JAMA , Abortion, and Editorial Responsibility

JAMA is, among other things, a forum for open discussion of matters relevant to the field of medicine, a place for responsible, balanced debate for the education of readers, primarily physicians, to help meet the overall mission of advancing the art and science of medicine and the betterment of public health. The members of the American Medical Association (AMA) (nearly 300000 or nearly 40% of US licensed physicians and medical students) are the owners of JAMA, and they, along with nonmember physicians through their representatives in the federation of American medicine (the House of Delegates representing 95% of US physicians), have consistently supported the editorial freedom of JAMA to operate within an approved set of goals and objectives.¹

This freedom, with responsibility and accountability, allows us to publish articles affecting medical practice representing various points of view no matter how onerous, inflammatory, or divisive the subject. Anchored to that knowledge, we plunge into one of medicine's (and life's) most controversial issues: abortion. In this issue of THE JOURNAL, we publish 3 major articles on late-term pregnancy termination.^{2 - 4} One is a scientific discourse with abundant references; the other 2 comprise a deliberate point-counterpoint debate of the controversy featuring 2 leading obstetrician-gynecologists; none necessarily represent AMA policy.

Few subjects boil the blood of people in general, and some physicians in particular, as rapidly and surely as does abortion. JAMA has published many articles about abortion—including articles about science,⁵ methods,^{6 - 7} clinical practice,^{8 - 9} research,^{10 - 11} hazards,¹² ethics,^{13 - 14} law,¹⁵ public opinion,¹⁶ international aspects,¹⁷ AMA positions,¹⁸ and special considerations for physicians.^{19 - 20} But, during my tenure as editor, JAMA has taken no editorial position on abortion, late-term or otherwise.

Americans are constitutionally guaranteed religious freedom. This editor considers abortion to be a religious issue—a decision to be reached by the pregnant woman, after consultation with the father (if possible), members of her family, perhaps a religious adviser, and the woman's physician. I believe that one woman's abortion is not the business of police, lawyers, courts, the US Department of Health and Human Services, the Congress of the United States, various state legislatures, or anybody else except the individuals named above. This editor has not performed an abortion and believes that he could not. Abortion is killing—regardless of length or stage of gestation. However, as a practical matter, this editor recognizes that abortion is considered necessary by many people on a situational basis and that many abortions will be done, often unrelated to what beliefs may have been held previously by the participants and regardless of any laws.

We hope that you, the reader, will find the 3 articles on late-term pregnancy termination informative, interesting, and useful. We anticipate a flood of protests from many points of view on this issue. Nonetheless, we believed it important for JAMA to serve again as a forum for responsible discussion and debate on even this troubling and divisive issue.