The American Medical Association is suing North Dakota to block two abortion-related laws, the latest signal the doctors' group is shifting to a more aggressive stance as the Trump administration and state conservatives ratchet up efforts to eliminate legal abortion.
The group, which represents all types of physicians, has tended to stay on the sidelines of many controversial political issues, and until recently has done so concerning abortion and contraception. Instead, it has focused on legislation that affects the practice and finances of large swaths of its membership.
But, said AMA President Patrice Harris in an interview, the organization felt it had to take a stand because new laws forced the small number of doctors who perform abortions to lie to patients, putting "physicians in a place where we are required by law to commit an ethical violation."
One of the laws, set to take effect Aug. 1, requires physicians to tell patients that medication abortions — a procedure involving two drugs taken at different times — can be reversed. The AMA said that is "a patently false and unproven claim unsupported by scientific evidence." North Dakota is one of several states to pass such a measure, even as researchers who study the procedure say it's not effective.
The AMA, along with the last remaining abortion clinic in the state, is also challenging an existing North Dakota law that requires doctors to tell pregnant women that an abortion terminates "the life of a whole, separate, unique, living human being." The AMA said that law "unconstitutionally forces physicians to act as the mouthpiece of the state."
It's the second time this year the AMA has taken legal action on an abortion-related issue. In March, the group filed a lawsuit in Oregon in response to the Trump administration's new rules for the federal family planning program. Those rules would, among other things, ban doctors and other health professionals from referring pregnant patients for abortions.
"The Administration is putting physicians in an untenable situation, prohibiting us from having open, frank conversations with our patients about all their health care options — a violation of patients' rights under the [AMA] Code of Medical Ethics," wrote then-AMA President Barbara McAneny.
It's an unusually assertive stance for a group that has taken multiple positions on abortion-related issues over the years.
Mary Ziegler, a law professor at Florida State University who has written several books about abortion, says that the AMA's history on abortion is complicated. In general, she says, the AMA "didn't want to get into the [abortion] issue because of the political fallout and because historically there have been doctors in the AMA on both sides of the issue."
In recent years, the AMA has taken mostly a back seat on abortion issues, even ones that directly addressed physician autonomy, leaving the policy lead to specialty groups like the American College of Obstetricians and Gynecologists, which has consistently defended doctors' rights to practice medicine as they see fit when it comes to abortion issues.
Ziegler says it is not entirely clear why the AMA has suddenly become more outspoken on women's reproductive issues. One reason could be that the organization's membership is skewing younger and less conservative. Also, this year, for the first time, the AMA's top elected officials are all women.
In its earliest days, the AMA led the fight to outlaw abortion in the late 1800s, as doctors wanted to assert their professionalism and clear the field of "untrained" practitioners like midwives.
Abortion was not an issue for the group in the first half of the 20th century. The AMA became best-known for successful fights to fend off a national health insurance system.
Leading up to Roe v. Wade, the 1973 Supreme Court decision that legalized abortion nationwide, the AMA softened its opposition. In 1970, the AMA board called for abortion decisions to be between "a woman and her doctor." But the organization declined to submit a friend-of-the-court brief to the high court during its consideration of Roe.
In 1997, the AMA, in a surprise move, endorsed a GOP-backed measure to ban what opponents called "partial-birth abortions," a little used procedure that anti-abortion forces likened to infanticide. A year later, however, an audit of the AMA's leadership found its trustees had "blundered" in endorsing the bill and had contradicted long-standing AMA policy.
One reason the organization may be moving on the issue now could be the shifting parameters of the abortion debate itself. In 1997, the abortion procedure ban that the AMA endorsed "polled well and allowed abortion opponents to paint the other side as extremist," Ziegler says.
Exactly the opposite is true today, she says, as states pass abortion bans more sweeping than those seen at any time since Roe. Yet most public opinion polls show a majority of Americans want abortion to remain legal in many or most cases.
"As abortion opponents take more extreme positions, the AMA is probably a little more comfortable intervening" Ziegler adds.
Molly Duane, a lawyer from the Center for Reproductive Rights who is arguing the case for the AMA and North Dakota's sole remaining abortion clinic, says the laws being challenged are "something all doctors should be alarmed by. ... This is an unprecedented act of invading the physician-patient relationship and forcing words into the mouths of physicians."
