Ethical Care for Patients with Self-Managed Abortion After Roe

Abstract

The 2022 Supreme Court decision leaving the regulation of abortion to the states is sure to result in a complex regulatory environment for patients and nurses. In states where abortion is illegal, patients may self-manage abortions using medications they obtain through the mail or by other means. Nurses may care for these patients in multiple settings and may wonder about their own legal and ethical obligations. This article reviews patient privacy as it relates to self-managed abortion, ethical reporting requirements for nurses, and best practices for treating complications of self-managed abortion using a harm reduction framework, with a focus on protecting patients' rights. Recommendations for ethical patient care are also provided.

Self-managed Medication Abortion in the United States

“…43 Harm reduction has been used successfully in other clinical contexts, including safe needle exchange, underage alcohol use, and sex work. 45 Maternal mortality related to unsafe abortion falls in international settings where individuals are supported in self-administration of misoprostol for SMMA, rather than selfinstrumentation or abdominal trauma. 43,44 A harm reduction approach to SMA would be relevant for all caregivers, such as emergency medicine physicians, family physicians, obstetrician-gynecologists, and internists as well as advanced practice clinicians, as a way to honor their commitment to care for all patients-despite legal or logistic barriers.…”

“…In areas where abortion access is limited in international settings, this framework has been associated with improved patient outcomes as well as decreased abortion-related morbidity and mortality 43 . Harm reduction has been used successfully in other clinical contexts, including safe needle exchange, underage alcohol use, and sex work 45 . Maternal mortality related to unsafe abortion falls in international settings where individuals are supported in self-administration of misoprostol for SMMA, rather than self-instrumentation or abdominal trauma 43,44 .…”