I’ve been thinking about “choice” a lot lately, not the rich, ethically grounded version we teach in medical school, rooted in autonomy, informed consent, and shared decision-making, but a thinner, more selective version now circulating in political and legal discourse. The kind that sounds principled until you read the fine print.

The message goes like this: You may choose, just make sure you choose correctly.

It’s the literary equivalent of Animal Farm: All choices are equal, until some are deemed more equal than others.

That tension sharpened for me after reading a recent investigation describing how U.S. Attorney General Pam Bondi personally intervened to drop federal charges against a Utah surgeon who knowingly falsified government medical records, undermined public health surveillance, destroyed federally supplied COVID-19 vaccines, and deceived children and families about what was being injected into their bodies, all explicitly reframed as acts of “medical freedom.”

I couldn’t help but wonder what this logic looks like when applied evenly across medicine.

Or rather: What it would look like if I were still practicing.

Because I, too, believe in patient choice. I support abortion care. I support gender-affirming treatment for transgender patients. I practiced medicine grounded in evidence, ethics, and professional consensus. I documented meticulously. I obtained informed consent. I stayed squarely within established standards of care.

Yet somehow, I suspect Pam Bondi would have questions about my version of “choice,” which now comes with an asterisk.

Choice as a one-way street

Let’s be clear about what kind of “choice” is being celebrated here.

The acts committed by the physician in this case would ordinarily be called fraud, deception, and serious ethical violations, all carrying substantial prison time. Instead, these actions were reframed as moral courage. The physician, we are told, “gave his patients a choice.”

Apparently, that choice included:

• Choosing to misrepresent vaccination status
• Choosing to sabotage public health systems
• Choosing to lie to children “for their own good” by injecting them with saline

And crucially, choosing in a direction politically favored by those in power.

This is not autonomy. This is alignment.

And it doesn’t stop with one surgeon. According to the reporting, the dismissal of charges has already emboldened other clinicians facing similar cases (some reconsidering guilty pleas, others seeking pardons, and still others newly confident that what was once prosecuted as fraud may now be celebrated as conscience).

This is how precedent works. Not quietly or abstractly, but contagiously.

When the system signals that certain violations will be forgiven, so long as they align with the “correct” version of choice, it invites repetition. The rules don’t disappear; they simply reveal whom they were never meant to bind.

The emerging rule seems to be this: Choice is sacred, provided it runs downstream from ideology.

My patients are choosing too

So let me ask (sincerely), what would Pam Bondi say about my choices?

When a pregnant patient chooses to terminate a pregnancy after careful counseling, evidence-based discussion, and personal reflection, am I empowering autonomy, or suddenly a dangerous radical undermining society?

When a transgender adolescent, together with parents and a multidisciplinary care team, chooses gender-affirming treatment consistent with every major medical association, am I honoring informed consent, or “corrupting children”?

When I respect my patient’s identity, lived experience, and carefully considered decisions, am I practicing medicine, or committing a thought crime?

Because here’s the uncomfortable symmetry: My patients are choosing, too.

Yet selective tolerance for “choice” appears everywhere we look. We see it when physicians hesitate to provide emergency pregnancy care despite federal obligations; when FDA-approved medication abortion becomes inaccessible through telemedicine; when patients seeking medical aid in dying are told autonomy ends at the edge of suffering; and when harm-reduction strategies for substance use are discouraged despite overwhelming evidence of effectiveness.

In each case, the patient may choose (and the physician may agree) until that choice collides with a political boundary. Then autonomy yields, not to science or ethics, but to power.

The difference is not ethics. The difference is politics.

Freedom for me, not for thee

We are told this is about resisting government overreach. About standing up to mandates. About restoring the sanctity of the doctor-patient relationship.

But watch closely where that rhetoric stops.

It stops at abortion. It stops at transgender care. It stops at reproductive autonomy.

It stops the moment choice threatens a preferred moral order.

Suddenly, the same voices celebrating “medical freedom” begin issuing bans, restrictions, criminal penalties, and professional sanctions. Suddenly, doctors are told that this choice is illegal, that conversation is prohibited, and that evidence-based treatments endorsed by consensus are forbidden.

Apparently, the doctor-patient relationship is sacred, unless the patient chooses wrong and the doctor agrees.

The real test of principle

If “medical freedom” were a genuine ethical stance, it would be consistent. It would defend:

• A woman’s right to make reproductive decisions
• A transgender patient’s right to medically appropriate care
• A physician’s obligation to follow evidence rather than ideology

But consistency is precisely what’s missing.

Instead, we get a version of freedom that operates like a velvet rope:

• Step through if your beliefs align
• Bounce off if they don’t

This isn’t principled libertarianism. It’s selective permissiveness masquerading as moral courage.

What choice actually requires

True respect for choice is demanding. It requires humility. It requires tolerating decisions you personally dislike. It requires trusting evidence over instinct, process over passion. Most of all, it requires accepting that other people’s bodies are not your ideological battleground.

If falsifying vaccine cards is heroic because it honors choice, then so is providing abortion care. If deceiving public health systems is valorized because it resists authority, then so is resisting laws that criminalize gender-affirming medicine. If the doctor-patient relationship must be protected from government intrusion, then protect it everywhere, or stop pretending.

A final question

So I’ll ask plainly, in the spirit of transparency: Pam Bondi, do I get to practice “medical freedom” too? Or is freedom only freedom when it flows in one ideological direction?

Because from where I sit, this isn’t about choice. It isn’t about autonomy. It isn’t even about medicine. It’s about deciding which patients deserve agency and which doctors deserve protection.

And once choice becomes conditional, it stops being a principle at all.

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia. He is the author of several books on narrative medicine and the fictional series Real Medicine, Unreal Stories. His latest book, a novel, is Standard of Care: Medical Judgment on Trial.