In December 2012, two Catholic hospitals in Cologne, Germany, reportedly refused to provide a gynecological exam to a 25-year-old woman who said she had been sexually assaulted. German law requires hospitals that treat rape victims to make available emergency contraceptive (EC) medications (also called “morning-after pills”). Many people believe that these medications can cause abortions by preventing the implantation of a newly conceived embryo.
To avoid needing to administer the EC medication, the hospitals referred the woman elsewhere without ever seeing her. The London Telegraph broke the story in English on Jan. 18, with the polemical headline: “German rape victim ‘turned away by Catholic hospitals over pregnancy fears.’”
Cardinal Meisner
On Jan. 22, Cologne’s Cardinal Joachim Meisner issued a statement of profound regret, saying the situation should never have happened, that the oversight “shames us [i.e., the Catholic community] deeply,” and that Catholic hospitals should never refuse care to vulnerable rape victims.
On Jan. 31, the cardinal issued a second statement, setting forth two conditions for rightly administering EC medications to rape victims. He said that if the mode of activity of some treatment is to prevent conception, and the intention aligns itself with that purpose, then the treatment is licit. If, however, a treatment is administered whose mode of activity is to prevent the implantation of a newly conceived embryo, then the treatment would be wrongful to administer. He asked doctors in Catholic institutions to care for rape victims according to these two principles.
German Bishops' Conference
On Thursday, Feb. 21, the Catholic bishops of Germany, during a plenary assembly in Trier, released a statement on the central question raised by Cardinal Meisner’s intervention, namely the legitimacy of administering EC medications to rape victims. LifeSiteNews provided the following translation of one ofmits key paragraphs:
The plenary meeting affirmed that at Catholic hospitals women who are victims of rape receive human, medical, psychological and pastoral help as a matter of course. This can include administration of a “morning-after pill” to the extent that it has a preventative and not an abortifacient effect. Medical-pharmacological methods that cause the death of an embryo still may not be used. The German bishops trust that in Catholic institutions practical treatment decisions will be made on the basis of these moral theological precepts.
Affirming Cardinal Meisner’s reasoning, the German bishops teach here that it is licit to administer EC medications to rape victims if those medications act to prevent conception, but they may not be administered if they act as abortifacients.
The statements by Cardinal Meisner and the German Bishops' Conferences both raise two questions. The first regards the morality of contraceptive acts; the second the clinical mode of activity of EC medications.
First question: Aren’t contraceptive acts always wrong?
If the Church teaches that contraceptive acts are wrong, why is it legitimate in cases of rape to use EC medications?
If EC is administered as a prophylactic against a rapist’s sperm, then the object of the act is not to render one’s freely chosen intercourse sterile (i.e., is not, morally speaking, a contraceptive act), but to prevent the completion of an unjust act of sexual aggression. The attacker’s sperm is an extension of the attacker himself. Just as it would be legitimate for a woman to defend herself against him by attacking his person, or to pull herself away from him as he penetrates her vagina so that he does not ejaculate inside her, so too she has the right to prevent his sperm from achieving the completion of his act of aggression by fertilizing her ovum. The U.S. Catholic Conference of Bishops formulates this norm as follows:
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 ("Ethical and Religious Directives for Catholic Health Care Services" [ERDs], 5th ed., 2009, No. 36).
Notice that the bishops qualify their statement in a way similar to the German bishops. They teach that EC medications may be used so long at the mode of activity of those medications does not interfere with the implantation of an already conceived embryo.
This, of course, raises another crucial question.
Second question: Do EC medications sometimes act as abortifacients?
Although neither the German bishops' statement nor the U.S. bishops’ directives explicitly states it, both imply that before EC would be licit to administer health-care workers should have moral certitude that the treatment will not act as an abortifacient.
The question then to be settled is whether or not EC medications sometimes act as abortifacients, and, if so, under what conditions?
It is important to see that the answer to this question, although having moral implications, is not itself a moral question. It is a scientific question. Apparently, the German bishops, after considering evidence they took to be credible, concluded that at least some EC meds do not act as abortifacients, and so they authorized in principle the use of those meds for rape victims at Catholic hospitals in Germany. And they left it to physicians to decide which meds to use and which to avoid.
In the United States, most Catholic hospitals that treat rape victims administer a pregnancy test and require it to be negative before giving EC medications (the most common of which is Plan B); some administer in addition one or more ovulation tests. One commonly adopted procedure is called the “Peoria Protocol” (developed by a hospital in the Diocese of Peoria, Ill.). It stipulates that before EC may be administered, a rape victim must have a negative pregnancy test and a negative urine-based ovulation test; if the urine-based test is positive, a blood test measuring serum progesterone levels is administered as a backup.
