Ohio Issue 1 asks voters if health care should be left to patients and physicians, or politicians
The emergency room sign at O’Bleness hospital in Athens, Ohio. (Photo by David DeWitt, Ohio Capital Journal.)
Ohioans have a little less than a week to vote on Issue 1, which will encode Roe-like, pre-viability abortion rights in the Ohio Constitution. With opponents kicking up a great deal of misinformation dust, we need to zoom out to see the bigger picture. Clarity, after all, is a cornerstone of democratic life. Americans need to know what they are voting on for the system to work.
In 2019, I published a book on the concept of medical necessity. Some physicians didn’t like my argument that “medical necessity” is laden with politics and cannot be defined in purely clinical terms. I wanted readers to take their civic and political obligations more seriously. Though the Dobbs decision that overturned Roe undid a lot of the history I narrated in my chapter on abortion, the key argument still holds: The question of abortion is and has always been a political one that reaches into the very philosophical foundations of our country.
Sure, we could sit around at debate what constitutes a “medical emergency” and what is and is not “medically necessary.” These are important questions. The truth is, however, that if we make armchair prognostication about medical determinations our focus, two things are going to happen.
First, physicians and other healthcare professionals are going to be perennially confused about what they are legally allowed to do in the service of their patients. As some excellent reporting in the Washington Post explains, hospitals across the U.S. are out to sea when it comes to providing clear guidance to their employees. Part of the problem is that states that have passed anti-abortion legislation have left key terms — such as what constitutes a “medical emergency” — vague. The difficulty of defining such terms in the abstract is precisely why Issue 1 empowers physicians to make these determinations “on a case-by-case basis.”
Issue 1 opponents worry that this vagueness advantages those who support a patient’s right to choose to have an abortion. Everywhere they look they see a slippery slope of unfettered and unlimited abortions. In doing so, opponents have cast health care providers as dubious actors with nefarious intentions. If the Issue 1 opposition is to be believed, too many Ohio physicians are abortion-loving zealots who need to be constrained by Statehouse legislation. As a medical educator I can assure you: This insulting characterization couldn’t be further from the truth.
It is true that Americans’ trust in science has declined under persistent attacks during the pandemic. But physicians are still among the most trusted members of our society. If Issue 1 does not pass, physicians will be faced with a horrible choice: They can risk prosecution for attempting to serve their patients, or they can shy away from serving their patients out of fear. It doesn’t help, as I argued in a recent Columbus Dispatch commentary, that a key member of the Ohio State Medical Board is the most prominent anti-abortion advocate in Ohio. Who will have physicians’ backs in their efforts to serve the patients to whom they have pledged fidelity?
The proliferation of disinformation has mired Issue 1 in a he said/she said fight over almost everything that issue 1 has nothing to do with — parental rights, trans health care, and the ridiculous specter of 40th week abortions. Issue 1 opponents seem uninterested in talking about the actual issue.
To see the question more clearly, consider the following rules of thumb:
- Abortion — and all health care, really — is a question for patients to make in consultation with their health care providers. Full stop.
- If medicine is to remain the important institution we need it to be, we will need to trust physicians’ professional judgment. This point has a corollary: If Issue 1 doesn’t pass and Ohio criminalizes abortion (which it is posed to do), we may see an exodus of physicians at a time when we are experiencing serious workforce shortages. Students, residents, and practicing physicians are watching and waiting to see what happens next.
- Trust in physicians doesn’t mean blind trust. Larry Nassar, Richard Strauss, and a host of sexual assault cases in Ohio make clear that we need to reform the Ohio State Medical Board to ensure it is up to the important task with which it is charged. That body should be carefully composed in accordance with the highest ethical standards.
Elections are moments of political expression. As Dr. Marcela Azevedo, co-founder of Ohio Physicians for Reproductive Rights told me in a recent interview on my podcast, Prognosis Ohio, the citizen-led effort that brought us to Issue 1 is “wonderful,” “beautiful,” and “democracy at its best.”
Issue 1 asks Ohioans to take a political position on the matter of leaving health care decisions to patients and their physicians. It is fundamentally concerned with core questions of liberty, bodily autonomy, and the role we want government to play in our lives. ‘Politics’ gets a bad rap these days, and a lot of that is deserved. But only if we are clear on the political nature of the question Issue 1 poses to us can we cast a clearheaded and informed vote.
Dan Skinner is Associate Professor of Health Policy at Ohio University and host of the podcast, Prognosis Ohio.
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