They Call It Medical Freedom. Epictetus Called It What It Is.

The government invoking patient autonomy to dismantle vaccine recommendations is simultaneously threatening doctors with prison for saving pregnant women’s lives.

The Stoics had a precise name for people who apply principles only when convenient. We should use it.

“Don’t explain your philosophy. Embody it.” -- Epictetus, Discourses

A woman is hemorrhaging. Her doctor knows exactly what she needs. The government has decided she cannot have it.

Somewhere else, a parent is told: the flu shot is a personal choice now. Between you and your doctor. Your body. Your decision. Medical freedom.

Same government. Same week. Same principle -- applied to one patient, denied to another.

The Stoics called this akrasia -- acting against one’s own stated reason. But Epictetus, who began life as a slave and understood power better than most philosophers ever would, had a harsher word. He called it moral cowardice dressed in borrowed language. You do not actually believe the principle. You use it. That is the definition of hypocrisy. And hypocrisy, to a Stoic, was not a personality flaw. It was a corruption of logos -- of reason itself -- the gravest failure a thinking person could commit.

The Words They Used

Let the record be precise, because precision is what this moment requires.

In October 2025, when the CDC moved COVID-19 vaccination from a blanket recommendation to “shared clinical decision-making,” HHS Deputy Secretary Jim O’Neill announced it this way: “Informed consent is back.” (1)

Secretary Robert F. Kennedy Jr. followed: “Government bureaucracies should never coerce doctors or families into accepting vaccines or penalize physicians for respecting patient choice. That practice ends now.” (2)

In December 2025, the White House ordered a restructuring of the entire childhood vaccine schedule -- from 17 recommended vaccines to 11. The stated reason: empowering families and clinicians to make individualized decisions.

Medical freedom.

Patient autonomy.

Shared decision-making.

Write those words down. We will need them.

What They Actually Did

In June 2025, this same administration rescinded the federal EMTALA guidance that had told hospitals across the country what every physician already knew: when a pregnant woman arrives in your emergency room and abortion is the medically necessary treatment to save her life, you treat her. (4)

EMTALA -- the Emergency Medical Treatment and Labor Act -- has been federal law since 1986. The Biden guidance did not invent new rights. It clarified existing law at a moment when clarification was desperately needed, because in the wake of Dobbs, physicians in states like Idaho, Texas, Arkansas, and South Dakota were watching patients deteriorate while they calculated their legal exposure.

That guidance is now gone.

What replaced it is silence. And in medicine, when the government goes silent while state laws threaten criminal prosecution for providing standard care, silence is a decision. It is a decision against the patient.

The same officials who declared “informed consent is back” have made it a crime to exercise it.

In Arkansas, Idaho, Mississippi, Oklahoma, and South Dakota, there are no meaningful health exceptions to abortion bans. A physician can watch a patient’s blood pressure climb toward stroke. She can watch a septic uterus fail to respond to antibiotics. She knows the treatment. And in those states, the government has already made the clinical decision for her. (5)

Doctors describe it now as “waiting for the patient to get sick enough.” Waiting until she crosses whatever invisible threshold might satisfy a prosecutor who was never in the room and who has never managed a hemorrhaging patient at 2 in the morning.

This is not shared clinical decision-making. This is the government making the clinical decision -- and threatening the physician with prison if she disagrees.

Marcus Aurelius on Consistency

“If it is not right, do not do it. If it is not true, do not say it.” -- Marcus Aurelius, Meditations IV.17

Marcus Aurelius wrote that in the 2nd century. He was Emperor of Rome. He had more power than any person today, and he chose to write about the discipline of consistency -- the obligation to mean what you say and to say only what you mean.

The Stoics called the alignment between word and deed homologia -- agreement, coherence, integrity in the literal sense of the word. To live with homologia was the goal of the philosophical life. To live without it was to live against nature, against reason, against everything that made human beings distinct from animals.

Patient autonomy is a real principle. Informed consent is a real principle. A principle is only a principle if it applies universally. The moment you decide it applies to flu shots but not to ectopic pregnancies, you have revealed that it was never a principle at all. It was a political instrument. And the Stoics would say you have not merely failed the patient. You have failed yourself.

The Surgeon General Nomination Explains Everything

The administration’s nominee for Surgeon General -- the nation’s doctor -- is Dr. Casey Means. She holds a medical degree from Stanford. She left her surgical residency six months before completion. Her medical license has been inactive since January 2024. She is a wellness influencer and supplement brand collaborator whose primary professional platform is social media. (6)

This is not an attack on Dr. Means. It is a statement of what this administration believes the nation’s doctor should look like.

The Surgeon General is the most visible public health communicator in America. She issues advisories. She shapes what the public believes about medicine. And this administration chose someone who has not practiced medicine in years, whose license is inactive, and whose credentials are a bestselling book and a podcast audience.