The policy decision of the German bishops was reportedly praised by Msgr. Ignacio Carrasco de Paula, the president of the Pontifical Academy for Life, who called it “an exemplary law which reiterates what the Catholic Church has been proposing for the past 50 years — but a law that has been misinterpreted.” He stressed that the policy does no more than direct doctors to follow the principle that prohibits the use of abortifacients but permits the use of anti-conceptives in treating rape victims.
Apparently not every member of the Pontifical Academy for Life agrees with Msgr. de Paula. Spanish doctor and academy member Justo Aznar criticized the decision of the German bishops, saying it was based on “technical ignorance” of the activity of EC medications. He argued that research demonstrates that these medications have an anti-implantation effect: “I would say that in approximately half of the cases it acts as a contraceptive and the other half it has an anti-implantation effect.”
E. Christian Brugger, the senior fellow in ethics and director of the fellows’ program
at the Culture of Life Foundation in Washington, holds the
Stafford Chair of Moral Theology at St. John Vianney Theological Seminary in Denver.
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I would agree with the bishops’ statement if there was a consistently reliable way to know exactly when and with which drugs the possiblity of abortion was present AND enforce the practice within the hospital. The philosophy is sound, but our science/technology is not yet perfect—we still don’t know precisely how this group of EC drugs work, separately or as a whole. Furthermore, the proper implementation of this teaching requires rigorous (and quite conservative) methods… I wonder how many doctors would actually jump through all of those time-consuming hoops before prescribing.
Another question arises:
In the time it takes to perform adequate tests for pregnancy, wouldn’t such a delay increase the chance of fertilization? which then renders any anti-conceptive method as futile?
It seems that time is of the essence in rape cases, where any moment passed increases the likeliness of sperm meeting ovum.
The only chance of preventing of fertilization, I think, would be effective and swift spermicides (or similar agents). Otherwise, what’s needed is to know the victim’s fertile periods so as to speed up the process of pregnancy testing.
Nonetheless, this is not a simple problem to solve with present medical practice/options. I don’t think medicine has devoted enough research to developing methods for treating rape victims with the dignity the Church demands and the dignity victims deserve.
So how effective is Plan B at preventing ovulation?
While moral certitude and scientific certitude are different, in the case of this particular pill, as a matter of prudential judgment, though it may be moral to use in some cases, the scandal it causes among those who do not understand the subtle differences needs to be considered.
Consent and conception are not linked at all. A fertised ovem is a distinct human being in the process of becoming. The bishops are silly. Does a male or female high on drugs give consent? Does a person who is drunk? Does a person who is suffering a mental illness. Does a woman who reluctantly or half asleep says nothing during a sexual act? Now rather than preserving natural fertity which does not care about inner dispositions or positions but is designed to bring about life we have allowed ourself to sterilise. Now we will be moving in the direction of contraception for those mentally inpaired…. so on and so on into eugenics.
So…it’s okay if it’s birth control but not if it’s an abortifacient. Um, I have news for the Germans. The Church condemns birth control too.
Well, the camel has his nose in the tent now, hasn’t he? Time to queue up for whatever other unfortunate story you might use to plead your case: girl was too young, woman was too old, too many kids already, husband was drunk. Hey - if the woman loses her job the morning after, but hasn’t yet ovulated, can she argue the need to suddenly prevent ovulation? Now rape is covered, how about incest? Do the bishops want prevention of ovulation to be safe, legal, and rare? Can married couples with a ‘genuine hardship’ decide to prevent ovulation every month? It appears that, all along, OVULATION has been the pesky culprit separating the repressed Catholics from those happily living the Sexual Revolution. Who knew?
The problem with “Emergency Contraception” is not simply that it can act as an abortifacient. “Emergency Contraception” puts a molotov cocktail of hormones into a woman’s body in order to halt a natural biological process from occurring. Testing on a victim of sexual assualt should not be used only to verify if conception has occured. A victim of sexual assault should rather be tested to find out if she is even in her fertile period of her cycle. Just because a woman has been violated does not mean that her body is now a cesspool of waste and that we can continue to dump garbage into her body. She deserves to have her body and fertility respected and treated with reverence and awe. Furthermore, shooting a woman up with these synthetic hormones has risks to her health and can cause health problems. Therefore, to just blindly give her “emergency Contraception” when she is not even fertile is ofensive and quack medicine and all women, including victims of assault, deserve better.
I guess reading the article is too much trouble. The proper term matters here as does a proper understanding of both theological principles and scientific technology. The article clearly explains the Church’s stance, which is that contraception is the attempt to prevent conception during a consensual sexual act. If the act is an assault it is not contraception in the theological sense, it is a defense against further assault. I understand John Fisher’s concern that a nuanced understanding of consent may open the door to misapplication in cases where full consent may be lacking. However there is still a strong enough difference between a sex act perpetrated as a form of violence and one which is merely ill advised, or conducted under diminished capacity. This is particularly the case when the diminished capacity is self-induced.
