May victims of rape be administered a “Plan B” (levonorgestrel-only) contraceptive?
Catholic bishops, ethicists, and researchers have given a variety of answers to this question. Some forbid its use entirely, others permit it only after certain tests are done, still others allow it every time a victim of rape seeks care. This disparity in policy is primarily a result of the status of the science that continues to explore how this drug works. Recently a furor over the announcement by the German bishops that Plan B was approved for use at Catholic hospitals seemed to end with widespread confusion and a deepening of divisions between those who disagree on the issue. We believe that such a resolution on so important a question is completely unsatisfactory.
Given the findings of the latest science that Plan B may very well have an abortifacient or embryocidal effect, it is Human Life International’s position that all use of Plan B in Catholic hospitals should be discontinued. We respectfully request that all bishops and those who advise bishops on these matters reconsider as soon as possible the approval of Plan B for use in Catholic hospitals.
Catholic bishops, ethicists, and researchers have given a variety of answers to this question. Some forbid its use entirely, others permit it only after certain tests are done, still others allow it every time a victim of rape seeks care. This disparity in policy is primarily a result of the status of the science that continues to explore how this drug works. Recently a furor over the announcement by the German bishops that Plan B was approved for use at Catholic hospitals seemed to end with widespread confusion and a deepening of divisions between those who disagree on the issue. We believe that such a resolution on so important a question is completely unsatisfactory.
Given the findings of the latest science that Plan B may very well have an abortifacient or embryocidal effect, it is Human Life International’s position that all use of Plan B in Catholic hospitals should be discontinued. We respectfully request that all bishops and those who advise bishops on these matters reconsider as soon as possible the approval of Plan B for use in Catholic hospitals.
The Church’s moral teaching regarding this matter is summarized by the Bishops of the United States in the Ethical and Religious Directives for Catholic Health Care Services:
A female who has been raped should be able to defend herself against a potential conception from the sexual assault...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. (36)With this moral principle in place, the question then becomes, Does Plan B cause early abortions? We set out to explore this through a series of articles published on our Truth and Charity Forum (part 1, part 2, part 3, part 4, part 5, part 6). By publishing some of the strongest authors on the subject, all of whom approach the relevant science through the lens of orthodox Catholic moral theology, we wanted to provide a resource for bishops, and for those who advise bishops on the question of Plan B. Having researched the question and completed the series, HLI makes the following conclusions:
1. Recent large and robust studies indicate that Levonorgestrel-only contraceptives such as Plan B rarely block ovulation, and most likely do result in the death of the embryo if administered during the first 4-5 days of the fertile window.*These are our conclusions pending any developments in scientific research. Further, it appears that no contraceptive exists that is known to meet the reasonable criteria expressed by the Church above.
2. A Luteinizing Hormone (LH) protocol – a test whose outcome has been understood to determine whether a drug can be administered based on where the victim is in her cycle – cannot in fact detect that a woman is in these first days of her fertile window. Therefore a negative LH test may well encourage administration of Plan B precisely when it is most likely to cause an early direct abortion.**
3. Because recent scientific studies have provided very strong data that indicates Plan B rarely has any contraceptive effects and is likely to have embryocidal effects, a medical practitioner cannot attain moral certainty that administration will not lead to early abortion.
4. Since one cannot attain moral certainty that abortion will be avoided, protocols and policies that currently permit Catholic health care providers to administer Plan B need to be reconsidered by the appropriate diocesan authorities and hospital administrators. Nations in which abortion is illegal should be aware of this potential abortion-inducing effect and should prohibit the administration of these drugs.
The urgency of addressing this matter comes to light when one considers the Church’s teaching regarding abortion expressed most recently in Dignitas personae:
It must be noted, however, that anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived, and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion. … Therefore the use of means of interception…fall within the sin of abortion and are gravely immoral. (23)Here we have considered the use of a contraceptive following the unjust act of rape. We must, however, also reaffirm the Church’s unchanged and unchangeable doctrine on both abortion and the contraception of the marital act – both remain morally illicit without exception. As Pope Paul VI wrote in Humanae vitae, “it is necessary that each and every marriage act remain ordered per se to the procreation of human life.” (11)
We hope that Catholic bishops and those who advise them in these issues will see the urgency of revisiting the approval of Plan B for treatment of women who have been raped. These women deserve the absolute best life-affirming care possible, and this care should not include drugs that only compound the violence already suffered by causing abortions.
Further, we ask those concerned both for women who suffer rape and for nascent human life to approach bishops on these questions with respect, and pray for our shepherds that these and all answers to questions about human life and dignity may express, in the words of Dignitas personae, “a great ‘yes’ to human life.”
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* There is a distinction in the scientific community between an abortifacient effect, which disrupts a pregnancy after implantation, and an embryocidal effect, which is “interceptive” or prevents implantation. Plan B appears to have the latter, embryocidal, effect. Since a human life is destroyed in either case, the distinction is not moral but technical, so we have stayed with the common language term and note here the difference.
** Previous scientific statements on Plan B’s mechanism of action declared Plan B to work mainly by preventing ovulation. Recent scientific evidence suggests, however, that Plan B does not work by preventing ovulation. Moreover, recent scientific evidence also shows that Plan B has no effect on cervical mucus or sperm function. Finally, as suggested in Point 1, recent evidence suggests that due to shortening of the luteal phase and other indicators, Plan B may likely prevent the new embryo from implanting into the uterine wall, resulting in an embryocidal effect.
