Welcome to "The Hypocritical Oath," my 51˶ series where I explore ethical failures in medicine, from shortcomings in medical culture to abuses of power and patient harm. I try to give a voice to those that have been dismissed in an effort to inspire better doctors, committed to upholding our stated values.
"Religious exemption" can be a highly convenient get-out-of-jail-free card. As soon as the concept of personal belief is invoked, we tread lightly; infringing upon deeply held beliefs is widely acknowledged as unacceptable. Religious exemption and personal beliefs constitute the argument to end all arguments. Realistically, how can you respond to someone who resolutely announces, "I have the constitutional right to follow my personal beliefs"? You can't.
I do not oppose anyone's right to practice their religion freely. I too hold a set of core, cherished values by which I try to live. But I do have a problem with weaponizing personal beliefs to restrict the freedoms of others, and I absolutely have a problem with personal beliefs superseding evidence-based medicine.
Personal beliefs become especially problematic when they govern medical practice. The Minnesota Court of Appeals recently found a pharmacist, George Badeaux, after he allegedly denied a woman her emergency contraception prescription (ella) in 2019, invoking personal belief in his decision. His lawyer argued, "As a devout Christian, George believes every human life has value. As such, George cannot provide or facilitate the use of any potential abortion-causing drugs," concluding with a reminder of Badeaux's constitutionally protected freedom to practice his beliefs at work. Of note, an earlier complaint had also been lodged against Badeaux in 2015 for refusing to dispense Plan B.
I'd like to address Badeaux's defense from a medical perspective: nor cause abortion. Plan B works by preventing ovulation and is ineffective once a pregnancy has actually taken place, which the FDA has . Meanwhile, that an anti-implantation effect by ella is highly unlikely and that ella does not terminate a pregnancy.
By definition, Plan B and ella are not abortifacients and with implantation of a fertilized egg, contrary to anti-abortion rhetoric. As a resident who works closely with and frequently relies on pharmacists, I would expect a pharmacist to know that. This case suggests that Badeaux's contention is not with abortion, but with a woman's right to access birth control.
I must ask, why? Why does anyone believe a woman does not have the right to choose to prevent pregnancy? The pregnancy termination argument isn't even applicable here, so why employ it?
A pharmacist who does not know the difference between abortion and contraception shows a weak knowledge base, and a pharmacist who willfully conflates the two disregards the evidence that should inform their work. Either way, I would be concerned if such a pharmacist were practicing.
Anti-choice proponents have infringed successfully on reproductive rights on multiple fronts: the Dobbs decision, rigid abortion restrictions, and that the pro-choice position advocates casual infanticide. Now they are distorting facts to further their agenda. The Supreme Court recently rejected the Alliance for Hippocratic Medicine's challenge to FDA expansion of mifepristone access, unanimously opining that the anti-abortion group -- ostensibly disguising its attempt to encroach on reproductive rights with flimsy safety concerns about mifepristone -- did not have legal standing to sue.
And I have to ask -- to what end? What have we accomplished with polarizing rhetoric that defies medical evidence?
I'm not confident that these increasingly extreme measures protect innocent life. In fact, they do the opposite, endangering the creation or expansion of families, counter to the pro-life movement's purported principles.
In a disappointing but unsurprising decision, the Texas Supreme Court who had allegedly been denied medically necessary abortions and subsequently requested clarification of the exemptions to the state's extreme abortion ban. One plaintiff, , experienced preterm premature rupture of membranes at 18 weeks and landed in the ICU with sepsis after being denied an abortion under Texas's current law (the natural outcome of this type of case), with devastating consequences: permanent damage to her fertility.
As a woman who hopes to become a mother someday, I hurt for her when I imagine her distress, and am outraged that it was entirely preventable, but for deliberately obtuse political posturing that interferes with sound medical judgment and renders a woman's well-being extraneous in the eyes of the law.
Why are we giving shows of willful ignorance credence, to the point of codifying them into law? A growing contingent of anti-choice advocates with extreme beliefs proudly displays its lack of knowledge and has consequently instituted healthcare policies ranging from woefully uninformed -- as in Louisiana's reclassification of mifepristone as a controlled substance -- to overtly dangerous.
The Supreme Court on whether the 1986 law known as the Emergency Medical Treatment and Active Labor Act (EMTALA) allows doctors practicing in states with strict abortion bans to perform necessary abortions to stabilize pregnant patients in emergency situations. Presently, Idaho's abortion law allows a woman to receive an abortion -- not her health -- is at risk. I anticipate more tragedies like Zurawski's, should SCOTUS uphold Idaho's current abortion law.
How much women's suffering is acceptable to the anti-choice movement? Is loss of a woman's reproductive organs and fertility when she hopes to become a mother acceptable? Is septic shock acceptable? It would seem so, under this trend of enacting healthcare policy predicated on ignorance.
On some level, I anticipate deception or willful ignorance from politicians. But I expect far better from my healthcare colleagues. I find it highly unethical for healthcare workers to push their personal beliefs by misrepresenting medical evidence and by misleading patients who trust us. I'm glad that Badeaux was held accountable, and I hope others do not follow his example. Furthermore, even if you hold pro-life views and won't perform an abortion, if you adamantly oppose a patient's right to abortion in an emergency, I question how pro-life you truly are. Extremist ideologies inflict unnecessary distress and threaten patient safety; they have no place in clinical decision-making.
To paraphrase former U.S. senator and ambassador to the United Nations, , everyone is entitled to their own opinion, but not to their own facts. As medicine becomes increasingly politicized to the detriment of our patients, it is our responsibility as physicians to make rational clinical judgments guided by medical facts, not by personal agendas.
is a resident physician in the Department of Psychiatry at the University of Rochester Medical Center in New York.