© 8/2/08

Re:   I am pleased to learn of the APA’s desire to review the evidence on the benefits and harms attributed to induced abortion.  It is wise that you take the position that abortion should be considered like every other medical procedure.  After all it is a medical and/or surgical procedure, done by medical staff in medical facilities usually paid for by medical funding and controlled by medical licensing bodies.  The problem of how to regard the provision of this service to society and women in particular has arisen primarily because physicians have neglected their ancient mandate to always provide the best treatment. They have neglected to properly collect and evaluate the data necessary to provide good evidenced based medicine.  It seems this happened because of political pressure.

       I hope the APA is seeing this as an opportunity to help correct this aberration in medicine.  To do that the APA must free itself of polemics and utilize the best of science and the most objective of scientists.  History has shown that in this life, truth and gravity always win.  None of us would like to be known to history as one of those who were more motivated by a desire to agree with public opinion or to gain momentary prestige.

       I am reminded of Philippe Semmelweise who lost his hospital privileges and honor among his colleagues when he persistently recommended they change their procedure He discovered that washing his hands between doing an autopsy and giving a women in labor a vaginal examination prevented her from contracting puerperal fever.  Physicians of his day refused to believe him and persisted in their usual routine.  As a result many women in Budapest and other teaching hospitals died.  I do not wish to be among those physicians and psychologists who hang their head in shame when the truths of abortion finally come out.

      The mandate of medicine is to insure that before beginning any procedure there clearly is: 1) necessity for any person with this disease, 2) after careful examination, the procedure is required for this particular person 3) scientifically convincing evidence of benefit, 4) relatively few reported harmful effects, 5) beneficial intent on the part of the practitioner in that he/she has made careful evaluation of the data from a follow-up of patients on whom he has already performed this procedure and is convinced by knowledge of his patient, his skills, the best science on the matter and the outcome of his treatment that he is doing the right thing for her/him, 6)that a clear treatment recommendation is made 7) fully informed consent is freely given by a competent patient who has sufficient time for consideration 8) other less invasive, less potentially harmful and less irreversible treatments have been discussed, 9) these alternatives have all been tried and found wanting, 10) sufficient capacity of the patient to endure the procedure and pay for its performance. If these criteria are not met, then primum non nocere must apply.

      We also need to remember that the onus of proof is born by those to perform, support or finance the procedure in question. Those who discover harmful effects have a duty to report and keep reporting until someone with authority takes notice and withdraws the medication or procedure from the market until more research is done.  But the greater obligation to show benefit and safety lies with the practitioners.  It is note-worthy that there are no abortionists who have provided convincing evidence of necessity, benefit and few side effects from their own practice.

       I believe all physician, must give a clear understanding of all consequences to their choice and as much scientific knowledge as they can conveniently acquire and use.  This is another place where the APA’s critical review can be helpful.  They must not be confused by polemics or coerced by party or parental or partner pressure.