The ``abortion pill'' now available in France and China adds a new layer of ethical questions to an issue already deep in dispute. Among them: Does it make abortion ``too easy''?
Is the prospect of early abortion, which the pill promotes, preferable to later abortions?
Is it moral to distribute the pill - or immoral not to?
Has safety been slighted in the debate over access to the pill?
The drug, RU 486, was approved for use in France in September. Taken very early in pregnancy, and with a second drug, the pill is reportedly more than 95 percent effective in producing a miscarriage.
The French company that developed the drug, Groupe Roussel Uclaf, abruptly withdrew it Oct. 26, citing opposition by antiabortion groups and boycott fears. Two days later the French government - prompted, perhaps, by an outcry from a conference of obstetricians and gynecologists - in effect ordered Roussel to reintroduce it.
With the authority of the French government behind them, ``We are relieved of the moral burden weighing on our group,'' the vice-president of Roussel said. ``For us the problem is now solved.''
To Dr. Louise B. Tyrer, Planned Parenthood Federation of America's vice-president for medical affairs, ``Denying this pill to women ... is basically signing the death warrant for 200,000 women who die annually from abortions.'' (World mortality statistics for abortions are informed guesses. The 200,000 figure, extrapolated from incomplete World Health Organization data, is widely accepted.)
All but a fraction of these abortion-related deaths are in developing countries and the result of illegal operations. Some are in places like India, where abortion is legal but access to surgical facilities is limited by scarcity or poverty.
There will ``likely be a black market immediately'' in RU 486, says Dr. Tyrer. By making illegal abortions safer, the pill will save lives, she says.
That claim is ``unrealistic, and a bad argument,'' says Arthur Caplan, director of the Center for Biomedical Ethics at the University of Minnesota.
It is unrealistic, he says, because rich women living in countries where abortion is illegal simply go to countries where it is legal. Only poor women suffer, and they won't know they are pregnant soon enough for the pill to be effective. Nor will they be more able to afford it. (American women who can obtain a prescription from a doctor in France may import the pills for their own use.)
Another danger of a black market in RU 486 is that its effects could not be monitored, Mr. Caplan says. The pill has been tested on some 10,000 women since 1982. But it will take hundreds of thousands of women taking the pill over the course of years to get a true picture of the drug's effects and its long-term safety, he says.
The dispute over access to the pill has made its proponents ``reckless,'' Caplan concludes. ``If it were just any old pill, I think they'd go slower'' introducing it.
While the prospect of abortion is distasteful, he says an early abortion (which the pill promotes) is preferable to a later one. The moral issues surrounding the abortion of a fetus loom larger as it approaches viability, he says. Other ethicists concur.
Tests show that the pill has no major side effects, though it is not without considerable discomfort. It seems to present fewer risks than surgery. It is cheaper, and more private. The treatment does not require a hospital stay, and the miscarriage occurs over the course of a couple weeks. No longer might a woman have to run a gantlet of protesters at a clinic, though she may still be emotionally jarred if she sees the aborted fetus.
Does it make abortion too easy? Yes, says Richard Glasow, of the National Right to Life Committee. ``It trivializes the decision to take an unborn human life,'' he says.
``It becomes more tempting to substitute [the abortion pill] for contraceptives in the third world,'' says Lisa Sowle Cahill, a professor of theology at Boston College. ``It's an easy solution, but the implications are worse.''
Dr. Tyrer dismisses the idea of RU 486 becoming the birth-control method of choice, given the pill's associated discomfort. Still, the phenomenon of surgical abortions being used as a birth-control method where contraceptives are not readily available is widely acknowledged.
Caplan does not see the pill encouraging more women to have abortions. Many women already have abortions, he notes, pointing to the estimated 1.7 million abortions annually in the US, 10 million in the Soviet Union, 12 million in China.
Prospects for the pill's sale in the United States are years away, experts say. No drug company yet has applied to the Food and Drug Administration to distribute the pill, which would entail five to seven years of testing and an investment of $10 million to $25 million.