Rebouché Rachel
Temple University Beasley School of Law, Philadelphia, PA, USA.
Am J Law Med. 2022 Jul;48(2-3):244-255. doi: 10.1017/amj.2022.29.
In July 2020, a federal district court lifted the U.S. Food & Drug Administration's ("FDA") restriction requiring patients to pick up the first drug of a medication abortion-mifepristone-at a healthcare facility. Soon after, an ongoing experiment with remote care for abortion expanded, as telemedicine did in other areas, and virtual clinics began offering no-touch abortions. Growth of virtual care stalled in January 2021 when the Supreme Court stayed a district court's order pending the appeals process. But in April 2022, persuaded by the evidence of remote abortion's safety and efficacy, the FDA suspended enforcement of the in-person rule for the course of the pandemic. On December 16, 2021, the FDA lifted the requirement that patients pick up mifepristone at a healthcare facility, clearing the way for supervised mail delivery and pharmacy dispensation.The expansion of virtual clinics, however, is not without significant limitations. First, questions remain about how to implement the new FDA regulation, specifically regarding certified pharmacies, and several FDA restrictions on mifepristone remain in place. Second, about half the country prohibits telehealth for abortion by either banning all abortion or by requiring the physical presence of a healthcare professional. Third, participation in telemedicine depends on various forms of privilege. Patients must have a stable internet connection or smartphone as well as an uncomplicated pregnancy, which, in part because of U.S. health disparities, is more likely for wealthier and white people. Even with the expansion of remote care, the need for clinical spaces will not disappear; in fact, it will come under increasing pressure.This Article maps the emergence of virtual abortion care and analyzes the potential trajectory of medication abortion access, given that the Supreme Court has overturned constitutional protections for abortion. It considers the limits of telehealth for abortion-who telehealth can reach and who it cannot. Those living in states that permit abortion will have new options for ending early pregnancies. Those residing in states hostile to abortion will have to seek cross-border care, carry pregnancies to term, or find other avenues to end pregnancies. But the portability of abortion pills, when mailed by prescribers or dispensed by certified pharmacies, will test how closely states officials (or anyone else) can police or impede access to medication abortion.
2020年7月，一家联邦地区法院解除了美国食品药品监督管理局（“FDA”）的一项限制规定，该规定要求患者在医疗机构领取药物流产的第一种药物——米非司酮。此后不久，一项正在进行的堕胎远程护理实验扩大了范围，就像远程医疗在其他领域的发展一样，虚拟诊所开始提供无接触堕胎服务。2021年1月，当最高法院暂停了地方法院的一项命令，等待上诉程序时，虚拟护理的发展停滞了。但在2022年4月，由于远程堕胎安全性和有效性的证据，FDA在疫情期间暂停了对当面就诊规定的执行。2021年12月16日，FDA取消了患者必须在医疗机构领取米非司酮这一要求，为受监管的邮寄配送和药房配药扫清了障碍。然而，虚拟诊所的扩张并非没有重大限制。首先，关于如何实施FDA的新规定，特别是关于认证药房的规定，仍然存在问题，而且FDA对米非司酮的几项限制仍然有效。其次，美国约一半的州禁止通过远程医疗进行堕胎，要么是全面禁止堕胎，要么是要求有医疗专业人员在场。第三，参与远程医疗取决于各种特权形式。患者必须有稳定的互联网连接或智能手机，以及简单的怀孕情况，部分由于美国的健康差距，这对更富有和白人来说更有可能实现。即使远程护理有所扩展，临床空间的需求也不会消失；事实上，它将面临越来越大的压力。鉴于最高法院推翻了对堕胎的宪法保护，本文梳理了虚拟堕胎护理的出现，并分析了药物流产可及性的潜在发展轨迹。它考虑了堕胎远程医疗的局限性——哪些人可以通过远程医疗获得服务，哪些人不能。生活在允许堕胎的州的人将有新的选择来终止早期妊娠。居住在敌视堕胎的州的人将不得不寻求跨境护理、将妊娠维持至足月，或者寻找其他终止妊娠的途径。但是，当堕胎药由开处方者邮寄或由认证药房配药时，其便携性将考验州政府官员（或其他任何人）能够在多大程度上监管或阻碍人们获得药物流产服务。
