A second Trump administration will accelerate the decriminalization of the medical profession

Unlike the first, Donald Trump’s second campaign did not focus on the Affordable Care Act or health care policy. An Associated Press poll found that the majority of voters do not view health care as a major concern, with only 8% of voters ranking it as a top issue.

However, the consequences of these choices will damage the medical profession. Over the past four years we have seen a dramatic erosion of the ability of physicians to set standards and standards for their practices. Instead, judges, politicians, and politicians—many without any medical training—have placed their judgment on what is appropriate medical treatment. The legal erosion of the medical profession will only accelerate under a second Trump administration.

Historically, law, medicine, and divinity have been self-regulating. Medical professional societies, specialty organizations, and physician-run organizations are the ones that develop both standards of care and standards of practice, including for potential physicians. And self-care of the medical profession allows doctors and patients a wide freedom to make the right decision in each situation.

But in the last four years there has been a significant erosion in the ability of doctors to take care of themselves. First, during the epidemic, trust in doctors decreased. Another study, published in the Journal of the American Medical Academy, showed that between April 2020 and January 2024, trust in doctors and hospitals dropped from 71.5% to 40.1%. The study suggested that people with low trust in the medical profession are less likely to be vaccinated against Covid-19. Community trust is a necessary part of volunteer work. The widespread distrust of doctors in the wake of the epidemic leaves the medical profession vulnerable to an attack on its ability to regulate itself.

Dobbs v. Jackson Women’s Health, the Supreme Court case that struck down the federal right to abortion care, provided a blueprint for substituting political judgment for medical expertise. States moved quickly to criminalize abortion care, often without much medical involvement. This shows how exceptions for the health or life of the patient in most abortion restrictions do not work. For example, in Texas, a doctor must determine that a patient has a “life-threatening condition” that puts him or her “at risk of death” or “at serious risk of serious impairment of major bodily function.” before giving an abortion. But this need already deviates from the standard of medical care, which is to intervene before the patient has a life-threatening condition. Doctors now risk criminal charges, hundreds of thousands of dollars in fines, and even jail time if they try to provide evidence-based care to patients who need abortions.

Trump himself certainly played a major role in the collapse of physician regulation. His nominees to the Supreme Court formed the majority that overturned Roe v. Wade. His advice on combating Covid-19 often contradicted that of his experts, such as his suggestion of injecting bleach.

And Trump has only doubled down on his attacks on the medical profession by courting the Make America Healthy Again movement. Make American Healthy is also spearheaded by vaccine skeptic Robert F. Kennedy Jr., who promises to end the FDA’s “war on public health.” That would translate into eliminating water fluoridation, against the recommendations of the American Dental Association and the Centers for Disease Control and Prevention. That will almost certainly mean pressure to revoke vaccine approvals and remove other vaccines from the market, even though there is general medical agreement about the importance of vaccines against many diseases. Kennedy, in particular, has no medical experience or training but may be empowered to “walk” on health as Trump has said.

There is also concern that Trump will “clean house” in federal agencies, removing public servants he sees as disloyal to him and his plans. In his last few months in office in 2020, Trump issued an executive order, “Schedule F,” that would have exempted the job security status of “a private, policy-making individual.” , who makes or advocates for regulations.” This would have made it easier for Trump to replace about 50,000 government workers — including those in health-care agencies who have degree and years of training. By removing civil servants, it will be easier for Kennedy, or another Trump nominee, to push controversial, untested plans.

But Kennedy is not the only one challenging the medical management of health care in the coming years. This fall, in the case of Braidwood v. Becerra, 5th^th The Circuit Court of Appeals ruled that the ACA improperly incorporated preventive care recommendations issued by the US Preventive Services Task Force (USPSTF), an independent, volunteer group of disease prevention experts and evidence-based medicine. The Appointments Clause of the Constitution, the 5^th The circuit argued, prohibiting public policy from being conducted by a group of experts who are not subject to government officials and who are not appointed “officers of the United States” themselves.

Braidwood is alarming not only because it would undo the cost-free preventive care mandate but because many other public health policy standards are currently set by the same non-governmental expert panels. In fact, the Braidwood plaintiffs are trying to expand this case to include a review of the ability of the Advisory Committee on Immunization Practices and the Department of Health and Human Services to make recommendations about preventive care. The case is likely to be argued before the Supreme Court, which has been established by Trump to have doubts about the expertise, which may include some of Trump’s nominees. The result may reduce the influence of medical and public health professionals by preventing government agencies from being able to incorporate recommendations, standards and other decisions into regulations.

At the federal level, the playbook that was used to shut doctors out of administering abortions will be used elsewhere. Many countries already prohibit gender-based care, especially for children. This statement the Supreme Court will hear United States v. Skrmetti, which focused on Tennessee’s ban on all gender-based treatments for children. These restrictions are against the recommendations of major American medical groups, such as the American Academy of Pediatrics, the American Psychiatric Association, and the American Medical Association.

If the court upholds the gender-based care ban, it could open the door for states seeking to block or limit access to health care that is politically unpopular. For example, the plaintiffs in Braidwood argued that the provision of free HIV pre-exposure prophylaxis encourages promiscuous sexual behavior and intravenous drug use. A state, which uses the same approach to prevent abortion or gender-based care, could make the provision of PrEP a crime. Drug treatment, IVF, and vaccinations have been politically controversial at times and may be held up again.

These restrictions are likely to come from the states – in part because under their police powers they have a wider area of ​​control over health care – and cause the medical profession to lose control of procedures. good and maintenance standards. But the Trump administration is likely to embolden state politicians and advocates who want to defund health care in part because Trump has already identified the gender-based care ban as a priority for the day first home in the office.

Much has been made of the details of Project 2025 and other Trump-related health care plans. Others, such as focusing on chronic diseases, may be beneficial. But in general, Trump and his team show little respect for doctors and other public health professionals. This comes at a time when the ability of medical professionals to self-regulate, including determining which treatments are appropriate to give patients, is under attack.

Medical leadership must find ways in the next four years to restore public trust and emphasize to the public that the patient and physician, not the legislator, are the ones making health care decisions. Their ability to determine the amount of medication can depend on it.

Carmel Shachar is an assistant professor of jurisprudence at Harvard Law School. He also serves as director of the Health Law and Policy Clinic at Harvard Law School’s Center for Health Law and Policy.