AmericanPapist Comments
There is an article in the current volume of "The Linacre Quarterly," the official journal of the Catholic Medical Association, called "Emergency Contraception for Victims of Rape: Ten Myths," by A. Patrick Schneider. Although I haven't read it yet, I'm sure it might be worth reading.
Awesome coverage of this issue and recent developments, Thom. Keep up the good work!
Thomas, I second Cate's comment. Thanks for the opportunity you set up for getting facts and discussion on this.
I was wondering what the NCBC would have to say. Your posting of their statement is helpful, as is your commentary. I agree that the "howevers" say something ...is it the NCBC's way of saying that the CT decision is in error? I wonder if the center is free to publicly and explicitly disagree with the bishops?
I cannot understand how the Bishops and now the NCBC can say no one really knows how this drug works, and the Church has not really said something about it, when there is the crystal clear pronouncement of the Pontifical Academy for Life from 2000: "It is clear, therefore, that the proven "anti-implantation" action of the morning-after pill is really nothing other than a chemically induced abortion. It is neither intellectually consistent nor scientifically justifiable to say that we are not dealing with the same thing." (http://www.vatican.va/roman_curia/
pontifical_academies/acdlife/documents/
rc_pa_acdlife_doc_20001031_pillola-giorno-
dopo_en.html). If they said "there's new science, the pronouncement doesn't apply anymore", I still think they would need to pruduce much more and conclusive evidence that it is certain that no chemical abortion is induced (and I'm sorry but I have to repeat that at least in Europe this pill is commonly known as "the abortion pill", so without making any moral judgement of a particular person, generally it seems absurd to assert that in administering it there can be no intention of abortion whatsoever. In the Pontifical Academy's words: "However, the woman who uses this kind of pill does so in the fear that she may be in her fertile period and therefore intends to cause the expulsion of a possible new conceptus."). But as the Bishops (and many commenters on the blogs) do, just completely ignore the statement of the competent Academy of the Holy See is simply incomprehensible.
Also, I cannot understand the argument put forward that the law is immoral because it violates consciences. If procuring the drug is not immoral, as they claim (and not an abortion, as the Pontifical Academy says), then why should it violate consciences?
Berolinensis, there have been comments that the morning after pill is not the same thing as Plan B which has a different composition and is not yet shown to be abortifacient. I think that is the dilemma. Some say it hasn't been shown not to be so it is not moral to administer Plan B without first testing for ovulation. I agree with this point of view. Others however say that the risk of Plan B actually being abortifacient is slim, and that studies on animals to this point have produced no evidence that it is, and so it is, by the principle of double effect, moral to procede with a contraceptive response.
I am glad you pointed out that the NCBC sees no moral dilemma as far as the possibility of abortifacient effect yet sees ground for conscientious objection to the practice of administering Plan B. I was wondering what they mean also. It is because a medical professional is forced to administer a contraceptive when any pregnancy detectible would have already occurred before the sexual assault therefore rendering the drug an unnecessary intervention? Or is it because additional evidence of ovulation provided by a now proscribed ovulation test is denied the victim? Can someone clarify this for me?
Ultimately some think that since we don't know definitively that Plan B is abortifacient we can proceed, others say that since we don't know definitively that it isn't we shouldn't proceed with administering it without testing for ovulation.
I wonder still that the bishops were so adamantly opposed just last week now see compliance with the law as morally permissible. I wonder what new study or data changed their view, or what reasoning.
I just know if I were in the position of administering Plan B, at gut level I couldn't. I hope I would be brave enough to take the consequences.
John,
Thank you for your fair and balanced comment. As for why "the bishops were so adamantly opposed just last week now see compliance with the law as morally permissible," my best speculation would be that they objected to the governmental interference as a matter of principle. Indeed, if further studies should indicate that Plan B operates predominately or frequently as an abortifacient, then the moral calculus changes and Catholic hospitals arguably *must* refuse to offer it to women, even those who have been raped. Moreover, the performance of an ovulation test would seem to be an appropriate precaution given the lack of certainty as to Plan B's abortifacient properties, and as such may even be morally required if lawful and not unduly burdensome. As I've said before, the villians here are the CT legislators and regulators who have taken a step that could, under altered circumstances, legally require Catholic hospitals to do something that is immoral.
