Guest post by John Hughes
The American College of Emergency Physicians has nearly 40,000 members in its ranks. Most ER physicians in the US are members. Its mission statement from its own website reads “ACEP promotes the highest quality of emergency care and is the leading advocate for emergency physicians, their patients, and the public.
On 24 June 2022, SCOTUS ruled on the Dobbs Vs Jackson abortion rights case. Within hours, ACEP Now (The Official Voice of Emergency Medicine and available to anyone online) posted an article that discussed the ruling, reviewed the medications and doses Emergency Providers (EPs) can prescribe to cause abortions (EPs doing abortion), and commented negatively on crisis pregnancy centers.
“If providing patients with clinic referrals, emergency physicians should be aware of crisis pregnancy centers (CPCs). These centers are usually staffed by non-medical personnel, are meant to dissuade patients from seeking abortions through misinformation and intimidation, and currently outnumber abortion clinics by three to one in some states and as high as nine to one in others.”1
The article didn’t advocate discussing options other than abortion to pregnant patients and lacked the usual risk/benefit discussion of any procedure, especially in this case when post abortion depression and suicidality is well documented?
Bear in mind, the webpage for ACEP Now states the following about its mission:
“ACEP Now is an official publication of the American College of Emergency Physicians. Emergency physicians rely on ACEP Now for indispensable content that can be used in daily practice.
ACEP is the specialty society for Emergency Medicine, and ACEP Now is the official voice of Emergency Medicine.
With a rapidly evolving heath care system, emergency physicians need a trustworthy source for the most valuable and insightful information that impacts the practice of Emergency Medicine. That source is ACEP Now.
Written by physicians for physicians, each issue delivers cutting edge news, practice changing tips, regulatory updates, and the most up to date information on health care reform.”
The article in ACEP Now is articulate, full of references, and appears to have been written well ahead of the SCOTUS decision that was released just hours before the article was published, indicating a likely pre-meditated ACEP stance/bias. The article is not labeled as an opinion or editorial and does not have the usual disclaimer that ‘the views of the authors don’t reflect the views of ACEP.’ This means ACEP approved the article and published it in the ‘Official Voice of Emergency Medicine’ declaring a biased policy to be the policy of ACEP.
ACEP nor any other medical organization has condemned Senator Warren for calling for the closure of all Crisis Pregnancy Centers (CPCs). CPCs offer another course of action and if medical organizations wish to remain neutral and comprehensive they should dissuade politicians from ‘legislating’ medicine and depriving doctors and patients of a discussion option for an alternate course of action.
That same day, 24 June 2022, also within hours of the SCOTUS decision, the President of ACEP posted the following on the ACEP discussion board:
‘Good afternoon, ACEP Nation. As our Board convened in Dallas today, two major issues broke that affect our daily practice and I wanted to bring them to your attention.
First, the Supreme Court overturned Roe v. Wade.
Second, the House and Senate passed a Firearm Injury Prevention Bill.
Highs and lows…we emergency physicians know them well. I am grateful to be on this roller coaster with my fellow emergency physicians whom I deeply respect. I will keep you updated on issues as I can. Know we continue to fight for you.’
Regarding this thread itself, the ACEP president labeled the SCOTUS ruling and firearm prevention bill as a “High and Low.” One can guess by the tone that the firearm bill was the “High” and the SCOTUS abortion ruling was the “Low.” Words have meaning. High and Low are descriptors of emotion. Emotion means bias and thus another biased statement by the ACEP president on behalf of the organization. This one is only visible to ACEP members, but shows potential bias nonetheless.
That same day, 24 June 2022, ACEP posted its 3rd statement on the SCOTUS Ruling. The following was posted on the ACEP page visible to members and nonmembers:
“Emergency Physicians Deeply Concerned by Laws that Interfere with the Physician-Patient Relationship
As the Supreme Court overturns precedent established by Roe v. Wade, the American College of Emergency Physicians (ACEP) is deeply concerned about the medical and legal implications of judicial overreach into the practice of medicine.
ACEP believes that emergency physicians must be able to practice high quality, objective, evidence-based medicine without legislative, regulatory, or judicial interference in the physician-patient relationship. This strong principle was codified in a policy statement approved by the ACEP Board of Directors yesterday.
“Decisions by nonmedical professionals that interfere with the physician-patient relationship are extremely worrisome,” said Dr Schmitz, MD, FACEP, president of ACEP. “Politics should never compromise an emergency physician’s ability to have an honest discussion with a patient about their health or to evaluate all treatment options.””
