Guest post by medical students Megan Hunt and Katharine Clark.
As eager, idealistic Johns Hopkins medical students, much of our education has focused on the humanistic and ethical side of medicine. We have taken an oath that we truly believe in: Our professional values mandate that we grant the same access and treatment to all who seek our care (justice), provide patients independent choice in their care (autonomy) and make treatment decisions that benefit our patients (beneficence).
We realized the necessity of these core values as we faced a patient without insurance coverage for the only anti-depression medication that worked for her. This patient entered the office in a hurry, juggling a mountain of problems from home, including being unable to afford groceries for her and her family, and worrying she would lose the only medication that kept her well. The physician we worked with assured our patient that the team would do everything in its power to advocate on her behalf to Medicaid to expand coverage. The pillars of autonomy, beneficence and justice guided us to ensure this patient’s needs were at the center of her care, encouraging us to persevere despite systematic limitations to health care. It would have been easy to simply let the system win.
The professional morals of medicine have become increasingly vulnerable to disregard from the Trump administration. With recent tweets promising eradication of the Affordable Care Act (ACA), proposed budget cuts to Medicare, Medicaid and Social Security, and constant threats to reproductive health access through the Title X gag rule, this administration continues to neglect the health of low-income patients, our country’s most vulnerable population. Yet, hope remains with statewide policies resisting such unethical changes.
The most looming national health care disappointment comes in the form of new restrictions to Title X, the federal program that provides access to affordable reproductive health care such as birth control, sexually transmitted infection testing and cancer screening for more than 4 million low-income people. The Title X gag rule seeks to reduce access to abortion by shoving physicians squarely between a rock and a hard place. Should physicians provide full disclosure of management services, namely abortion, they will lose all Title X funding. Intentional omission of a medically legitimate (and legal) treatment option, abortion, is rewarded by continuation of funding, but jeopardizes the health of patients.
Simply stated, this nationwide policy will block disadvantaged patients from accessing comprehensive reproductive health care services that are widely available to higher-income and privately insured patients. As medical students, it is disheartening to watch justice exit the exam room.
Patients expect their doctor to counsel them on the full range of clinical options available, including the risks and benefits of each choice. By dictating what doctors can and cannot say to their patients, this gag rule effectively subverts autonomy, as well.
With every major health care organization and over 10,000 physicians and nurses strongly opposing the Title X gag rule, we must question why national politicians have discounted medical expert opinion. This administration is moving forward with policy that is contrary to beneficence and will directly hurt the most vulnerable women, those who are unable to advocate for themselves.
This is not so in Maryland. Our state legislators and physicians are standing up to the policies that are barging their way into the exam room and the safe space between a doctor and a patient. Refusing funding for Title X in order to provide care for all patients instead upholds the values so integral to the medical profession.
It is imperative that medical students, the future of health care, speak out against injustices. In conjunction with our politicians in Annapolis, we are sending a clear message that political agendas will not compromise the ethics of our profession. The Trump administration’s indifference to these core principles, demonstrated by the Title X legislation, health care budget cuts and proposed ACA repeal, sets a slippery precedent for our profession.
We applaud the Maryland legislature for understanding that the ethics at the heart of health care are not a political issue. Access to health care, regardless of your beliefs or background, is a human right.
We acknowledge the assistance of Stacey Leigh Rubin, a Gyn/Ob physician in Baltimore and an advocate for reproductive health, for her guidance on this topic.
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