PERSPECTIVE ON THE ‘ABORTION PILL’ : Is a Flat Ban Ethical? : Advances in medicine on the scale of RU-486 demand to be weighed on two levels of benefit, individual and societal.

As with so many medical breakthroughs, RU-486 challenges society to decide whether what is technically feasible is also ethically correct.

Ethics involves the traditional principles of justice, respect for persons and the duty to do good (beneficence) and avoid harm (non-maleficence). Questions arise at two levels--the microethical, that is, applying to relations between individuals, and the macroethical, applying to relations among communities themselves and between communities and their members.

Microethical issues raised by RU-486, popularly described as the French abortion pill, concern the relative moral status of a woman and her embryo. RU-486 is currently used in France for very early abortion, undertaken before seven weeks from the last menstrual period. Since the embryo develops into a fetus at about 10 weeks, use of the term “embryo” is medically appropriate.

Those who accord both embryo and woman equal moral significance find no reason to favor a woman’s autonomy over continued life of the embryo. They are as opposed to RU-486 as to any other abortifacient, and they find no offsetting merit in achieving abortion very early in pregnancy or by a non-surgical method. Indeed, they view the drug as especially threatening because, they say, it makes abortion “too easy.”

This argument is a modern manifestation of the historical subordination of women’s best interests to an imposed vision of moral order. Those accustomed to making decisions for society once opposed giving women anesthetics in childbirth. The pain, it was argued, was a deterrent to promiscuity, and thus served society’s interest in women’s moral behavior.

The “too-easy” reason for opposing RU-486 offends the ethical principle of respect for persons. It fails to appreciate a woman’s conscientious weighing of competing values in her present and future life and in the lives of others she feels morally bound to consider.

When unintended pregnancy devastates a woman’s plans for her and her family’s future, inconvenience of methods of abortion does not influence her choice. The determination and desperation with which women pursued hazardous abortion in the past contradicts the suggestion that women’s decisions are primarily directed by convenient availability of abortion.

A claim that the interests of an embryo trump all others may itself be too easy and ethically inadequate. Simplistic resolutions of others’ ethical dilemmas may suit ideological agendas, but they denigrate the duty of individuals to make conscientious judgments in complex emergencies.

Cause-and-effect arguments require empirical evidence. There is no evidence that access to non-surgical abortion encourages abortions that would not otherwise occur, or leads to an increase in abortions. There is evidence that when abortion is part of comprehensive reproductive-health care, including sex education and contraception, rates of abortion do not rise.

Indeed, the Netherlands, with publicly funded abortion services widely available, has the lowest abortion rate in the industrialized world. That’s because the Dutch also have access to sex education and information as well as contraceptive and voluntary sterilization services. It may be argued that the Dutch approach is an ethically more beneficent way to reduce the rate of abortion than denying access to new methods.

In the sphere of macroethical problems, RU-486 raises questions concerning how decisions made at a community level affect individuals. The question of proceeding with further research on RU-486 requires consideration of its potential benefits apart from non-surgical abortion, in such areas as contraception, breast cancer treatment, childbirth and treatment of Cushing’s syndrome.

Does it offend the ethical principle of justice to compromise promising research in these health areas in order to limit abortion services? Such an obstruction of non-surgical abortion may also impair a doctor’s or a scientist’s ethical duties to benefit and to avoid harm to those people with such diseases as breast cancer and Cushing’s syndrome.

If the interests of those patients are sacrificed to those of potential embryos, there must be, at an ethical minimum, some evidence that this step will likely achieve greater social benefit than harm. For example, arguments to restrict the availability of the anti-ulcer drug Cytotech because it might be used for abortion have been found unjust; benefits to ulcer patients were not denied in order to prevent speculated loss of embryos.

The abortion-deterrence argument against RU-486 raises the question of whether women’s ethical judgment involves only a behavioral outcome or is part of a process of ethical reflection and decision-making. In other words, is the result of an action the only concern, or is the process a consideration as well? Religions have at times assessed moral conduct in terms only of obedience to judgments made by their leaders. It is increasingly recognized, however, that truly ethical conduct consists not simply in behavioral conformity but in personal searching of relevant values that leads to an ethically inspired personal decision.

On both the personal and community levels, constructive ethical reflection and dialogue requires respect for a plurality of ethically based judgments.

Ethical discourse is necessary for any society to form its responses to any scientific or medical innovation. Simply to prohibit research based on RU-486 without critical evaluation of the ethical implications is to deny a society an opportunity to improve its ethical sensitivity.

Justice requires that ethical answers to the questions raised by RU-486 not be reached by reference to a single interest, but by participation of a wide range of interests liable to be affected, and by assessment of the balance of all of the reasonably foreseeable risks and benefits.

The exclusion of RU-486 research without multilateral weighing of its proven powers and its potential impoverishes the exercise of ethical judgment in society and allows political power to displace ethical principle. A society that values ethical discourse and the exercise of personal conscience must ask whether the cost of a flat ban on RU-486 for any and all purposes is too high.

Next: Psychology professor Sidney Callahan criticizes RU-486 abortions as morally ambiguous.