While the American public focused on the controversial “religious freedom” bill passed in Indiana last month, two other states also made far-reaching and dangerous political moves: Arizona Gov. Doug Ducey and Arkansas Gov. Asa Hutchinson each signed legislation forcing doctors to tell women seeking medication-induced abortions that the process can be reversed once it has begun.
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As doctors, we do not recommend a treatment until it’s been proven safe and effective. This legislature-supported treatment has not met these standards, so to be governmentally mandated to recommend it is deeply disturbing. Consequently, our organizations, the American Congress of Obstetricians and Gynecologists and Physicians for Reproductive Health, are speaking out against this reckless and dangerous intrusion into the practice of medicine.
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Simply put, evidence and science must guide the care that patients receive in any area of medicine. When political agendas get in the way of that, patients suffer.
New theories and ideas emerge every day in medicine, but they must be proven by thorough clinical research. Only then do we recommend them as part of mainstream medical care. These laws are based on an untested theory, put forth by a single anti-choice doctor, without legitimate evidence of its efficacy. It is government-mandated experimentation on women and it is unethical.
Medication abortion is administered in two doses. The first medication, mifepristone, is taken in the office and blocks the main hormone of pregnancy, progesterone. The second, misoprostol, then induces cramps that make the early pregnancy pass out of the uterus like a miscarriage. The new laws in Arizona and Arkansas require that doctors who provide medication abortion tell their patients they can “reverse” the effects of the first medication by administering a high dose of progesterone. There is no credible, medical evidence that meets the standards necessary for discussing this approach to patients. This is bad advice and bad medicine.
Furthermore, this mandated discussion of supposed “abortion reversal” assumes that women do not know their minds and physicians are not thoughtful, thorough counselors. When we counsel a woman before a medical abortion, we discuss her decision-making carefully and recommend that she start the two-medication abortion regimen only if she is certain of her decision. Most women are certain of their decisions and are grateful to have the option of an early, non-surgical abortion. For those few who are unsure, we recommend they take more time in their consideration.
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This would all be laughable if it were not so dangerous and if it were not part of a larger nationwide trend to have politics trump medical evidence. In the past few years, a surge of laws has passed that impose unfounded restrictions and mandates on abortion providers that are contrary to best medical practices.
According to the Guttmacher Institute, 17 states have passed laws requiring doctors to provide medication abortion contrary to modern evidence-based protocols. Five require that patients be told about a widely discredited theory, debunked by countless bodies including the American Cancer Society and the National Institutes of Health, that abortion causes breast cancer. Thirteen mandate that a doctor perform an ultrasound even if the physician determines there is no medical need for one.
Legislatures and governors would never presume to tell an oncologist which cancer chemotherapy to prescribe. They would never presume to tell a breast surgeon to do a lumpectomy rather than a mastectomy. They would never presume to tell an endocrinologist how to treat diabetes most effectively. They would never — in any other area of medicine — step into the exam room with a physician and a patient and force the physician to recommend an untested treatment.
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And yet, this is what we see time and again when it comes to the physicians who provide women with the medical treatment needed to end a pregnancy. These politicians presume to know better. But they do not and never will.
So this is the current state of affairs: Legislatures are mandating that doctors in one area of medicine lie to their patients. We would not stand for this in any other area of medicine and we shouldn’t stand for it when it comes to abortion care.
If doctors in any other area deliberately lied to their patients, the public would be rightfully outraged. This senseless and reckless intrusion into medical practice must stop now. For a political body to mandate that doctors provide advice contrary to science is abhorrent, irresponsible, and offensive. Medicine must be practiced based on evidence, not political agendas.
Dr. John C. Jennings is President of the American Congress of Obstetricians and Gynecologists. Dr. Nancy L. Stanwood is Board Chair of Physicians for Reproductive Health.
Dr. John C. Jennings
Dr. Nancy L. Stanwood