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Example 1 - The Global Gag Rule

If I'm the President, we're going to have emergency-room care, we're going to have gag orders.

George W. Bush[2]

During the 2000 presidential campaign, George W. Bush warned us that if he were elected we would have gag orders. And we do. One of his first official acts after election was to re-impose this governmental censorship. The "global gag rule" (also known as the "Mexico City policy") is a twisted policy conceived during the Reagan administration. It was first trotted out at the Mexico City population meeting in 1984. The policy mandates that no US funds can be provided to any foreign nongovernmental organization (NGO) that uses its own money to perform abortions, except in cases in which a woman's life is threatened or she is victim of rape or incest.[3] This restriction applies also to NGO in countries where abortion is legal and widely used. Moreover, the ban prohibits NGOs from providing advice and information regarding abortion, referral to other healthcare facilities, or lobbying their governments regarding their abortion laws -- hence the description "gag rule." In 1993, President Clinton issued an executive order ending the policy, but in January 2001 President Bush reinstated the ban for all US Agency for International Development (USAID) population programs.[4] Further, in August 2003, President Bush issued an executive order that expanded the gag rule to include organizations receiving money through the US Department of State.[5] According to the Center for Reproductive Rights, provision of services that are "permitted" on paper (eg, life-saving abortion, post-abortion care, or provision of emergency contraception) is often curtailed because NGOs fear jeopardizing their funding through any association with abortion.[3] Our government, like other repressive regimes and religions, censors those who do not adhere to prevailing political orthodoxy.

Although we happily export this censorship overseas, it could never be used here, since this policy is unconstitutional. It clearly violates the free speech protection guaranteed by our Constitution. The policy is discriminatory. Only nongovernment organizations have to abide by it, whereas governmental organizations are exempt. More concerning to us as physicians is that this gag rule also violates a physician's ethical obligation to provide information and informed consent. The global gag rule forces doctors overseas to violate the Hippocratic Oath and medical ethics.

The net effect is tragic. It deprives care to the most disadvantaged women in some of the world's most desperate places... women living in regions ravaged by HIV infection, refugees and migrants displaced by violent conflict -- who are often victims of sexual violence and rape -- widows of war, victims of famine. As might be predicted, depriving others of information and care leads to more unintended pregnancies, more unsafe abortions, and more deaths.[3,5,6]

But as author Tom Robbins noted, Isn't that what politics is all about: imposing one's views on others?[7]

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