by Craig Klugman, Ph.D.
One of the main concepts that most medical ethics instructors teach to their students is that of autonomy—self governance. I usually explain that this evolved in response to the age of paternalistic medicine. During the civil rights movement, where voiceless groups were demanding a voice, patients were among those who received a voice through autonomy. However, recent legislation suggests that the age of paternalism has returned anew, but this time medical authority is wielded by legislators and not physicians trying to ensure their continued privilege in society.
Consider that the state of Indiana signed a bill that makes it illegal for a person to have an abortion on the basis of a test that shows the fetus has “disability or defect such as Down syndrome.” This is the second law of its kind in the nation, following on North Dakota’s “fetal anomaly” ban in 2013. Seven states (AZ, KS, NC, ND, OK, PA, SD; IL after viability) already ban abortion for sex selection (AZ also bans for race selection) and 4 states (AZ, KS, MN, OK) require counseling on “perinatal hospice services” in the event of a “lethal fetal abnormality.”
Republican members of the House of Representatives’ House Select Investigative Panel on Infant Lives have begun an inquiry into medical laboratories. The panel is asking for the names of all personnel involved with fetal tissue research including principle investigators, students and even administrative assistants. The Panel was created in light of the concocted allegations that Planned Parenthood was allegedly selling fetal parts and performing abortions to make parts available. These allegations have been proven false. Opponents to the panel contend that it could put an end to much medical research and endanger the lives of researchers if the list should ever get out (after all, 11 physicians have been killed by pro-life supporters since 1993).
The Food and Drug Administration (FDA) has ordered a black box warning for opioid pain medications to highlight the possibility of abuse, addiction, and overdoes for these drugs. This follows on the heels of new Centers for Disease Control & Prevention (CDC) guidelines that make opioids a last choice medication for pain control. The irony is that these restrictions occur in the years following a 2011 Institute of Medicine (IOM) report that pain is severely undertreated. Chronic pain sufferers just lost a battle to the war on drugs. In fact, a new study lays blame for an increase in HIV and HCV infection on anti-drug efforts as people in pain search for street drugs to control their suffering.
Utah became the 16th state to restrict or ban abortion after 20 weeks gestation. The unique twist this time is that a woman having an abortion at 20 weeks or later must have anesthesia administered to make sure the fetus does not feel pain. The drugs are purported to have no affect on the woman and may in fact be risky for her. In addition, she will have pay for the anesthesia and its administration, meaning that people with low socioeconomic means are more effected by this law than those with means. This statute joins a slate of new laws are aimed at limiting abortions after a fetus can allegedly feel pain. Fifteen states have tried to pass so-called fetal pain laws, though only 12 laws are active since 3 are under court challenge. The U.S. House even passed the Pain-Capable Unborn Child Protection Act in 2015. The problem is that scientific evidence seems to indicate that the ability to feel pain develops at a much later time.
What these cases and statutes have in common is ignoring science in efforts to put forth political, philosophical, or religious agendas. Consider that Mississippi and North Carolina have enacted new laws that actually permit religious people to discriminate against others. Georgia’s legislature also passed such a bill but the governor vetoed it. These paternalistic efforts are nothing more than an effort to infringe upon patient autonomy and to further cement privilege. These efforts limit patient and physician freedom to be accurate, scientific, and independent. They also ensure that those with privilege maintain it. The paternalists are trying to silence the voices who only a few decades ago were demanding to be heard.