Introduction

Introduction

Decision making involving contraception, sterilization, and abortion has been the key nexus between medical practice and the law. The modern notions of patient autonomy and privacy arose from U.S. Supreme Court decisions on access to contraceptives and abortion. Most precedent-setting litigation on the physician-patient relationship has arisen in the context of contraception first, and then abortion, because these are areas with no general political consensus on the proper reach of the law. Even the Cruzan right-to-die decision (see Chapter 13) was based on a law passed as part of an antiabortion legislative package. In several states, a majority of the population believes that abortion should be illegal in all but the most extreme cases. In many states, a majority of the population believes that a minor should not be allowed to have an abortion without notifying her parents. While access to contraception has not been as emotionally charged an issue as abortion, a substantial percentage of the population would limit a minor's access to contraceptives unless she had parental permission.

Abortion promises to remain controversial. The U.S. Supreme Court is allowing the states more latitude to regulate abortions. This is resulting in the passage of very restrictive antiabortion laws in some states at the same time that others are considering allowing the use of new abortifacients such as RU-486.

While there has not been a corresponding turmoil in the laws governing access to contraceptives, products liability litigation has limited the availability of some contraceptive options. More fundamentally, HIV infection is changing the assumptions on which traditional contraception counseling is based. For some populations, the risk of HIV infections is sufficiently high as to make the use of nonbarrier contraceptives questionable at best. This will add to the already substantial risk of medical malpractice litigation surrounding contraception and sterilization. Properly managing the legal risks and ethical dilemmas of reproductive medicine requires physicians to understand the legal and emotional issues that this care engenders.

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Introduction