Yes, kudos to Thomas for keeping on top of this! Berolinensis & John, I think your concerns are legit. Mike P. - you say "if further studies should indicate that Plan B operates predominately or frequently as an abortifacient, then the moral calculus changes..." It would seem to me that the best science at present indicates that Plan B operates as an abortifacient in at least some cases. As such, it would seem the "moral calculus" should only change from not administering this pill to possibly allowing its use if "further studies" show that it NEVER acts to cause an abortion in the circumstances for which it is being prescribed.
Fr. Bill,
What science says that Plan B operates as an abotifacient in at least some cases? I am aware of the science surrounding the morning after pill RU-486, but not those regarding levonorgestrel-only Plan B. Papers were written that hypothesized that it could act as an abortifacient in some cases, but the actual studies have been done suggest that this is either not the case or only rarely the case. If there have been studies on Plan B that indicate that it likely operates as an abortifacient in at least some cases, I have been posting bad information and apologize. Please share with me the science you mention. Many thanks.
And why do you think that the standard must be zero risk? If the side effect (i.e. second effect) risk is very small, wouldn't the principle of double effect potentially apply assuming the user's intention is to contracept and not abort? If not, does that mean that I cannot take a medication that introduces a slight risk of heart failure because suicide is morally impermissible? Thanks in advance for your response.
Mike, You ask some great questions that are at part of the heart of the matter. Just wanted to post this to let you know am not running away from your inquiry! Just have a ton of things to do at present. Of course this blog has many good resources to follow but would also point you to the www.all.org page for some comments from American Life League (including Judie's blog).
Hope to get back to you shortly!
Certainly, no matter how we see things as we sort through this particular issue...all of us, thankfully, seem to see the need we have to pray, pray, pray in these difficult days. Peace be with you.
Mike, w/re why the CT bishops changed their position: their original opposition doesn't seem to have been due mainly to the governmental interference. Their website explicitly states numerous times in question-and-answer format that they believe Plan B acts as an abortifacient. e.g "If the LH test indicates that the woman is already in the ovulation stage of her cycle, then Plan B cannot have a contraceptive effect. In these extremely rare cases, the only objective of administering Plan B is to impede the implantation of a fertilized ovum, which is abortion that the Catholic hospital cannot perform directly or in cooperation with others." This perception is reiterated several times. I am then still wondering what new evidence or argument persuaded them otherwise. Also the NCBC endorsed the now discarded protocol of the Catholic hospitals. If the NCBC orginally supported drawing a line in the sand at ovulation, why does it now, in essence, retract its endorsement. Is the double effect calculus that much different to the bishops and NCBC from last week to this? Perhaps so because of the new legal risks. But that is quite a hugh step away from their original stated position. That is why their calculus doesn't seem accurate to me.
You ask must the standard be zero risk. I am saying yes to that because the consequences here of defying the law, grave as they could be, are not irreparable and do not equal in graveness the real, though rare, abortion of a conceptus. Thanks in advance for further clarifications.
CCC page:
http://www.connecticut.nasccd.org/bins
/connecticut/templates/default.
asp?_resolutionfile=templatespath
|default.asp&area_2=Plan%20B%20QA
Thank you John14v15 for your well reasoned response to Mike...it saves me a little time in compiling things to post my promised response!
It does seem the "risk" must be ZERO that the drug would possibly work as an abortifacient...esp when you consider that it's not like taking say antibiotic's which could possibly cause harm or even produce an abortion in say, 1 of 10,000 cases. This "Plan B" is to prevent pregnancy and regardless of the main mechanism of action it's use is "targeted" at the very biology of human reproduction and at the narrow window of possible ovulation, conception, etc. It seems, am just thinking out loud here, that this focus makes the tolerances much more tight in parsing out the implications of any decision or "statement" any Church official would make. Again, going back to the "science" of this chemical and what it does or does not do...the manufacturer has stated that it "may" prevent a fertilized egg from implanting in the womb. I don't care if this is just a "legal disclaimer"-it IS in the manufacturers prescribing information.
