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The Changing Nature of Abortion

While abortion is still a surgical procedure in the United States, this will rapidly change as RU 486 and second-generation progesterone inhibitors become available. These drugs make it possible to perform 95 percent of first-trimester abortions as outpatient procedures. This is disturbing to antiabortion activists because it does away with easily targeted abortion clinics. As states begin to restrict the availability of legal abortions, the demand for RU 486 will become enormous. Since RU 486 also has value in the treatment of disorders such as progesterone-dependent cancer, it is anticipated that it will be licensed for cancer chemotherapy but not abortions. This will allow physicians to use it as an abortifacient because the use of prescription drugs is not limited to FDA-approved uses. (If drugs could be used only for FDA-approved uses, there would be very few drugs available for pregnant women.)

If the FDA refuses to license RU 486, it may become available on the black market either from supplies diverted from European clinics, or illegally manufactured in the United States. Given that an illegal abortion can cost several hundred dollars, the profit margin on a dose of RU 486 and a prostaglandin would be much higher than on cocaine. Restrictive abortion laws probably will add RU 486 and its analogues to the profitable inventory of the illicit drug industry. This will pose a dilemma for physicians who will be asked by patients to obtain RU 486 or supervise the administration of patient-acquired RU 486. While physicians should not deal with illegally obtained drugs, ethical demands to help a patient otherwise unable to obtain an abortion will be strong.

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