More troubling is the limits of medical technology, which means that there is effectively no treatment which can insure preventing fertilization without also preventing implantation. In other words a treatment that will always prevent the conception without destroying an already conceived child.
A Vatican statement on the morning after pill:
http://www.vatican.va/roman_curia/pontifical_academies/acdlife/documents/rc_pa_acdlife_doc_20001031_pillola-giorno-dopo_en.html
Here are some of the side effects of Levonorgestrel (Plan B) - (intrauteral device, oral tablet, and subcutaneous implant forms): Nausea, diarrhea, or stomach pain, dizziness, tired feeling, breast pain or tenderness, changes in menstrual periods, headache, hypertension, acne and other skin disorders, upper respiratory infection and sinusitis, weight gain, fatigue, depression, and back pain.
Would the german bishops seriously want an accurate test result about conception or not? Or they just play innocent and ignore the abortificient aspect because a negative pregnancy test is almost guaranteed at such a short time after the assault? Why offend anyone when the burden of prove is with the helpless embryo itself?
Those who think the Catholic church is being inconsistent here, or is opening a can of worms, need to think a bit more precisely. A key difference between attemtping to prevent pregnancy in the case of rape vs. case of consensual sex is that in the former case, only the perpetrator is intending to use sex illicitly, while in the case of consenusal sex, it is both parties (presuming in the second case both know cotnraception is being used). If a women engaging in consensual sex approves birth control, then it is her intention to engage in sex for illicit reasons-and she is also aiding in the man’s offense of the same illicit sex (as he is for her, naturally). On the other hand, in the case of rape, the woman does not intend to have sex at all, and she cannot reasonably prevent the man from acting illicitly. Thus, as she does not intend sex, and she cannot help but be party to his illicit intention, then it is appropriate for her to do what she can to prevent participation in this illicit action to the extent that it is possible to do so without destroying innocent human life. That’s the difference.
Remembber back in the 60’s when suddenly it was alright for Catholics to eat meat on Friday? What the Church had actually said was that Fridays are always a day of penence and encouraged fasting, but that fasting does not have to be strictly abstaining from meat… the average catholic simply thought we could now eat meat on Fridays. I think the typical Catolic will now simply hear..now the morning after pill is okay. A bunch of horses just left the barn.
Posted by TerryC on Tuesday, Feb 26, 2013 12:29 PM (EST):
I guess reading the article is too much trouble.”
**********************************************************
Nine times out of ten that’s true.And even if read, it’s often a comprehension issue.
My point is simply that a woman should be tested to see if she is entering into or in the fertile period of her cycle before administering EC. If she is not in her fertile period or if her fertile period has passed than it is not necessary to give her EC. The “Peoria Test” is insufficient. Testing should be administered to determine where a woman is in her cycle. She may not need her ovulation delayed and her body should not be doused with hormones “just in case.” Also, Plan B uses progesterin to suppress or delay ovulation, but it is not the only form of EC. Other forms with estrogen can make the uterine lining hostile to new life and therefore act as an abortifacient. It saddens me that whenever contraception/abortifacient hormone pills and EC are discussed the statements from The Church and others seem to focus on whether it is an abortifacient or if in a rape you can “protect” yourself from not becoming pregnant. There should be a parallel discussion that focuses on the fact that these synthetic hormones are not good for women. There seems to be no reverence and care for a woman’s fertility and the importance of maintaining this fertility for her overall health and well being. The current medical treatment of women with synthetic hormones treats woman’s fertility as a sickness and her body as a garbage can you can put anything into at any time just so “she doesn’t conceive. Women are the most complex creatures in all creation and our unique hormonal balance is integral to our health. I would hope that the focus of treating victims of assault would reflect this dignity and treatment of a victim would include trying to not put synthetic hormones into her body if not needed.
I am a Pharmaceutical Chemist and I’ve been working quite a lot on the mechanisms of action of EC. The key factor in this debate should not be whether the EC acts as an abortifacient or not, but to what extent it does so. If you are certain that the rape victim is in -2 day (with respect to ovulation) and that Levonorgestrel completely inhibits ovulation if administered in the day -2 (which scientific evidence shows it actually does), you don’t have to worry about its eventual abortifacient effect. If administered in the -1 or 0 days, the anovulatory effect is much lower or even null, and it is then when you have to worry about its abortifacient effect (which is also certain). The main problem here is: can you know, with the regular ovulation tests that are given in hospitals, that the woman is in the -2 day? If the answer to this question is YES, or if it is so, in general terms, to the question if you can effectively inhibit ovulation not having to mind post-ovulation effects of EC, then it would be morally licit to administer the EC.
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