PHILADELPHIA -- After hours of debating conflicting amendments and untangling parliamentary procedure, the American Academy of Family Physicians (AAFP) Congress of Delegates approved a policy nominally backing family physicians trained in providing abortions.
Passed by a vote of 70-45 here on Tuesday, the agreed-upon resolution states that the AAFP "support[s] family physicians who have the training experience and demonstrated competence in providing medication and first trimester aspiration terminations."
The final resolution was narrower than a proposed statement calling for the AAFP to support "all clinicians" providing such services, which was put forward by the Washington Academy and debated in a smaller committee earlier at the meeting. Two clashing amendments -- one from the New York delegation to alter "first trimester aspiration terminations" to "procedural abortions" and another from Louisiana that called for "a position of neutrality on abortion" -- both failed to pass.
Expanding Access
Kevin Wang, MD, an alternate delegate from Washington, called the approved resolution "a good first step," and said this is the first time in his experience that the AAFP has offered support to physicians performing first trimester manual aspirations as opposed to a general blanket statement of support for all reproductive health services.
"This is a step in the right direction, calling out, 'We do support people in performing this legal procedure,'" he said. "I'm hoping we'll be able to move forward in future years."
Wang told ľֱ that the intent of the initial proposed resolution was to improve patient access to abortion by supporting advanced practice clinicians trained in performing these services. In their initial resolution, the Washington delegation noted that roughly 87% of U.S. counties have no abortion providers and that patients travel an average of 30 miles to access care, with nearly one-third of women in rural areas needing to travel over 100 miles.
Washington state, and several others, allows advanced practitioners to provide abortion.
Pro-Abortion, Anti-Abortion, or Neutral?
During a committee discussion on Monday, Thomas Field, MD, of Indiana, spoke to the substance of the resolution, expressing his frustration after having watched the Academy "flip and dodge" around abortion for years, and urged his colleagues to focus specifically on the resolution's language.
"All we're saying is we're supporting physicians who are doing a very legal, reasonable procedure for their patients," he said. "I don't see this as advocacy that someone should or should not get [an] abortion."
"Any language that says 'support' means support," countered Ian Jackson, MD, of Michigan, speaking for himself and several of his pro-life colleagues. "That language is very divisive."
"'All clinicians' also brings up, I think, some murky waters about ability without any restrictions," he added.
Lisa Gilbert, MD, an AAFP member from Wichita, Kansas, speaking for herself and over 1,700 other clinicians who signed a petition requesting neutrality on the issue of abortion, said some of those members would leave the organization if it were to declare a pro-abortion stance.
"It's, to me, very sad that we cannot agree to just disagree and be neutral on this topic," said Janet Hurley, MD, a member from Texas.
In discussing a separate abortion-related resolution at the meeting, Catherine Romanos, MD, of Columbus, Ohio, said many of her patients tell her they don't want their family physicians to know they've had the procedure, but that "staying neutral is not staying out of the debate."
It's "abandoning" the one in four women who have an abortion, she said.
Parliamentary Quandary
A good portion of the debate Tuesday was spent considering a resolution put forward by anti-abortion delegates from Louisiana, which called for the AAFP to "reaffirm that our current policies on reproductive decisions and maternity health are appropriate for our diverse membership and do not require revision" and called for the Academy's board of directors to "formally communicate to the leadership of all constituent chapters their intention for a position of neutrality on abortion."
At the end of the day, delegates and alternate delegates from New York and Texas challenged Speaker Alan Schwartzstein, MD, over his decision to allow the Congress to consider the Louisiana resolution in the first place.
When the amendment had first been introduced, Marc Price, MD, a delegate from New York, argued that it had nothing at all to do with the policy resolution being discussed, but later acknowledged that he had not specifically put forward a motion questioning the "germaneness" of that resolution.
Eventually, AAFP President John Cullen, MD, stepped in and pointed out that Louisiana's resolution was indeed "problematic" because the Academy's current position "is not neutral, but is based on Supreme Court decision [Roe v. Wade] and patient-physician autonomy."
Soon afterward, in a voice vote, the decision to consider the Louisiana resolution for further debate and a potential vote was overturned.
Related Abortion Policies
A series of similar resolutions intended to affirm the safety and legality of abortion were not adopted because they were thought to be "consistent with current policies" that support protecting AAFP members "who choose to practice medically legal procedures, as well as those who do not, while upholding the patient's right to informed decision-making."
The AAFP also reaffirmed policy protecting members from criminalization of medical practice broadly in lieu of two separate resolutions, one of which called on the AAFP to specifically oppose the criminalization of physicians providing abortion and another which urged the Academy to issue a position paper opposing such criminalization and to oppose any laws targeting family physicians who provide such services.