Canadian Medical Association Journal 1996; 155: 11-20
Ferris and Basinski state that there is a "high potential for teratogenicity in continued pregnancy with the use of methotrexate and misoprostol. . . . Safeguards to ensure quality of care to the woman and to minimize the potential for continued pregnancy resulting in congenital abnormality will be needed."
Wiebe states that medical abortion is 99% safe for pregnant women. Ferris and Basinski's concern is the potential danger to the surviving fetus in the up to 7% of "failed" medical abortions, since many of the fetuses in Wiebe's study were found to have significant abnormalities after follow-up surgical aspiration.
The ethical paradox is obvious and painful. Are the authors saying that the birth of a child with developmental abnormalities, albeit iatrogenic, is more tragic than the elective termination of an otherwise normal fetus? If, as a society, we believe that the morality of abortion hinges completely on the choice of the pregnant woman, what of those women who choose medical but not surgical abortion, or who change their minds in the meantime?
The nuances of "technique" in this situation bear on the morality of induced abortion itself. These and other questions will have to be dealt with by the medical community and society at large before medical abortion is widely accepted and implemented.
Donato Gugliotta, MD
Trenton, Ont.
Dr. Gugliotta presents a position in the debate about abortion that clearly does not favour either medical or surgical abortion. However, abortion procedures, like other medical procedures, are regulated under the Canada Health Act. Wiebe's article may have influenced other physicians' choice of these two medical services, medical and surgical abortion. The purpose of our editorial was to provide an evidence-based appraisal of the relevant, current literature as an informed context for physicians and patients who may be considering these options.
Lorraine E. Ferris, PhD, CPsych
Division of Community Health
Faculty of Medicine
University of Toronto
Institute for Clinical Evaluative Sciences
in Ontario and Clinical Epidemiology
Unit
Sunnybrook Health Science Centre
Antoni S.H. Basinski, MD, PhD, CCFP
Institute for Clinical Evaluative Sciences
in Ontario
Department of Family and Community
Medicine
Faculty of Medicine
University of Toronto
Toronto, Ont.