June 29, 2010
Abortion by Telemedicine
From the NY Times:
The situation has played out hundreds of times. From his office here, a doctor asks a woman on the computer screen before him one final question: Are you ready to take your pill?
Then, with a click of his mouse, a modified cash register drawer pops open in front of the woman seated next to a nurse in a clinic — perhaps 100 miles from this city — with mifepristone, the medicine formerly known as RU-486, that is meant to end her pregnancy.
Efforts to provide medical services by videoconference, a notion known as telemedicine, are expanding into all sorts of realms, but these clinics in Iowa are the first in the nation, and so far the only ones, experts say, to provide abortions this way.
Advocates say the idea offers an answer to an essential struggle that has long troubled those who favor abortion rights: How to make abortions available in far-flung, rural places and communities where abortion providers are unable or unwilling to travel. So far only Planned Parenthood clinics in Iowa use this method, but around the country, abortion providers have begun asking how they might replicate the concept.
For some, however, the program tests the already complicated bounds of telemedicine. Abortion opponents say they are alarmed, fearful for the safety of women who undergo abortions after consulting with doctors who have never actually been in the same room with them. Opponents filed a complaint this spring with the Iowa Board of Medicine, arguing that a doctor’s remote clicking of a mouse hardly meets the state’s law requiring licensed physicians to perform abortions, and more objections are coming.
Before the videoconference begins, a patient in a distant clinic meets (in person) with a nurse. There, blood tests, a medical history, an exam, an ultrasound and counseling on matters like what to expect from the procedure and plans for a follow-up exam are completed. The results are shared (by computer) with a doctor miles away, and the doctor and the patient (at all times accompanied by the nurse, who sits beside her) meet by videoconference over a private network.
“I don’t feel like something is lost or missing,” Dr. Tom Ross, one of Planned Parenthood’s doctors, said.
Dr. Ross said he talked to patients — asking his questions and answering any of theirs — as if he were speaking to them in person. In most cases, he then clicks on a button that releases the drawer in front of the woman. Inside are two bottles — one for the mifepristone she will take immediately, while still sitting in the clinic, and the other for the misoprostol she will take later.
No serious complications have occurred in Iowa involving these videoconference patients. And the patients, mainly, seem fine with the procedure. They have a choice: when they call to seek an abortion, women who live far from city clinics can either take abortion medication in a distant office with the doctor on teleconference, or travel to the doctor.
It is uncertain how long it will take the State Board of Medicine to investigate Operation Rescue’s complaint that this method does not meet the state requirement that licensed physicians — not nurses or others — perform abortions.
Read the full article here.
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