The most difficult and controversial issues in medicine invariably involve either the beginning or end of life. So I suppose as medicine expands into new high-tech frontiers, it was just a matter of time before these difficult questions followed.
Planned Parenthood of Iowa recently developed a new program to help provide abortion services to women in areas where physicians are not available, utilizing a physician-extender in conjunction with a physician linked in via video-conference.
The program has abortion-rights advocates cheering telemedicine’s potential to allow medical care to reach those with poor access while abortion-opponents simultaneously decry the technology as destroying the physician-patient relationship and exposing women to dangerous unsupervised therapy. The outcome of this debate could be a defining moment in the future of telemedicine.
Basically, the way the program works is that a woman comes to a clinic staffed by a nurse. The nurse performs a history and physical exam, obtains some basic labs, and performs an ultrasound to verify pregnancy. All of this data is then sent to a remotely-located physician who reviews the information.
The video-link then kicks in and the physician and patient discuss the results. The physician provides counseling on the options available to to the patient. If she elects to go forward with a medical termination, then the physician activates a dispenser of mifepristone/misoprostolol from which the patient can obtain the medication. To be clear, this is the kind of medical termination that can only occur in the first few weeks for pregnancy.
As quoted in Radio Iowa, the leader of one anti-abortion group argues:
“There is no doctor-patient relationship. There is not a physician she can call. There is no one she can go to in the middle of the night when she is hemorrhaging very badly.”
Planned Parenthood leaders counter that:
“The people who are opposing us, they oppose abortion, they don’t oppose telemedicine and they’re using telemedicine as a way to obstruct access to abortion.”
According to the Des Moines Register, the Iowa Board of Medicine plans to review the numerous petitions to stop Planned Parenthoods telemedicine program, with discussions at the October meeting after staff have had the opportunity to review relevant rules and laws. Perhaps the most telling part of these proceedings will be the referencing of policy dating to the 1990’s. It appears the Iowa Board of Medicine will really have their work cut out for them considering the potential impact of their decision.