The politics of abortion and Amendment 4 have shined a light on rifts among medical practitioners across the state. Amendment 4 would enshrine abortion protections into the state constitution, and physicians of varying specialties have come out both for and against the measure.
“Having practiced now for over 20 years, I can't think of anything else in the past that has become so political,” said Dr. Lynda Balint, an OB-GYN who teaches ethics in medicine at Rollins College in Winter Park.
“I don't recall in my past having physicians against public health measures.”
That was until the COVID-19 pandemic.
Balint recalled health care providers having differing opinions on the usefulness of masks and Dr. Joseph Ladapo, Florida’s surgeon general, coming out against the mRNA vaccines recommended by the Centers for Disease Control and Prevention.
Since then, the divide within Florida’s medical community has been deepening, Balint said.
Still, she said what’s happening over Amendment 4 is different.
The political-medical divide has reached the ballot box, and physicians are reaching out to voters.
Over the summer, Floridian Physicians Against Amendment 4 emerged with more than 700 physicians of varying specialties from around the state. The group has been appearing alongside the Florida Agency for Health Care Administration and Gov. Ron DeSantis rallying against the measure.
The group’s founder, Dr. Grazie Christie, is a radiologist in South Florida.
“It was written in a very deceptive manner, and the results of Amendment 4 would be to almost completely deregulate abortion in Florida,” Christie said.
According to Christie, Physicians Against Amendment 4 is a mix of doctors both pro-life and pro-choice. Christie said what’s bringing them together is the belief that the wording of the amendment could actually eliminate protections in place.
“Amendment 4 is written precisely to make things difficult to interpret for voters, and that's why there's so much confusion out there,” Christie said.
Amendment 4 reads:
“No law shall prohibit, penalize, delay, or restrict abortion before viability or when necessary to protect the patient's health, as determined by the patient's healthcare provider. This amendment does not change the Legislature's constitutional authority to require notification to a parent or guardian before a minor has an abortion.”
Floridians Protecting Freedom was the coalition that petitioned to get the measure on Tuesday's ballot. According to its campaign, it has over 850 doctors who support Amendment 4.
Among them is Dr. Matthew Wollenschlaeger, an OB-GYN in Central Florida.
About six months ago, he had a patient who was diagnosed with cancer and was six weeks pregnant.
“She decided to continue the pregnancy, but that was her choice. The state wouldn't have given me an option to help protect her, to go ahead and end the pregnancy if necessary,” he said. “If ending the pregnancy was the correct thing, the state forces us to ask permission from other physicians from the hospitals, to do our jobs, to do the things we’re board-certified and able to do and are trained to do,” Wollenschlaeger said.
In May, Florida enacted a law that prevents patients from undergoing an abortion after six weeks of gestation, with exceptions to save the life of the mother or for victims of rape, incest or human trafficking.
When asked about this anecdote, Christie said that particular cancer case was actually a good argument against Florida’s restrictions.
“Abortion is health care in a sense, right? Sometimes a woman wants to start her chemo and she doesn't want to wait till she gives birth to her live baby, and she wants to abort, and that's a reason for abortion,” she said. “But those cases are very rare in general.”
What doctors are saying about the other side
Christie pointed out that doctors are people, too, and are susceptible to misinformation.
“Doctors are not immune from the misdirection and the misinformation and the vagueness of the wording of the amendment. Doctors aren't lawyers,” she said. “So they're not experts on how amendments in the constitution play out.”
Physicians Against Amendment 4 has stated that the ballot measure would create an unsafe world of abortion for women, removing safety regulations and allowing for late-trimester abortions.
Wollenschlaeger disagrees with that assessment and acknowledges that every doctor has a choice, but he felt confident he was making the best choice for his patients.
“If they don't want to do (an abortion), don't do one. That's their choice. Doctors should not be standing in the way of other physicians who don't have that conscientious objection and believe that this is appropriate health care,” he said. “You look at the list of physicians who sign up for (against Amendment 4), most of them are not OB-GYNs. So they don’t have the specialized knowledge base to make that decision.”
Doctors being involved in politics (and especially politics regarding abortion) isn’t anything new.
Midwives had traditionally carried out abortions until the 1860s, when a small coalition of doctors started a campaign to criminalize abortion throughout the country, according to Planned Parenthood.
In terms of safety, legal experts have stated that Amendment 4 would prevent laws that would restrict or prohibit abortions but shouldn’t remove health guardrails that would keep patients safe in any standard medical procedure. Abortions after 21 weeks do happen but are difficult to obtain and make up 1% of all abortions, according to a study by KFF.
“Physicians have come down with opinions (on public health law) in the past,” Balint said. “We physicians are entitled to different opinions and different beliefs. … But we certainly know that abortion is safe. It has been happening since the beginning of society. It's become safer because of developments. It's become safer because it's in the hands of health care.”
When doctors fight, what do patients do?
At the heart of the matter, according to Balint, is the impact of doctors disagreeing and the effect it has on patients. Balint said this fight could harm public trust in doctors since this matter is so close to people’s personal beliefs.
“I always tell my patients or friends who are calling me, 'Don't be afraid to get a second opinion.' If you don't feel like you are being heard, you don't feel like you're a partner in decision-making with your physician, you probably need to find another opinion,” she said.
But not all patients may respond that way, said Chanae Jackson, a social justice and community activist. She’s been a voice for patient advocacy in the Black community and concerned about a political divide in medicine.
“It's dangerous,” she said. “Speaking as a patient, most often, especially again, from the perspective of a Black woman, Black people often trust their doctor. Many don't understand that they have self-determination. They have a choice. So when their doctor says one thing, they go with their doctor on that thing, even if it's not necessarily the best thing.”
Ultimately, Jackson’s concern falls on patients not knowing what options are available to them. She believes what’s medically available and approved to be safe in one doctor’s office should be true in all offices.
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