By Robert E. Cranston, MD, MA (Ethics) | December 08, 2016
by Robert E. Cranston, MD, MA (Ethics)
Internet holiday shopping continues to grow on a yearly basis. Countless people now do a large portion of their Christmas shopping online, as opposed to in brick and mortar retail outlets. Interestingly, though not unexpectedly, items purchased online are three times more likely to be returned than items bought in traditional stores. Some of this stems from the fact that one cannot actually smell, taste, touch or see what one is purchasing online, and part of this likely is the result of how easy online retailers have made it to return unwanted merchandise. Some things, however, are not so easy to return.
As abortion clinics across America have become fewer and further between, a new way of obtaining abortions has emerged—telemedicine and the use of mail-order abortifacients. Hailed as a welcome new option for women seeking abortions, particularly in locales where immediate access to abortion clinics is limited, this relatively new process for obtaining an abortion has already achieved widespread usage across the globe. In just the last 10 years, Women on Web, the oldest such group, has provided 50,000 abortion medication packages to women in 130 countries.
A recent article in the New York Times details a new study being conducted by Credit Gynuity Health Projects that follows the course of women requesting the mail-order option, and it is attempting to track their clinical outcomes. At present the numbers are small, and it is unclear who is providing research oversight quality assurance for the project. The true incidence of complications among users of mail-order abortifacients is yet to be determined.
The Food and Drug Administration has warned against buying any medications over the internet, but erectile dysfunction medications and nutritional supplements have had a huge market for years. Many of the medications purchased in this manner, the FDA warns, may not meet appropriate quality standards. Another danger issue when it comes to quality of care related particularly to mail-order abortifacients is that since there is no established doctor-patient relationship and the provider of the medications essentially ends the relationship on delivery of the drugs, the patient is left to fend for themselves in the event of adverse drug reactions or medical complications. There is no established medical oversight.
For mail-order abortions, the drugs used are the same as those currently employed in medical abortions by abortion clinics across the world: mifepristone on day one to terminate the pregnancy, and misoprostol the following day to induce expulsion of the now dead fetus. While surgical abortions, medical abortions performed with clinic oversight and mail-order abortions all kill the fetus, and while all carry immediate and long-term medical risks for the mother, the mail-order process carries additional risks:
- Mail-order abortion prescriptions may be obtained with an online interview or, at times, a Skype-type interview. There is no way to verify the true age and health of the intended recipient. Underage girls may lie about their age and have an older female perform any telemedicine interview required. Particularly in situations where the older woman has a financial or emotional incentive to deceive, the pathway to this manner of abortion is easy and straightforward.
- Alternatively, mail-order prescription recipients may choose to do this without the knowledge of any friend or family member, putting them at added personal risk should there be any complications, such as prolonged bleeding, retained products of conception, acute anaphylaxis or other adverse reactions to the prescriptions. No one else may know of the actions taken—an appealing aspect to some who seek abortion—making the woman’s or girl’s potential short-term vulnerability greater and long-term abortion sequelae a buried emotional or physical landmine.
- Mail-order abortifacients make obtaining an abortion so easy that abortion may become even more widespread than is currently the case.
- The normal FDA quality oversight of the medications themselves may be completely lacking as the manufacture of such scripts may occur in any country in multiple factories and may be channeled through legitimate sounding mail-order sites on the internet.
- The general medical and societal oversight of abortion clinics in our current structure is minimal and poorly documented, as demonstrated in the Kermit Gosnell debacle. In this setting, it is totally non-existent.
- Mifepristone and misoprostol are only approved for use during the first trimester of pregnancy, but without face-to-face oversight, these limits may be pushed. Medical abortions after this time frame are more dangerous for the woman.
One of the early arguments for legalization of surgical abortion was that women were obtaining “back alley” abortions and many were dying as a result. Thus, there was a need to “make abortion safe and legal.” In fact, actual statistics for frequency of or complications from these illegitimate procedures are suspect and hard to verify. We don’t know how many women were hurt or killed by these illicit abortions. We do know that abortion has taken the lives of more than 50 million babies since Roe v. Wade.
Abortion in general is legal in many parts of the world today, but it remains largely unregulated and not always safe. It is particularly lethal for the developing children whose lives are terminated. We should continue to fight for tighter restrictions on abortion and support organizations such as Americans United for Life, Pro-Life America and Students for Life. As the Talmud says, “Whoever destroys a soul, it is considered as he destroyed an entire world. And whoever safes a life, it is considered as if he saved an entire world” (Mishnah Sanhedrin 4:5).
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