Leave medicine to the doctors


IN THE RECENT decision concerning Carhart v. Stenberg and the so-called partial birth abortion procedure, it was encouraging to see that someone in government -- in this case, five members of the U.S. Supreme Court -- finally appears to understand the importance of the physician-patient relationship and why it supercedes any discussion surrounding the relative social or political merits of a particular abortion procedure.

Indeed, while there has been agonizing debate over such issues as the stages of fetal development and the relative acceptability of certain abortion procedures, such discussion is really not germane to the central issue, correctly identified by the Supreme Court: before viability, a woman has the constitutionally protected right to an abortion.

In addition, given the complexities of modern medicine, the nature of the abortion procedure is a decision best left solely between the woman and her physician. After all, aren't physicians honor-bound to provide the best possible care for their patients and to ensure that the procedure used is the one with the highest likelihood of a safe and successful outcome?

They are, and in every area of medicine, patients rely on a doctor's ability to apply his or her best clinical judgment in a given situation. Patients further depend on their doctors to arrive at such clinical decisions based on objective analysis of scientific literature and clinical expertise, not on the opinions of politically motivated legislators with no experience in patient care and the accompanying good faith obligations.

Although the proponents of this legislation said they wanted to ban a procedure they call "partial-birth abortion," the language is so medically vague that it would be difficult for a physician to know exactly what it is that is being banned.

In fact, as the court perceived, the language is so vague that it could have been used to ban all abortions.

Further, it would be unprecedented for a legislature to ban a particular procedure -- essentially, to practice medicine from the State House without knowledge of a particular patient's needs and circumstances. What if there were groups philosophically opposed to brain surgery or transplant operations? Would the public stand for these procedures to be banned on religious grounds?

The point has also been made that other procedures could be performed in lieu of the one in question, but whose judgment is that? The practice of medicine is difficult enough these days without legislative incursions designed to place a political wedge between physicians and their patients.

A woman's health must remain a physician's primary concern throughout pregnancy and, as such, the physician must be given the discretion to take the most medically appropriate procedural steps, as clinically indicated, independent of politics and policies.

The Nebraska statute examined in Carhart v. Stenberg and similar state laws would have evoked a scenario in which physicians would have to require that their attorneys be present in the operating room to advise and counsel at each step. If a procedure even appeared to go in a certain direction, the physician could be criminally charged for using his or her best medical judgment.

Is this what women and their families really want?

I doubt it. The Supreme Court got it right. Medicine should be practiced by physicians, not by politicians, and the relationship between physician and patient is one that will endure long after this political storm has abated and congressional wind has calmed.

Paul Blumenthal is a medical doctor and medical director of Planned Parenthood of Maryland.

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