ISSUES IN LAW & MEDICINE

Medication Abortion and Preterm Birth
Calhoun B
Considerable controversy exists about the effects of medication abortion on the incidence of preterm birth (PTB). Medication abortion of various types continues to be touted as a safe alternative to surgical abortion, and without increased risk for PTB. There is a paucity of evidence regarding medication abortion and PTB, but available papers are reviewed here. There is moderate-quality evidence that medication abortions which require surgical completion increase PTB rates more than surgical abortion alone.
Maternal-Fetal Bonding
Wright J
A complex biological and psychological series of events commence at fertilization and continue through parturition between the preborn human organism and his or her mother, which extends far beyond the physical connection between an adult patient and contained tissue. This guideline reviews evidence in support of various aspects of this bond and its implications for care of the maternal patient.
Limiting Conscience Rights in Obstetrics and Gynecology
The American College of Obstetricians and Gynecologists (ACOG) released a Committee Opinion in November 2007 titled "The Limits of Conscientious Refusal in Reproductive Medicine." This document, claiming to speak on behalf of the entire profession of Obstetrics and Gynecology, proposed that conscience rights of healthcare professionals have limits with regard to certain aspects of patient care. Despite calls for revision from many within the profession, this document was reaffirmed in 2016, unchanged. This document provides a detailed analysis of the ethical flaws in ACOG Committee Opinion 385.
Ethical Research Involving Fetal Human Subjects
Fetal tissue research refers to research using several types of tissue, including but not limited to samples obtained from aborted fetuses, cell lines derived from aborted fetuses, and in rarer cases, living previable neonates who have survived an abortion attempt. The ethical questions surrounding each type of tissue procurement are not identical, but do share similarities. This guideline on fetal tissue research discusses the moral status of the human fetus, the state of ethics for medical research on vulnerable subjects, aspects of medical research using human fetal tissue, and the necessity of including fetuses as a protected class under vulnerable populations in research. The debates connected to embryo stem cell research and other research related to embryos are beyond the scope of this document.
The Pregnancy Continuum in Domestic Sex Trafficking in the United States: Examining the Unspoken Gynecological, Reproductive, and Procreative Issues of Victims and Survivors
Lederer LJ, Flores T and Chandler MJ
Crucial to the fight against sex trafficking is understanding the experiences of victims and survivors. Survivor surveys have illuminated key areas to address, but a clear gap in the research is in the reproductive, gynecological, and procreative health issues of victims and survivors. This article opens the door to research and dialogue by publishing the findings of a pilot survivor survey focused on survivors' sexual and reproductive health. The retrospective survey offers preliminary findings for a larger national study underway in 2023 that will enable healthcare providers, service providers and other first responders to identify and better meet the unique needs of victims and survivors of human trafficking in this area.
Turnaway Study Report Unethically Violated Participants' Privacy and Misleads Public with a Non-Representative Sample, Selective Reporting, and Overstated Conclusions
Reardon DC
Results from the Turnaway Study, conducted by Advancing New Standards in Reproductive Health (ANSRH), have widely been represented as definitive proof that women denied access to abortion will suffer severe injury to their health and economic wellbeing. Yet a careful examination reveals that the study is based on a non-random, non-representative sample of women that grossly underrepresents the experiences of the majority of women undergoing abortions. In addition, a reanalysis of its reported results reveal that the effect size of the outcomes observed have been grossly overstated, leading to conclusions that are not supported by the results. There also appears to be selective reporting and misrepresentation of results previously published. In addition, inconsistencies in ANSRH's published record strongly suggest that the credit history reports of the Turnaway Study participants were obtained without their informed consent.
