Ethics of the abortion drug RU 486

Abortion: Ethical and Political Issues of RU 486

Abortion is a totally unacceptable, cruel and unethical practice and should be considered illegal except under some special cases and medical circumstances that indicate a danger to the mother. Our judicial system must consider the ethical and moral aspects of abortion as an intrinsic part of the problem when approaching this social issue. Even from the practical prospective the abortion pill RU486 has not been a breakthrough and instead of making abortion a private and safe method it has only increased the physical discomfort and the psychological ordeal for the woman.

Abortion is the one of the most debated social issues of this century. The controversy as to the right that man has over the life of a baby in the fetus and in controlling its entry into the world is a much-debated topic. Abortion is nothing but putting an end to the life of the baby by killing it in the womb itself. This social issue assumes all the more importance given the fact that an astounding 1.7 million people have abortions every year in the United States alone. Abortion, which was initially indicated as a life saving procedure, is today misused to suit the whims and fancies of the people. Let us briefly discuss the abortion procedures before going into the ethical and political aspects of RU 486, the latest abortion pill.

Abortion Options

There are both surgical and non-surgical methods of abortion. The Non-surgical abortions are also known as 'Medical abortions'. Usually non-surgical abortions are carried out in within the first seven weeks of the first three months of pregnancy. (trimester). Non-surgical abortion can be effected using either the pill or the liquid form. Chief among the non-surgical methods includes the abortion pill RU486. Also known as Mifeprex, RU486 stops the growth of the baby by inhibiting the release of the growth hormone called Progesterone, which is very essential for the growth of the fetus. Usually RU486 is used in conjunction with another drug called Misoprostol. Misoprostol stimulates the uterine muscles and increases the contractions. In this way the fetal matter is expelled from the body. This non-surgical procedure is considered to be effective in 95% of the cases and in the 5% where it fails surgical methods are used as a follow up to complete the abortion process.

Moral Justification for Abortion

Though as human beings we are under the obligation to save the precious life of the baby there are circumstances in which abortion can be justified. We come to a strong sense of understanding that in cases of women who were victimized abortion can be a rightful solution. In these cases the women in fact have a right for aborting rather than undergoing the burden of having to live up with the trauma of the horrible incident. This is especially so because she had no real control over her pregnancy and it was not a matter of choice.

Nonsurgical Abortion (Working Mechanism of RU 486)

Before we delve in depth about the ethical issues pertaining to the use of the abortion pill it is essential that we discern a fine point of distinction between the action of contraceptives and the abortion pill RU 486. Unlike contraceptives, which are taken immediately after an intercourse, and before the newly conceived baby attaches itself to the uterine wall, RU 486 is an abortion pill that is used within 7 weeks of the first trimester. This means that by this time the fetus is sufficiently developed with a working heart and brain.

Mifepristone is in fact designed to act in the same way as progesterone, the hormone that is responsible for the fetal growth. Because of this chemical and structural resemblance RU 486 attaches itself to the receptor sites of the fetus without triggering the signals for the same. This leads the body to misinterpret it for a drop in progesterone level (a sign that the woman is not pregnant) and so it continues with the normal menstrual cycle leading to cutting off of the nutrition and the expelling of the fetus. RU 486 is very effective in aborting the fetus and has a success rate of more than 85%. The usual medical procedure is to supplement RU 486 with a dose of Misoprostol (a prostaglandin) two days after the intake of Mifepristone. Misoprostol is a drug, which increases the contraction of the uterine muscles thus aiding in the successful expulsion of the dead fetal matter. [Vital Signs, Nov 2000]

The Legal Battle -Row Vs Wade (The landmark Case)

Row Vs Wade was an important landmark in American legal history. It all happened when Norma McCorvey, (under the name of Jane Roe) a 25-year-old woman challenged the Texas laws which regarded abortion as criminal. McCovery was denied an abortion in 1969 and was forced to give birth to her third child. (Which she attributed to be a consequence of rape and later claimed to be a false testimony). But in her second appeal in 1973 her case was taken by Sarah Weddington, an attorney from Dallas. This time they successfully argued that the anti-abortion law was an infringement of the women's personal rights and defeated the Texas government attorney Henry Wade. [BBC News]

The outcome of this case marked a great victory for the women's rights movement as for the first time in the United States abortion was made a legal medical option out of pregnancy. By a majority of seven to two the justice bench ruled that the government did not have any control over the reproductive rights of women. Citing the fourteenth amendment of the constitution, which expounds the freedom of personal and family affairs, the judiciary ratified the decision to abort the child as a personal choice and freedom of the mother. However this decision is still viewed as a highly controversial one. The judges also defined the time period (trimesters) within which abortion is legal. Abortion within the first trimester was made legal throughout the United States while abortions in the second trimester were regulated. The judgement also ruled out abortions in the last trimester except under critical medical conditions. (To save the life of the mother)

