Antiprogestin Drugs: Ethical, Legal and Medical Issues.

Abstract

PIP: RU 486 allows women the choice of a medical rather than a surgical abortion, and, for most women, the choice is one of procedure, not of whether to have an abortion. Issues surrounding RU 486 were explored in an American Society of Law and Medicine conference in December 1991 entitled Antiprogestin Drugs: Ethical, Legal and Medical Issues. An introduction to 14 conference papers provides an overview of the proceedings. Baulieu, the father of RU 486, described updated developments in its and the medically supervised method of abortion. Bygdeman and Swahn presented their work in Sweden on combining RU 486 with a prostaglandin to make abortion more effective. They suggested that the drug may be an attractive postovulation contraceptive. Greenslad et al. discussed service delivery aspects of the of RU 486. Holt considered the implications of of the drug in low-resource settings. A survey of obstetricians and gynecologists, presented by Heilig, indicates that 22% more physicians would perform a medical abortion. Patient perspectives were addressed by David, who stated that measuring acceptability of an abortion technique is difficult; women have historically used whatever method is available. A collaborative research project in India and Cuba on why women chose certain methods was reported by Winikoff et al. (90% of women would choose medical abortion if faced with the choice again). Berer analyzed French data on women's perspectives on medical vs. surgical abortion. The question of adolescent of the drug was considered by Senderowitz, who lamented the lack of data on the subject and described what is known about adolescent pregnancy. Macklin proposed a framework for ethical analysis and used facts to address ethical questions. Weinstein provided another ethical framework, to analyze whether pharmacists have a right to refuse to provide abortifacient drugs. Buc approached the subject from a legal point of view and concluded that, whereas legal problems are minimal, political problem are of first concern. Boland described differences in introduction of the drug in France and Britain and the US. The theory of use or lose it in patent legislation is applied differently in the US, France, and the UK. Hayhurst, in a complementary legal analysis, noted that Canadian importation would open access to affluent US women. Pine reported on the legal case Benten vs. Kessler, which did not result in successful importation of the drug for personal use, but resulted in some supportive language from the courts. By refusing to apply to the FDA for marketing approval, RU 486's manufacturer may be setting itself up for a boycott. Approaching the problem from these various perspectives addressed the challenge between medical advances and politics and highlighted the need to balance the benefits to women with perceived threats to values.