Controversy in Cologne: The German Bishops and the ‘Morning-After Pill’


Cathedral of Cologne
Cathedral of Cologne (photo: Wikipedia)

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.