Politicians Must Stop Playing Doctor

Chloe Nazra Lee, MD, MPH
Chloe Nazra Lee, MD, MPH
8 Min Read

Lee is a psychiatry resident.

Lately, I’ve found myself using the words “irrational” and “U.S. Court of Appeals for the Fifth Circuit” in the same sentence with increasing frequency. To that mix, I add, “dangerous.”

The latest misadventures from the Fifth Circuit include a ruling in favor of Attorney General Ken Paxton and anti-abortion groups that Texas hospitals receiving Medicare cannot be required to perform life-saving abortions to stabilize patients, despite federal guidance.

This grim beginning to 2024 in Texas comes on the heels of the Kate Cox case, one that I believe Paxton pursued without empathy or reason.

The same day that a lower court granted Cox the right to abortion for an unviable and complicated pregnancy that threatened her health and future fertility, Paxton fought the decision and intimidated physicians and hospitals with a threat that the ruling would not shield them from criminal charges for violating Texas’ abortion laws, should they be involved in Cox’s care. He was successful.

In his argument, Paxton belittled the original ruling: “Judge Guerra Gamble is not medically qualified to make this determination,” ignoring his own lack of medical qualifications.

I see a couple of concerning themes here. The first is that the state of Texas has determined itself to be more qualified than trained physicians to practice medicine. Had Paxton been genuinely concerned with medical expertise, he would have respected the professional opinions of Cox’s physicians and would not need to threaten them with litigation.

The second is that Texas politicians’ “practice” of medicine is decidedly antithetical to the practice of medicine that I was taught. Our Hippocratic Oath is succinctly distilled into the phrase: “First, do no harm.” I do not see Paxton abiding by that credo either in his challenge to the federal guidelines on EMTALA and emergency abortions or in his efforts against Cox. Neither bullying patients by weaponizing the legal system against them nor prioritizing personal ideology over scientific evidence are considered good medical care. Furthermore, denying an emergency abortion to a medically unstable patient who needs one is the exact opposite of preserving life, especially when the fetus carries a deadly condition.

Ideology has governed the state of Texas’s “practice” of public health, as well as its “practice” of medicine. In November, the Supreme Court reviewed U.S. v. Rahimi, the decision issued by the Fifth Circuit upending decades of federal law that had previously disarmed people subject to restraining orders for domestic violence.

The original Rahimi Fifth Circuit ruling ignores the facts: access to firearms is a highly significant predictor for intimate partner homicide, increasing the risk by 1,000%. Furthermore, the children of abusive relationships are not exempt from abuse, and firearms are the leading cause of death among children in this country. The Fifth Circuit ruling disregards public health expertise and consequently endangers women and children.

The Fifth Circuit’s practice of medicine continues with further frivolous barriers to care. SCOTUS has agreed to review a decision by the court limiting access to mifepristone (Mifeprex) and imposing wholly unnecessary burdens and confusion for patients who need this medication. These restrictions do nothing to improve patient outcomes or experience with mifepristone.

As physicians, we can follow neither our ethics nor the appropriate standard of care if politicians flagrantly disrespect our training. If they can undermine our careful decision-making so easily, what is the point of our expertise?

The medical students I train are already considering the politicization of healthcare in their future career plans. Despite ob/gyn becoming more competitive, many medical students are reluctant to consider residency in states with rigid restrictions. “I would like to train at an institution that teaches family planning. And I don’t think I’ll apply to [ob/gyn residency] programs in states where there are restrictions or bans on abortion,” said one of my third-years, who is already a valuable asset to our medical team.

If you drive away physicians with the threat of criminal charges when they don’t practice according to your personal beliefs, they will not come to your state.

Another casualty of ideological extremism? Women’s access to comprehensive reproductive healthcare.

Anti-abortion advocates will inevitably challenge me on this, but the anti-abortion “murder” argument is an egregious misrepresentation and oversimplification of healthcare decisions in which abortion is determined to be the best option for the patient. This position suggests that hordes of callous and irresponsible women will casually line up to dispose of infant children, given the opportunity. That is not happening. Nor is Texas’s misrepresentation of federal guidance on emergency abortions and EMTALA happening: that the guidelines strive to turn emergency departments into abortion clinics.

What is happening is that a group of politicians are dictating medical care without medical training, and endangering women’s lives. These decisions are tantamount to enforcing decidedly inferior medical care that disproportionately harms women, prioritizing personal belief over evidence-based medicine, and in my view, effectively codifying misogyny into standard of care. This most recent decision by the Fifth Circuit, which allows the denial of an emergency abortion to a critically ill and unstable pregnant patient, highlights the chilling truth that the life of the mother is not, in fact, a priority in the eyes of the law.

For a group that professes to value life, the politicians and courts of Texas are certainly demonstrating otherwise, with unyielding dedication to preserving a black-and-white ideology and enforcing it without nuance or compassion, without firm grounding in scientific evidence, and even at the expense of women’s lives.

I would lose my job very quickly if I practiced medicine this way.

If politicians wish to play doctor, we should hold them to the same standard. The situation has become dire for too many innocent people.

Chloe Nazra Lee, MD, MPH, is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.

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