AmericanPapist Comments
In accordance with Catholic moral teaching, these hospitals provide emergency contraception
What are they talking about?? Even if they weren't abortifacients, contraception is NEVER "in accordance with Catholic theaching", emergency or not.
John Paul II, Address to Priests of Sept. 17th 1983:
"Contraception is to be judged so profoundly unlawful as never to be, for any reason, justified. To think or to say the contrary is equal to maintaining that, in human life, situations may arise in which it's lawful not to recognize God as God".
The modernist heresy continues in Connecticut.
As an aside, I fail to follow the logic of the hospitals providing Plan B to women whose pregnancy tests come back negative. Are they just trying to use up all the extra abortifacients in their stockroom?
Although contraception is never ok, rape victims are allowed to protect themselves against the unjust aggression of a sexual attack. Coitus interruptus is not ok as an act of contraception during a truly marital act, but a woman who could interrupt a rape, even during coitus is entitled to do this. The presence of sperm in the body constitutes a continuation of the unjust attack. Once a sperm has fused with an ovum, a sperm is no longer present, only the new embryo.
Plan B is probably not as effective as manufacturers say. I am a medical doctor and reviewed the literature for a paper this summer looking for ideal ovulation testing. What I found instead was evidence that the pills aren't abortifacient. Regular birth control pills do thin the uterine lining, disallowing embryos to implant and are abortifacient in some cases. But Plan B, in follow-up uterine lining biopsies in women with previous tubal ligation does not appear to thin the lining. In monkeys that mate only when the female is fertile, Plan B did not prevent any pregnancies. In humans, it's effect seems to be on thickening cervival mucous to prevent sperm transport, preventing ovulation (ultrasound studies confirm it does have this effect if taken pre-ovulation) and perhaps, making ova more resistant to penetration by sperm. All these would be morally reasonable acts of protection against an ongoing attack by sperm placed during an act of violence and morally acceptable for Catholics in such cases.
As a consequence of my research, I finallly stopped prescribing birth control pills because of the evidence of abortifacient effect, but I changed my approach to Plan B and in conscience find no evidence that they are immoral
And I'm sorry for the long post, but I think it's a more complicated issue than the newspapers will tell us. I don't think the Conn. bishops caved to pressure but did the right thing in view of the science.
Great point, Rob. Exactly: why the need to administer an abortifacient to someone who is not pregnant? In case they get pregnant? Then, aren't you contracepting? And isn't that what JPII is talking about in the point Fabrizio made?
Just so we in Connecticut do not feel so bad - can anyone confirm that other dioceses also administer this drug? The CT lawmakers used this argument to pass the law - they claim that in NY the hospitals hand out this drug without testing - does anyone know if this is true?
Ovulation testing is not readily available in many hospitals. It's a somewhat specialized blood test to be perfect. The urine tests are helpful, but limited.
Again, despite what the manufacturer says, I couldn't find direct scientific evidence that this drug hurts conceived humans and I think ovulation testing is just a possible peace of mind issue, but should not impact the decision to use the pills. If someone has a study to contradict my conclusions, please let me know, since I'm using the info. I have in my practice.
Mary,
The effect of levonorgestrel on the endometrium is the problem. The conceived human (blastocyst/conceptus - whatever you choose to call it) is intentionally prevented from implanting and growing. The probability of this happening is unknown - but the fact that levonorgestrel will prevent implantation seems pretty well established...
Michaelus,Thanks for the feedback. A month of daily levonorgestrel will often prevent adequate endometrial growth. But, I believe the studies show Plan B, only two doses in 12 hours is insufficient to have a sigificant effect. Dr. Marta Durand gave LNG in Plan B doses to women in late follicular phase and found normal endometrial histology. Small study but I think it makes sense that it would take a longer treatment to disrupt a process that takes about 28 days. The citation is: Contraception 64 (2001) 227-234.
Darn what a time for the media to get something right. The Bishop's statement was portrayed accurately.
According to the statement they will never revisit this since no one is going to do the research that will make this more evident. The medical industry is in no hurry to prove that anything acts as an abortafacient.
Mary, the information you reference could potentially change the way my husband (a pediatric ER physician) practices medicine. Could you please provide some more specific sources for your research?
JaneFrances, the monkey article is:Post-coital administration of levonorgestrel does not interfere with post-fertilization events in new-world monkey Cebus apella. M.E. Ortiz, et al Human Reproduction, Vol. 19, No. 6, 1352-1356, June, 2004. Also, Effect of post-coital contraceptive methods on the endometrium and the menstrual cycle. Marja-Liisa Swahn, et al Acta Obstetricia et Gynecologica Scandinavica 1996; 75:738-744. I have more if that's not enough. In the origianl WHO study of efficacy, they actually enrolled 4 women who in retrospect, were already pregnant. So, I'm a little suspicious of the conclusions of 89% effectiveness.
Mary, I've sent you an email to follow-up on your comments (thank you for them).