In Vitro Fertilization, State Wrongful Death Statutes and State Fetal Homicide Statutes: The Reaction to LePage v. Center for Reproductive Medicine
Linton PB
The Alabama Supreme Court recently held, in , that the parents of human embryos that were negligently destroyed at a fertility clinic could bring an action for damages under the State's wrongful death statute. Although the Alabama legislature promptly enacted a law essentially overturning the state supreme court's decision, concerns have been raised that the court's decision might influence courts in other States to interpret their wrongful death statutes, or possibly even their fetal homicide statutes, to apply in similar circumstances, thereby threatening the availability of fertilization (IVF) technology. This article addresses those concerns. With respect to wrongful death statutes, only fourteen States (excluding Alabama) have interpreted their statutes to apply to unborn children without regard to their stage of gestation or development. The majority of States impose a gestational requirement (typically, viability) which would preclude their application to the destruction of human embryos. Even with respect to the minority of States that impose no limitation on the cause of action, those statutes, either by their express language or by fair interpretation, would not apply to unimplanted human embryos. With respect to the fetal homicide statutes in thirty-one States that do not have any gestational or developmental limitation, the statutes in twenty-six of those States apply only to acts causing the death of an unborn child . As to the statutes in the other five States, the structure of the statute, considered in light of the applicable case law, strongly suggests that there would be no liability for causing the death of an unborn child before implantation. In sum, the Alabama Supreme Court's decision in is not likely to be followed as a precedent in interpreting either the wrongful death statutes or the fetal homicide statutes of any other State.
The Teenage Brain: Under Construction
Can sexual activity, alcohol and drug use, violent video games, pornography and other activities, including use of social media, damage adolescent minds? Early high-risk behaviors appear to have significant harmful effects on the brain's development. Evidence suggests that the hormones and neural patterns triggered may lead to addictive, and other high-risk behaviors, social withdrawal, and depression. Compounding these concerns are the immature decision-making processes during adolescence. Fortunately, parents can positively impact the brain development of adolescents as they assist in decision-making, provide structure to the adolescent's environment, and monitor the adolescent's activities.
Misleading Statements About "Life of the Mother" Exceptions in Pro-life Laws Require Correction
Harned M and Skop I
Misleading statements in a recent article require correction. No state has an abortion law that is a total ban on abortion. Every state law permits abortion when necessary to save a mother's life. Texas law does not require an "imminent" risk and allows a doctor to use his "reasonable medical judgment" to determine if an abortion is necessary to prevent a "risk" of maternal death. Similarly, Idaho allows a doctor to use his "good faith medical judgment" to determine when to intervene, without need for "immediacy".
A Reanalysis of Mental Disorders Risk Following First-Trimester Abortions in Denmark
Reardon DC
A previous Danish study of monthly and tri-monthly rates of first-time psychiatric contact following first induced abortions reported higher rates compared to first live births but similar rates compared to nine months pre-abortion. Therefore, the researchers concluded abortion has no independent effect on mental health; any differences between psychiatric contacts after abortion and delivery are entirely attributable to pre-existing mental health differences. However, these conclusions are inconsistent with similar studies that used longer time frames. Reanalysis of the published Danish data over slightly longer time frames may reconcile this discordance.
A Statement on Abortion by 170 Obstetricians/Gynecologists after the Reversal of Roe v Wade
Cirucci C and Valley M
In a recent American Journal of Obstetrics and Gynecology, 900 professors submitted a Special Report calling for reinstating federal protection for abortion. Here, we provide an alternative consensus statement. Induced abortion is not a constitutional right. We, too, value patient autonomy, but autonomy does not allow for causing harm to another human being, in this case, the human fetus. We share concern about maternal mortality in the United States, but evidence shows that induced abortion increases, not decreases, maternal mortality. We share the authors' concern for the effect of induced abortion on minority populations and mourn the fact that the abortion rate in non-Hispanic black patients is three times that of non-Hispanic white patients and twice that of Hispanic patients. Many obstetricians/gynecologists, like ourselves, do not support abortion, and most obstetricians/gynecologists do not perform abortions. Induced abortion is not necessary to provide evidence-based care. We also have seen tragic situations and misinformation and want to work toward addressing these issues. We support the highest level of clinical practice, bodily autonomy, reproductive freedom, and evidence-based care for both our patients-the pregnant woman and the human being in utero-whom we have dedicated our lives to serving.
