There’s No “M.D.” in Government

While I personally believe that the federal government needs to play an important role in the promotion and establishment of universal health care (that is, facilitating and making sure that everyone has health care coverage, but not necessarily paying for everyone as a single payer), I am amazed by the many instances in which government officials have severely damaged the practice of medicine in the U.S during the Bush Administration. I will mention just a handful that particularly bother me at this time due to their blatant impositions of government authority in medical decisions.

The Current Issue: Partial-Birth Abortion

On April 18, 2007, the Supreme Court upheld the 2003 Partial-Birth Abortion Act in the court case Gonzales vs. Carhart that bans D&X, the safest procedure used in second-trimester abortions. Previously, the 8th Circuit Court of Appeals ruled in favor of partial-birth abortion, until Attorney General Alberto Gonzales appealed the decision and brought it in front of the Supreme Court. The 2003 act was pushed through Congress through the leadership of Senator Bill Frist.

The ruling by the Supreme Court “allows” D&X to be used in cases where the mother’s life is “in imminent danger,” but for no other reason, including in cases where the pregnancy is just “threatening her health.” A series of editorials in this week’s New England Journal of Medicine strongly question this decision, particularly since there is no specification of what degree of mortal risk permits the procedure. The Supreme Court ruling endangers physicians who are involved in reproductive health by further exposing them to prosecution based on an act with vague definitions of what is permissible, what isn’t permissible, and when and where the act applies. Editor-in-Chief Jeffrey Drazen, M.D., asserts that the Judicial branch has joined the Legislative Branch in trying to “practice medicine without a license,” owing to the interference in medical decisions by both branches of government at the expense of the health of patients.

The act states:

(1) A moral, medical, and ethical consensus exists that the practice of performing a partial-birth abortion — an abortion in which a physician delivers an unborn child’s body until only the head remains inside the womb, punctures the back of the child’s skull with a sharp instrument, and sucks the child’s brains out before completing delivery of the dead infant — is a gruesome and inhumane procedure that is never medically necessary and should be prohibited.

(2) Rather than being an abortion procedure that is embraced by the medical community, particularly among physicians who routinely perform other abortion procedures, partial-birth abortion remains a disfavored procedure that is not only unnecessary to preserve the health of the mother, but in fact poses serious risks to the long-term health of women and in some circumstances, their lives. As a result, at least 27 States banned the procedure as did the United States Congress which voted to ban the procedure during the 104th, 105th, and 106th Congresses.

and furthermore:

An abortion in which the person performing the abortion, deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the body of the mother, or, in the case of breech presentation, any part of the fetal trunk past the navel is outside the body of the mother, for the purpose of performing an overt act that the person knows will kill the partially delivered living fetus; and performs the overt act, other than completion of delivery, that kills the partially delivered living fetus.

The Key Players:

Shameful and Knowing It

1. U.S. Attorney General Alberto Gonzales

That Gonzales has taken on the cause of fighting abortion rights signifies his departure from his prior personal convictions in order to serve as one of President Bush’s many yes-men. He, in fact, was perceived as being in favor of abortion rights, a notion that drew opposition from Republicans prior to his appointment. His term as Attorney General, however, has thus far been marked by conduct consistent with the often inconsistent, incompetent and undeniably frustrating manner exhibited by many Bush appointees. For example, during his testimony in front of Congress on April 19 about the questionable dismissal of eight U.S. attorneys, he stated 71 times in response to questions that he had no memory regarding events surrounding the dismissals. On another occasion, he stated in front of the Senate Judiciary Committee that the U.S Constitution does not guarantee habeas corpus, a statement that was immediately questioned by Senator Arlen Specter.

