Ethics of a pandemic of deliberate health misinformation: From abortion care to vaccines

Much has been written about the decline of legacy publishing models like newspapers. Much has also been written about the parallel rise of misinformation disseminated on internet platforms like X, TikTok, Instagram, and others. For someone belonging to an older generation, it is stunning to see that a convicted child abuser like Ruby Franke, who gave child education advice to parents on her popular YouTube channel, managed to attract 2.5 million followers. She pleaded guilty to torturing her kids.1 Clearly, many internet netizens of the postnewspaper era are not the most discerning of audience members. And don't get me started on the massive amount of antivaccine misinformation disseminated successfully during the COVID-19 pandemic.2

What is oftentimes overlooked is that efforts at manipulating vulnerable populations into acting in particular ways that may not be in their best interest, has a history going back much longer. Arguably the internet turbocharged some of these efforts, but this has been happening for a long time.

A case in point is brick-and-mortar “pregnancy crisis centers.” They exist in many countries, including, for instance the United States and Canada, today. The American College of Obstetrics and Gynecology, in a fact sheet, notes that they typically target marginalized and vulnerable populations, in particular “people of color, young people, and under-resourced people who are struggling to afford an abortion.”3 Their objective, invariably, to manipulate a pregnant woman considering having an abortion into not having one. Laypeople with no relevant professional expertise masquerade, oftentimes for good measure in white coats, as counselors when really their agenda is manipulation. A litany of misinformation is typically provided to the information-seeking pregnant women. In jurisdictions where there are time limits on abortion, efforts are made to ensure pregnant women miss the window during which they can legally access an abortion, and the list of misconduct goes on.

Sometimes healthcare professionals serve on the boards of directors of such establishments, but usually—there are exceptions—they themselves do not directly engage in the spreading of misinformation. Instead pregnant women seeking unbiased information will be seen by “trained advocates,” as the Chequamegon Pregnancy Center in Wisconsin puts it so deceptively. The Pregnancy Center in Sanford's Florida meanwhile provides on its website misleading information on the morning-after pill, despite the known safety profile of the pill having led to its availability as over-the-counter medication across the European Union member-states.4 Images of medical equipment and machinery feature prominently on the photos of many of these centers. Anyone can buy them, after all.

What is interesting is that arguments invoking the ethical and fiduciary obligations of professionals, vis-a-vis their patients do not apply here, precisely because these establishments deliberately mislead their clients or customers into thinking that they are professional healthcare facilities, when they are nothing of that sort. While the pregnant woman might consider herself a patient, for all intent and purposes she is not. No formal fiduciary healthcare professional–patient relationship was ever entered into.

That does not mean that other ethical arguments do not apply here. For starters, clearly, the provision of information that is misleading and manipulative is unethical, because it prevents people from making autonomous choices. It is also harmful if it manipulates pregnant women into missing abortion-related timelines that prevent them from having an abortion, because they eventually are so far down the track of their pregnancy that legally they cannot access an abortion.

People visiting these establishments for advice may be further misled by placing trust in these organizations because they oftentimes are registered charities. Charities are oftentimes mistakenly assumed to serve uncontroversially the public good, but clearly that isn't quite the case here. Interestingly, having clicked the “donate” button on some of these make-believe health clinics' websites, I was quickly taken to a registered religious charity, so at that point it is clear that one isn't actually supporting a clinic, but the religiously motivated deception of vulnerable people in a make-believe clinic setting.

Pretending to be a clinic when one is patently not is in its own right quite eye-opening, because it demonstrates how far religious extremists are willing to go in their quest to shape the world according to their religious beliefs.

The question arises, of course, how societies should approach the regulation of these establishments. Unsurprisingly, the proprietors of these nonclinic clinics will be quick to make religious freedom claims to justify their right to exist. Remarkably, U.S. federal courts apparently decided that because these establishments provide such misleading information free of charge, “the government can neither compel disclosures to correct false and misleading information about the services offered by these clinics nor regulate any false or misleading advertisements made by the clinics.”5 This strikes me, a nonlawyer, as implausible. It seems to me that the relationship the clients entered into with these establishments were based on false representations about who they are to begin with, regardless of whether the misinformation was free or charged for. How can the determining factor be whether the service was charged for or not, when it led to demonstrable harm? It is difficult to find a suitable term to describe the victims of these establishments. Clearly, they are not patients. Are they consumers of a kind or clients? I have great difficulty accepting those labels either, given that the relationship is based on deceptive activities. These women would—likely—not have consented to ultrasound and counseling activities had they understood that they were not in a proper healthcare facility. Whatever consent was given under false assumptions about the nature of these establishments surely is null and void. Anyone acting on that information who suffers harmful consequences—such as being unable to terminate an unwanted pregnancy—should be able to receive some form of compensation from whoever maneuvered them into that outcome.