In a 5-3 decision Monday, the U.S. Supreme Court set forth a framework under which state laws that restrict patient choice to a legal medical procedure must be based on evidence of actual benefit to health and safety in order to withstand constitutional challenge. The Court’s decision is likely to have far-reaching implications on cases beyond the medical procedure at issue—abortion—and represents an important acknowledgement of the critical role medical evidence serves in shaping and evaluating legislation that impacts the patient-physician relationship.
In Whole Woman’s Health v. Hellerstedt, the Court struck down a Texas law that required physicians performing an abortion to have admitting privileges at a hospital within 30 miles of where the abortion is performed and that required facilities performing abortions to meet the standards of an ambulatory surgical center. The Court directed that such regulations can only withstand challenge if the greater weight of medical evidence demonstrates that the regulation will further, not harm, patient health and safety. That finding must then be compared to the burden imposed by the regulation, such as a reduction in access, to determine whether the regulation imposes an undue burden on a patient’s right of access to the procedure.
Applying this framework, the Court, relying on peer reviewed studies and expert medical testimony, found there was no basis to single out abortions, which have a lower complication rate than many outpatient procedures such as colonoscopy, and that requiring admitting privileges would decrease access to a legal medical procedure without any corresponding benefits.
“The Society welcomes the Supreme Court’s focus on the benefits to health and safety in evaluating the regulation of legal medical procedures, as well as its reliance on the best medical evidence available,” said Wisconsin Medical Society Chief Medical Officer Donn Dexter, MD.
The Society urged courts to apply a similar analysis in a related case, Planned Parenthood of Wisconsin v. Schimel, involving a challenge to a Wisconsin admitting privileges requirement. The Seventh Circuit Court of Appeals struck down Wisconsin’s admitting privileges requirement last December. The Society participated in two amicus briefs in that case, asserting, along with the American Medical Association (AMA) and American College of Obstetrics and Gynecology (ACOG), that the best medical evidence available demonstrated that the regulation would not improve patient health or safety, but would negatively impact the patient-physician relationship and physicians’ ability to provide high quality care. The two briefs are available here and here. The Society opposed Wisconsin’s admitting privileges requirement because it interferes with the patient-physician relationship and was not supported by evidence demonstrating improvement to the quality of patient care. See the Society’s testimony here.
On Tuesday the Supreme Court denied the State of Wisconsin’s appeal in Planned Parenthood of Wisconsin, Inc. v. Schimel, meaning the Wisconsin admitting privileges requirement is permanently barred from enforcement.
See this Dec. 3, 2015 Medigram story for more information about the case.
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