2. Senator Bill Frist, M.D.

More disturbing on this topic is the conduct of Senator Frist, not only in pushing forth the Partial-Birth Abortion Act of 2003 (as representing the “consensus” of moral, medical, and ethical opinion) but also in his conduct as a representative of the medical communty with Congress. As a physician and the Senate Majority Leader, Senator Frist played a very influential and controversial role as the voice of the American medical community within the Legislative branch of the federal government. However, on numerous occasions, he misled Congress. The most public and obvious of these was in the case of Terri Shiavo, a woman who was in a persistent vegetative state. Dr. Frist, after viewing a home video from Shiavo’s parents (who wanted to keep her on life support indefinitely, unlike her husband, who petitioned to a Florida court to determine whether or not she would have wanted to have life support removed) stated in a speech to Congress that he did not think she was in a persistent vegetative state (a state, unlike coma, from which there is virtually no possibility of recovering consciousness). Although the Florida 6th Circuit court determined that there was convincing evidence from numerous statements and accounts from people close to Shiavo that she would want to have life support removed, Governor Jeb Bush and Congress swooped in to stop the removal of life support. The Republican-led Congress went so far as to subpoena Terri Shiavo and her husband to testify in front of Congress, noting that her inability to do anything would mean that she would be held in contempt of Congress and this would effectively block any attempts to remove her feeding tube.

shiavo.jpeg

This is a CT Scan, the left showing a normal 25-year-old’s brain and the right showing Shiavo’s brain in 2002, three years before she was allowed to die. Now, a neurologist, or even a first year medical student, could tell that someone cannot recover consciousness with that extent of damage to the cerebral cortex. There simply aren’t enough neurons there. Despite this, Dr. Frist compromised his integrity as a physician by disputing the assessment of the Shiavo’s neurologists and effectively asserting to Congress that Shiavo had a chance of regaining consciousness and should not be taken off life support. Not to mention that Dr. Frist is a cardiothoracic surgeon. Now, specialist physicians do have knowledge outside their own specialties, but typically, it’s worth deferring to the opinion of a specialist in the field in question (i.e. the neurologist for neurological issues).

Dr. Frist doesn’t represent the medical community, and if anything, seems to have done a disservice to medicine and patients. While he may have been an excellent physician prior to his political career, it seems that he has taken considerable measures toward rejecting the professional integrity with which physicians are supposed to conduct themselves in order to further his political career. This is quite unfortunate, because his example will undoubtedly discourage other more credible physicians from pursuing political careers with ideal aims.

Strong Enough to Brave the Fire

Dr. LeRoy Carhart – I know nothing about this man, except that he is a practicing physician who has taken a stand on a highly-charged, political issue with profound impact on his practice of medicine. Dr. Carhart is one of three abortion providers in the state of Nebraska, and he challenged the 2003 Partial-Birth Abortion ban in the U.S. 8th Circuit Court of Appeals. Like many abortion providers, he has been the target of violence: at least on one occasion, arsonists (presumably anti-abortion activists) set fire to his house and farm, killing pets and livestock and destroying much property.

Nonetheless, he is still pursuing this cause: not out of financial profit or because he hates babies, but probably because he believes that there are real-life situations where mothers must choose abortion in order to avoid serious risks to their health (not just lethal risks). After all, how can one expect a mother to be able to take care of her child if she is severely debilitated by the pregnancy? Would the child, looking back at the situation after birth, even have wanted to be born under those conditions? These risks to health may not be apparent until the second trimester, and the risk to life may not fully develop until after the second trimester. What then? The Supreme Court and Congress have just given this woman a death sentence – or the physician a prison term for trying to save her life.

I have profound respect for abortion providers. No doctor delights in killing. But good doctors do uphold the wishes of their patients that correspond with improvements in happiness and health, even if it means ending life. One major change in the provision of end-of-life care is the emphasis on patient autonomy: if a patient would die without life support and expresses that desire (himself/herself, through a power of attorney or living will, or if sufficient evidence is demonstrated of that desire), then physicians must allow the patient to die rather than needlessly take heroic measures to keep him/her alive. In a way, this is exactly what Congress and the Supreme Court have done during the Bush administration: take heroic measures to preserve life, at the expense of the wishes of the patients.

Concluding Thoughts

My political views tend toward the liberal, but my approach tends to be more moderate. I listen to both conservative and liberal views, as there is wisdom to gain from all sides and progress to be made in the space between. However, several changes to medical practice enforced by Bush administration-led entities have constituted serious breaches into the doctor-patient relationship and the ability of doctors to provide services to patients. Unless the medical community and its allies inside and outside government take a stand, this trend may just get worse. My hope is that future presidential administrations have more foresight and respect for patients, particularly women. This administration has, through its appointments in the Supreme Court and the FDA and through Congress, shown contempt for both women and the autonomy and authority of physicians in medical decision-making. If we know any better, we won’t let this happen again.

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