Transgender care, abortion bans continue to debate provider and patient rights

Senator Marsha Blackburn (R-Tenn.) took the stage at the “Rally to End Child Mutilation” in Nashville, Tennessee, last month in front of protesters, including the far-right Proud Boys. , to corroborate the message that Vanderbilt University Medical Center is causing injuries to children and needs to be stopped.

“To protect our children,” repeated a chorus of state lawmakers and conservative pundits, one after the other, who will seek to ban sex-determination surgeries and hormone therapy for women. with transgender adolescents. If enacted, Tennessee would become the fourth state in the nation to do so. The Nashville event is part of a larger campaign to subject healthcare providers to restrictive new laws, jeopardizing their funding and expose them to threats of violence.

The relentless debate over who has the final say in clinical decisions is manifesting in new ways as state policymakers enact a series of restrictions or bans on specific treatments related to sex and reproduction to which they are religiously, morally, or politically opposed. Practices deemed safe and effective by health professionals are being considered criminal by Republican officials, who say they are protecting children. As providers grapple with the ramifications of the new regulatory landscape, Some services are limitedmay be harmful to the patient.

In addition to transgender health care services, access to abortion is limited, and reproductive rights advocates are concerned that other forms of medical care, such as birth control and insemination, are limited. in vitro, may be the next option. Providers have faced a wave of bans or restrictions on abortion since the Supreme Court Overturned Roe v. Wade in June, ending federal abortion rights and allowing states to impose new restrictions on the procedure or ban it altogether.

Healthcare is tightly regulated, and some providers argue that the government has no role in overseeing health practices. Pharmaceuticals and medical devices must meet the standards of the Food and Drug Administration. Hospitals, nursing homes and other service providers must comply with safety and quality regulations. Medical professionals must be licensed. Many of the regulations involved in participating in Medicare and Medicaid are, in theory, voluntary and use the appeal of government reimbursements to encourage or discourage certain clinical practices.

Mark Silberman, vice president of the healthcare practice group at the law firm Benesch, said the bans on transgender healthcare or abortions vary. “The previous debate was whether it was paid or not,” he said. “But now what we’re talking about is whether people have access to it—and that’s a fundamentally different level of energy.”

Fourteen states have implemented outright bans on abortion and introduced criminal sanctions against those who provide abortion services. In Texas, for example, abortion is prohibited at all stages of pregnancy with no exceptions for rape or incest. Performing abortions in the Lone Star State is currently punishable by life in prison and civil penalties that can exceed $100,000.

Most state laws make narrow exceptions when abortion is legal, even when the patient’s life is in immediate danger. However, that policy is forcing clinical teams to determine how close a patient is to death to ensure due process, creating ethical dilemmas for physicians and users. their employment.

In Tennessee, where abortion carries a sentence of 15 years in prison, an obstetrician sent a pregnant woman at risk of severe preeclampsia on a six-hour ambulance ride to North Carolina. abortion before her kidneys fail. street magazine report. In Wisconsin, a woman bled for 10 days in the emergency department after doctors refused to remove fetal tissue related to a miscarriage for fear of criminal prosecution, based on Washington Posts.

Under these conditions, providers are forced to limit their medical arsenal and practice with targets on their backs. Patients affected by these bans are starting to take legal action with huge implications for physician autonomy. Both are trying to convince the court that medicine’s evidence-based approach, decades of research and patient desires will replace politicians’ opposition to medical services. economy that they do not receive.

Rights dispute

Constitutional questions surrounding patient provider decisions have been circulating for more than a century. But the dispute is growing, American Medical Association President Dr Jack Resneck said in a speech on government interference and misinformation before the AMA’s House of Representatives on Nov. “There are more and more attempts to sabotage the operation of organized medicine. by those who seek to divide,” he said.

Christy Tosh Crider, president of healthcare litigation at law firm Baker Donelson, said the courts that have brought this issue up in the past have tried to balance patient and provider rights with the right to act. for the greater good of the government.

