Editor’s Note: The editors present this series (read part 2, part 3, part 4)
on the recent furor over Plan B as an opportunity for our fellow
pro-lifers to slow down, step out of activist mode, and enter into the
conversation in a prayerful and thoughtful way.
The Church encourages conversation among faithful scientists and
theologians as new science comes to light and as we deepen ethical
reflection. Typically such conversations occur in academic settings, but
since the recent furor pushed the issue into the open, causing much
confusion and scandal, we felt it important to present the latest
science and moral reflection in a context of faithful discussion.
We offer this series in a spirit of obedience to the
Magisterium, and as an opportunity for faithful Catholics and people of
good will to come to a greater understanding of the nuances of the
Church’s teaching and the complexities of the science and art of
medicine in the difficult situations involving the treatment of women
who have been raped. There has been no (and will be no) revision in the
Church’s teaching concerning direct abortion or contraceptive sexual
acts between spouses. Both are morally illicit without exception.
As with all Truth and Charity Forum articles, opinions
belong to the author alone and do not necessarily represent the official
position of Human Life International.
It seems the infamous issue of emergency contraception (hereafter as
EC) and rape victims is back in the news. In Germany, it was recently
announced that Catholic hospitals would allow the “morning-after pill”
to be given to victims of sexual assault. LifeSiteNews and other news sources have reported
on the particulars of the situation. Our purpose here is not to repeat
the news reports and analysis, but to consider some of the medical/moral
questions that are often asked when the issue of administering
“emergency contraception” to rape victims arises.
In the Ethical and Religious Directives for Catholic Health Care Services,
the guiding document that applies Catholic moral teaching to Catholic
health care facilities in the U.S., directive 36 discusses the issue of
treating victims of sexual assault:
Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.
No one would deny the need for sensitive and compassionate care to a
person, who has been done such violence. The Church teaches that a
female rape victim should be able to defend her bodily integrity.
However, things can seem a little complicated when we look at exactly
what that might entail, so let us try to clarify the issues at hand.
Directive 36 indicates the need for “appropriate testing” to
determine if conception has occurred already. There are two types of
testing: pregnancy testing and ovulation testing. Both however, have
limitations.
A positive pregnancy test means the woman was already pregnant before
the rape, and thus there would be no logical or medical reason for
prescribing emergency contraception. A negative pregnancy test does not
tell us whether or not the woman has conceived.
If conception has occurred (as a result of the rape, or even another
act in the past few days), it still takes about a week for the newly
conceived developing embryo to travel through the fallopian tube to
implant in the uterus. A pregnancy is clinically detectable only after
implantation.
Ovulation testing might make it possible to ascertain whether or not
the woman was in the ovulatory phase of her cycle at the time of the
rape. If it were possible to effectively determine that the woman was in
an infertile time of her cycle, again there would be no logical or
medical reason for prescribing EC. But, what is the likelihood that the
victim would faithfully chart her cycles and could determine her fertile
time with pinpoint accuracy? Additionally, ovulation testing, while
helpful, can sometimes miss the hormone surge needed to determine the
potential window for fertilization, so we have to ask, can we ever be
truly sure that emergency contraception wouldn’t cause an abortion?
Let’s say, for the sake of example, that it is deemed “safe” for the
victim to be offered drugs to prevent conception. Then we must ask the
question, what drugs are capable of doing what Directive 36 defines as
acceptable?
According to Directive 36, it is permissible to treat the victim with drugs that would be contraceptive per se,
but it is not permissible “to initiate or to recommend treatments that
have as their purpose or direct effect the removal, destruction, or
interference with the implantation of a fertilized ovum.” Reports on the
recent controversy of the Catholic hospitals in Germany, indicate that
this principle holds there as well.
It has not been proven that any of the drugs used to treat rape
victims, which are commonly known as “morning-after pills” or “emergency
contraception” (usually Plan B, NextChoice, or sometimes higher doses of regular birth control pills), only prevent ovulation, sperm capacitation, or fertilization.
These drugs are purposefully designed to have multiple mechanisms of
action. That is, they may sometimes prevent ovulation, sperm
capacitation, or fertilization, but, they also may act as abortifacients
by inhibiting the implantation of a newly conceived child in his or her
mother’s womb. There is no way of knowing for sure when particular
mechanisms of the drug will “kick in.”
To date, there is no such drug that meets both criteria (contraceptive, but not abortifacient).
Some studies mislead by suggesting there is no “post-fertilization”
effect and claim the drugs only act by preventing conception. A study
cited in the journal Contraception made this erroneous
assertion in 2012. This study has been called into question because the
lead author is affiliated with the pharmaceutical companies that produce
the drug. Other researchers do admit to the post-fertilization
(abortifacient) effects. EC proponent and researcher James Trussell, in a
recent study, acknowledges that post-fertilization effects do exist.
It is always important to consider the source. What degrees of
objectivity and truth are there in a given study or opinion? Proponents
of contraception (“emergency” or otherwise) typically operate by a false
definition of pregnancy, as beginning at implantation. This is
approximately one week later than when pregnancy truly begins – at
conception. God is not the author of confusion!
One of the best ways for us to understand what is at stake is to
remember the classic analogy of the hunter in the woods. Two men are
hunting deer. One goes off on his own. Suddenly the hunter hears a
noise, and readies his gun. But, is it a deer or is it his hunting buddy
returning? Obviously, the hunter would not proceed in doubt and risk
shooting his hunting partner. Neither should we proceed in doubt by
offering emergency contraception to victims of sexual assault when a
human life may be at stake. One life lost is too many.
How do we sort through the conflict? With one simple axiom: “When in doubt, choose life!”
