How silencing medical debates puts patients at risk

Alison Riddoch is a legal clerk for Campus Rights Advocacy at FIRE and a student at Duke Law School, class of 2027.

“There’s much misinformation about this care,” says Shelley Sella, a longtime provider of third-trimester abortions. “It’s shrouded in secrecy and, because of that, it’s stigmatized.” Sella has made public education part of her mission, which is why Medical Students for Choice invited her to give a talk on third-trimester abortion care at Texas Tech University Health Sciences Center this past January. But after a campaign by TTUHSC’s Turning Point USA chapter and off-campus pro-life activists, the school canceled the event, claiming it was “not in the best interest of the university.” 

But allowing the event to proceed would have been in the school’s best interests — not only because of its obligation to protect student events under the First Amendment, but also because it should aim to prepare students to respond to challenges they will surely face in their future careers.

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Some topics in medicine can be uncomfortable to discuss. But debate and disagreement are signs of conversations worth having, not problems to be avoided. It is only through open discussion that we can meaningfully address questions about ethics, patient care, and medical judgment. When educational institutions censor these conversations, they prevent the very debate necessary for informed decision-making, leaving students less equipped to navigate the ethical and clinical challenges of their chosen fields.

Regardless of one’s views on late-term abortion, the ethical questions it raises are a reality that future medical practitioners must confront. Nine states and the District of Columbia currently have no abortion cutoff period. In many other states, late-term abortions are allowed if the fetus has a fatal condition or if the pregnancy threatens the mother’s health. Medical professionals need to learn as students to be prepared to communicate clearly and compassionately with future patients facing difficult decisions while balancing their own moral beliefs, institutional policies, and legal constraints. 

Efforts to censor controversial medical and scientific knowledge are not new. In the late 19th century, the Comstock Act and numerous state laws criminalized distributing information about contraception and reproductive health. Classifying what we now see as basic medical knowledge as “obscene” material, these laws prevented doctors, educators, and ordinary people from making their own informed opinions. These laws also had wide-ranging negative effects on public health and health education, from preventing the sharing of information about how to prevent sexually transmitted diseases to restricting the publication of accurate medical textbooks.

If students are not able to engage in these conversations in classrooms and at campus events, with the guidance of faculty and the benefit of diverse perspectives, how can we expect them to do so competently when real patients, real communities, and real consequences are at stake?

Or consider the infamous Tuskegee syphilis study, in which the U.S. government deliberately withheld treatment from 400 black men with syphilis in order to observe the effects of the disease, even to the point of death. It was only through open scrutiny, public discourse, and investigative reporting that the study’s harmful practices were exposed and ultimately ended, leading to sweeping reforms in research ethics. This stain on American medical history remains an essential topic of discussion precisely because it teaches us that suppressing difficult conversations about medical ethics can allow harm to persist — and that open, honest engagement with even the most uncomfortable chapters in medical history is necessary to prevent their repetition.

Shielding individuals from conversations to prevent potential discomfort sends a powerful but damaging message that it is better to remain silent and uninformed than to engage thoughtfully with difficult questions. But nobody benefits from ignorance, particularly in the medical arena. Reasonable people can and do disagree in good faith about the ethics of specific medical procedures, emerging technologies, and areas of scientific research. Exposure to and discussion of controversial medical topics allows future professionals to develop their own ethical frameworks, grapple with competing values, and learn from the experiences of those who have gone before. Accordingly, these conversations have direct implications for the future of patient care, public health, and scientific research.

Advances in science and medicine will continue, raising new and difficult ethical questions that future professionals will have to confront. If students are not able to engage in these conversations in classrooms and at campus events, with the guidance of faculty and the benefit of diverse perspectives, how can we expect them to do so competently when real patients, real communities, and real consequences are at stake?