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LETTER |
John M. Goldenring is in private practice in San Diego, Calif. Gloria Allred is with Allred, Maroko, & Goldberg Law Offices, Los Angeles, Calif.
Correspondence: Requests for reprints should be sent to John M. Goldenring, MD, MPH, 10650 Lakecrest Point, San Diego, CA 92131 (e-mail: jgoldenr{at}san.rr.com).
In 1985, we brought the issue of improper post-rape care rendered in hospital emergency rooms with religious (particularly Catholic) affiliations to the attention of the health care community.1–3 We are dismayed to read the recent paper by Smugar et al.,4 which shows that fully 15 years later, the problem remains largely the same.
The law in this matter was clearly articulated in the case of Brownfield vs Daniel Freeman Marina Hospital (Calif State Court of Appeals, B032109, 1989), filed on behalf of our patient/client. The California State Court of Appeals ruled that a woman who did not receive complete post-rape counseling and the right to choose a post-rape antipregnancy treatment had standing to sue the hospital that provided the inadequate care. We had hoped that this California precedent would send a clear message to hospital emergency rooms across the nation.
Given the current political climate, we believe that in most states the only reasonable approach to this long-standing interference with women's basic health rights will be for more victims to file lawsuits—publicized to allow others to come forward in class actions—against hospitals that forbid post-rape prophylaxis and counseling and against physicians who allow hospitals to interfere with their duty to counsel patients appropriately in accordance with standard of care. We call upon women's health advocates, rape counselors, and members of the American Public Health Association to find cases that demonstrate violations of rape victims' rights and encourage the filing of legal challenges.
We (and the California State Appeals Court, in its ruling in the case cited above) believe that post-rape antipregnancy treatment and the use of contraceptives as a "morning after" rescue for unprotected consensual sexual intercourse do not constitute "abortion," because the treatment prevents implantation of a fertilized egg by causing shedding of the uterine lining.5,6
Nonetheless, we wish to emphasize that we do not believe that any physician has a duty to prescribe any medication to which he or she is ethically opposed. We do believe that physicians must counsel their patients about all available options and that they must arrange for timely prescription of contraceptives after rape if the woman chooses that treatment.
Finally, it is important to note that since we first began work in this field, 15 years ago, treatment regimens have improved with the availability of progestin-only prophylaxis,7 which is as effective as older estrogen-containing treatments but with a far lower incidence of unpleasant side effects, and now—potentially—the use of low-dose mifepristone (RU-486) treatments.8 The approval (finally!) of mifepristone for early abortion may also eventually help to mitigate the awful potential effects of lack of immediate post-rape antipregnancy treatment. We wonder, however, whether religiously affiliated institutions will also try to prevent patient knowledge of and access to this drug, to the great detriment of women's health and well-being.
Footnotes
Letters to the Editor will be reviewed and are published as space permits. By submitting a Letter to the Editor, the author gives permission for its publication in the Journal. Letters should not duplicate material being published or submitted elsewhere. Those referring to a recent Journal article should be received within 3 months of the article's appearance. The editors reserve the right to edit and abridge letters and to publish responses.
Text is limited to 400 words and fewer than 10 references. Submit on-line at www.ajph.org, or send 3 copies to the editorial office. Both text and references must be typed and double-spaced.
References
1. Goldenring JM. Denial of antipregnancy prophylaxis to rape victims [letter]. N Engl J Med.1984;311:1637.[Medline]
2. Goldenring JM. Estrogen treatment for victims of rape [reply]. N Engl J Med.1985;312:988–989.[Medline]
3. Goldenring JM. Inadequate care of rape cases in emergency rooms of hospitals with a religious affiliation. J Adolesc Health Care. 1986;7:141–142.[Medline]
4.
Smugar SS, Spina BJ, Merz JF. Informed consent for emergency contraception: variability in hospital care of rape victims. Am J Public Health.2000;90:1372–1376.
5. Goldenring JM. The brain life theory: toward a consistent biological definition of humanness. J Med Ethics. 1985;11:198–204.[Abstract]
6.
Goldenring JM. Abortion and progesterone inhibitors [letter]. Am J Public Health.1990;80:1394.
7. Taskforce on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet.1998;352:428–433.[Medline]
8. Task Force on Postovulatory Methods of Fertility Regulation. Comparison of three single doses of mifepristone as emergency contraception: a randomised trial. Lancet.1999;353:697–702.[Medline]
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