As doctors struggle to comply with new state laws criminalizing certain kinds of medical care, Dr Jesse Ehrenfeld, the new president of the American Medical Association (AMA), says the organization will support doctors who feel ethically compelled to disobey.
“I expect there may be a moment where a physician is charged,” he said in an interview last week. “If that happens, we will certainly stand with them, as an association, to stand up for what’s right for our patients.”
Ehrenfeld took over the top post at the AMA, the main industry group for doctors, this past June – only months after states including Idaho, North Dakota and Alabama passed laws making it a felony to provide transition care to minor patients.
The supreme court’s 2022 decision to strike down Roe v Wade makes providing abortion a felony in numerous states. In at least one state, it’s now punishable by up to 99 years’ imprisonment.
“This is new territory for us,” Ehrenfeld said. “We have just never seen laws that criminalize the provision of medical care … This is an unprecedented moment that we continue to try to navigate.”
Ehrenfeld didn’t specify what “standing with” doctors arrested on criminal charges might look like. But he added that the group’s “longstanding policy is to push back against any intrusion on medical decision making”.
Back in 2019, the AMA took what Ehrenfeld said was an at the time “unusual” move of filing suit against the state of North Dakota over a law that compelled doctors to deliver medical misinformation to patients seeking abortions.
More recently, the group provided an ethics expert to testify on behalf of Dr Caitlin Bernard, the Indiana physician who provided an abortion to a 10-year-old rape victim, after her state’s Republican attorney general filed a complaint against her with the medical licensing board.
“Physicians need to know someone’s got their back,” Ehrenfeld said.
As lawmakers target doctors, civilians are following suit: doctors are facing “increasingly hostile rhetoric and threats of violence”, Ehrenfeld said. While abortion providers have long dealt with harassment, he said, threats are now increasingly directed at providers of transition care, especially those who care for trans children.
Ehrenfeld said that the AMA has asked the US attorney general and the Department of Justice to investigate threats against physicians. They’ve also asked social media companies to help curb online rhetoric against doctors – without much success.
“We’ve been in touch with all of the major online technology platforms,” he said. “I wouldn’t say we’ve had a lot of movement that’s been particularly satisfactory.”
These challenges come as doctors are already dealing with burnout and “moral injury” in the wake of the Covid-19 crisis.
“It’s a very, very difficult moment right now for physicians trying to do the appropriate ethical thing for the patients in front of them,” Ehrenfeld said.
So far, doctors have been hesitant to defy the new laws restricting their practices. And Ehrenfeld reiterated that he did not encourage them to do so.
“Our obligation is to respect the law,” he said. “We don’t advocate for physicians breaking the law.”
But, he added, “we also stand up against bad laws that put physicians in untenable situations … where they have an ethical obligation to patients that is no longer permissible because of an action by a lawmaker.”
Ultimately, he said, he’s optimistic that laws restricting standard medical care will be overturned.
“Medicine will survive all of this,” Ehrenfeld said. “We have to; we don’t have a choice. In my mind, it’s not a question of [whether] we get through this – it’s a question of how quickly we get through this, and how many patients are needlessly harmed during the process.”