You do not nominate a practicing clinician who might apply evidence consistently. You nominate a communicator who will deliver the message you need delivered -- even when the message contradicts itself from one medical procedure to the next.

Vaccine autonomy for parents who may choose to decline. Criminal prosecution for physicians who choose to save a pregnant woman’s life. Both positions, from the same office, in the same year.

What Epictetus Would Say

“Seek not that the things which happen should happen as you wish; but wish the things which happen to be as they are, and you will have a tranquil flow of life.” -- Epictetus, Enchiridion VIII

That is not the Epictetus I want to invoke here. I want the Epictetus of the Discourses -- the former slave who had seen what it looked like when powerful people used beautiful language to justify cruelty.

He wrote that the hypocrite is the most dangerous person in any community -- not because he does evil, but because he does evil while speaking the language of good. He confuses everyone around him. He makes it harder to name what is actually happening. He borrows the moral authority of real principles and spends it on their opposite.

“First say to yourself what you would be,” Epictetus wrote, “and then do accordingly.” This administration has said what it would be. Patient choice. Medical freedom. Informed consent. It has not done accordingly. It has done the opposite, to the patients who needed those principles most.

That is not a policy difference. That is not a values disagreement. That is a failure of logos -- of reason, of consistency, of basic human integrity.

Epictetus called it exactly what it is. We should too.

What Physicians Must Understand Right Now

If you practice obstetrics in a state with a near-total abortion ban, you are operating in deliberately manufactured legal ambiguity. The federal guidance that clarified your EMTALA obligations is gone. The federal government has no current enforcement position. Your state law may expose you to criminal prosecution for providing treatment that would be standard of care in 37 other states.

That ambiguity was not an accident. It was a choice. The administration that eliminated it had the option to clarify it in the other direction. It chose not to.

Document everything. Know your hospital’s legal counsel. Know your state’s specific exceptions, narrow as they are. And know this: the physician who hesitates while a patient hemorrhages because she is calculating her legal exposure is being asked to be something no physician should ever be asked to be -- a defendant deciding whether to treat.

What Women Must Understand Right Now

The administration using the phrase “between you and your doctor” is not applying that principle to you if you are pregnant.

If you live in a state with an abortion ban and you develop a life-threatening complication of pregnancy, the decision about your care is not between you and your doctor. It is between your doctor and a prosecutor. Your autonomy -- the autonomy this administration invokes loudly in every vaccine press release -- does not reach the emergency room when you need it most.

Know your state’s laws before you need them. Know which hospitals have the strongest legal and ethics support. Know that EMTALA still exists as federal law even without the Biden guidance -- the statute has not changed, only the enforcement posture. If you are denied emergency care you believe was medically necessary, contact the Center for Reproductive Rights, the ACLU Reproductive Freedom Project, or your state’s medical board. Document everything. You have rights that have not been abolished, only obscured.

“Waste no more time arguing what a good man should be. Be one.” -- Marcus Aurelius, Meditations X.16

This administration has wasted considerable time telling us what a patient-centered health system should sound like. It has not been one.

Medical freedom is not a slogan. Patient autonomy is not a press release. Informed consent is not a political instrument to be deployed against vaccines and withheld from pregnant women bleeding in emergency rooms.

Either the principle applies to every patient, or it is not a principle.

Either the doctor-patient relationship is sacred, or it is not.

You cannot have it both ways. You cannot invoke medical freedom at a podium and then criminalize the exercise of clinical judgment in an operating room.

The Stoics understood that a person’s character is revealed not by what they say when it is easy, but by what they do when the principle costs them something. This administration has told us exactly who it is.

We should believe it.

References

1. O’Neill J. CDC Immunization Schedule Adopts Individual-Based Decision-Making for COVID-19. HHS Press Release. October 6, 2025.

2. Kennedy RF. Post on X (formerly Twitter). December 31, 2025.

3. White House Fact Sheet. President Donald J. Trump Begins Process to Align U.S. Core Childhood Vaccine Recommendations with Best Practices from Peer, Developed Countries. December 7, 2025.

4. Center for Reproductive Rights. Trump Administration Attacks Federal Protections for Pregnant People in Emergency Rooms. June 3, 2025.

5. PBS NewsHour. White House revokes guidance requiring hospitals to provide emergency abortions. June 5, 2025.

6. Wikipedia. Casey Means. Accessed February 2026.

7. Epictetus. Discourses. Trans. Oldfather WA. Harvard University Press; 1926.

8. Aurelius M. Meditations. Trans. Hays G. Modern Library; 2002.

9. [VERIFY] -- U.S. maternal mortality comparative data vs. peer nations. CDC/WHO.