Although abortion is still a surgical procedure in the United States, this may change as RU 486 and second-generation progesterone inhibitors become available. These drugs make it possible to perform 95% of first- trimester abortions as without surgical 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 pharmaceutical abortions will increase. Since many of these agents also have value in the treatment of disorders such as progesterone- dependent cancer, it is anticipated that they will be licensed for cancer chemotherapy but not for abortions. This will allow medical care practitioners to use them 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 or related compounds, they may become available on the black market either from supplies diverted from European clinics, or from those 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 that 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 medical care practitioners who will be asked by patients to obtain RU 486 or to supervise the administration of patient- acquired RU 486. Although medical care practitioners should not deal with illegally obtained drugs, ethical demands to help a patient otherwise unable to obtain an abortion will be strong.