Grisso and Ness [1] lament the "increasing shortage of physicians trained to do first-trimester abortions." They invite internists to fill the void by learning and practicing the technique of medical abortion. Their only caution is that "the physician must know how to interpret ultrasonographic data to be able to deal with the few incomplete abortions that do occur." Ethical issues are not discussed, and "special training" in medical abortion is advertised with a telephone number.

Before adding to the 1.5 million abortions done each year in the United States, internists should consider several important medical and ethical issues. We should first ask why a shortage of abortion providers exists. Could it be that fewer obstetricians and gynecologists are finding the practice of abortion ethically appealing? The consequences of legal abortion in the United States should also be examined. We now have transplantation of aborted human fetal tissue and late-term "partial-birth" abortions [2]. Human embryos are being created in the laboratory for the sole purpose of experimentation, and the case of Roe v. Wade is even being used to justify assisted suicide [3]. Medical abortion represents a departure from our tradition of protecting the unborn from the harmful effects of such maternal drugs as thalidomide.

Internists should also review early human development. Many of us have forgotten that the heart of the human embryo beats independently just 22 days after conception [4]. The new technique of contact embryoscopy provides compelling video evidence of the humanity of the embryo and early fetus. (For more information, contact the Health Science Curriculum Foundation, 913-469-5116). Finally, internists should be aware of maternal postabortion grief reactions that may be more severe after medical abortion [5].

Serious ethical controversy continues to surround the practice of abortion. This controversy now reaches out seductively to willing internists.