Verified by 
In this new and uncertain time in American history, we physicians and trainees feel a special responsibility. We strive to keep our clinical judgment unclouded by our political persuasions, yet we cannot help but see the manifestations of our society’s ills in our everyday practice. For our patients, poverty, violence, and marginalization are not mere abstractions but instead harsh realities. As a result, we feel compelled to act and advocate against any threat to our patients’ well-being.
The policies proposed by the incoming administration under President-Elect Donald Trump may pose just such a threat. In light of these proposed changes to our healthcare system, we proudly affirm the following eight beliefs on behalf of the health of all Americans:
1. We believe that health is a human right.
Health is a fundamental condition for human flourishing, without which economic prosperity and political freedom have little meaning. Therefore, all Americans should have access to essential, effective healthcare regardless of their ability to pay. With the passage of the Affordable Care Act (ACA), we made great gains towards increasing access to care, particularly for economically disadvantaged communities. The tens of millions of Americans who gained insurance coverage under the ACA are understandably frightened by calls for this legislation to be taken down in whole or in part. We vow to fight for the provisions of the ACA that have enabled us to achieve these gains in access and quality of care, while continuing to push healthcare reform toward our goal of access to care for all.
2. We believe in evidence-based medicine and public health policy.
After an electoral cycle in which feelings often triumphed over facts, we must reaffirm our commitment to the principles of science. In medicine, we strive to produce research that is non-partisan and free of personal bias in order to guide our practice as physicians. We must continue to place our trust in scientific consensus and use facts to fight feelings when elected leaders raise doubts about long-settled debates, from vaccines to climate change. Moreover, we must ensure that the regulatory process for determining the safety and efficacy of pharmaceutical drugs remains rigorous and uninfluenced by financial incentives from the private sector. We vow to defend the pursuit of scientific truth and free inquiry in America.
3. We believe that there is no health without mental health.
Individuals with mental illness and substance use disorders experience debilitating stigma and are often prevented from accessing essential care by underfunding and intentional insurance roadblocks. These issues are all the more pressing in the midst of our current opioid epidemic. Every day, 78 Americans die from an opioid overdose. As physicians, we understand addiction as a chronic and debilitating disease that requires compassion and treatment, not judgment and punishment. We vow to support parity — in practice, not just in word — for mental health care and treatment for substance use disorders.
4. We believe that women’s health must be protected.
Women should be able to access comprehensive health services without fear of intimidation or violence. This care must include safe and effective contraception as essential preventive health services. We pledge to support every woman’s right to self-determination, without government intervention in decisions that should be based solely on an individual woman’s values and safety. This fight is everyone’s fight: high-quality women’s healthcare improves health outcomes not only for women themselves but also for their families and communities. Additionally, we demand a political culture that does not condone sexual assault, physical or verbal. We vow to fight for women’s health and to reject violence against women in all forms.
5. We believe that all Americans deserve access to healthcare and freedom from violence, no matter their immigration status.
Every day, we take care of people who contribute meaningfully to their communities — and our economy — yet struggle to keep themselves and their families healthy with limited or nonexistent insurance coverage. Since the election, we have seen a surge in fear among our immigrant patients, as they face the prospect of torn-apart families and forced exile to conditions of poverty and political violence. We vow to protect our undocumented patients, advocate for their rights, and continue to serve them as healers.
6. We believe that the oppressive structures which harm people of color in America must be dismantled.
Racism and xenophobia adversely affect our patients’ health on multiple levels. The lived experience of discrimination is itself a strong risk factor for morbidity and mortality, while hate crimes and police violence against religious and racial minorities pose direct harm to people’s bodies. These problems are compounded by the inequities of access and quality that still plague our healthcare system. We vow to combat bias and prejudice in our own interactions with patients, as well as in our clinics, hospitals, and communities.
7. We believe that all Americans, irrespective of their gender identity or sexual orientation, deserve to be treated with dignity and respect.
Not only are LGBT individuals the most frequent target of hate crimes in America, they also face widespread challenges in accessing culturally competent and comprehensive medical care. We vow to stand up against the violence, victimization, and health disparities affecting the LGBT population.
8. We believe that torture and human rights violations have no place in American society.
Every major international medical organization has opposed torture, and we stand firm in opposing all forms of torture or “enhanced interrogations” no matter the setting or supposed justification. The victims of these human rights violations may not identify as American, but we cannot justify a double standard that equates “not American” with “not human”. Moreover, as physicians, we understand the devastating consequences of trauma on the health of both victims and perpetrators. We vow to resist the cycle of violence proposed in the name of national security.
The presidential administration may be changing, but our values and priorities as America’s physicians will not. We declare these eight beliefs as fundamental principles that we will advocate for in our daily work as we care for Americans of all classes, genders, colors, faiths, and sexual orientations. Our statement highlights the marginalized groups most threatened in our nation’s recent political discourse, but we insist that these principles stand for white Americans and other majority groups as well. We will resist all efforts to violate these principles, as we firmly believe that such change would jeopardize the health of our patients, whom we are sworn to serve.
Sincerely,
Nina Sreshta, MD; Cambridge Health Alliance
Siva Sundaram, MD Candidate; Harvard Medical School
Nikhil “Sunny” Patel, MD, MPH, MS; Cambridge Health Alliance
Laurie Schleimer, MD Candidate; Harvard Medical School
Rachel Hathaway, MD; Cambridge Health Alliance
James B. McKenzie, DO, MBA; Cambridge Health Alliance
Jennifer Adaeze Okwerekwu, MD, MS; Cambridge Health Alliance
J. Wesley Boyd, MD, PhD; Cambridge Health Alliance, Harvard Medical School Center for Bioethics
To sign this letter or to share it, please go to: https://medium.com/@socialjusticecoalition/a-letter-to-our-patients-in-…
