This essay was selected by the University of Arizona School of Medicine from a group of student essays that were submitted in response to a question concerning government’s role in healthcare, and, specifically, how it impacts the doctor-patient relationship. This essay was prepared and submitted by the student author in his personal capacity. The opinions expressed in his essay are the author’s own and do not reflect the views of the Arizona Medical Association, Maricopa County Medical Society, or Pima County Medical Society.
Combating Government Incursion upon the Patient-Physician Relationship BY A LE X A NDER A LVA R E Z
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n order to consider what physicians and medical trainees can do to ensure that government does not further erode the doctor-patient relationship, we must first look at how government has undermined this relationship in the past. For the sake of this essay, I would like to consider Arizona’s 2011 Revised Statute (ARS) 36-2156, which, amongst other regulations, requires fetal ultrasound to be performed at least twenty-four hours prior to any abortion.1 Regardless of one’s stance on the United States Supreme Court’s 1973 decision on Roe v. Wade and subsequent challenges to the legality of abortion care, this Arizona statute reveals how government regulation can undermine physician-patient relationships and provides a window into how those in the medical community can combat it. The issue with ARS 36-2156 and other state and federal laws like it can be found in their encroachment on the primary elements of the physician-patient relationship – patient autonomy and partnership in decision-making. In a 1992 article in the Journal of the American Medical Association, Drs. Ezekiel and Linda Emanuel described that the core aim of the physician-patient relationship is such autonomy and partnership, or in their words: “[helping] the patient determine and choose the best health-related values that can be realized in the clinical situation”.2 By mandating physicians to perform imaging before abortion, our state destroys patients’ autonomy: patients are no longer allowed the self-determination to decline a test that is not medically necessitated for an abortion (as defined by the American College of Obstetricians and Gynecologists3). By so doing, the state also sabotages the decision-making partnership between physician and patient: patients and physicians can no longer follow Emanuel’s precept to reason together in choosing what treatment pathway to follow; rather, physicians are forced to perform fetal ultrasound. In their 2012 “Statement of Principles on the Role of Governments in Regulating the Patient-Physician Relationship,” the American College of Physicians extends this assessment to all such government-mandated treatment stating that “Even laws and regulations that mandate a test...when generally consistent with the standard of care...should be approached cautiously, because they cannot allow for all potential situations in which their application would be unnecessary”4. An obvious and oft-encouraged solution to this problem is for physicians to be involved in state and national medical associations. By so doing, they can lobby against new federal and state laws like ARS 36-2156 from further dismantling patient-physician relationships. Although medical associations are successful in many of their legislative initiatives each year, innovative ideas must be enacted in order to advocate for patients who would be negatively affected by proposed statutes that these organizations currently do not address, or in which our legislators fail to listen. The solution I propose addresses what many legislators are constantly concerned
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ARIZONA PHYSICIAN | February 2017