For two decades, Republican opponents of health care reform have turned to a tried if untrue talking point. In 1994, GOP strategist Bill Kristol warned that "the Clinton Plan is damaging to the quality of American medicine and to the relationship between the patient and the doctor." Twelve years later, President George W. Bush proclaimed, "Ours is a party that understands the best health care system is when the doctor-patient relationship is central to decision-making." Then in 2009, GOP spinmeister Frank Luntz told Republican obstructionists in Congress to "call for the 'protection of the personalized doctor-patient relationship.'"
Now with their ever-more aggressive nationwide crusade against Americans' reproductive rights, Republicans are determined to undermine the very doctor-patient relationship they pretend to cherish. Across the country, GOP anti-choice leaders are requiring procedures women don't need and their physicians don't want. And now in states like Arizona and Kansas, Republicans seeking to prevent abortion services are demanding doctors lie about them.
This week, the Arizona Senate voted 29 to 9 for a "wrongful birth bill" that would shield physicians from malpractice claims if they withhold vital information from their patients. As the AP explained:
Those are lawsuits that can arise if physicians don't inform pregnant women of prenatal problems that could lead to the decision to have an abortion.
But if Arizona Republicans want their state to join 9 others in encouraging that sin of omission, in Kansas anti-choice GOP legislators want doctors to participate in a sin of commission.
There, Governor Sam Brownback and his GOP allies don't merely want to raise taxes on women seeking abortions, even in cases involving sexual assault or a life-threatening pregnancy. Now, Republican legislators want state law to require that physicians mislead their patients about the non-existent link between abortion and breast cancer:
Kansas state lawmakers heard testimony this week saying there is a link between abortion and breast cancer. The testimony in front of the committee on Federal and state affairs came from Dr. Angela Lanfranchi, an oncologist specializing in breast cancer. The committee did not hear any other testimony before drafting H.B. 2598.
That link has been firmly rejected by organizations including the American Cancer Association and the National Cancer Institute, which concluded that "abortion is not associated with an increase in breast cancer." (Nonetheless, the Bush administration repeatedly claimed otherwise on federal government web sites aimed at teenagers and pregnant women. As a 2006 Congressional investigation found, 20 of 23 federally-funded "pregnancy resource centers"—facilities often affiliated with antiabortion religious groups—incorrectly told women "that abortion results in an increased risk of breast cancer, infertility and deep psychological trauma.")
But Republican governors and state legislatures aren't just requiring doctors to lie to their patients about real birth defects, bogus cancer risks and unproven claims about "fetal pain." (In Idaho, Jennie Linn McCormack was briefly charged with having an illegal abortion under that state's fetal pain law barring the procedure after 20 weeks.) Now, Texas, Virginia, Alabama, and other states are demanding that women seeking abortions undergo and pay for medically unnecessary ultra-sound tests their physicians oppose.
Even leaving aside the "forced rape" bills considered in Virginia and Alabama, Republican legislators are dictating the terms of the doctor-patient relationship with the ultra-sound laws. Recently, a Federal Appeals Court upheld Rick Perry's new statute in Texas requiring abortion providers "to show or describe an ultrasound image to a woman of her pregnancy and to play sounds of the fetal heart." As Reuters explained:
While a woman seeking an abortion can decline to view the legally required ultrasound, she cannot decline to hear the physician's description of it unless she qualifies for an exception due to rape, incest or fetal abnormality.
A coalition of medical providers sued in June to block the law, arguing that it made doctors a "mouthpiece" for the state's ideological message. The First Amendment includes protections against compelled speech.
The challengers, represented by the Center for Reproductive Rights, also argued that disclosure of the sonogram and fetal heartbeat was not "medically necessary" and therefore beyond the state's power to regulate the practice of medicine.
And in states like Virginia and Mississippi, the Republican intrusion into the doctor-patient relationship extends beyond mandating what unneeded and costly procedures must be performed, but where as well. Since in 2006, all Magnolia State facilities performing second and third trimester abortions must meet the same regulatory standards as full surgical hospitals, 36 pages of rules in all. As a result, the entire state of Mississippi, one of the poorest in the nation, now has only a single abortion clinic, the Jacksonboro Women's Health Clinic. A similar law signed in December 2011 by Governor Bob McDonnell will shutter most of the clinics providing abortion services by requiring they operate under the same regulations as ambulatory care centers:
The regulations treat abortion clinics as ambulatory surgery centers instead of doctor's offices, as they have been classified. Clinics must meet hospital-type standards mandating the size of exam rooms and the width of hallways. The regulations also establish new requirements for inspections, medical procedures and record-keeping.
Behind all of these Republican attacks on the supposedly sacred doctor-patient relationship is an arrogant and paternalistic assault on the dignity and moral agency of American women. That sneering condescension is at work both when conservatives pretend to care about women's health and when they don't. After all, one of the defining moments of the 2008 presidential campaign came when John McCain used "air quotes" to mock "the health of the mother" during a debate with Barack Obama:
"Just again, the example of the eloquence of Sen. Obama. He's [for] health for the mother. You know, that's been stretched by the pro-abortion movement in America to mean almost anything. That's the extreme pro-abortion position, quote, 'health.'"
That jaw-dropping statement came a year after Supreme Court Justice Anthony Kennedy issued his shocking opinion in Gonzales v. Carhart. Kennedy put the mythical "post abortion syndrome" at the heart of his reasoning in upholding the federal ban on what Republicans deemed "partial birth abortion." As Ruth Marcus lamented, Kennedy basically decided that doctors had no right to perform the rare but medically necessary procedure because, in essence, women might get the vapors:
"Respect for human life finds an ultimate expression in the bond of love the mother has for her child," Kennedy intoned. This is one of those sentences about women's essential natures that are invariably followed by an explanation of why the right at stake needs to be limited. For the woman's own good, of course.
Kennedy continues: "While we find no reliable data to measure the phenomenon, it seems unexceptionable to conclude some women come to regret their choice to abort the infant life they once created and sustained." No reliable data? No problem!
In the five years since, a mountain of studies (including a new analysis in the Journal of Psychiatric Research this week) has debunked Kennedy's dangerous pseudo-science about abortion and mental health. Regardless, Republicans at the federal, state and local level will continue to interpose themselves between doctor and patient when it comes to women's reproductive health.
Apparently, the conservative idea of "protecting the doctor-patient" relationship is destroying it.
(This piece also appears at Perrspectives.)