AUDIE CORNISH, HOST:
The American Medical Association has largely stayed on the sidelines of political fights over the past 30 years or so. But a North Dakota law set to go into effect next month is spurring the doctor's group to get involved now. The law will require doctors in North Dakota to tell patients that medically induced abortions can be reversed. Now, there's no scientific evidence to support that claim, and the AMA is taking the state to court over it and another existing abortion law. Julie Rovner covers health policy at Kaiser Health News. She joins us now.
Welcome back to the program, Julie.
JULIE ROVNER: Thanks for having me.
CORNISH: We just described one of these laws. What's the other one, and why is the AMA concerned about it?
ROVNER: The other law requires physicians to tell women who are seeking an abortion that it would end the life of a whole separate, unique living human being. The AMA says that that law unconstitutionally forces physicians to act as the mouthpiece of the state. So these are two different laws in North Dakota. They're unhappy with both of them.
CORNISH: At the same time, there have been several new laws restricting abortion access across the South and Midwest. So why is the AMA getting involved now?
ROVNER: It's really interesting. You know, they've been involved on and off in sort of smaller ways. But you know, they put out a press release. They're filing lawsuits. There's a lot of speculation as to why now. Some of it may be just they feel like these laws have finally gone too far. Some of it may be there's a woman president of the AMA and a woman past president and there'll be a woman president next year. For a group that's long been older, whiter and more male, that's changing.
CORNISH: So what kind of stance had they taken in the past?
ROVNER: Well, the AMA has been kind of everywhere on abortion. The AMA in the late 1800s led the fight to make abortion illegal in the United States. That was part of their effort to sort of centralize power over the medical profession. They wanted to get rid of unlicensed practitioners like midwives, who had traditionally been involved with women's reproductive health. And they really didn't change that position until just before Roe v. Wade. And even when Roe v. Wade happened, the effort to liberalize abortion laws in the U.S. was really led by the legal profession, not by the medical profession.
CORNISH: You reached out to the American Medical Association - seems like maybe they're not so comfortable with this new stance. Can you tell us what you learned?
ROVNER: Yeah. They made clear that their problems with these laws are not about abortion per se, but about interference in the doctor-patient relationship, which is true. And that is their complaint. I would point out that there have been a number of other abortion laws or abortion regulations that they have not been so outspoken on that would have equally interfered with the doctor-patient relationship.
CORNISH: For a little more context, though, how influential is the American Medical Association at this point?
ROVNER: Well, they're still pretty influential in that people see that name and think, oh, the AMA - they represent doctors. But the AMA has represented a smaller percentage of doctors over the years. It is not quite as big and powerful as it used to be. But still, the brand carries some weight, and it carries some weight in Washington and in state capitals.
CORNISH: Doesn't it carry weight precisely because people see it as apolitical? And is this jeopardizing that?
ROVNER: Oh, I don't think they've ever been seen as apolitical. The AMA really led the fight against national health insurance for decades. They've always been political. Where they've been, I think, loathed to intervene is on delicate social issues like abortion.
CORNISH: In this era of increased restrictions on abortion, are other medical groups, other professional associations and the like, getting involved in legislative fights?
ROVNER: Well, the American Congress (ph) of Obstetricians and Gynecologists, which represents most of the doctors who actually do abortions and take care of women's reproductive needs, has long been fairly outspoken on many of these laws, if not most of them. So there have been other physician groups that have stepped up to take the lead on this. There are also anti-abortion physician groups. They're much smaller, but they are out there. And they also argue the AMA has sort of preferred to step back and let the fight go on elsewhere.
CORNISH: Julie, you've been covering this area for a long time. What strikes you about this moment? I mean, is this as significant as it looks?
ROVNER: It's hard to tell. As I said, the AMA's been kind of everywhere on abortion issues. It looks like they're maybe coming out - finding this to be such a threat to the doctor-patient relationship that they're willing to take a leading role. It remains to be seen exactly where they will go from here.
CORNISH: That's Julie Rovner, chief Washington correspondent for Kaiser Health News.
Thanks for coming in.
ROVNER: Thank you. Transcript provided by NPR, Copyright NPR.