RU 486 (The Controversial pill)

RU 486 was first developed by Rousell-Uclaf, a French pharmaceutical company in 1980 and by 1989 it was available for use in France. In the next decade other European nations soon followed suit and approved the drug. But it took nearly two decades for the United States to approve the drug. Finally in 2000 the FDA approved and legalized the drug. The ethical considerations of the pill are manifold. There are two main factions that argue for and against abortion within the United States. They are the pro-choice and the pro-life groups. So we need to understand the viewpoints of the two opposing groups in discussing the ethics of abortion. The main issue under question is the right of women as against the moral and ethical implications of killing a baby, which cannot even pray. Though these two groups have a totally different outlook and approach to the issue there are some general cases where there seems to be a general agreement over the abortion option. Let us look briefly into the views of these two rival groups so that we can understand their stance better before taking our stand on this issue.

Pro-Choice (Women's rights)

Ever since the women's rights movement gained force the pro-choice group has argued for abortion as a rightful choice. Abortion is perceived as an option that empowers women with the right to exercise her choice to prevent unwanted pregnancy. The result of the Row Vs Wade case added impetus to the Pro-choice group. The main stress is on the rights regarding the reproductive choice of women. The Pro-Choice group does not consider destroying the fetus as an act of killing. Furthermore they argue that the embryo cannot be treated as a human being until such a time that it is fully developed to live outside the mothers womb. So they consider using the RU 486 pill as perfectly right and acceptable method of terminating pregnancy.

Pro-Life

On the other hand we have the Pro-life group, which opines that abortion in any form to be an unacceptable and inhuman practice and nothing short of brutal murder and infringement of the rights of the baby in the fetus. The Pro-life group views the problem from an entirely different perspective. This group considers that life begins as soon as the baby is conceived and hence abortion is viewed as a breach of rights of the baby. However the group approves abortion as the last and only resort in cases of emergency wherein the life of both the baby and the mother or at least one of them is at stake. Abortion is also approved in cases wherein the child is abnormal with severe birth defects.

Safety of RU 486

Ever since the Food and Drug control agency of the United States approved RU 486 (Sep 28th, 2000) it has been subject to controversies. Asides the fact that there are inevitable side effects for any kind of pharmaceutical preparation there are two main aspects to be considered when we discuss the safety of the drug. The main contentious issue is that the drug was introduced without sufficient clinical tests in the U.S. In fact the approval was mainly based on the results of the drug usage from abroad and a single clinical test inside the United States. This has left room for skepticism about the urgency with which the government approved the drug. RU 486 was given an accelerated approval under the 'under 21 CFR 314 Subpart H' process. This is something, which is inexplicable as generally the accelerated approval is only meant for potentially life saving drugs whose side effects are overridden by the critical condition of the patient.

Mr.Brad Clanton, the counsel for the Judiciary subcommittee had this to say about the hasty approval of the drug under the 'Subpart H', "It's an accelerated process for approving drugs for people who are basically dying or are going to have some serious deformity if they don't get something [treatment] right away," "It was basically created for AIDS patients." He further adds, "If you look at the FDA's own medical review, it shows that RU-486 is much worse on every single side effect. It's obvious that it doesn't provide meaningful therapeutic benefit over existing procedures." This in spite of the FDA medical review, which found out that RU 486 "had more adverse events, particularly bleeding, than did surgical abortion." [Stephanie K. Taylor].

Further there is an important point which needs to be discussed here. The FDA, has only approved mifepristone while it has not approved the usage of misoprostol as a supplementary medicine. This is all the more important given the warning from 'Searle' the manufacturer that "Misoprostol is not approved for the induction of labor or abortion." So in the absence of a clear approval by the manufacturer the issue of the adverse reactions, due to the interactions of the different drugs inside the body, is yet unclear. The analgesics and the other complementary drugs that are prescribed further augment this problem.

While this is one side of the issue the National Abortionists Organization is bent upon making the drug more accessible to the women. In fact in 2001 alone there was a massive advertising campaign for which it spent around $2 million. Vicki Saporta, the executive director of the federation says '"The anti-abortionists are trying to frighten women with medical misinformation. They have been talking about how dangerous RU-486 is when, in fact, the trials show 12 years of safe and effective experience. We want women to have accurate medical information."[Gavin Yamey, BMJ]. So we see that there is no uniform consensus about the drug in the United States.