First Pregnancy Abortion or Natural Pregnancy Loss: A Cohort Study of Mental Health Services Utilization
Studnicki J, Cox TL, Fisher JW, Cirucci CA, Reardon DC, Skop I, Craver C, Tsulukidze M and Ras Z
While both induced abortion and natural pregnancy loss have been associated with subsequent mental health problems, population-based studies directly comparing these two pregnancy outcomes are rare. We sought to compare mental health morbidity after an induced abortion or natural loss.
Challenging Vavřička: Questioning Compatibility of the Mandatory Tetanus Vaccination with ECHR
Paksoy MS and Taner Z
The compatibility of mandatory vaccinations with human rights has become a very current issue with the COVID-19 pandemic and the Vavřička ruling by the European Court of Human Rights. This ruling has faced criticism for not conducting examinations related to disease and vaccines based on direct scientific evidence. In this analysis, an assessment will be made based on direct scientific evidence about tetanus and its vaccine. The prevailing reason for mandatory tetanus vaccination is to protect the health of the vaccinated individual. Competent adults have the right to refuse treatment. This rule also applies to preventive medical interventions, including tetanus vaccination. As a rule, parents are entitled to give consent for medical interventions on their children. If an immediate and serious threat permanently endangers the minor's life, medical intervention can be carried out against the parents' will. The limitation of parental autonomy is more disputed when the minor's life is not immediately threatened. With respect to tetanus vaccination as a preventive medical intervention, it does not eliminate an immediate and serious risk of harm. As a result, interference with the parent's discretion on tetanus vaccination as a preventive medical intervention should be evaluated for its compatibility with the current legal approach to medical interventions on minors and patient rights.
How Controversy and Socioeconomic Factors Influence Stem Cell Research
Casey DP, McCartney GM and Doroski DM
Adult stem cells dominate worldwide stem cell clinical trials. We investigated factors that may explain levels of stem cell research across different countries. Stem cell trials from clinicaltrials.gov were counted and categorized based on the country, the type of stem cell used, and whether that type is ethically controversial. The trial data were compared with characteristics of the countries such as population and GDP. We looked at the general ethical position of the countries by ranking their favorability toward abortion via their legislation. We found GDP, which may be indicative of the interest and means a nation can put toward research, to be the most predictive measure of stem cell use. No correlation was found with national abortion legislation, which is an indicator of ethical positions on life issues in a country. Thus, it would seem that the use of stem cells, namely the significantly greater use of adult stem cells over other more controversial types, is likely to be more influenced by their scientific utility and not by other social or ethical opinions. In addition, ESC and other ethically controversial research does not appear to be necessary for the US to dominate worldwide stem cell research.
United Kingdom Data Deficiencies Influencing U.S. FDA Decisions
Skop I, Miller C and Duffy K
The U.S. FDA has permanently removed the in-person prescribing requirements that previously safeguarded the use of mifepristone/misoprostol medical abortions, allowing prescribing through telemedicine or on-line ordering and distribution through the mail and pharmacies, without standard pre-abortion testing. This will increase the risk of complications due to failure to adequately determine the gestational age or rule out ectopic pregnancy by ultrasound or physical exam, failure to perform labs to document whether RhoGAM is indicated, and failure to obtain appropriate informed consent to prevent unwanted abortions, among other concerns. The FDA justified this action by referencing flawed studies with significantly undercounted complications. The details of these study deficiencies are examined in this paper.
