Practicing Medicine in the Culture Wars — Gender-Affirming Care and the Battles over Clinician Autonomy

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Massachusetts Medical Society




A politically motivated culture war is being waged over the practice of medicine in the United States, and transgender young people are its latest victims.1 Political efforts led to the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Organization, which empowered some states to prohibit abortion even in emergencies and sparked efforts to ban mifepristone. These changes limit physicians’ ability to properly care for patients dealing with serious conditions such as preterm premature rupture of membranes, abruption or hemorrhage, ectopic pregnancy, and miscarriage, undoubtedly worsening this country’s already horrific maternal morbidity and mortality — especially in marginalized racial and ethnic groups. Now, ongoing litigation over bans on gender-affirming care could further establish the authority of politicians and courts to determine patients’ treatment options, while similarly exacerbating health disparities.

Given the high rates of suicide, suicide attempts, and suicidal ideation among transgender young people,2 it is not hyperbole to say that lives are at risk in states pursuing these bans on needed care. The Supreme Court is likely to determine the constitutionality of such bans now that the American Civil Liberties Union has requested the Court’s review. It is imperative, I believe, that the medical, scientific, and public health communities help safeguard against the Court’s indiscriminate acceptance of unsubstantiated, disingenuous claims of medical uncertainty by demonstrating that these restrictions are flawed medically and ethically — and as a result, legally. Otherwise, we risk ever more culture-war legislation that limits clinician autonomy, resulting in harm to patients.

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