Arriving at a correct assessment of the drug as to its safety seems a really difficult proposition given the disparity in views between medical professionals. What we need is that our perceptions of the positive effects of the drug should not deter a through scrutiny of its negative effects. The working mechanism of RU 486 indicates that the drug is not essentially restricted to the uterus. Because RU 486 inhibits the action of the progesterone hormone it invariably affects the other parts of the body like the breasts and the nervous system. Furthermore chemically RU 486 is identified as a 'glucocorticoid blockers'. This means that they may affect the proper functioning of the adrenal glands, which directly indicates a susceptibility to infections. This chemical property assumes all the more importance in cases where the drug fails in its purpose and a surgical intervention is needed. (Surgery exposes the negative effects of glucocorticoid blocking function of RU 486).

Empowering women

When we have a quick look at the national scenario it is quite obvious that in spite of abortion being legalized (with restrictions) women are not having an easy time. In fact It is found out that 86% of the counties in the United States do not have a clinical facility for surgical abortion. This problem is only augmented by the radical actions of the anti-abortion groups, which have threatened and attacked the clinics that offer the service. Given this circumstance we can understand the significance of the pill. But still when we look at the whole process of chemical abortion, it seems that this method of abortion is not really a private, quick fix solution but instead it is a complex, time-consuming process.

RU 486 and the Abortion Choice (The Impact)

The pill is not a breakthrough at all but a rather laborious process wherein the patient is subjected to many tests before and after the treatment. There is no question of privacy as medical supervision is inevitable. The false propaganda of the drug being a totally private and problem less alternative to surgery is ill founded. Furthermore the stringent stipulations that the government has issued for the treatment means that it is not an easy procedure. In short, though the drug is a successful abortifacent it is not an off the shelf pill which a woman can use directly without medical intervention. Also the abortion process itself extends from a three days to a week alongside the bleeding, pain and other symptoms associated with it.

In a study conducted by the WHO in which 38 Australian women underwent Medical abortion it was found out that the outcome of the process was successful. Out of the thirty-eight women 25 considered Medical abortion as natural. However a similar test conducted in Britain on a sample of 353 women resulted in a different outcome with almost 26% choosing surgical abortion and 20% opting for Medical abortion. [Pam M. Mamers, MJA] So there is not a real shift towards medical abortion. The one main reason for the RU 486 pill not gaining the confidence of women is that it involves a great ordeal. The abortion process extends over a week as against the surgical method, which lasts only a few minutes and a couple of checkups. [Pam M. Mamers]

The moral or the ethical aspects of abortion depends a lot on how we understand the underlying differences between abortions performed under different time periods. We are confronted with two main issues. Firstly we have to decide upon the status of the fetus or what is called the moral status of the baby. Another important consideration is the right of the women over the life of the innocent baby. Invariably all our ethical and moral reasoning revolves around these two important points.

The Politics behind RU 486

The introduction of RU 486 has been mainly viewed as a political duel especially under the circumstances in which the FDA approved the drug. (When election was due). The republics and the democrats were split in their views. While the democrats proclaimed the pill to be a rightful solution providing for a safe, secure, and private abortion method for women the republicans argued about the moral and ethical unacceptability of the drug. If we set aside the moral and ethical issues involved and look from a medical point-of-view RU 486 has certain advantages.

The main argument in favor of RU 486 revolved around the fact that it offers women the best and early way out of pregnancy in their own privacy. But after a careful study of the procedure it is now plainly obvious that RU 486 is still not a self-help drug and it requires intervention from the physician. So from the women's point-of-view RU 486 is not a real breakthrough. But the democrats argue that abortion pill offers women a chance to escape the intimidation that is usually involved in the surgical abortion process. As the democratic representative Jerrold Nadler says "Mifeprex makes it easier to avoid the terrorization by the thug elements of the anti-choice movement in this country who have used every opportunity to terrorize doctors and women," [Jeff Levine] While there may be some truth in this argument the issue of privacy still remains a unattended concern.

The republic party has its own views on the matter. Tom Coburn republican representative and a physician said, "The character and the integrity of the Food and Drug Administration has sunk to a new low today. Not only have they spent time trying to figure out how to deal death to an unborn child, what they have done is violate their own code of ethics." [Jeff Levine]. We see that the abortion issue has become more of a political spotlight in the recent years. But what we are missing out is that our deliberations on this subject of RU 486 mean little in terms of the moral and ethical aspects of accepting abortion itself. In the first instance many physicians consider the battle against RU 486 as grossly mistaken and misdirected effort against abortion itself. As Mr. Arthur Caplan, Ph.D. says, "I think fighting over abortion technology is not the right battleground for fighting about abortion.... You don't want to get to the point where, out of the attempt to achieve what you see as a moral goal, you put people at more risk," [Jeff Levine].