Bioethics Forum Essay
Keep Politics Out of State Medical Policy
State medical boards and other government-appointed health officials have an obligation to follow evidence-based medicine to frame their opinions and regulations. However, there is disturbing evidence that, in some cases, political ideology is guiding health policy.
For example, last year the Florida State Medical Board and the Florida Board of Osteopathic Medicine banned gender-affirming care for transgender youth, going against recommendations from medical groups such as the American Association of Pediatrics and the American Medical Association. On June 6, a federal judge issued a preliminary order partially blocking the ban, which had been signed into law.
The Indiana attorney general recently filed a complaint with the state medical board against an obstetrician-gynecologist who spoke with a reporter about an abortion she provided for a 10-year-old rape victim who traveled from Ohio after that state banned most abortions after six weeks of pregnancy. While the state medical board dismissed several of the accusations by the attorney general, it found that the doctor violated the patient’s privacy rights, even though the board also found that none of the information shared with the reporter was protected under HIPAA, the federal health privacy act. The board fined the physician $3,000 and issued a letter of reprimand. The medical board’s decision may well have a chilling effect on doctors in other states where abortion is legal.
Members of state medical boards are appointed by governors and, in some states, also require senate confirmation. As such, membership is inherently political. There is no national or federal oversight of state medical boards to assure that their decisions are not political. But they have a professional obligation to make decisions and recommendations supported by evidence-based medicine, regardless of political affiliation or personal ideology. Genuine disagreement about health policy inevitably occurs among medical professionals, and when this happens, they have an ethical duty to identify a problem or issue, gather credible data, perform appropriate data analysis, and devise an evidence-based strategy for addressing the issue.
Professional medical organizations have voiced concern when state legislation and regulations are inconsistent with accepted standards of care. The AMA wrote a letter to the National Governor’s Association about state legislation banning gender-affirming care, saying, “We believe this legislation represents a dangerous governmental intrusion into the practice of medicine and will be detrimental to the health of transgender children across the country.” In a statement on its website the AAP warned, “Evidence-based medical care for transgender and gender diverse children is a complex issue. Pediatricians are best able to determine what care is necessary and appropriate for these children, but these bills [prohibiting gender-affirming care and forbidding transgender youth from participating in sports according to their gender identity] interfere in the physician-patient-family relationship and would cause undue harm.”
Among the many lessons from the Covid-19 pandemic is that the politicization of health policy contributes to mixed messaging and misinformation and decreased public trust in health officials. But the intrusion of politics into state medical information on Covid persists. A recent report found that Florida’s surgeon general selectively eliminated data that would help the public understand the importance of vaccination against Covid. This manipulation of public health information was based on ideology, not evidence.
State officials who use state medical appointees as an extension of their political power harm the public, compromise trust, and do a disservice to the profession of medicine. Medical societies have a professional duty to illuminate the politicization of medicine and expose poor public health policy. So do bioethicists, as was recently pointed out in this publication. We call on bioethicists and professional medical organizations, including the Federation of State Medical Boards, to stay vigilant and speak out against harmful medical policies enacted by state medical boards and other government-appointed health officers under the influence of political ideology.
Jessica A. Rosh, JD, MBE, is an instructor of medical ethics at New York Medical College, an educational consultant for the Benjamin Ferencz Institute for Ethics, Human Rights and the Holocaust, and a doctoral candidate in bioethics, health ethics, and policy at the Alden March Bioethics Institute at Albany Medical College.
Michael J. Murphy, PhD, is a State University of New York Distinguished Teaching Professor Emeritus, a member of the SUNY Distinguished Academy, and a doctoral candidate at Alden March Bioethics Institute.