New in @NEJM– I argue that medical societies should support (socially, financially, legally…) members who disobey state laws that put pregnant patients at risk of harm. *Professional* civil disobedience has some important unique features. A🧵… 1/ nejm.org/doi/full/10.10…
First, you should know that there is remarkably strong agreement among medical associations that the #Dobbs decision was a terrible mistake and an infringement on fundamental human rights. Just try Googling “medical association statements on Dobbs” 2/ ama-assn.org/delivering-car…
75 orgs, led by @AmerMedicalAssn and @ACOG said #Dobbs “will harm patients, impair the integrity of the medical profession, and have a devastating and unquantifiable impact on the patients and clinicians...” 3/ acog.org/news/news-rele…
@acog said Dobbs is “a direct blow to bodily autonomy, reproductive health, patient safety, and health equity in the United States….not based on science or medicine...” 4/ acog.org/news/news-rele…
Even anti-abortion clinicians often oppose laws restricting abortion, because these decisions are so medically complex. Lois Perkins-King, MD., JD says legislators often seek to draw artificial “lines in the sand” that don’t match medical reality. 5/ newyorker.com/news/q-and-a/e…
Conditions like hydrocephalus, cardiomyopathy, pre-eclampsia & sepsis are too nuanced for laws setting a week of gestation as a line in the sand. It takes expertise to work through these issues with patients who are terrified, sad, angry or in pain. 6/ nejm.org/doi/full/10.10…
Research is very clear on the many negative consequences of laws banning or severely restricting abortion care, with disproportionate harms piling onto already-disadvantaged women and families. 7/ nature.com/articles/d4158…
Many cases have already been reported of women being harmed by state abortion bans – it’s only a matter of time before the first deaths of women needing abortions in the US will be documented. 8/ nytimes.com/2022/07/20/us/…
Early reports from Texas are terrifying. Women who want to be able to have another baby are being forced to risk permanent infertility by carrying a fetus with fatal anomalies to term. Women who need reduction to save one child are forced to lose both… 9/ nejm.org/doi/full/10.10…
This is why @ACPinternist, @APApsychiatric, @AAFP and @AmerAcadPeds say #Dobbs “Jeopardizes Patient-Physician Relationship, Penalizes Evidence-Based Care” and it sets “a dangerous precedent for legislative interference across medicine.” 10/ assets.acponline.org/acp_policy/sta…
The question is, apart from issuing strongly worded statements, what should medical professional associations DO when their members face the “impossible choice” between whether to harm a patient or obey a state law? 11/ npr.org/sections/healt…
Side note: Anyone who says its different to harm someone vs standing by when you could help should know doctors are responsible to help preserve the life and health of our patients – it's an error whether you harm a patient by omission or commission. 12/ psnet.ahrq.gov/taxonomy/term/…
For non-doctors wondering about the omission/commission distinction, please re-watch #BreakingBad… Walt is 100% guilty for Jane’s death.13/ indiewire.com/2018/09/breaki…
Should professional associations support their members in breaking state laws that directly endanger their patients? I think so for three reasons... 14/ nejm.org/doi/full/10.10…
First, the medical profession has a special role to play in society, protecting people when they are at their most vulnerable and protecting core values of health care when they are threatened. We need to play that role now. 15/ nejm.org/doi/full/10.10…
Second, the usual arguments against civil disobedience – disregarding laws fosters disrespect for law and possibly anarchy – don’t apply when a professional group debates the issue and says we reject this law as inimical to our work. 16/ journalofethics.ama-assn.org/article/civic-…
Third, civil disobedience is more likely to be effective than alternative strategies. If the whole profession stands up in defense of our patients – if we act together – it will be more effective and less damaging for us and for our patients. 17/ amazon.com/gp/product/B07…
Doctors are hardly radicals – in fact, we are typically rule followers, sometimes to a fault – but if state lawmakers tell us we have to stand by and watch as our patients suffer and die from completely treatable conditions, that ought to change. Fin/
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