Women seeking abortion with remote guidance from off-shore physicians must be permitted on Guam, a federal judge ruled Friday, giving credence to medical experts who testified that in the context of telemedicine, videoconferencing is as good as an in-person practice.
Upholding the Supreme Court's doctrine on women’s right to choose, Federal Judge Frances Tydingco-Gatewood struck down the government's attempt to bar access to abortion on Guam by adding layers of requirements that restrict the medical process.
The court issued a preliminary injunction on Guam laws requiring that abortions be “performed” in a clinic or hospital, and after completing government-mandated counseling "in person."
Ruling in favor of two Hawaii doctors who sued Guam, Tydingco-Gatewood pointed out that the government failed to support its argument about the "superiority" of in-person communication, other than invoking “common sense.”
"The undisputed evidence before the court all points to the fact that a live, face-to-face video conferencing is 'comparable to, and may even have some benefits over, in-person communication," the court said.
There are no records of abortions being performed on Guam since the retirement of Dr. William Freedman of the Women's Clinic in 2018.
The only option left for women who want to end their pregnancies is to get the procedure off-island. But for those who cannot afford to shoulder the travel cost, this is not even an option. As a result, they are compelled to carry on with unwanted pregnancies.
Another potential option is a do-it-yourself abortion through medication with consultation and instructions provided remotely by a physician through telemedicine practice.
"Tele-abortion" is a quietly growing phenomenon in the U.S., driven partly by restrictions from conservative states and, coupled with limited access due to the pandemic-triggered travel restrictions.
Hawaii-based physicians Dr. Shandhini Raidoo and Bliss Kaneshiro are willing to remotely supply abortion pills.
While Guam-licensed, board-certified OB- GYNs experienced in providing abortion services, Raido and Kaneshiro do not live on the island.
They sought the court’s intervention to be able to provide the service, arguing that Guam’s requirements are preventing them from using telemedicine to provide medication abortion.
Unlike the traditional abortion procedures performed in clinics by a doctor, medication abortion can be self-administered by the patient herself.
To obtain the medication abortion, the patient orally ingests a regimen of mifepristone, and then misoprostol, approximately 24-48 hours apart. The medication causes the fetal tissue to detach from the uterine wall, which is then expelled through the uterus, mimicking an early miscarriage.
The court noted that an ongoing FDA-approved clinical study has allowed certain doctors to send abortion medication directly to patients.
“The record demonstrates that medication abortion is safe. The chance of a major adverse health event is “exceedingly rare, generally far below 0.1 percent" the court said.
However, the court noted that Guam’s “in-person” requirement “creates an extra step in the medication abortion process,” reflecting its interest in limiting access to abortion and “promoting fetal life.”
“Here, there is undisputed evidence of the burdens the law imposes on a woman seeking abortion in Guam,” the court said.
“The other possible state justification is that in-person visit is superior to video conference. Even if this is the case, this justification is feeble and is easily outweighed by the burdens imposed on the woman seeking an abortion.”