October 25, 2012 — Summary of "Legislative Interference with the Patient-Physician Relationship," Weinberger et al., New England Journal of Medicine, October 18, 2012.
"Increasingly in recent years, legislators in the United States have been overstepping the proper limits of their role in the health care of Americans to dictate the nature and content of patients' interactions with their physicians," according to a commentary by Steven Weinberger of the American College of Physicians and executive staff members representing the American Academy of Family Physicians, American Academy of Pediatrics, American College of Obstetricians and Gynecologists and American College of Surgeons.
Together, the five groups represent the majority of physicians providing clinical care in the U.S., according to the authors.
Four Types of Problematic Legislation
Lawmakers' intrusion into the doctor-patient relationship is often propelled by "political agendas without regard to established, evidence-based guidelines for care," the authors write. They point to four specific types of laws or legislative proposals that are "[o]f particular concern."
One example is laws that prohibit physicians from talking to patients or asking them about certain risk factors that might affect their health or that of their families, as recommended by clinical guidelines. A second type of new law requires physicians to go against their best judgment and discuss certain practices with a patient that might not be appropriate at the time, such as end-of-life care.
Meanwhile, a third type of measure requires physicians to provide diagnostic tests or medical interventions -- including invasive procedures that are not evidence-based -- without or against a patient's consent. Fourth, some states have enacted laws that limit the information doctors can legally disclose to patients, individuals who consult in patient care or both.
Applications to Reproductive Health Care
Regarding reproductive health, the third type of inappropriate law -- those that require physicians to perform certain procedures without a patient's consent -- are of particular concern. Specifically, Weinberger and colleague cite legislation in Virginia that would have forced women to undergo transvaginal ultrasounds before abortions.
In a letter urging Virginia Gov. Bob McDonnell (R) to veto the bill, the local chapter of the American College of Physicians wrote,"[T]his legislation represents a dangerous and unprecedented intrusion by the Commonwealth of Virginia into patient privacy" and "encroaches on the doctor-patient relationship."
Weinberger and colleagues note that the version of the bill that ultimately became law requires that the ultrasound be performed on the abdomen, "which still represents inappropriate legislative intrusion into the patient-physician relationship."
Problems With Legislative Interference
"[R]educing health care decisions to a series of mandates ... devalue[s] the patient-physician relationship," the authors write. Legislators frequently disregard scientific evidence and the needs of patients, and they "do not allow for the infinite array" of cases where a mandate might be "unnecessary, inappropriate, or even harmful to an individual patient," the authors add.
Laws dictating what physicians must or cannot tell patients infringe on medical professionals' "ability and freedom to speak to their patients freely and confidentially, to provide patients with factual information relevant to their health, to fully answer their patients' questions, and to advise them on the course of best care without the fear of penalty," according to the authors.
The authors write that their concerns about legislative interference do not mean that they oppose all government involvement in health care. Government plays an important role in ensuring patient safety and health care access for vulnerable populations. However, they "believe that health legislation should focus on public health measures that extend beyond the individual patient and are outside the capacity of individual physicians or patients to control."
Further, the authors' arguments should not be construed as meaning that physicians should be allowed to "do whatever they want," they write, adding, "The fundamental principles of respect for autonomy, beneficence, nonmaleficence, and justice dictate physicians' actions and behavior and shape the interactions between patients and their physicians."
The authors conclude, "When physicians adhere to these principles, when patients are empowered to make informed decisions about their care, and when legislators avoid inappropriate interference with the patient-physician relationship, we can best balance and serve the health care needs of individual patients and the broader society."