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August 2001, Vol 91, No. 8 | American Journal of Public Health 1169-1170
© 2001 American Public Health Association

LETTER

SMUGAR ET AL. RESPOND

Steve S. Smugar, MD, Bernadette J. Spina, BA and Jon F. Merz, JD, PhD

Correspondence: Requests for reprints should be sent to Jon F. Merz, The Center for Bioethics, 3401 Market Street Suite 320, Philadelphia, PA 19104 (email: merz{at}mail.med.upenn.edu).

We agree with the sentiments expressed by Goldenring and Allred regarding the possibility of using the courts to bring hospitals into compliance with the medical standards of care. Unfortunately, there are many reasons why an uninformed rape survivor who undergoes a subsequent pregnancy and abortion might not want to, as they say, make a federal case of her plight. A lawsuit necessarily extends the ordeal, which may be therapeutic for some but will be traumatic for others. A lawsuit also may be a very public act, trial of which involves the airing of private and stigmatizing information about the rape and abortion. Of course, malpractice and abandonment might be so clear that any such case would be promptly—and very quietly—settled.

Thus, we believe the best resolution is for legislation or equivalent sanctioning by the Joint Commission for the Accreditation of Healthcare Organizations requiring providers to meet the standard of care. Community hospitals that do not have level 3 neonatal intensive care units do not treat extremely low-birthweight infants, and those not qualified as level 1 trauma centers do not treat patients with extremely severe injuries. For the same reasons, those institutions that do not satisfy the standard of care simply must not represent themselves as providing post-rape care. Police and emergency medical services must be aware of hospital practices and must not bring women to these institutions except in exigent circumstances.





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