Gag Me with a Spoon

Arthur Caplan

For doctors, the old saw “Gag me with a spoon” no longer applies. Today it is “Gag me with a (a) toxic chemical, (b) gun, or (c) transvaginal ultrasound probe.” This appears to be the new ethics of medicine for doctors in America. Why are we letting state legislators, religious zealots, and big business tell doctors what they can and cannot talk about with patients and with other doctors? Since when is a government official welcome to dictate the nature of the conversation that goes on between you and your doctor? Since the past few years, which have seen an explosion in both legislative restrictions and mandates on what your doctor can say.

A new law in Pennsylvania, modeled after existing laws in Texas and Colorado, restricts what doctors can say about chemicals used in natural gas drilling or fracking that might be making people sick. Let’s say you think you or your child is sick because of exposure to chemicals in the water or soil near a fracking operation. And let’s say some of those chemicals being used are trade secrets. The law says your doctor can, with some effort, get access to information about the identity of these trade-secret chemicals but can’t tell anyone else—you, your family, or even other doctors—about what he or she thinks it is that might be making you sick! So business, not your doctor, is dictating what is best for your health.

Last year, the Florida legislature passed, and Governor Rick Scott signed, the Firearms Owners’ Privacy Act. That law made it illegal for physicians to ask patients whether there were guns in their homes. This despite the fact that pediatrics groups recommend that physicians ask patients whether they keep guns at home and discuss gun safety with those who do, in order to prevent shootings involving children. In 2009, according to the CDC, almost four hundred children younger than fifteen years old were killed by the mishandling of firearms.

This muzzle on doctor speech was challenged in court, and a federal judge in Miami ruled the law unconstitutional, but the governor and legislature have vowed to pass another law. So the legislature and the gun lobby are in charge of telling your doctor what to say about how best to protect children’s health in Florida.

And let us not forget about the endless stream of efforts to make doctors do invasive tests and report the results to women seeking abortions. Republican majorities in both chambers in Virginia’s legislature last February passed one of the strictest mandatory pre-abortion ultrasound bills in the nation—a measure that would require women seeking early-stage abortions to submit to being vaginally penetrated by a condom-covered electronic probe and hear a speech about the fetus before an abortion is allowed to proceed. Oklahoma passed a bill allowing abortion providers or those prescribing abortion-inducing drugs to be sued by if they fail to follow state law that requires that ultrasound imaging and heart-monitoring be done before an abortion is performed, accompanied by the mandatory informed consent speech about the fetus. So even if the woman does not want either the test or the speech, the solons of the Sooner State know better than her.

Such third-party intrusions on the sanctity of the doctor-patient relationship bode ill for both the trust patients have in their doctors and for doctors’ ability to do what they deem is best for their patients. The exam room is too small to fit greedy corporate titans, gun nuts, religious zanies, and state officials alongside the doctor and patient. Allowing them to dictate medical practice is simply bad medicine for all of us.

Arthur Caplan

Arthur Caplan is director of the University of Pennsylvania’s Center for Bioethics and a nationally prominent voice in the debates over cloning and other bioethical concerns.


For doctors, the old saw “Gag me with a spoon” no longer applies. Today it is “Gag me with a (a) toxic chemical, (b) gun, or (c) transvaginal ultrasound probe.” This appears to be the new ethics of medicine for doctors in America. Why are we letting state legislators, religious zealots, and big business tell …

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