February 09, 2010
How many mass murderers do we want?
A medical abortion is a type of non-surgical abortion in which an abortifacient is used to induce voluntary miscarriage. Safe and effective abortifacients for use in the first trimester became available in the 1970s. The most widely used medication are mifepristone or methotrexate either alone or in combination with a prostaglandin. Medical abortions accounted for 9.9% of abortions in the United States in 2005, 35% of abortions in England and Wales in 2007, 46% of abortions in France in 2006, 61.8% of abortions in Scotland in 2007, and 64.2% of abortions in Sweden in 2008.The huge difference between Sweden and the U.S. surprised me greatly, as it seems puzzling that American women who seek to terminate their pregnancies would prefer a surgical procedure to taking pills. Perhaps it's because the abortifacient pill has to be taken within the first 63 days, and Swedish women are more attentive to spotting their own pregnancies. But that doesn't make much sense either.
The only reason I can see which would explain the much higher percentage of medical abortions in Sweden (and in the rest of Europe) is the length of time mifepristone has been available.
Worldwide over 30 million women have used mifepristone and a prostaglandin analog to terminate pregnancy with impressive safety and efficacy. In France, Sweden, and Great Britain, where mifepristone has been available for more than 15 years, there has been an increase in the proportion of abortions performed at earlier gestation .The drug was approved in European countries beginning in 1988, but the FDA didn't approve it in the United States until 2000. Furthermore,
mifepristone is only authorized in the United States during the first 49 days (as opposed to 63 in Sweden) and it is not allowed to be sold in pharmacies:
It is a prescription drug, but it is not available to the public through pharmacies; its distribution is restricted to specially qualified licensed physicians, sold by Danco Laboratories under the tradename Mifeprex.Despite these restrictions, its use in the United States has increased steadily:
Medical abortions as a percentage of total abortions in the United States have increased every year since the approval of mifepristone: 1.0% in 2000, 2.9% in 2001, 5.2% in 2002, 7.9% in 2003, 9.3% in 2004, 9.9% in 2005 (15.1% of those at less than 9 weeks gestation); although data is limited by ten states not reporting statistics to the Centers for Disease Control and Prevention (CDC) (including California where an estimated >23% of total U.S. abortions were performed in 1997).More interestingly, even though mifepristone is effective as an emergency contraceptive, it is not approved for that purpose.
I realize that to the anti-abortion people, mifepristone is morally no different than surgical abortion, and the main reason I disagree with that is because I think that earlier abortions are less immoral than later abortions, and to the extent this drug encourages earlier abortions, I would consider it to be ultimately less of a social evil than the previous methods.
But what fascinates me the most is the change it will ultimately have on the dynamics of activism. Americans (myself included) have long been accustomed to seeing an abortion as a procedure done by a doctor using instruments. This has caused the anti-abortion activists to view such doctors as murderers and demonstrate in front of clinics of known abortion providers. By allowing any doctor to provide pills, the whole process becomes much more anonymous -- almost impossible to detect or protest. (I'm sure that's a major reason the activists hate these drugs.)
Through a strange process the logic of which I cannot comprehend, women who have abortions tend to be seen by the activists as victims of doctors, with the doctor as the greater villain than the woman. Which doesn't make sense, for even if we assume abortion is murder (which I don't), by going to a clinic and paying a doctor for an abortion, the woman has quite knowingly hired a hit man to kill her baby -- just as much as if she went to the Mob and took out a contract on her son or husband. Since when is someone who hires a killer less guilty than the killer?
But when a woman takes pills to kill the fetus, unless they are pushed down her throat she becomes the actual killer, and it is much harder to visualize a prescribing doctor as a murderer. I think that's a good result, because I have long believed that women who terminate their pregnancies are the ones who are responsible for their actions. And just as I get sick of people calling doctors murderers, I get even more sick of people who say that "we" as Americans are murderers. Call me callused, but I do not consider myself responsible for the conduct of others, whether they terminate their pregnancies, take fatal overdoses of drugs, or eat themselves to death. I realize that the immorality of a doctor who wields his pen to write a prescription is the same as the one who wields a scalpel, but ordinary people will not see it that way. Mifepristone will be seen as less ugly, and therefore less culpable.
To continue with the responsibility argument, if in fact the providing doctor or nurse is guilty of murder, then why wouldn't the pharmaceutical distributor be guilty? How about the manufacturer? Right now, mifepristone is only approved as an abortifacient, but it appears to have a number of other possible uses:
Other medical applications of mifepristone that have been studied in Phase II clinical trials include regular long-term use as an oral contraceptive, and treatment of: uterine fibroids, endometriosis, major depression with psychotic features, glaucoma, meningiomas, breast cancer, ovarian cancer, and prostate cancer. Mifepristone has been used to treat Cushing's syndrome with treatment durations being as long as 10 years without noticeable adverse effect.Once it becomes approved for any of those other uses, seeing the manufacturer as a murderer would become even more difficult. Plus, if it can prevent breast cancer or inhibit ovarian cancer and could be legally prescribed as a treatment, pharmaceutical suppliers would have no way of knowing the intended use of the product. (It would also make it infinitely harder to prevent the drug's use as an abortifacient, so I would expect anti-abortion activists to oppose the testing or approval of mifepristone as a treatment for disease. According to this article, they already have.)
I am also fascinated by the way emergency contraception (the so-called "morning-after pill") is being discussed. Now sold over the counter, the way these drugs work is by preventing implantation of the fertilized egg. As abortion is defined as the termination of pregnancy, whether or not emergency contraception is abortion depends on how pregnancy is defined. I realize that many activists and the Catholic Church maintain that life begins at conception. But does pregnancy begin at conception? If it does, then the existing abortion statistics are understating the number of abortions by a substantial, possibly huge, number. That's because countless women take contraceptives which not only prevent ovulation and fertilization, but also prevent implantation of any egg which does get fertilized.
One of the forms of contraception which prevents implantation is the IUD, which is so effective in preventing pregnancy that not only will it work as normally worn, but it will work even if inserted within five days after intercourse.
An alternative to emergency contraceptive pills is the copper-T intrauterine device (IUD) which can be used up to 5 days after unprotected intercourse to prevent pregnancy. Insertion of an IUD is more effective than use of Emergency Contraceptive Pills - pregnancy rates when used as emergency contraception are the same as with normal IUD use. IUDs may be left in place following the subsequent menstruation to provide ongoing contraception (3-10 years depending upon type).Is that the prevention of pregnancy? Or is it an abortion?
I realize this sounds a hair-splitting distinction (and at 145 microns, the human egg is only slightly wider than a human hair), but a lot of people care. I was also told by a doctor that about half of all fertilized eggs never make it to the implantation stage, and if they were all people who had a right to life, in theory we could be talking about a lot of murders. The reasons for the failure of implantation are varied (and most of them are natural causes -- which means that God might be the world's biggest abortionist), but if a woman was taking a drug known to prevent implantation, and if preventing implantation is murder, then there may be millions and millions of mass murderesses walking among us.
Whether they're guilty of murder or not, I think they are responsible for their actions, not "us."
posted by Eric on 02.09.10 at 03:02 PM
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