Herald-Leader reports on why Ky.'s main doctors' lobby has taken no real stance on abortion despite many doctors' worries: politics

Despite unwavering opposition to Kentucky's near-total abortion ban from the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and dozens of others, the Kentucky Medical Association's governing body chose to not adopt multiple evidence-based statements that abortion is an essential part of health care for Kentucky women. 

"The reason, according to half a dozen physician KMA members interviewed for this story, was largely political, and an attempt to strike a balance between competing opinions," Alex Acquisto reports for the Lexington Herald-Leader in a 2,564-word story. 

She writes, "In a state like Kentucky, where broad support of those laws is often buttressed by Christian doctrine rather than peer-reviewed research, many doctors are pinned between their ethical obligation to publicly advocate for patients and a need to compromise and avoid alienating the political party in power that passes those laws." Republicans have supermajorities in both legislative chambers. 

Acquisto adds, "Kentucky’s criminal penalty for violating the trigger law adds another layer of reluctance to speak up, doctors said." 

They are reluctant at a time when "Kentuckians are looking to physicians to cut through the political jargon, religious ideology and misinformation swirling around abortion access, and weigh in as health care professionals, especially with Constitutional Amendment No. 2 on the ballot in November," she writes. The proposal would prevent courts from finding in the state constitution a right to abortion or funding of it. 

The KMA "largely sidestepped" taking a stance on the issue at its annual meeting in August, she reports. "While doctors said restoring access to the full spectrum of reproductive health care is still their end goal, KMA sacrificed its pointed vocal opposition to laws not rooted in health care in order to preserve its working relationship with the Kentucky General Assembly." Doctors have long held sway in the legislature, especially in the Senate, and have been leading financiers of legislators' campaigns. 

Acquisto reports on five policy resolutions related to abortion that were considered by KMA's House of Delegates at its meeting in late August. 

A KMA spokesperson told Acquisto that the annual meeting debate proceedings are private and so are the lists of delegates and other attendees. 

"Three of the five were overtly critical of the Kentucky state legislature for banning abortion in all cases except medical emergencies by way of a trigger law." The delegates chose not to adopt any of the three "biting policy statements," but instead adopted one that does not mention abortion or “reproductive health care,” but urges passage of health-care policy that is “evidence-based.” 

It also adopted one titled "Improving Maternal Health" that more generally says KMA will "advocate for improved reproductive health care and resources" for Kentucky women, Acquisto reports. 

She reports that the Herald-Leader reached out to 19 KMA members for the story and six agreed to be interviewed. All said they either helped write the three rejected resolutions, participated in debate on them at the meeting, or cast votes. 

They told Acquisto that, despite the consensus among obstetrician-gynecologists on the importance of access to abortion, there is division in KMA over public advocacy of reproductive rights, often stemming from religious convictions and political beliefs among doctors outside that specialty.

"But a prevailing reason KMA didn’t take a stronger public stance," she reports, "was fear that lawmakers, seeing it as a slight, would refuse future input from the association on abortion policy."

Sen. Ralph Alvarado, M.D.

Acquisto reports that during debate at the meeting, Sen. Ralph Alvarado, R-Winchester, a KMA member, "was matter-of-fact in his warning: the legislature would be much less inclined to work with the KMA if it publicly bucked GOP lawmakers and their abortion laws, according to three people in the room who said it sounded threatening."

Alvarado, a family physician who ran for lieutenant governor in 2019 with then-Gov. Matt Bevin and has celebrated the fall of Roe v. Wade, gave Acquisto a statement saying he felt “uniquely positioned, qualified and obligated to offer my consultation” at the meeting and spoke “plainly about how an effective, collaborative working relationship between KMA and the General Assembly could and should occur,” adding that the association “cannot and should not be defined by a single policy issue.”

After the debate, the resolutions “took a more neutral position,” one that “better reflects current KMA members’ views,” Alvarado said. 

In other Southern states, such as Tennessee and South Carolina, doctors have been more assertive in asking their legislatures to reconsider their abortion bans, Acquisto reports: "In mid-June, at its annual meeting in Chicago, the American Medical Association publicly declared abortion a 'human right,' with 100% support' from Kentucky’s official delegation, said Dr. Coy Flowers, a Lexington OB-GYN who oversaw that local support."

But Flowers told Acquisto that it's not as easy [to take such a stance] back home in Kentucky, though, where it’s a “game of chess, not checkers in terms of politics and public advocacy." 

Flowers is one of 14 OB-GYNs nationwide to serve as an American College of Obstetrics and Gynecology delegate to the AMA.

Acquisto also writes about challenges faced by doctors because they are unsure how to interpret Kentucky's abortion ban. It forbids abortion except to prevent the woman's death, a “substantial risk of death due to a physical condition,” or “serious, permanent impairment” of a “life-sustaining organ.”

The law does not define those terms, nor does legal guidance exist on the range of conditions for which an abortion is medically necessary even if a the woman's life is not imminently threatened. Attorney General Daniel Cameron issued a second advisory opinion Oct. 26 to clarify the scope of the ban, but it "didn't provide clarification on a litany of other medical conditions and treatments impacted by those laws," Acquisto reports. Doctors told her that this is yet another reason that the KMA should more strongly assert itself.