Exploring Human Potential

Healthy Women Mean a Healthy Democracy.

Posted on | June 17, 2024 | 2 Comments

Mike Magee

When he assumed the role on June 13, 2023, Jesse M. Ehrenfeld, MD, MPH focused on inequities in health care as a top priority for his year in office. In a memorable opening that day in Chicago, the Wisconsin anesthesiologist shared a personal mission with 700 AMA delegates centered on his then 4 year old son. Ethan was born 10 weeks premature at 2 lbs 7 oz.

“Watching my son cling to life, I was struck by the painful reality that, even though I was a physician and now, a father, neither I, nor my husband, could donate blood simply because we are gay. Discriminatory policies—policies rooted in stigma, not science—barred us from doing the most humane of acts, donating our blood.”

As the AMA’s 178th president, Dr. Ehrenfeld used that story as a jumping off point to share his priorities as their new President. He pledged that day to seek justice and equity, highlighting:

“Black women are at least three times as likely as white women to die as a result of their pregnancy.

“Black men are 50% more likely to die following elective surgery.

“LGBTQ+ teens and young adults suffer higher rates of mental health challenges that often go undiagnosed.”

He also warned, in the shadow of the Dobbs decision on June 24, 2022, of  “… discouraging trends related to health outcomes—maternal mortality rates in the U.S. are more than double those of other well-resourced nations, for instance—and are becoming more prevalent.”

But when it came to the politics of reproductive health access, he chose his words carefully and took a quieter tone with the audience of politically savvy doctors from red and blue states.

“Certain aspects of the country’s political climate have become dangerously polarized. Politicians and judges are making decisions about health care formerly reserved for patients and physicians and patients…” he said.

This statement, coming one year after Dobbs, clearly did not mirror, in intensity, the words of his predecessor, Jack Resneck Jr.,MD, who wrote on the day of the decision, “The American Medical Association is deeply disturbed by the U.S. Supreme Court’s decision to overturn nearly a half century of precedent protecting patients’ right to critical reproductive health care…In alignment with our long-held position that the early termination of a pregnancy is a medical matter between the patient and physician, subject only to the physician’s clinical judgment and the patient’s informed consent, the AMA condemns the high court’s interpretation in this case.”

That sentiment was reinforced by the nation’s 25,000 OBGYNs, 60% of whom are women. Their association (ACOG) wrote, “Today’s decision is a direct blow to bodily autonomy, reproductive health, patient safety, and health equity in the United States. Reversing the constitutional protection for safe, legal abortion established by the Supreme Court nearly 50 years ago exposes pregnant people to arbitrary state-based restrictions, regulations, and bans that will leave many people unable to access needed medical care.” 

Statements on behalf of the American Nurses Association, and the organizational arms for both physicians associates (PAs) and nurse practitioners (NPs) were equally forthright.

There are 4.2 million nurses, over 1 million doctors, and over 1/2 million PAs and NPs in the US. And as the latest US Census Report headlined, “Your health care is in women’s hands. Women hold 76% of all health care jobs.” This includes 90% of all nursing positions, 66% of PAs, and 55% of all current Medical School slots.

Not surprisingly, as women numbers have risen, traditional oaths for the caring professions have reflected changing priorities. For example, the women majority 2022 entering class of Penn State’s College of Medicine for the first time gave top billing in their professional oath to patients, not to the gods: “By all that I hold highest, I promise my patients competence, integrity, candor, personal commitment to their best interest, compassion, and absolute discretion, and confidentiality within the law.”

Seven years earlier, the American Nurses Association (ANA), created a formal Code of Ethics, which largely supplanted the 1893 Nightingale Pledge, with a four pillared Code which celebrated Autonomy (patient self-determination), Beneficence (kindness and charity), Justice,(fairness) and Nonmaleficence (do no harm), as anchors to Nursing’s 9 Provisions (or Pledges) that commit to: compassion and respect, patient-focus, advocacy, active decision making, self-health, ethical environment, scholarly pursuit, collaborative teamwork, professional integrity and social justice.

During Dr. Ehrenfeld’s one-year tenure following the Dobbs decision women’s access to health care deteriorated in red state after red state, a point reflected in clear losses for Republications on statewide initiatives supporting abortion access from Kansas to Kentucky, and Vermont to Michigan. But as the Kaiser Family Foundation reported this year, “As of April 2024, 14 states have implemented abortion bans, 11 states have placed gestational limits on abortion between 6 and 22 weeks…” Add to this that 1 in 5 current OB residents say they have decided to steer away from restrictive red states when they pursue practice opportunities on graduation.

And still, red states embracing MAGA’s marriage to White Nationalists seem to have doubled down on everything from restricting access to medication abortion and contraception, to book banning, to limiting  LBGTQ+ rights and promoting prayer in public schools in the hopes of achieving a Christian Nationalist society.

Which brings us to the fast approaching 2024 Presidential debate. Women’s reproductive autonomy will be well represented. It is arguably the premier equity and justice issue before us, central to both America’s patients and their caring health professionals. But let’s not forget it is also central to the health of our democracy.

John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.” 

What other form of government is there that so closely aligns with the aspirational pledges and oaths of our doctors, nurses, and body politic?


2 Responses to “Healthy Women Mean a Healthy Democracy.”

  1. Lawrence Williams
    June 19th, 2024 @ 2:03 pm

    Hi Michael.
    Why is that every time we begin a discussion of almost any matter sponsored by the MAGA crowd that I feel like we are suddenly swept into a horse mounted, wild, screaming, sword waving cavalry charge furiously racing straight into the 19th century? And why is it that millions of Trump supporters, and this group includes millions of WOMEN who are gleefully participating is this headlong assault on the most basic principles of our democratic society. I don’t understand. And I am terrified by the wide spread nonchalance of the Republican hierarchy in Congress and red state legislatures to all of these issues which would certainly have destroyed any presidential campaign of the past. I am having trouble understanding Donald Trump’s strangle hold on the entire Republican Party. In reality there is no longer a Republican “Party”. What has taken its place is the Republican RICO. You are no doubt aware of the federal law 18 U.S.C. (§§ 1961-1968), commonly referred to as the “RICO” statutes. This is where the definition of the word RICO was born. Colloquially it means a Racketeer Influenced Corrupt Organization and I cannot think of a better definition of what now passes as the Republican Party. As your material clearly demonstrates this MAGA bunch do not want women to have their hard earned rights of bodily and intellectual self-determination. Rather, they want to have a tight knit group of old white men telling everyone what they can and cannot do in every situation. Period.
    All I can say is that I hope that all of those women you have spoken of and all their friends, relatives and co-workers make a hard charging, horse mounted, wild, screaming, sword waving cavalry charge to the polls in November and vote against every MAGA candidate from the level of dog catcher to President of the United States. I promise to vote early and often.LOL
    Thanks as always Mike and my best to you and Patricia.
    Larry Williams

  2. Mike Magee
    June 20th, 2024 @ 8:33 am

    Couldn’t say it better myself, Larry. RICO = Republican (at least for npw.)

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