title: Long-acting contraceptives. Ethical guidance for policymakers and health care providers.
abstract: Realizing the promise of long-acting contraceptives depends on continuing efforts to distinguish appropriate from inappropriate policies and practices. The current debates concerning Norplant and other long-term methods generally have based ethical judgment on too slim a reed. It is insufficient and overly divisive to limit the tools of analysis to questions of freedom and coercion. A richer perspective is needed. We have sketched out an alternative approach that rests on a close, case-by-case analysis attentive to the social dimension and consequences of contraceptive decisionmaking, as well as to the individual interests at stake. The approach also takes special note of the need for access to long-acting contraceptive, the possibility for mistaken nonuse as well as mistaken use, and our country's past and present biases and power imbalances. We do not claim that this method will make judgments about justifiable or unjustifiable influence easy or automatic. However, it should prove adept at underscoring the factors that require particular scrutiny. Perhaps more importantly, the approach highlights that influences for the use of long-acting contraceptives ought to be judged, not merely dismissed.
authors.forename: E H
authors.initials: EH
authors.lastname: Moskowitz
authors.forename: B
authors.initials: B
authors.lastname: Jennings
authors.forename: D
authors.initials: D
authors.lastname: Callahan
mesh_terms: D000293:Adolescent; D002649:Child Abuse / Q000331:legislation & jurisprudence; D002961:Civil Rights; D003266:Continuity of Patient Care; D004992:Ethics, Medical; D005193:Family Planning Services / Q000592:standards; D005260:Female; D017408:Guidelines as Topic; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards; D006801:Humans; D007258:Informed Consent; D007348:Insurance, Health; D007434:Intrauterine Devices / Q000191:economics / Q000706:statistics & numerical data; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000191:economics; D017258:Medroxyprogesterone Acetate / Q000191:economics; D010358:Patient Participation; D026684:Personal Autonomy; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D011306:Prescription Fees; D011632:Public Assistance / Q000592:standards; D012106:Research; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014481:United States
chemical_list: D016912:Levonorgestrel; D017258:Medroxyprogesterone Acetate