HLI Position on Administration of "Plan B" Contraceptives to Victims of Rape

In HLI

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.

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.*

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.

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.

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.

When in Doubt, Choose Life: Symposium on Plan B (Morning-after Pill): Part I - by Allison LeDoux

In Truth and Charity Forum 

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.

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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!”

 read part 2, part 3, part 4

The truth about ‘Morning-after pills’ - by Anna Maria Hoffman

In FRC Blog

On June 5, 2012, New York Times writer Pam Belluck wrote an article called “Abortion Qualms on Morning-After Pill May Be Unfounded.” In her article, Belluck mistakenly lumps Plan B and Ella—two very different drugs—together, ignorantly proclaims that these drugs do not prevent implantation, and does not account for Ella’s abortion-inducing actions. 

Unsurprisingly, Belluck claims that the pro-life view of morning-after pills “is probably rooted in outdated or incorrect scientific guesses about how [they] work.” As she presents her empty argument, Belluck argues that no studies have confirmed “that emergency contraceptive pills prevent fertilized eggs from implanting in the womb” and that these pills only “delay ovulation.”  She heavily refers to a New York Times review, along with “scientists” and “experts” she forgets to cite, to support her view that Plan B does not prevent implantation and that “the one-shot dose in morning-after pills does not have time to affect the uterine lining.”

Disheartened by Belluck’s reporting? Luckily, several renowned pro-life advocates have written articles against Belluck’s dishonest claims:

Donna Harrison, The Times’s Convolution of Facts on Abortifacients

Gerard Nadal, Responding to the New York Times on ‘Morning After’ Pills: A Factual Recalibration (Part I)

Jeanne Monahan, Emergency Contraception: We need an unbiased review of the facts

Richard Doerflinger, Letter in Response to NY Times Article of June 6, 2012

Marie T. Hilliard, Are Journalists Now Scientists? A Reporter Loses Sight of Data on Plan B