COMMENTARY

The State Shouldn't Tell Doctors What to Say, Says Ethicist

Arthur L. Caplan, PhD

Disclosures

March 21, 2017

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Hi. I am Art Caplan. I am at the Division of Medical Ethics at the New York University School of Medicine. What can you talk about with your patients? Some doctors might be thinking, well, if you give me time I can talk about whatever I want. State legislators in different states have been trying to put some limits on what you can say and require you to talk about certain things that maybe you do not want to talk about.

In the case of Florida, there was a state law that said doctors should not be talking about guns or gun safety with their patients. In South Dakota and Arkansas, laws have been passed to say that if a woman uses a pill to try to abort a pregnancy, she has to be told that there might be another pill that could possibly reverse the abortion if she changes her mind after taking that pill.

It is interesting that doctors historically have been given freedom to talk about what they want with their patients without intrusion by the government or any other third parties.[1] We viewed the doctor-patient relationship as a kind of sacred trust, a covenant between the patient and the doctor, leaving pretty much the medical information and the diagnosis up to the physician to decide what they are going to do in terms of communication. I think that is the right stance. Interestingly enough, very recently, the Florida Supreme Court agreed. They said that restrictions on what doctors can say about guns are unconstitutional. They are intrusions into free speech and they violate the historic deference shown to letting doctors talk about what they want.

It is certainly the case, whatever the issue, that you cannot harangue, coerce, or berate your patient. It would not be right to go in and say, "How dare you own a gun. Do you not realize that you are putting yourself at risk?" and so on and so on. If you want to talk about gun safety because there are children in the house and you want to make sure the parents have had a discussion with the kids about what to do if they find a gun, or if there may be someone who has depression or might be a suicide risk, are you locking up the guns?—those seem to me to be very reasonable things to talk about. The limit is time; it is not really content. If you want to talk about those matters and you have time to do so, I think you should absolutely be free to do so.

Similarly, with the abortion reversal pill, there is not a lot of evidence that it works.[2] It is something that people have thought about. A few doctors have said that maybe this might be capable of reversing a chemical abortion, but mainstream medicine does not really know or does not think the evidence is there to support the claim that reversal is possible. Again, even if the state legislature says you better talk about this, if a woman is trying to have a chemical abortion, you can feel free to say, "No, I am not going to because it is not recognized as a treatment. It is not recognized as evidence-based. It is just an experimental idea that a few people have talked about."

At the end of the day, I still think the right course is for doctors to talk with their patients about what they deem appropriate. What we need to do is try to ensure that the time is there to have those conversations. The content, I think, is something that medicine should decide—no other third parties. I am Art Caplan at the Division of Medical Ethics at New York University. Thanks for watching.

Talking Points: The State Shouldn't Tell Doctors What to Say, Says Ethicist

Issues to consider:

  • Some physicians have expressed concern that children need to be educated more as to what to do when they find or see a gun.

  • Some healthcare professionals cite the following barriers to effective firearm safety counseling: lack of training and time, low expectancy that counseling is effective, uncertainty about what to say, as well as a desire not to offend parents.

  • Many Americans believe that a gun in the house makes it a safer place to be, and more Americans own firearms for protection.

  • An argument often cited against legislating what a doctor must or must not say to a patient is that it is a clear interference in the patient-physician relationship.

  • Many healthcare professionals worry that dictating abortion counseling through law is an infringement on the patient-physician relationship.

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