On Friday, the Trump Administration released new regulations affecting the low income family planning and preventative health services program known as Title X. The final rule takes an important step towards bringing the program into compliance with long-standing federal policy prohibiting the expenditure of federal funds on abortion services, and also safeguards the ability of physicians to practice medicine in accordance with the dictates of their own consciences. Furthermore, with these regulations, President Trump has struck a blow against the scourge of sexual abuse, child molestation, and human trafficking, by mandating new training for Title X clinic staff as well as compliance with state and local sexual assault reporting guidelines.
Instead of recognizing these positive improvements to the program, the American Medical Association (AMA), our nation’s premier physician organization, has instead chosen to issue misleading public commentary on the purpose and effect of these new rules. Let’s cut through the noise:
First, consider the AMA’s repeated incantation of the term “gag rule” to describe the new restriction on abortion referral at Title X facilities. The phrase draws an obvious comparison to a recent Florida statute which expressly prohibited physicians in that state from asking patients about guns in the home, which the AMA has previously described as a “gun gag law.” In its statement, the AMA even criticizes the rule by averring that “the government should not be telling physicians what they can and cannot say to their patients.” To the casual observer, this gives the impression that the new Title X rules forbid physicians from discussing abortions altogether. This false implication is directly contradicted by the plain text of the Department of Health and and Human Services statement on the regulations: “The final rule does not bar nondirective counseling on abortion, but eliminates the requirement that Title X providers offer abortion counseling and referral.”
Second, despite its citation of one segment of the Code of Medical Ethics, the AMA, in fact, fails to apply its other ethical precepts to the impact of this regulation. As HHS makes clear, the new regulations protect “healthcare providers so that they are not required to choose between participating in the program and violating their own consciences by providing abortion counseling and referral.” This is consistent with the AMA’s stated position on the ethics of physician exercise of conscience, which calls for doctors to have “considerable latitude to practice in accord with well-considered, deeply held beliefs that are central to their self-identities.” AMA guidelines acknowledge that profound ethical convictions can override a physician’s duty to refer, so long as impartial guidance is still offered. As stated above, this is entirely in keeping with the new regulations.
Finally, although the AMA statement gamely attempts to focus on women’s access to non-abortion reproductive health services such as birth control and cancer screenings, it neglects to recognize that any Title X facility — including Planned Parenthood — still has unfettered access to federal funding to provide these services to low income patients, so long as they don’t provide abortion, or at least adequately separate the components of their facilities providing abortion from those receiving federal dollars. One could just as easily argue that it is Planned Parenthood’s insistence on performing abortion, at least as much as the Trump administration’s rule, that places women’s access to these services in jeopardy.
The requirement for physical separation of facilities that provide abortion is merely a common sense effort to enforce the Hyde Amendment: money and purchased equipment is largely fungible, and it isn’t really possible to fully disentangle the origin of funds used to pay for intangibles like electricity, or medical equipment such as lights, hospital beds, and tools which are used in the provision of abortion and non-abortion services, when both are performed in a single facility.
The AMA is a strong organization with a generously funded and effective health care policy staff. Unfortunately, its urge to condemn the president, even as he takes decisive action against sexual assault and child abuse, is evidently stronger than its commitment to fairly and accurately describe the effect and purpose of his actions. It yields to this partisan temptation at the peril of its own influence.
William A. Estes is executive director for the Texas Young Republican Federation, and a fourth-year medical student in central Texas.
