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OB/GYN Editorial JULY 2005
Reproductive Rights
Lee P. Shulman, MD
once promised myself
that I would never
write an editorial
about legal morass in obstetrics
and gynecology—or health care in
general. Although I am not going
to break that promise technically,
the impact of this deepening quagmire
and the associated political
maneuvering is placing our ability
to care for patients—and especially
to provide reproductive
care—in great jeopardy.
The arguments concerning various
issues in reproductive care,
including contraception and abortion,
have become strident and
angry. The complex social, religious,
moral, and economic implications
of unintended pregnancy
preclude a thorough discussion of
these subjects in this editorial.
However, regardless of your position
on these difficult topics, your
ability to help your patients prevent
unintended pregnancy, by
whatever means you have found
to be successful, is in peril because
of the uninvited and unwelcome
intrusion of the legal community
and government into the practice
of medicine.
In the past, such intrusions were largely limited to the medical malpractice
arena. However, the
recent controversy over rofecoxib
has served to highlight a new
potential battle front. In the neverending
search for a new pool of
defendants, professionals who
provide important nonmedical
services by participating on drug
safety monitoring boards, advisory
panels, and governmentbased
study sections may soon
find themselves at risk for personal
litigation. And when such legal
actions occur, malpractice insurance
will not protect these individuals
from personal economic risk.
What does this have to do with
reproductive care? Not only is our
ability to provide appropriate care
hampered by needless tests and
senseless maneuverings to satisfy
lawyers, but the development of
improved diagnostic and therapeutic
procedures and new drugs
may be considerably impeded if
leaders in womenÍs health care are
not able to participate in governmental-
or industry-related developmental
programs due to
personal risk. Combine this with
increasing government intrusion
into the physician-patient relationship
and a flagrant abandonment
of evidence-based medicine for
political expediency (eg, the US
Food and Drug AdministrationÍs
failure to approve over-thecounter
emergency contraception),
and we may be seeing a wholesale
change in our approach to
patientsÍ reproductive issues—a
change that is unlikely to facilitate
patient care during these challenging
times.
Voters in Illinois (my home state)
recently replaced a State Supreme
Court Justice who had actively
supported plaintiffÍs attorneys in
the southern districts. Citizens in
that area—with the help of the Illinois
State Medical Society and
other organizations—recognized
that the current medical crisis
might be ameliorated with judges
who would not allow plaintiffsÍ
attorneys to ride roughshod over
the medical malpractice landscape.
It was a victory, albeit a small
one, in Illinois physiciansÍ continuing
struggle to reclaim our profession.
More importantly, it shows
that with hard work and determination,
the medical community
can promote change for the better
for patients and physicians. Now
more than ever, it is vital to
become involved in local, regional,
or national organizations. Most
importantly, physicians must vote
in every election. Do it for our profession—and do it so that we can
continue to provide the kind of
care that empowers our patients to
make the decisions that are best
for them and their families.
Okay, you caught me; I broke my
promise. But I will never write
another medicolegal editorial
again. Instead, I will leave that
task to my editorial board colleagues
Tom Nolan and Ron
Burkman.
Lee P. Shulman, MD
Associate Advisory
Board Member
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