Leana Wen is a physician and president of the Planned Parenthood Federation of America.
As a physician, I know my obligation is always first and foremost to my patients. My patients trust me to be honest, open and truthful with them. Our relationship relies on the understanding that I will provide the accurate, science-based and comprehensive information they need to make difficult decisions that will affect their health. Health care is personal and often deeply emotional. When patients feel judged, ignored or misled, they may shut down. They may stop seeking health care altogether, or they may hide their symptoms or habits, preventing their provider from being able to treat them fully and effectively.
The Title X gag rule interferes with the sacred physician-patient relationship by censoring doctors, nurses and other health-care providers who participate in Title X, our nation’s dedicated program for affordable birth control and reproductive health care. The rule essentially gags us by forcing doctors to choose between providing information to women and families about how and where they can access abortion care and receiving funding through Title X. This is a direct interference with the practice of medicine and with doctors’ ethical obligation to our patients.
Not only does this rule severely undermine patients’ rights to know what care is available to them and how to receive it, it also goes against the core values of the medical profession. The American Medical Association’s Code of Medical Ethics states that “withholding information without the patient’s knowledge or consent is ethically unacceptable.” This gag rule violates the trusting bond between doctors and patients and it compromises the oath we took to serve our patients and help them make the best decisions for their own health. More than 100 physician groups, nursing associations and public-health organizations have spoken up in opposition to the Title X gag rule.
Title X enables 4 million low-income women and families to receive access to birth control, breast and cervical cancer screenings, sexually transmitted infection testing and treatment, and other preventive care. If you have ever received free or reduced-cost birth control or a Pap test, it may have been thanks to the Title X program. Title X is critical to improving health outcomes in communities that already face the greatest barriers to care. Recognized as one of the most successful public-health initiatives in history, Title X has been essential to reducing sexually transmitted infection (STI) rates and unintended pregnancies.
For many patients, their visit to Planned Parenthood or another Title X provider is their sole source of health care; in many parts of the country, Planned Parenthood is the sole Title X provider. In Wisconsin, Planned Parenthood health centers served about 80 percent of Title X patients in 2017 and were the only Title X provider in seven counties. In California alone, we serve 700,000 people through Title X health centers. In Ohio, Planned Parenthood is the only Title X provider in nine counties. By drastically altering Title X, millions of patients may be left with nowhere to turn for basic health care.
This rule has nothing to do with medicine and everything to do with politics. It is one more example of a discriminatory policy from the Trump-Pence administration that hurts those who are most vulnerable: If you’re wealthy with private insurance, you can find a way to get accurate and comprehensive information about your options. But if you’re struggling to make ends meet, you will be forced to receive inaccurate, misleading information from your doctor. And because Title X primarily serves patients who are people of color, Hispanic or Latino, the gag rule adds yet another layer of discrimination that will perpetuate health disparities and racial inequity.
Because we are committed to providing patients with compassionate, judgment-free and comprehensive care, Planned Parenthood cannot continue participating in Title X under the gag rule. We will never force our doctors and nurses to compromise their ethics. We will never let politicians censor our health-care providers and erode the trust our patients have placed in us to provide them with compassionate, judgment-free and comprehensive care.
This rule does not affect only Planned Parenthood. Other providers will also be forced out of participating in Title X, which means patients will go without access to care. Title X is lauded as one of the most successful public-health programs that has reduced unintended pregnancies and STI rates. The gag rule will have widespread consequences on patient rights, access to health care and public-health outcomes.
We have to stop treating reproductive health as if it were different from other kinds of health care. Reproductive health care is health care.
Politicians have no role in the exam room, whether patients are seeking reproductive care or any other kind of treatment. As a doctor, it’s my job to provide evidence-based, full and accurate information to my patients. Politicians who truly care about their constituents’ health should let doctors and nurses care for our patients.
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