Political Interference in Medicine: The Start of a Dangerous Slide Down a Slippery Slope

In significant portions of the United States, political agendas and legal interference have fundamentally restricted patients’ reproductive options, and these anti-abortion laws will alter the training of the future physician workforce. Currently, over 50% of medical students, ¹ and 33% of resident physicians ² reside in states with complete or partial abortion bans. In the specialty of Obstetrics and Gynecology (OBGYN), over 44% of residents are training in restricted states. ³ In this issue of the Journal of Women’s Health, Dr. Kate Meriwether and colleagues present OBGYN trainees’ perspectives of how these restrictions will impact their training, ⁴ and the results are sobering. Approximately one-third of respondents believed that they would not be able to provide the standard of care for their patients for induced abortion care, and one-quarter did not believe that they would be able to achieve the 20 abortion procedures recommended by the OBGYN Residency Review Committee. Notably, one-tenth of respondents also reported that they would not be able to provide the standard of care for patients with a pregnancy of unknown location, ectopic pregnancies or with assisted reproductive technology services. These findings highlight the insidious creep of anti-abortion legislation into many areas of OBGYN-care; in which evidence-based practices cannot be followed because of concern over legal repercussions. Trainees’ concerns are proving to be justified by current events, with the abrupt cessation of all In Vitro Fertilization care for patients in a large Alabama health system in February 2024. ⁵

These times of explicit interferences into patient care and medical training are unprecedented in terms of their breadth and scope of influence. The deluge of anti-abortion legislation impacts any specialty that provides care for pregnant individuals ^6,7 and their offspring. ⁸ In addition, many states with abortion restrictions are also enacting limits on care for lesbian, gay, bi-sexual, trans, queer, intersex, and asexual (LGBTQIA+) patients, ^9,10 and bans on diversity, equity and inclusion (DEI) initiatives. ¹¹ Nearly all specialties have the potential to be impacted by these legislative actions, from primary care, endocrinology, and surgical specialties. These backlashes against inclusive initiatives have created a landscape in which learner and faculty recruitment, support, and patient care will be mandated by political climate and geographic location.

The potential for how far we could slide down this slippery slope venture into dystopian possibilities. Some medical schools have already been required to submit curricular materials for review to state attorney generals’ offices. Other medical schools have circumvented these requirements by converting lecture sessions to small group breakout session to limit the amount of written curricular materials available for legal subpoena. Will practicing physicians soon need to regularly consult legal resources to inform what they are allowed to prescribe or provide for their patients? Although thus far the majority of actions have targeted women and marginalized groups, recent upheavals for fertility patients in Alabama illustrate the broad reach of legislative interference into even the most privileged patient populations. Local institutions and single specialties cannot counter these political and legal interferences on their own. National medical education organizations and specialties must work together as a united front to counter these insidious influences into the house of medicine.