The Big Story: “In a time when America feels fractured — by political party, ideology and culture — the First Amendment has the potential to be a uniting force.”
— “Where America Stands,” Freedom Forum survey, 2025
The Power of 1A
3.5-minute read
For much of this year, you have weighed whether and how to use your voice in a tumultuous time. Along with other healthcare leaders, you’ve deliberated over how to advocate for this policy or against that legislation. You’ve considered the political calculus. You’ve thought through the impact on your team members.
And in these calculations, you have, perhaps, taken for granted the ability to speak openly, even vigorously. Yet it’s an ability that feels more constrained by the day.
To state it plainly: The First Amendment makes healthcare better. Advance it where you can. Defend it where you must.
At first glance, your quiet exam rooms might feel far removed from the cultural storm fronts of speech fights, censorious threats and horrific violence.
But our “first freedoms” — speech, press, religion, assembly, petition — aren’t abstractions fading on parchment hanging behind glass in the back of your board room.
They are alive every day in your ER, research lab, board room… and yes, in that irritating call from the journalist you wish would go away.
These five freedoms are the laboring muscles that keep medicine available, innovative and accountable. They let patients and colleagues question authority (even yours). They check government, commercial and cultural powers that would throttle inconvenient truths.
They create the noisy, jostling, sometimes exasperating marketplace of ideas that makes healthcare better.
The vast freedoms we enjoy have grown from these roots. That’s why the First Amendment, ratified in 1791, is affectionately nicknamed “America’s 1A.”
Please note. We’re not trying to toss a torch onto today’s political tinderbox. But we do want to remind leaders of healthcare’s duty to exercise and defend these rights. Because when the First Amendment is weakened, healthcare is weakened.
Rising Support
Here’s the good news: Support for the First Amendment is climbing. A new Freedom Forum survey found nine in 10 Americans say it’s “vital,” and nearly two-thirds say it should never be changed — up 10 points since 2020.
That’s not abstract patriotism. It’s a first line of defense. It’s a recognition that these freedoms are how we navigate fracture. By their design, these freedoms frustrate those with much power and empower those with little. And in fragile times, they’re the binding elements that hold us together.
Because healthcare is the nation’s largest workforce, you, our industry’s leaders, have a special responsibility – and opportunity.
It’s the chance to model grown-up behavior in today’s cultural kindergarten.
Protecting the Sharp Edges
True, the First Amendment also protects the noise that drives you crazy: misinformation, conspiracy theories, outrageous claims. That’s the rub. The same principle that shields whistleblowers shields provocateurs. The answer isn’t less freedom — it’s more responsibility, more discernment, more dialogue.
Suppressing voices in the name of order only erodes trust. When your staff feels it’s unsafe to speak, errors go unreported. When patients feel unheard, outcomes worsen. When dissent is silenced, innovation dries up. Healthcare is healthier on a rich soup of ideas. Without it, care gets stale, uninspired.
A Speed Round: 1A in Healthcare
Speech
Doctors must be free to share evidence-based knowledge, even when it offends politics or commerce. Patients must be free to question and seek second opinions. Staff must be free to call out unsafe practices.
Press
Responsible journalism shines light on unsafe systems and translates complexity into public understanding. The credibility every health system craves is built on the very press scrutiny that makes leaders squirm.
Religion
Pluralism protects patients’ right to let faith inform care. It protects diverse caregivers, too. And it sparks the debates we’d sometimes rather avoid – where conscience ends and patient access begins.
Assembly
From nurses’ unions to advocacy campaigns, collective action has always driven reform. Grassroots activism — whether AIDS protests in the ’80s or today’s mental health campaigns — turns pain into policy.
Petition
Lobbying, letter-writing, testifying. Citizens pressing the government is how we got disability rights, mental health parity and women’s health access. Policy changes because people demand it.
The 1A of Trust-Building
Trust in healthcare is fragile. So, what can one leader do to fortify it?
Start here. Trust grows in the exercise of the 1A muscle. Yes, it’s a hard workout. Dialogue is “inefficient.” Disagreement is exhausting. Correcting misinformation feels endless. But trust is built in precisely those uncomfortable moments and your visible leadership in them.
Sometimes you’ll need to offend. Sometimes you’ll need to be disagreeable. Sometimes your organization will be the minority voice — speaking for patients or communities who have no voice at all.
But the First Amendment is the source of good trouble, and the founders knew it. It’s why it must be defended at its extreme, offensive edges. It’s our heavy, virtuous burden.
We are not constitutional scholars, but we well recognize that First Amendment rights live in tension with other vital rights, limitations and duties you carry as caregivers and organizational stewards. Keeping all in proper balance is one of the great charges leaders choose to accept.
But what a great charge it is.
Contributors: Tim Stewart and Emme Baxter
Image Credit: Shannon Threadgill