ALSO, I'd think, the possibility of scandal swirling around the "treatment" or the Bishop's "protocols" is all the more acute because the drug manufacturers, promoters of the drug, the media and the American mindset see this as a contraceptive drug...and for them flushing out a fertilized egg is contraception and not abortion..."pregnancy" as defined, or thought of, by them is only after the "product of conception" is implanted in the womb.
Fr Bill, yes I am troubled also by Plan B's narrow target: the site and function of fertilization and implantation. I am not confident that Plan B is that precise a smart-bomb. Besides possibly, if rarely, preventing implantation by thinning the uterine lining, what else could the potent chemicals we are introducing into a woman's ovulatory episode do to a conceptus? Does anyone know if birth defects or later stage miscarriage could result in a conceptus exposed to these chemicals? I also remain concerned that the manufacturer thinks it necessary to protect itself from potential abortifacient effect by noting that possibility in the drug's literature. The manufacturer must have some basis for this concern -- there is no warning of, say, an earthquake or tsunami or limb dysfunction, to radically juxtapose non-concerns, in the literature. I agree also that the nomenclature is slippery, and that what the Church considers abortion seemingly almost the rest of the planet considers merely taking out the trash. All this is why, after all the really insightful comments in this and other threads, I still at gut level cannot agree to the morality of giving Plan B without testing for ovulation.
John,
I don't have time to reply substantively to your recent posts, but would mention that my understanding of the genesis of the label language is that it derives from lobbying of the FDA by pro-life groups concerned about the hypothesis we discussed earlier.
"I still at gut level cannot agree to the morality of giving Plan B without testing for ovulation."
I would agree with that assuming (i) the practical efficacy of ovulation testing (something other commentators have questioned) and (ii) its practical availability. The problem is that the option is not legally available, so that leaves us with the harder question of how confident must we be that Plan B won't act as an abortifacient before its use can be accepted as morally licit. I continue to disagree with the assertion that Catholic teaching requires 100% certainty in this regard.
I do wonder whether Catholic hospitals will offer ovulation testing as an option, which I would think would be legally permissible. If so, I would think that the acceptance of such an option by the patient would be morally required insomuch as an election to decline the test would seem to indicate that her intention is not to prevent conception of a baby (morally acceptable in case of rape) but to prevent the birth of a baby whether conceived or not (morally unacceptable). Then it gets even trickier. Once a rape victim reveals by her decision that her intent is the latter, does that remove the situation from safety of the principle of double effect since the intent is infirm? If that is indeed the case, then can the hospital morally offer Plan B even though legally required? Plainly I have more questions than answers, but I worry whether the Bishops have thought through the implications of the possiblility that some victims would desire a ovulation test.
Mike, thanks again for more grist. (i)Yes ovulation testing is not perfect and may give a false negative. Does this possiblity create yet further moral questions? At this point I wouldn't think so -- we have tried to the best of our current ability to determine if ovulation has occurred. But some could disagree, though at this point it seems to me to be the beginning of scrupulosity. (ii)I don't think the option of ovulation testing is proscribed, only the requirement. So it is available should someone ask. Which leads us to your excellent insight: if a woman doesn't ask for testing that would indicate intent, hence a definitively immoral act. Presupposing of course that the woman knew of the availability of testing and of what testing implies. I would think the hospital would be morally required to provide that information. Her refusal would then most likely show intent to abort a possible conceptus, but then again only if her mental state at that time allowed her competency in decision making. Mike, I keep thinking we are done exploring this issue, and more implications and questions keep becoming evident. Your comments have been really very helpful.
Thanks, John. I continue to appreciate your willingness to debate in measured, thoughtful and charitable terms, while trying to keep an open mind.
As you can see from these exchanges, moral reasoning can sometimes be hard work, especially when dealing with imperfect information and uncertain motivations.
As I very much appreciate yours, Mike. Thank you. Trying to figure these things out isn't really possible without a forum such as this somewhere. AmPap is doing us all a good service.
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