Health care professionals are not waiting for the U.S. Supreme Court to decide whether it is constitutional to send abortion pills through the mail.
Beginning in the summer of 2023, blue-state doctors have used a backdoor method to provide abortions to women in red states that have ostensibly banned or heavily restricted abortion procedures and abortion-inducing drugs.
Doctors and other licensed health professionals have mailed abortion pills to tens of thousands of women. So-called telemedicine shield laws in six blue states—California, Colorado, Massachusetts, New York, Vermont, and Washington—prevent out-of-state prosecutors from pursuing such doctors. These states will not extradite doctors, turn over records, or aid in any investigation, in sharp contrast to the usual practice of cooperation in arresting criminals across state lines.
Abortion providers and their allies have set up mobile clinics outside state borders, as well as funded abortion tourism, making it easier for women to travel to states where abortion is legal. Some women have stocked up on abortion pills, even if they are not pregnant, in case of that eventuality.
Dangers of Telemedicine
“The danger of telemedicine shield laws is really because they compound the threats of telemedicine abortions in general,” said Jane Orient, M.D., executive director of the Association of American Physicians and Surgeons.
“Telemedicine abortions provide no medical exam, no ruling out ectopic pregnancies, no ultrasound dating of gestational age, and finally no access to a medical provider in the event of a complication,” said Orient.
The inability to rule out ectopic pregnancies is especially dangerous for women, according to Orient, because “ectopic pregnancies occur in 1 to 2 percent of all pregnancies and the abortion pill is contraindicated.”
Orient added, “A ruptured ectopic pregnancy is deadly yet has similar symptoms to the expected effects of the abortion pill, thereby masking it.” Other dangers include taking the pill beyond the approved gestational limit, which “can lead to serious complications for the woman including hemorrhage.”
No Doctor-Patient Relationship
Furthermore, prescribing the abortion pill via telemedicine means the woman does not necessarily have a relationship with the doctor, says Orient. Women can simply search online, fill out a form, and then wait for the pills to arrive in the mail.
“By shipping abortion pills to states where abortion is prohibited, women who have a complication may be hundreds of miles away from the doctor who prescribed the abortion pill and will be forced to seek care at an emergency room,” said Orient. “In abortion-free states, the emergency room physician may not suspect an abortion complication. This could lead to misdiagnosis and inadequate treatment.”
Abortion ‘Privileged Form of Care’
“The root of the abortion problem is defining it as medical care, and a particularly privileged form of care, being exempt from regulations that apply to most care,” said Genevieve Marnon, the legislative director for Right to Life Michigan. “It certainly is unique—in that its intended purpose is to cause death. Mifepristone is a poison that causes death to a fetus.”
Mifepristone is the most common abortion drug and usually the first in a two-drug series doctors prescribe to women seeking abortions.
“Do we permit murderers to beat the rap if they send poison through the mail to a different state?” asks Marnon. “The one actually administering the poison is the mother. But I don’t know of any states that define the mother as the lawbreaker.”
Like ‘Back-Alley Abortions’
Marnon agreed with Orient that telehealth complicates the issue.
“Telehealth is appropriate in many instances—but not for a procedure that will make a person bleed, without supervision by a person who can stop the patient from bleeding to death,” said Marnon. “Abortion is a serious procedure that requires informed consent (almost always lacking), evaluation for ectopic pregnancy, and counseling. And awareness that the patient may be a victim of sex trafficking.”
Marnon says we should criminalize mail-order abortions, if not to completely reverse the approval of mifepristone. “Mifepristone should, arguably, have never been approved for causing abortion,” said Marnon, calling it “too dangerous” and noting that chemical abortions have more complications than surgical abortions.
“Mail-order abortions should be illegal everywhere,” said Marnon. “I suspect that they are at least as bad as back-alley abortions.”
As of press time, the Supreme Court was scheduled to hear arguments on whether the 2002 approval of mifepristone by the U.S. Food and Drug Administration (FDA) should be invalidated, on March 26.
Harry Painter (harry@harrypainter.com) writes from Oklahoma.
