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Given that hundreds of women a year died from botched illegal abortions in the United States before Roe v. Wade, which legalized the procedure in 1973, I expected to find hospitals in Chile overflowing with dying women. Instead, I found that abortion drugs have dramatically altered the situation.
I’ve spent the past decade studying abortions in Latin American countries where abortion is always, or almost always, illegal. Yet, abortion in these countries remains commonplace. It is vastly safer than it was in the past, thanks to a revolution that has replaced back alleys with blister packs ordered online.
.. Abortifacient drugs have become so readily available in places like Chile and El Salvador that today it is impossible to enforce abortion bans. That was also the case in Ireland, where by some accounts, before last week’s legalization vote, at least two Irish women a day were self-administering abortions using pills.
.. The most widely available abortion drug in Latin America, misoprostol, is commonly used to treat ulcers. Although less effective than the combination of mifepristone and misoprostol used in the United States, misoprostol taken in the first trimester triggers an abortion in approximately 90 percent of cases.
.. Efforts to restrict access to misoprostol will fail not simply because it costs pennies to make, but also because it saves lives. The World Health Organization lists misoprostol as an “essential medicine” for treating miscarriages, and it is credited with dramatically reducing deaths from illegal abortions.
.. If a woman takes the wrong drug or the wrong dosage, particularly too late in pregnancy, she is likely to wind up in the emergency room, bleeding. There is no ready way for doctors to tell the difference between the hemorrhaging from a natural miscarriage and that from an induced abortion. But that hasn’t stopped governments from tasking them with trying.
.. Historically, as well as in most countries today, abortion prosecutions typically target the doctor. This practice is endorsed by today’s anti-abortion movement, which with virtual unanimity proclaims that women are abortion’s “second victims,” deserving compassion rather than punishment... Government officials have toured the country’s hospitals to inform doctors of their duty to report women even suspected of having induced their miscarriages. Not only does this policy violate near-universal norms of patient confidentiality, but because doctors have no reliable way to tell a natural miscarriage from an abortion, reports are made on the basis of suspicion. Who do doctors tend to suspect most readily? Poor women... Doctors may suspect wealthier patients of inducing a miscarriage, but they report only poor patients. Confidentiality has become a commodity... The risk of being accused of a crime injects fear and distrust into the doctor-patient relationship, leading some women to postpone or forgo necessary care... even a substantial legal victory for abortion opponents will not be as effective in combating abortion as they imagine — not just because a woman who wants to terminate her pregnancy will find a way, but because abortion drugs make finding that way easier than ever. In the internet age, trying to stop abortion by closing clinics is like trying to eradicate pornography by seizing magazines... Doctors will find themselves torn between strong norms protecting confidentiality and the pressure to report their patients, and the pressure to treat women themselves as criminals is likely to grow,.. Abortions rates are driven not by legality but by economics. Half of the abortions in the United States are among women below the federal poverty line... the best way to lower abortion rates is to deal with what causes women to want to abort in the first place. Rather than ending abortion, criminalizing abortion will merely create new ways in which the state can intensify the misery of the poorest among us.
I see an interesting parallel to malpractice liability for physicians. The well known and understood best way to avoid malpractice is not expertise or avoiding mistakes, it’s having good beside manners and treating patients with respect. (Expertise and attention to detail are very, very important of course but have less impact on chances to get sued than these other soft factors, according to this advice.)
I’ve seen doctors miss cancers before and escape unscathed after frank discussions with the patient, while others that do everything technically correct are sued over a hangnail. Not saying missing cancer is “ok as long as your nice”, I’m saying that people don’t really sue over money, they sue over hurt feelings and seek retribution in monetary form. (There’s a big exception to all this in the patients who are opportunistically seeking an opening to sue. They are simply dangerous to have as patients, but are usually quick to move on.)
Finally, the physician who has good bedside manners is also a better witness and more sympathetic to juries.
> Doctors are part of a guild. They artificially limit the number of doctors available by capping the number of medical schools
They do not. You may be confusing the AMA (which less than 25% of doctors even belong to) with the AAMC. The latter does cap the number of medical school positions nationwide, but they’ve also made a concerted effort over the last ten years to increase that number steadily.
But even if they eliminated that cap entirely, it wouldn’t matter, because the number of medical school slots isn’t a bottleneck for the number of practicing physicians. The number of residency slots is, and the funding gap for that comes from Medicare, which is responsible for funding them.
Unless more residency programs are funded, increasing the number of medical school positions would simply increase the number of people who have medical school debt and aren’t licensed or trained to practice medicine, which would be even worse,