Abortion is a moral, ethical, and most importantly as SCOTUS has ruled twice, a legal issue. This is where courts operate. ACEP’s leadership is criticizing a government entity for a legal issue. This appears to show bias.
The ACEP President opened a new thread in the ACEP physician discussion board. Many in this thread have used the circular fiat argument to justify this ACEP statement. It goes something like: issue x is science, because I said it was science, it is science, therefore because it is science it is medical and therefore off limits to government control.
Interestingly, ACEP advocated for an ‘honest discussion’ to ‘evaluate all treatment options’ yet railed against CPCs. For all diseases doing nothing is a treatment option to discuss with a patient. CPCs offer an alternative to abortion and ACEP demands the ability to offer bedside dr/patient dialogue and a discussion on all options. In the same breath on the front page of ACEP Now, ACEP simultaneously advocates against CPCs and stays silent when a sitting Senator (Warren) wants to outlaw such options in the abortion discussion. Last week the Michigan governor defunded Crisis Pregnancy Centers, again with no ACEP leadership commentary. This shows bias and perhaps even hypocrisy.
Data on abortions is difficult to nail down. Admittedly, there is lots of cognitive bias in reporting. However, usually between 5-7% of abortions annually are done for actual emergencies/medical indications. The rest are elective. A healthy mother with healthy progressing IUP is not an emergency. This is a legal, moral, and ethical issue but not a medical one for sure. The fact that twice in a century a court has ruled on the issue means at least in the US it is a legal issue. Many if not most of the states looking at limiting abortions still allow emergent abortions especially early on for complications with a pregnancy. Lumping the 95% of elective abortions with potential emergency conditions muddies the water; many ACEP members attempted to do this. ACEP ER physicians debated this in the online forum thread. Moderators blocked several pro-life posts. Professional discussions about current events is healthy among members. Moderation/censorship by the organizational leadership that is supposed to be politically neutral is concerning.
Some within ACEP had advocated for those with differing views to just leave ACEP. Fortunately, some saner colleagues advised against such rhetoric. ACEP is a great organization representing most EPs by membership numbers. Forming new competing organizations is likely not in the best interest of emergency medicine or the public. At the same time, many providers and patients are beginning to distrust many medical organizations because of perceived self-interest and/or bias in the organizations. This is probably why the AMA membership has likely plummeted in the past 50 years. I don’t wish to leave ACEP and I also don’t want this to be the fate of ACEP as well. Bias fractures organizations. Many in ACEP don’t agree with what we see as progressively left leaning bias and we are also aware that expressing these views makes many in ACEP uncomfortable as we think they expect all members to fall in line with the prevailing or at least loudest speaking ideology of providers.
The 24 June 2022 Post by the ACEP president generated a very spirited debate between ER physicians that support abortion and those that don’t. I had one post accepted and one more blocked by moderators. I don’t know how many more posts were blocked. The thread was eventually shut down (the first time ACEP has done this on a thread). The moderator emailed the following to ACEP members as they closed the thread, “This thread will now be closed, but all members are encouraged to begin a new post on topics of relevance and importance to the profession.” This statement may indicate that ACEP does not consider examining its own political statements relevant to the profession. I contacted the moderator who said the thread was closed because it was becoming “purely political” and went on to say that posts would be blocked if they named specific doctors or used inflammatory language. Despite this revelation, the moderator had allowed pro abortionists to attack pro-life doctors by name with very unprofessional commentary. It seemed the moderators were only censoring pro-life doctors. It also seems ACEP wanted to be able to make very public partisan political statements but did not want its members to review its actions in an online forum.
A regional leader of ACEP posted the final comment before the thread was removed, saying abortions aren’t performed in ERs and encouraging ER physicians to focus on other, more relevant “existential issues” to medicine. In my view, bias/perceived bias is the biggest ‘existential’ threat to ACEP and medicine at large. Practical, broadly accepted solutions to many other important issues will likely be elusive until this is tackled. Some colleagues have pulled the ‘misinformation’ card; others attacked colleagues’ religion. I can only say that suppressing opposing views with threats of cancel culture/brute force further undermines trust and integrity in organizations. To date, ACEP leaders have not addressed the question of organizational partisanship that is circulating among many members.
5 days later the ACEP moderator allowed a new thread to begin by an ER physician complaining that the ACEP physician that testified before the Indiana Senate last week was not pro Abortion enough.
John Hughes, MD
USMA Class of 1996 (#1 graduate)
3rd Generation West Pointer
4 combat tours of duty in Iraq and Afghanistan
1Koyoma A, Et al. “The Emergency Department After the Fall of Roe: Are You Prepared?” ACEP Now. 24 JUN 2022.