The South Korean government's proposal to leave the prescription of abortion medication up to the professional discretion of individual physicians is facing fierce resistance. Private-practice obstetricians and gynecologists are pushing back strongly, labeling the move an attempt by the state to shift legal and medical responsibility onto front-line doctors.
On July 15, the Direct Election Korean Association of Private Practice Obstetricians and Gynecologists issued a statement declaring that before the medical abortion pill Mifegyne (mifepristone) is introduced, authorities must establish definitive guidelines on gestational age limits, follow-up care protocols, and the legal liability of clinicians. This followed a similar warning the previous day from the Korean Association of Obstetricians and Gynecologists. The back-to-back statements came after President Lee Jae-myung urged officials to find a realistic solution to curb the illegal overseas smuggling of the drug. Rather than opposing the drug's introduction itself, the two primary organizations representing private-practice OB-GYNs are resisting a system that relies on "conscience and professional discretion," fearing they will be left to bear the legal and clinical fallout when complications arise.
A Demand for Clear Guidelines, Not Just Discretion
The OB-GYN associations agree that the unchecked distribution of unverified abortion pills through illegal online channels poses a serious threat to women's safety. Both groups fully support establishing a regulated, legitimate system to bring medical abortions into the formal healthcare framework. However, they argue that the state cannot simply delegate prescribing authority to doctors without setting clear clinical boundaries first.
The physicians are calling for national clinical guidelines that explicitly define permissible gestational ages, patient eligibility, medical contraindications, necessary pre-tests, and post-administration monitoring protocols. Furthermore, they demand that the government establish clear legal protections for clinicians. Without these safeguards, they warn, doctors could face severe civil and criminal liability in the event of incomplete abortions—where fetal tissue is not fully expelled—or severe complications like hemorrhaging and systemic infections. The Korean Association of Obstetricians and Gynecologists went so far as to warn that they would launch a nationwide refusal campaign if the government pushes the drug into the market without establishing a comprehensive safety management system.
Why 'Discretion' Is a Liability for Private Clinics
While "professional discretion" is typically viewed as clinical authority, private practitioners view it as a heavy liability. Unlike large university hospitals, which house integrated emergency departments, operating rooms, and blood banks under one roof, most local OB-GYN clinics lack the infrastructure to handle acute complications.
If a patient experiences severe bleeding or acute pain after hours or over the weekend, a small clinic cannot easily provide immediate emergency surgery or blood transfusions. If the patient has to be transferred, clear criteria and designated receiving hospitals are required to prevent dangerous delays. Private-practice owners, who act as both the treating physicians and the business operators of their clinics, worry they will be held legally responsible for complications even if a patient fails to return for mandatory follow-up care.
This reality stands in stark contrast to international standards. For example, the U.S. Food and Drug Administration (FDA) requires that clinicians prescribing mifepristone must have the ability to accurately assess pregnancy duration, diagnose ectopic pregnancies, and either perform emergency surgical interventions directly or arrange immediate transfers to equipped medical facilities. Without a similar, state-supported emergency transfer network in South Korea, "discretion" simply shifts the immense clinical risk from the state to individual clinic owners.
Resolving the Regulatory and Legislative Vacuum
Safely implementing medication-induced abortions also raises complex clinical debates, such as whether to mandate pre-prescription ultrasounds. While the World Health Organization (WHO) and the U.S. FDA do not require ultrasounds for every patient—recommending them primarily to confirm gestational age or rule out ectopic pregnancies when clinically uncertain—some South Korean medical circles are debating a blanket mandate. Experts argue that establishing a reliable emergency referral system is far more critical than imposing rigid diagnostic mandates.
Ultimately, the dispute over Mifegyne is paralyzed by a broader legislative vacuum. While Hyundai Pharm has applied for domestic product approval for Mifegymiso—a combination package of mifepristone and misoprostol—the Ministry of Food and Drug Safety has stated that it cannot finalize clinical indications or risk management plans until the law defines the legal parameters of abortion.
Although the Constitutional Court ruled the nation's abortion ban unconstitutional in 2019, the National Assembly missed its late-2020 deadline to pass substitute legislation, leaving the country without a formal legal framework. The debate over Mifegyne extends far beyond approving a single pharmaceutical product; it requires the state to resolve the legal status of abortion, define gestational limits, and build a system that guarantees both safe access for patients and essential protections for healthcare providers.
