Although I am not a provider of reproductive medical services,I was alarmed to read of the recent decision of the SupremeCourt in Gonzales v. Carhart. Why should I feel so concerned?The practical consequences of the "partial-birth abortion" billare so far from my medical practice in pulmonary and intensivecare medicine that the ruling should have no impact on me. Indeed,since most health care practitioners will not be directly affectedby this decision, why should we care at all? It is because,as Charo1 and Greene2 point out in this issue of the Journal,with this decision the Supreme Court has sanctioned the intrusionof legislation into the day-to-day practice of medicine.
In 2005, we all saw the disastrous consequences of congressionalinterference in the case of Terri Schiavo. In that case, thecourts wisely decided that Congress should not be practicingmedicine. They correctly ruled that wrenching medical decisionsshould be made by those closest to the details and subtletiesof the case at hand. Such decisions must be made on an individualbasis, with the best interests of the patient foremost in thepractitioner's mind.
It is not that physicians do not want oversight and open discussionof delicate matters but, rather, that we want these discussionsto occur among informed and knowledgeable people who are actingin the best interests of a specific patient. Government regulationhas no place in this process. In 1997, another editor of theJournal, Jerome Kassirer, took Congress to task for practicingmedicine without a license.3 He cited a number of instances,including the passage of a forerunner of the bill that the SupremeCourt upheld last week. With Gonzales v. Carhart, the judicialbranch has regrettably joined the legislative branch in practicingmedicine without a license.
Source Information
This article (10.1056/NEJMe078086) was published at www.nejm.org on April 23, 2007.
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Greene MF. The intimidation of American physicians -- banning partial-birth abortion. N Engl J Med 2007;356:2128-2129. [Free Full Text]
Kassirer JP. Practicing medicine without a license -- the new intrusions by Congress. N Engl J Med 1997;336:1747-1747. [Free Full Text]
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