And then there’s Iowa, where the state Board of Medicine in 2011 authorized doctors to use videoconferencing to dispense the medication that induces abortion in early pregnancy. Under this “telemedicine” system, with a procedure developed by Planned Parenthood, a nurse performs an ultrasound examination, which the doctor views over a video link to determine the stage of pregnancy. If satisfied that a medication abortion is appropriate, the doctor sends a remote command that opens a drawer containing the pills.
The medical board’s action, aimed at providing increased access to abortion at lower cost, was controversial. Among those urging the board to reject the procedure was a prominent Catholic priest, Msgr. Frank Bognanno. After Iowa’s Gov. Terry Branstad used a recess appointment to place Monsignor Bognanno on one of the board’s three seats reserved for non-physicians, the board promptly reversed itself and barred the telemedicine procedure. Seventeen other states have done the same. (The Iowa Supreme Court
ruled last June that the prohibition violated the right to abortion as understood by the Iowa Constitution. Noting that the state medical board had approved telemedicine in other settings, the court said that “the board appears to hold abortion to a different medical standard than other procedures.”)
But of all these states, Arizona wins the prize. On March 31, Gov. Doug Ducey signed a bill forbidding doctors who prescribe the abortion medication mifepristone to deviate from the Food and Drug Administration’s specifications that were in effect as of last Dec. 31. Those specifications, issued in 2000 when the agency first approved mifepristone, required a 600-milligram dose and restricted the drug’s use to the first seven weeks of pregnancy.
With doctors having prescribed millions of doses of mifepristone since 2000, it became apparent that one-third of the original dose was equally effective with fewer side effects, and that the drug was safe and effective for up to 10 weeks of pregnancy rather than seven. These “off-label” uses became standard medical practice, endorsed by leading medical organizations; doctors commonly refused to give the original dose, on the ground that it was not in their patients’ best interest.
As medication abortion grew in popularity — now accounting for about 40 percent of first-trimester abortions performed at Planned Parenthood clinics, for example — the dosage issue became a handy target of anti-abortion activism. States began to require doctors to adhere to the original label, knowing that doctors would feel ethically obliged to stop administering medication abortion rather than comply. Arizona was one of the early adopters of this strategy with a 2012 law that required adherence to the F.D.A. label. In 2014, the United States Court of Appeals for the Ninth Circuit, describing the medical grounds for the state’s law as “nonexistent,” issued an injunction against its enforcement.
That ruling,
Planned Parenthood of Arizona v. Humble, was not a final judgment, and the State Legislature was determined to keep trying. The bill Governor Ducey signed was the product of the latest effort. But on March 30, the day before the bill signing, the F.D.A. announced that after 10 months of study,
it was revising the label to reflect the evidence accumulated through actual medical practice: a 200-milligram dose, to be administered during the first 10 weeks of pregnancy.
Recall that the Arizona bill specified not just adherence to the F.D.A. label, but adherence to the label that existed last Dec. 31. Unfazed, Governor Ducey
signed it anyway. “Some changes may need to be made in a later bill,” he said.
While a half-dozen other states have required adherence to the F.D.A. label (while not interfering with the “off-label” uses that doctors commonly make of other drugs), Arizona’s legislators are the only ones, as far as I know, to take measures to assure that a regulatory change in Washington would not render their efforts useless. There is no doubt that the courts will quickly dispose of the newly signed law, surely one of the more cynical political acts in this cynical season.
The new F.D.A. label should bring down the curtain on a fascinating and revealing episode in the abortion wars. I don’t know who first came up with the idea of requiring adherence to the old label; I do know that
model legislation under the title of “Abortion-Inducing Drugs Safety Act” was drafted several years ago and made available to the states by the influential Americans United for Life.
What accounts for opponents’ focus on medication abortion? After all, the procedure is limited to the first trimester, as opposed to the later-trimester abortions that would seem to be more obvious targets for legislative energy. (Gov. Gary Herbert of Utah
just signed a lawrequiring doctors to administer anesthesia to women undergoing abortions at 20 weeks, on the unproven and disputed theory that fetuses feel pain at that stage.)
The F.D.A.’s decision two weeks ago hardly went unobserved, but it didn’t make quite the splash I would have expected. Maybe that’s because the abortion-rights side is so accustomed to the dreary drumbeat of bad news that it’s hard to fully assimilate good news when it comes. As for the pro-life side, its legislative strategy could really work only as a subterfuge, a claim that legislators were really doing their level best for women. In the clear light of day, it’s not easy even for the most abortion-hostile politician to stand up and declare that doctors should be required by law to give three times the evidence-based dose of medicine, any medicine.The answer is apparent: Medication abortion promises the ultimate in women’s empowerment and privacy. No need for a fancy facility (although Texas, its motives as transparently shameless as ever, requires clinics that provide only medication abortions to meet the same physical standards as those providing surgical abortion). No need for a doctor’s presence. No pickets or gauntlet of “sidewalk counselors” urging women to turn back.
Or maybe the muted response reflects a kind of shock: While everyone was looking in the other direction, waiting with hope or fear for the Supreme Court to deliver its next word on abortion, the Obama administration moved with discretion and precision to fix a particular problem. Just one piece of a bigger problem, to be sure, but the result is a changed landscape for abortion access — east, west, north and south.
URL: http://nyti.ms/1WsqrMF
