Those who believe the million or more abortions each year in the U.S. are immoral seem willing to go to any length to restrict, discourage or hinder them — even, in some cases, if it means risking a woman's health or violating core values of health care.
The latest example is the emerging attack on "telemedicine." Planned Parenthood clinics in Iowa use telemedicine — essentially videoconferencing with physicians — to give access to pregnant women to drugs that will produce abortions. The patient meets with a nurse who does various tests and instructs the patient about RU-486, the so-called abortion pill. Then a computer videolinks to a doctor who may be hundreds of miles away who can, at the end of his interview, hit a button which releases the abortion drug to the patient in the nurse’s office.
A new study found that using telemedicine for instructing a woman on how to use RU-486 is just as effective and acceptable as a face-to-face office visit. Yet, the use of video or telemedicine to allow women to get RU-486 has drawn a firestorm of criticism — of telemedicine! Abortion opponents in Iowa say they are alarmed, telling the New York Times they are “fearful for the safety of women who undergo abortions after consulting with doctors who have never actually been in the same room with them.” They have filed formal complaints about telemedicine with the Iowa Board of Medicine.
The House of Representatives has just passed legislation defunding any federal grants for telemedicine that include what Iowa Congressman Stephen King sneeringly called “robo-abortions.” Telemedicine abortions have been banned in at least five states.
Telemedicine has been around for nearly a decade. Rural states use it to insure access to care for those who live where there are no doctors. The armed forces use telemedicine to get health care to troops deployed in farflung locations. Given the shortage or primary care docs in the U.S., more telemedicine is in the offing. No one has ever said a negative word about the merits of telemedicine until Planned Parenthood used the technology to remotely open a draw that contained abortion drugs. The very “robo” medicine that Congressman King fulminated about and that Operation Rescue says makes them worried sick has saved many civilian and military lives.
The undermining of American medicine in the name of restricting abortion goes way past impugning telemedicine. Six states have enacted "fetal pain" laws, which restrict abortions after 20 weeks of pregnancy. Anti-abortion activists argue that fetuses can feel pain at that point. There is no consensus in medicine or science that this is true. Making up the facts simply undermines public trust in science.
Kansas has enacted legislation requiring the mandatory stocking of items and medications in abortion clinics that they do not use. The law says an abortion clinic needs to have medical equipment for the delivery of full-term babies. The Kansas legislature has about the same idea of what a hospital or clinic should stock as they do what potions ought be available at Hogwarts academy.
Informed consent has perhaps been the greatest victim of anti-abortion sentiment. You have a right to know about any medical procedure that a doctor might want to provide to you — risks, benefits and alternatives. South Dakota recently passed a law requiring women to visit crisis pregnancy centers — facilities run by anti-abortion groups — before obtaining an abortion. The risks of childbirth and the safety of emergency contraception would surely not be mentioned.
Many states have enacted laws requiring women to view sonograms, look at pictures of fetuses and listen to a long list of ‘risk factors’ associated with abortion.
It is wrong to let a state legislator tell you who you need to talk to, what you must see or hear from your doctor, or to try and outline the "risks" of any medical activity. Will state legislators someday insist that before you have a baby with a disability you need to look at educational materials about the burden to society that baby poses?
At the end of the day most Americans understand that elective abortion, whether by surgery or pill, is a morally complex act. Few would deny the right to abort to the pre-adolescent victim of rape or incest. Few are comfortable seeing a woman use abortion as a form of contraception. But, none should permit legislators to trample their fundamental rights, the autonomy of doctors, nurses and pharmacists and key tools for providing care into the ground in the frenzy to restrict abortions.
Arthur Caplan, Ph.D., is director of the Center for Bioethics at the University of Pennsylvania.