AMA House of Delegates

The "don't ask, don't tell" law is "hurting people, it's making doctors lie, it's having patients not get proper care and it's hurting the military," says Dr. Wertsch, a family physician, who brought the issue before the house.

AMA meeting: "Don't ask, don't tell" said to hurt patient care; repeal urged

The House of Delegates also said a lack of marriage rights contributes to health care disparities that affect gay families.

By Kevin B. O’Reilly — Posted Nov. 23, 2009

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The American Medical Association came out in favor of ending the "don't ask, don't tell" law that requires gays in the military to hide their sexual orientation from their physicians and others. Delegates to the AMA Interim Meeting said the policy threatens the physician-patient relationship and compromises the medical care of gay patients in the military.

The military reserves the power to inspect service members' medical records for combat readiness purposes. So any mention of their sexual orientation could result in discharge under the federal law governing the military's policy on gays, known as "don't ask, don't tell."

The law puts gays in the military and their physicians in an untenable situation, said Wisconsin Medical Society delegate Paul A. Wertsch, MD, who brought the issue before the house. "If you can't trust your doctor to tell the truth, you're not going to tell the truth," said Dr. Wertsch, whose son is gay. "If a doctor feels that by writing down the truth, he can get you in trouble, that's a bad situation."

The "don't ask, don't tell" law is "hurting people, it's making doctors lie, it's having patients not get proper care and it's hurting the military," said Dr. Wertsch, a family physician.

His original resolution asked the AMA to lobby the armed forces to change policy to protect the confidentiality of any disclosures regarding sexual orientation. But military physicians testified in reference committee that federal law governed the matter and the law is what needs to change. The committee strengthened the resolution to call for a complete repeal of the "don't ask, don't tell" law, and the house adopted it without debate.

"The AMA took the horse by the reins in doing what needed to be done to call for the repeal of something that creates such disparities and such health care risks," said Jennifer Chaffin, MD, a San Ramon, Calif., forensic psychiatrist who chairs the AMA Advisory Committee on Gay, Lesbian, Bisexual and Transgender Issues. Dr. Wertsch also serves on the committee.

Alexander Nicholson, executive director of Servicemembers United, which represents gays actively serving in the military and veterans, testified before the AMA reference committee. "This is yet another nail in the coffin of the flawed and outdated 'don't ask, don't tell' law," he said later, "It should send a strong message to those who continue to blindly claim that this policy works."

A July 2008 Washington Post-ABC News poll found that 75% of Americans back allowing gays to openly serve in the military.

After months of inaction and growing complaints from gay advocacy groups, President Barack Obama in October reaffirmed his campaign pledge to sign legislation allowing gays in the military to reveal their sexual orientation.

"President Obama has been clear ... that he is committed to repeal the 'don't ask, don't tell' policy," said Lt. Col. Jonathan Withington, a Dept. of Defense spokesman. "He has also been clear that he is committed to doing it in a way that is least disruptive to our troops, especially given that they have been simultaneously waging two wars for six years now."

Repeal of "don't ask, don't tell" is likely to be part of next year's Defense Dept. authorization bill, according to Rep. Barney Frank (D, Mass.), who is one of three openly gay members of Congress.

Marriage disparities

A separate AMA Council on Science and Public Health report found that gay families face a host of health disparities, such as unequal access to health insurance benefits, due to laws barring them from marriage.

"Exclusion from civil marriage contributes to health care disparities affecting same-sex households," said the council's report recommendation, which the house adopted.

The AMA's new policy -- also adopted without house debate -- commits the organization to working to reduce health disparities in gay families and supporting "measures providing same-sex households with the same rights and privileges to health care, health insurance, and survivor benefits, as afforded opposite-sex households."

The policy does not call for repealing the Defense of Marriage Act -- which denies federal benefits to same-sex partners -- or for backing state-level attempts to give gays access to civil unions or legal marriage.

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Meeting notes: Medical ethics

Issue: Industry funding of continuing medical education and CME faculty with financial conflicts may inappropriately influence educational content.

Proposed action: Develop ethical guidance advising that commercial support should be avoided when possible. Lay out principles for how to minimize financial conflicts and reduce the potential for bias. [Referred]

Issue: Kidney transplant chains have become more prevalent in recent years, raising questions about their propriety.

Proposed action: Examine the scientific feasibility and ethical implications of these new practices. [Adopted]

Issue: Some medical students and doctors post unprofessional content online.

Proposed action: Write ethical standards for physician professionalism online and incorporate them into the modernized AMA Code of Medical Ethics. [Adopted]

Issue: Illegal immigrants sometimes are discharged from American hospitals and repatriated to their home countries, where they get little or no medical care.

Proposed action: Develop ethical guidance advising doctors to refuse to sign discharge orders that would repatriate such patients involuntarily. [Referred]

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