Ella approval moves emergency-contraception dilemmas back to doctors

When emergency contraceptive Plan B went to over-the-counter status in 2006, it largely took the prescribing decision--and potential legal and ethical dilemmas--out of physicians' hands for patients 17 and older. But now that the FDA has approved ella (ulipristal acetate), a prescription-only progesterone agonist/antagonist that prevents pregnancy when taken orally within 120 hours after a contraceptive failure or unprotected sex, doctors must once again wrestle with questions.

Twenty-one states have legislation that guides health professionals' actions concerning emergency contraception, according to the National Conference of State Legislatures. For instance, some states require hospitals to provide information about the drugs and/or administer them to women who have been sexually assaulted. In addition, many states have conscience laws that protect the rights of health professionals who objected on moral grounds to performing abortions, among other procedures. But these laws are typically broad and do not usually cover emergency contraception, Mary Harned, staff council for the nonprofit Americans United for Life, an anti-abortion law and policy organization in Washington, DC, told American Medical News.

However, most medical ethicists recommend physicians who object to prescribing emergency contraceptive simply refer patients to another physician. Similarly, American Medical Association policy states that it might be ethically permissible for physicians to decline a potential patient when requested treatment is incompatible with the doctor's personal, religious or moral beliefs.

But once a patient-physician relationship has been established, AMA policy says patients have the right to discuss the benefits, risks and costs of appropriate treatment alternatives with their doctors, and that physicians who decline to offer certain treatments are obligated to coordinate care with other health professionals to treat the patients.

To learn more:
- read the full article in American Medical News