Law, Ethics and Lockdowns: Impacts on Life, Liberty and the Economy
Keown J and Paton D
Many people worldwide, particularly those with disabilities and the elderly, suffered greatly not only as a result of the Covid-19 pandemic but also as a result of the lockdowns. In this article we set out widely-accepted ethical criteria for assessing when coercive public health measures are justified. We then review the empirical evidence, not least concerning the benefits and costs of the lockdowns, and conclude that lockdowns as instituted in the UK (and, presumptively, in many other jurisdictions) appeared to breach those criteria. We conclude that any future proposal to lockdown should be subjected to the strictest ethical scrutiny, and that a lockdown should not be contemplated unless it could be convincingly demonstrated that the benefits would substantially outweigh the harms; that it would be proportionate, and that legal coercion would be strictly necessary.
International Standards and Features of Financing in the Field of Health Care and Provision of Medical Services
Kiselyova E, Myrhorod-Karpova V, Shlapko T, Malanchuk T and Sadykova Y
The relevance of this article is due to the fact that international standards in the field of health care and medical services are central to the field of world principles of functioning and development of medical law. The aim of the article is to conduct research on the peculiarities of international standards in the field of health care and medical services, as well as to study the prospects of their implementation in Ukraine. Leading research methods are general and special research methods, including methods of logic, analysis, comparison. The results of this study are to outline recommendations for the use of international standards in the field of health care and medical services in Ukraine and to summarize the legal framework on this issue. The significance of the results is reflected in the fact that this study can serve as a basis for outlining future changes in current legislation of Ukraine on the functioning of the health care system and implementation of world practices in health care. Within the framework of this study, systematized the main international and European documents that reflect the main international standards in the field of health care and medical services and ratified in Ukraine and have a direct impact on the legal framework for this area.
Chemical Abortions: With and Without Medical Supervision
Chemical abortions, otherwise known as "medication-induced" abortions, were approved by the FDA in September 2000, and now account for over 50% of abortions in the United States. Women are being encouraged to order and carry out their own abortion, without in-person supervision by health care professionals, contributing to increased risks of complications. This paper describes the use of synthetic chemicals to induce abortion and the complications faced by women who obtain care in a medical setting, including hemorrhage and incomplete abortions that may require surgical intervention. Additionally, it describes the increased risks for those women who use telemedicine or the Internet to obtain their chemical abortion, especially when those abortions are completed without physician supervision (self-managed). The risks may include an undiagnosed ectopic pregnancy, increased complications due to underestimated or understated gestational age, Rh isoimmunization, and undiagnosed infection. Intimate partner violence, reproductive coercion, and human trafficking are also less likely to be suspected in the absence of an in-person medical evaluation. The American College of Pediatricians strongly encourages health care professionals, policy makers, and women of all ages and their families to understand the serious risks associated with chemical abortions, especially when self-managed. Additionally, pregnant women with regrets after starting chemical abortions need to be informed about the potential for abortion pill reversal.
State Regulation of Ensuring the Quality Medical Care During Martial Law in Ukraine: Lessons for the International Community
Korolchuk O, Semenets-Orlova I, Mamka V, Chernetchenko O and Vasiuk N
Nowadays, the quality of medical care and health care measures is considered the main target function of the health care system and at the same time the determining criterion for its activities.
A LOSS OF FACE: The Freedom of Access to Clinic Entrances Act post Dobbs v. Jackson Women's Health Organization
Roden GJ
The Freedom of Access to Clinic Entrances Act of 1994 is no longer a valid exercise of federal jurisdiction under the Fourteenth Amendment, in light of Dobbs v. Jackson Women's Health Organization, nor ever was under the Commerce Clause, properly understood, per United States v. Morrison.
Counseling the Abortion-Vulnerable Patient
Induced abortion is defined as a procedure done to end a pregnancy in such a manner as to avoid a live birth ie intentional feticide. Many physicians will encounter patients considering intentional feticide (induced abortion) for various reasons. Such interactions present an opportunity not only to create a lasting bond with the patient, but also to open doors for her to explore possibilities she may not have considered, and thereby enable her to make a life-affirming decision. Given the importance of offering accurate information about induced abortion and continuation of pregnancy, this Guideline provides guidance and resources for the prolife physician encountering an abortion-vulnerable patient.