Three Is a Crowd: The New Doctor–Patient–Policymaker Relationship

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A recent increase in legislative initiatives involving specific aspects of the practice of medicine is challenging traditional doctor–patient relationships. A Florida state law prohibiting physicians from asking patients about the presence of guns in the home could potentially result in real harm because of the risk of childhood injuries, domestic violence, suicide, and homicide. A number of states have specific language physicians are supposed to use when obtaining consent for pregnancy terminations. Some of these items required by law to be contained in the informed consent are not based on science, but instead on political beliefs. Other legislative initiatives involve issues as varied as hysterectomy consents, glomerular filtration rates, family planning, and palliative care. Laws that prohibit physicians from asking patients certain questions may be violating doctors' First Amendment rights. Laws mandating what information is contained in procedural consent forms and requiring certain scripts to be utilized may interfere with patients' ability to have accurate, unbiased, objective information to assist in their decision making. Physicians may be caught in the untenable position of balancing their professional and ethical obligations to their patients with their duty to obey the law as citizens. Physicians should be involved in legislative advocacy to try to prevent policy makers from legislating the practice of medicine. The American Congress of Obstetricians and Gynecologists' Committee on Ethics should consider review of this evolving issue.

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