A. Conry, MD, PhD, “Given the relentless legislative assault on the patient-physician relationship that we’ve seen in the past few years—and unfortunately continue to see—we were compelled to issue a formal Statement of Policy.”

“We are speaking out not just on behalf of ob-gyns, but for all physicians and patients,” said Dr. Conry. “Many of these laws are dangerous to patients’ health and safety. As physicians, we are obligated to offer the best evidence-based care to our patients. Government should stay out of imposing its political agenda on medical practice.”

But legislative interference is not limited to reproductive health as now we see parents suing about age discrimination and lung transplants. These recent cases involve two children in desperate need of lungs and parents who are beyond desperate. I’ve lost a child and have a son with severe lung disease who has been in and out of the intensive care unit multiple times so I know a little about that kind of visceral desperation. My heart aches for these families.

A judge agreed has already intervened in the first case ordering that then 10-year-old girl (in the first suit) be placed on the adult list.

But here’s the thing. I’m fairly well-educated person from a medical standpoint, but I don’t know the first thing about how to allocate organs. I know there is a complicated matching process that involves blood type, antigens, a severity score, organ size and probably hundreds of other factors that I can’t know and frankly a judge can’t either. That’s why doctors do fellowships in transplant medicine. It’s very, very complex.

And then what if doctors follow the variety of rulings that are likely to be handed down? (because when one lawsuit is successful, more will follow). In one court a judge might rule one way and in another court the exact opposite might happen. How is that good medicine?

I don’t fault the parents for trying. Not at all. And maybe organ allocation for children does need to be addressed. Raising public awareness to assess the situation is only a good thing, because if guidelines are truly robust they can handle the scrutiny. However, that scrutiny should come from educated peers, not a judge. Deciding who gets an organ must be evidence based (like all medicine) although there is evidence that some who are more connected or with more money may manage to work the system to get to the top of the list and I’d love to see legislation against that type of maneuvering.

When we allow the legal system to contaminate evidence based guidelines we get bad medicine. That is fact. In five states doctors must lie to women about a link between abortion and an increase risk of breast cancer. The growing number of ill-conceived reproductive laws (and now firearm laws) in this country already tell us that the legal system is incapable of interpreting medical literature or listening to guidelines from medical societies.

Just think of the Pandora’s box that government interference opens when every well thought out medical guideline can be tossed aside or suspended by a judge or a politician whose last biology course was 20 or more years ago.

Jennifer Gunter is an obstetrician-gynecologist and author of The Preemie Primer. She blogs at her self-titled site, Dr. Jen Gunter.

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  • RenegadeRN

    Excellent article! I couldn’t agree more. Thank you for posting it.

  • EmilyAnon

    The key words for the definition of rape as written in that article are “without consent” of the victim.

    • cyb pauli

      Consent must be given freely, that is, without coercion. A law demanding non-medically necessary vaginal penetration in return for medical service fits the definition of coercion. In such a situation, consent is impossible, because the denial of medical service is a threat. That’s what makes it rape.

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