In 1905, the Supreme Court ruled that government-mandated smallpox vaccination was a legitimate use of state power to protect public health. In 1997, a high court ruled that Washington state’s ban on physician-assisted suicide was appropriate, in part because the state had the right to preserve human life. Under the “Right to Trial” law for experimental medical treatments, the federal judiciary has repeatedly asserted the individual’s right to medical autonomy.

Now, courts are debating whether transgender youth have a constitutional right to equal gender treatment under the 14th Amendment’s equal protection provision. State attorneys general defended the law arguing that they could regulate these practices through police powers for the benefit of minors. Patients who challenge the bans argue that they have the right to make health decisions independently of the guidance of clinicians.

Trade associations and patient advocacy groups are submitting abstracts to support patients, citing decades of research and evidence. The United States Department of Justice maintains these state laws conflict with federal laws Ask the doctor to provide the pregnant patient with medically necessary treatment.

These states are rife with test cases where a patient’s life is at risk enough to perform an abortion under vague laws, Silberman said, and prosecution would be an additional invasive of the government’s decisions. medical regulations, Silberman said.

“It is incredibly complex to sit down with individual patients and get to know their condition and figure out how their treatment should align with the science and with the patient’s values. It’s all the more difficult when politicians are far from the exam room or law enforcement officers put themselves on the doctor’s shoulder and try to second-guess all that decision-making, Resneck said in an interview. .

Commercial organizations that represent providers, such as the AMA, the American Academy of Pediatrics, and the Children’s Hospital Association, are opposing new laws governing medical practice. in court and seek federal assistance. They opposed elected officials, mainly Republicans, and conservative political organizations including Americans Solidarity for Life, National Committee for the Right to Life, Tea Party Patriots and the Republican National Committee on Redistricting.

Uncertain legal background

The bans stem from policymakers’ ethical objections to specific health practices that conflict with physicians’ legal and professional obligations to provide care. quality care for their patients. Dr Matthew Wynia, director of the Center for Bioethics and Humanities at Anschutz University School of Medicine, said the conundrum was raising ethical concerns for providers about whether treatment should be treated. to someone and risk criminal prosecution or compliance with the law and risk being sued for negligence.

Patients with ectopic pregnancy are traveling great distances for life-saving abortions. Transgender adolescents in transition must pause treatment midway, which has negative consequences for their mental health.

The decisions that clinical teams make in these cases will play out in court over time and reshape the debate about the boundaries between government and medicine unless federal authorities step in, Silberman said. speak. There is widespread uncertainty about how the Supreme Court may ultimately rule on these issues, he said, given its recent tendency to disregard precedent.

“There’s going to be an unfortunate incident where someone is going to make the law,” Silberman said. “What terrifies me is that I don’t know which way it’s going to go.”

The AMA’s code of ethics states: “When physicians believe the law violates ethical values ​​or is unfair, they should work to change the law. In special cases of unjust law, moral responsibility should replace legal obligation.” However, performing a second duty exposes clinicians to serious consequences, which in some states may include felony charges, loss of medical license, fines or certain combined penalty.

“Doctors will be forced to determine how much they will support their patients and at what point that advocacy must be dropped due to the potential consequences of acting in the best interests of their patients,” says Silberman. the best interests of their patients,” says Silberman. “As a general rule, the two should not contradict each other.”

Concerns about breaking the law increased after former Vanderbilt nurse RaDonda Vaught was convicted of attempted murder this year because of a serious medication error she made in 2017, Crider said. “That makes the threat of criminal prosecution because of these mistakes very real. And then you take it and you move on to what we saw after that [the abortion ruling] Crider says:

The administration of President Joe Biden has returned sexual orientation and gender identity to its list of protections under the Affordable Care Act’s anti-discrimination rules and has strength bend Department of Health and Human Services to increase access to abortion providers and drugs.

But the position of the executive branch is determined by the person in charge. The administration of President Barack Obama initially included discriminatory protections based on sexual orientation and gender identity, but the administration of President Donald Trump removed them a few years later..

“Our government is going to have to make some decisions, especially at the federal level,” Crider said. “It will need to come from Congress. For it to be effective, it needs to be the rule of law.”


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