Should physicians engage in civil disobedience to protect their patients from over-reaching state legislatures? It’s a provocative suggestion made in a popular blog earlier this week. And yes, what with legislatures demanding that doctors tell their patients abortion is associated with breast cancer (which it is not) or be faced with felony charges; threatening doctors with losing their licenses if they don’t abide by requirements that women wait 72 hours after their first visit for an abortion even when the fetus is non-viable and waiting could cause harm or risk to the patient; and requiring physicians to perform an ultrasound prior to any abortion even if not medically indicated, along with a detailed description of what can be seen on the screen, it is certainly tempting. For instance, if I were practicing in Texas, it wouldn’t be that hard to start writing down in the medical records that no ultrasound was performed because it was not indicated, or that I was unable to get a clear ultrasound image, or I could even go another step and write down that an ultrasound was performed even if it wasn’t. I could justify it to myself (and to many sympathetic people on the internet) that I was doing it to protect my patients, because there was nobody else to protect them in the end. And I might even get away with it.
But chances are I wouldn’t actually get away with it. Some insurance company or state health inspector would look over my charts and notice that I always wrote that no ultrasound was performed, or there might be a complication (rare, but it happens) and somebody would realize that although I claimed I did an ultrasound, the patient had no recollection of it being done. Or one of my patients could be paid by anti-abortion activists to tape record my interactions with her and they could release that tape recording to the Department of Health or the state licensing board. Any of these events would not only get me in trouble, but would also jeopardize my co-workers and could even lead to the closure of the clinic I worked at.
The reality is that there are not enough doctors or clinics that provide comprehensive reproductive health care, including abortion services, for those of us who do to take this kind of risk. The major professional organizations that should be around to back us up in this kind of situation, such as the American Congress of Obstetricians and Gynecologists and the American Academy of Family Physicians, have been far from supportive of those of us who provide abortions. So in the end, although such a strategy might help a few patients along the way, it could lead to even worse access to abortion services in the future if we start to lose our licenses and our clinical sites.
Fortunately, public opposition has tempered or eliminated many of these noxious bills. We must keep up the opposition, and I hope more and more doctors, and eventually the national professional organizations, will join in.