Volume 44, Issue 2 (Spring-Summer 2026)
By Carmel Shachar, Susannah Baruch & Louise P. King*
In this Feature, we document the recent erosion of the medical profession’s ability to self-regulate, a trend which we define, in part, as substituting political and legal judgments for evidence-based medical decision-making. Historically, medicine developed a system of professional autonomy grounded in standardized education, certification, peer oversight, scientific inquiry, and shared decision-making between physicians and patients. Although government has long regulated healthcare to protect public health and safety, recent regulatory, judicial, and legislative actions increasingly reach beyond those functions in ways that can undermine medical decision-making and the ability to provide evidence-based standard of care medical services.
In our exploration of this “encroachment,” we analyze recent examples involving abortion, gender-affirming care, Medicaid provider choice, preventive-care recommendations, vaccine policy, and federal-funding conditions. Particular attention is given to Medina v. Planned Parenthood South Atlantic, United States v. Skrmetti, and Kennedy v. Braidwood Management, Inc., which illustrate how courts have restricted patient and provider autonomy, treated medical uncertainty as a justification for intervention, and weakened the independence of expert advisory committees.
We are concerned about this trend of “encroachment” because it risks worsening patient outcomes, chilling appropriate care, and obstructing continued research. To address this issue, we propose rebuilding trust through stronger professional accountability, transparency, public education, and engagement with dissenting views, while urging political actors to employ scientific methods and collaborate with medical experts when developing healthcare policy.
*Carmel Shachar, J.D., M.P.H., is the Assistant Clinical Professor of Law and Faculty Director of the Health Law and Policy Clinic at the Center for Health Law and Policy Innovation of Harvard Law School (CHLPI). Susannah Baruch, J.D., is the Executive Director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School. Louise P. King, M.D., J.D., is the Director of Reproductive Bioethics at the Harvard Medical School Center for Bioethics and Assistant Professor of Obstetrics, Gynecology and Reproduction.