At what point in choosing to read this article might you change your mind and decide not to read it? At any point. Perhaps now. You can reverse some choices more easily than others, however. For example, try to decide not to start reading this article. Is the decision to obtain an abortion more like the former or the latter? Can abortion be reversed?
While surgical abortions have always been the most common method of abortion, medication abortions have gradually increased in recent years to the point that they now make up about 45 percent of early abortions. With the medication method, women take a sequence of two drugs: mifepristone, which blocks the body’s progesterone, a hormone needed to sustain the fetus’s life; and then, 24 to 48 hours later, misoprostol, which expels the fetus from the uterus.
Some pro-lifers have pushed back against the rise of medication abortions by promoting abortion reversals. If a woman takes the first drug and then changes her mind, she can flood her body with progesterone to try save the pregnancy. Some states have now passed legislation that requires abortion providers to inform women that their decision to obtain a medication abortion can be reversed.
But a recent series of articles, including a New York Times Magazine cover article this summer, describe the possibility of abortion reversal as somewhere between controversial at best, and an unscientific sham at worst. Medication abortions, the critics insist, cannot actually be reversed, which is okay because women do not regret their abortions anyway.
The scientific case against abortion reversal rests primarily on the notion that mifepristone (the first drug in medication abortions) by itself is often ineffective at inducing abortion. “There’s no evidence that any kind of treatment is better than doing nothing,” says Dr. Daniel Grossman, a leading abortion reversal skeptic. In this case, the progesterone intended to reverse the abortion acts merely as a placebo.
The first point to make against this alleged scientific argument is that it is disputed. Physicians who support abortion reversals argue that mifepristone by itself (without progesterone as a counter) will yield much lower fetal survival rates. If mifepristone acts to prevent progesterone from nurturing the fetus, then countering that action provides a better chance at fetal survival.
Neither side easily admits that we do not yet know how effective progesterone is at reversing medication abortions. There is not sufficient research either way, so each side supports its favored conclusion with its own limited studies.
But the abortion reversal critics go a step further and accuse their opponents of ideology and junk science, while refusing to acknowledge their own biases. (Grossman, for example, has a long record of research that aims to expand access to abortion.) They paint themselves as models of objectivity and credibility and their opponents as wackos and rubes. Meanwhile, they ignore the fact that absence of evidence is not evidence of absence. And they exaggerate the negative effects of administering progesterone, which is already an FDA approved drug that is commonly used in other contexts and rarely has significant side effects.
The more important point obscured by reporting on this issue is that even if what critics say is true about the ineffectiveness of progesterone as a mechanism for abortion reversal, it inadvertently proves that there is a legitimate procedure that might reverse an abortion, namely by interrupting the two-drug sequence and not taking the second drug. It is not a “theoretical” option; women who wish to reverse their medication abortions must refuse the misoprostol and wait and see if the pregnancy continues.
Some states have mandated informing women about the progesterone reversal method while others mention only the wait-and-see method. The American Congress of Obstetricians and Gynecologists, which criticizes the former method as unproven, insists that the latter method works between 30 and 50 percent of the time.
So the contested issue turns out to be which method is most effective at reversing an abortion. That a medication abortion can be reversed is not in dispute. This point is almost entirely muddied by the abortion reversal critics for the simple reason that they are operating from their own ideological motivation to protect and promote abortion. Indeed, they do not call the wait-and-see method a “reversal” because this would interfere with their abortion agenda. So much for value-free science.
Given the possibility of abortion reversal, should we inform women about this option? Pro-choice activists like Grossman claim that doing so confuses women and falsely promotes the idea that women regret their abortions. Here they point to studies that indicate such regret is quite rare. Because of the credibility problem for reversal critics, it would be natural to cast doubt on their claims about the extent of abortion regret and indecision. But I’m prepared to grant the point that regret about abortion is rare, since even rare cases can be significant. According to one study cited by several reversal skeptics, women regret their abortions only 5 percent of the time. On a conservative estimate, there are over 600,000 abortions every year in the United States. If 5 percent of women who obtain abortions worry that their decision was the wrong one, that’s 30,000 women who might have benefited from knowing that abortion reversal, by whatever method, may have been an option for them.
However, the more important reason to grant the point that regret about abortion is rare is that it is not relevant to the question of whether women should be informed about the possibility of abortion reversal. The rationale for informing patients about the possibility of abortion reversal rests not on the likelihood that they will actually take advantage of this option. It rests instead on the effort to emphasize the gravity of the decision and to ensure the patient’s voluntary choice.
The pro-life position holds that abortion is the wrongful ending of innocent human life. As such, it is a grave decision that should not be taken lightly. Consider an analogy to assisted suicide. States that have legalized assisted suicide recognize the gravity of the decision for terminally ill patients by requiring an extensive protocol before they can obtain lethal drugs. In addition to mandating multiple requests and a waiting period, state laws require that patients be informed several times that their request for lethal drugs can be rescinded at any time.
Very few if any patients who go to the trouble to request lethal drugs will rescind their request. Nevertheless, we inform them of their right to do so as an acknowledgement of the seriousness of the decision. Yet there is no witch hunt for “death with dignity” laws, even among proponents of assisted suicide, to demand that these patients not be told that they can change their minds. No one accuses these laws of confusing terminally ill patients.
Abortion reversal critics like to point to a study that found women are more confident about their decision to obtain an abortion than they are about their decision to obtain reconstructive knee surgery. This too misses the point. Decisions about other kinds of medical treatment, significant as they are, lack the degree of weightiness that we find in decisions to end a human life.
The second rationale for informing people about reversing their choices has to do with protecting a decision that extends over a period of time as a genuinely voluntary decision. Consider a different analogy here. In medical experiments where people are used as subjects, we inform them that they can withdraw at any time. Very few do, but we continue to insist on this measure in order to protect the integrity of the subjects’ consent. We do not want subjects to be coerced or unduly influenced into participating in experimental medicine.
Bioethicists do not worry in this case that extending to research subjects the possibility of withdrawal somehow implies that their original decision to participate is uninformed. On the contrary, it’s a matter of offering complete information. Nor is the idea that many subjects understand what an experiment entails only after they enter one. Rather, the idea is that sometimes people simply change their minds.
In cases where changing a choice is possible, we extend the opportunity to do so on the basis of protecting that choice as fully coming from the agent’s will. Even if no woman ever did want to reverse her abortion, there would still be an important reason to inform her that she perhaps can. The fact that abortion reversal critics are not only unwilling to do this when it comes to medication abortions, but even campaign actively against it shows that, for all their rhetoric, they are ultimately not pro-choice, but pro-abortion. They pay lip service to allowing women to make their own decisions, but refuse to inform them honestly about the nature of those decisions.
Only one side of this controversy has perfected obfuscation and paternalism. The case against informing women about abortion reversal would be laughable if the issue weren’t so serious.
Philip Reed is an associate professor of philosophy at Canisius College in New York, specializing in ethics and moral psychology. He also co-directs the Ethics and Justice minors and directs the Conversations in Christ and Culture lecture series at Canisius.