Year: 2025
Type: article
Abstract: Pain is a recognized adverse effect of medication abortion, but its management has been understudied.This commentary on a case draws on principles of nonmaleficence, beneficence, and autonomy to consider equity in remote and in-person medication abortion pain management.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity.Case JN is a 24-year-old cis woman who has been pregnant twice and given birth vaginally both times.JN lives in a rural area, 75 miles from the nearest pharmacy or clinic.JN's last menstrual period was 7 weeks ago.She had a positive home pregnancy test, and an intrauterine pregnancy was confirmed at an out-of-town urgent care clinic.She wants to terminate the pregnancy and met virtually with Dr OBGYN, who prescribed mifepristone and misoprostol.JN took mifepristone 2 days ago and misoprostol yesterday.JN is experiencing severe cramping pain, despite taking over-the-counter analgesic medication.She messages Dr OBGYN to ask for a prescription medication to help manage her pain.Dr OBGYN considers how to respond. CommentaryUse of telemedicine for abortion has steadily increased over the last decade and was dramatically accelerated by the COVID-19 pandemic.1 Remote consultations are safe, effective ways to provide medication abortion, which can particularly benefit patients in remote, rural locations.2,3,4 Although telemedicine abortion safety has been questioned because physicians at a distance are generally unable to attend as quickly as those in in-person settings to bleeding, ectopic pregnancy, and other urgent complications, adverse events of medication abortion are rare.3,5,6 In the interests of nonmaleficence, it is important for abortion providers to consider the relative personal, legal, and financial risks to patients of attending telemedicine vs in-person appointments.
Source: The AMA Journal of Ethic
Authors: Eloise Smellie, John J. Reynolds-Wright
Institutions: NHS Education for Scotland, Chief Scientist Office
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4407088513