Summer 2025 Essay Contest
Honorable Mention – Medical Student Category
Under the Shadow of Dobbs: Are We Complicit or Complacent?
Essay written by Amanda Moser
I sat in Law auditorium on the first day of Penn Preview, almost a year ago to the day, fidgeting in the swivel chair, surrounded by unfamiliar faces, anxious to hear the PSOM administration speak. Looking back, I now see that day as the beginning of my journey toward understanding the ethical foundations that would guide my path in medicine- and that those once unfamiliar faces would soon become the peers who push me to question, to imagine more, and to lead with justice and integrity.
Dr. Cindy Christian stood at the podium, easing the room with humor before introducing what she affectionately called the “Christian Computation,” her own take on Einstein’s famous E=mc2: H = GZC2. In her words, health is a function of genetics multiplied by one’s zip code (ZC), squared.
Now, as I sit in that same auditorium seven months later, having completed courses in genetics, biochemistry, hematology, neurology, and psychiatry, I reflect on her equation with new insight. The power of that ZC2 speaks to how deeply social determinants impact health. As I’ve progressed through medical school, I’ve sought to understand, and more importantly, address, that impact—incorporating my passion for health equity and advocacy into the foundation of my training.
If I could expand Dr. Christian’s framework today, I would propose another variable, a second “C2,” not from the patient’s perspective, but from the providers. CC: Complicity and Complacency. Medicine is complex. Even with unlimited time, no number of lectures or research papers could fully encapsulate the intricacies of human illness. It is not for lack of trying. But if we accept that we cannot know or do everything, the real question becomes: what matters most?
Through courses like “Doctoring” and “Intro to Clinical Medicine”, patient panels, and standardized patient encounters, we are encouraged to hone the so-called “soft skills” of medicine. The core message underlying these experiences is beautifully simple: be human. Be present. Listen to your patients. Hear their stories. Let their narratives inform your clinical judgement and reshape your understanding of compassionate care.
But amidst the daily grind of academic excellence—the publishing, the boards, the resume-building—I’ve noticed how often these humanistic elements are sidelined. Patient panels become background noise to be tolerated while Anki decks and lecture notes take center stage. The quiet, profound work of connection is deprioritized in favor of measurable achievement. Today, we learn medicine not just in lecture halls, but under the shadow of Dobbs v. Jackson, a ruling that restricts clinical judgment. Since the Court’s decision, we face two choices: comply with politically driven injustice or remain silent—both at the expense of our patients’ wellbeing.
In our Doctoring course, we’re taught to “listen to the patient.” To recognize the patient’s autonomy as sacred.
But that ideal has been challenged. Patients are asked to navigate health systems bound by legislative mandates—and we, their providers, are too. For many of us, it’s a profound ethical reckoning:
How do we support patient decisions that laws may not permit?
These changes do not exist in abstraction. I have seen firsthand how Dobbs reverberates through our curriculum, our community, and our conscience. In class, we discuss legal geography and its consequences: how crossing a state line can mean the difference between access and denial. In clinic, I’ve seen the fear in patients’ eyes when disclosing pregnancies. In conversations with peers, I’ve noticed a deepening urgency: to resist, to advocate, and to learn how to safeguard care even within constraining systems.
And so, I return to the question: Are we complicit or complacent? Are we passive in the face of a system that limits reproductive autonomy, that prioritizes legal mandates over medical judgment? A system that pushes us to follow rules, not question them—even when our silence costs our patients their dignity, safety, and choice.
When political rulings begin to dictate medical decisions, neutrality is no longer ethical. As trainees, we must be vigilant not only in our knowledge of pharmacology and physiology, but also in our civic awareness, legal literacy, and moral courage.
This is not a condemnation, but a call—a call to see the patient in front of us not only as a case, but as a citizen with rights that we are charged to uphold, especially when systems fail them. In building my future in medicine, I hope to be both a student of science and a steward of humanity—someone who knows that while H = GZC2 might explain health, healing begins when we lean into that final, often-forgotten CÇ and dare to challenge our role as providers and choose to continually reflect and do better.
We must be more than clinicians¬—we must be translators, protectors, and advocates. We must know how to write appeals, to cite precedent, to educate lawmakers as well as patients. It is our duty to create safety where policy has removed it, and to reassert humanity where it has been stripped away.
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