Mary's comments are consistent with my research on these matters -- both medical and theological. The concern about Plan B being an abortifacient is grounded in several articles that theorized that if it fails as a contraceptive it could hypothetically work as an abortifacient. This theory is grounded in several reasonable hypotheses, but the studies that have tested that theory have failed to corroborate it both for the reasons explained by Mary as well as evidence that its failure as a contraceptive is remote. These nuanced facts notwithstanding, many Catholics have consistently made unqualified and unsupported claims that Plan B is an abortifacient, period. As these claims are repeated they become the conventional wisdom that is again repeated, as so goes the cycle.
I have no particular stake in this issue. Whatever the Church teaches is fine by me. But the debate provides yet another example of a very interesting phenomenon, to wit: the tendency of so-called liberal Catholics to unduly narrowly define those acts that are "intrinsically evil" in order to enable functional consequentialism; and the tendency of so-called conservative Catholics to unduly broadly define those acts that are "intrinsically evil" even at the price of undesireable consequences.
Note to liberals: the ends DO NOT always justify the means, no matter how desireable the ends.
Note to conservatives: the list of intrinsically evil means is pretty short, and those that are on the list are usually defined very carefully and include some qualifiers.
Aren't the effects of levonorgestrel on the endometrial lining are well documented in studies of the IUD's based on this steroid - isn't that how they actually work?
Good God! Did you read the 4th paragraph of their statement? Because they're unsure about the abortifacient nature of Plan B, it's ok to use!!???!?!? Now where have we heard that convoluted logic before??? It's coming to me... It's coming to me.. Oh, yeah!!! Roe v Wade!!! I knew that sounded familiar!!! These bishops must have taken legal lessons from Georgetown University Law School!! Drinan must be so proud!
Of course the "pill" (I absolutely refuse to use the cynical-beyond-belief term "plan B") is abortifacient. Among the Catholics making these "unqualified and unsupported claims", as you put it, is the negligible institution of the PONTIFICAL ACADEMY FOR LIFE: http://www.vatican.va/roman_curi...no-
dopo_en.html
They say (but better read the whole statement):
"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."
"Consequently, from the ethical standpoint the same absolute unlawfulness of abortifacient procedures also applies to distributing, prescribing and taking the morning-after pill. All who, whether sharing the intention or not, directly co-operate with this procedure are also morally responsible for it."
"Consequently, from the ethical standpoint the same absolute unlawfulness of abortifacient procedures also applies to distributing, prescribing and taking the morning-after pill. All who, whether sharing the intention or not, directly co-operate with this procedure are also morally responsible for it."
Michaelus, Yes, the IUD does thin the uterine lining via contiuous excretion of progesterone. Ultrasound of the lining in women who took a bolus of progesterone in Plan B does not show that thinning. Thus, my conclusions from medical literature is that standard oral contraceptives and IUDs are certainly sometimes abortifacient but post-coital contraceptives are really contraceptive. IUDs probably have some nonabortifacient mechanisms such as making cervical mucous more "hostile" and oral contraceptives certainly have some true contraceptive effect such as prevention of ovulation.
Berolinensis, I agree "Plan B" is a cynical term and post-coital treatment is more accurate. Until a few months ago, when I had occassion to review more recent studies, I did not prescribe such treatment because the older literature suggested it caused a chemically induced abortion. I was surprised to find that newer literature does not support these conclusions and in fact, supports the opposite.
Again, I am not an expert in such matters and will change my practice if someone finds evidence I have over-looked.
Thank goodness for Pope Mary and Pope Mike who have determined for us that, not only is use of the pill 'Plan B' ethical, it is also theologically correct. I love how Mike describes himself as a "status quo" Catholic as well. That is typically how all liberals argue. "I'm neither liberal nor conservative". That's of course just before they cast out their liberal garbage. How can Pope Mary and Mike pretend to know what is theologically sound by their own research?!
C'mon, Thomas. If ever there were a time that your studies in moral theology would be put to good service on this blog, it would be today. This post is riddled with inaccuracies.
For what it's worth (probably not much to you), I've responded to your post due to the seriousness of the issue and the true need for responsible and informed commentary on this matter.
Mary, Doesn't Plan B cause you to "shed" early because of the high dose of levonorgestre?
I don't know who's right or who's wrong in this matter. I'm sure that the Vatican will step in if this is abhorrent to Church teaching. I find it difficult to believe that three bishops would agree to flouting Church teachings.
I'll be curious to see how this impacts Archbishop Mansell. Rocco said he "is more than the hometown favorite to come back" to New York and succeed Egan. If the Vatican frowns on this decision by the Connecticut bishops, Mansell won't have to worry about hiring a moving company.
Joe,
I really have no aspirations to be Pope and I'm quite sure that's not something God has planned either. I don't think I'm at all creative in my theology. The Church has long taught that rape victims can defend themselves against spermatazoa placed as part of an unjust attack. They cannot destroy an embryo, even one created by an unjust attack. The question with post-coital levo-norgestrel in the doses commonly given is whether it prevents conception by preventing ovulation or sperm capacitation or whether it endangers an embryo by, as annonymous questions, causing early shedding of the endometrium. These are objective medical questions, not questions of theology and the best answer I can find from the literature based on recent observations is that the endometrium does not change at these doses, but if timing is right, ovulation may be prevented. This is consistant with the fact that even the manufacturer doesn't claim the products have 100% or even 90% effectivness.
Mary,
Is there a possibility, even the smallest possibility, that 'Plan B' may thin the uterine lining (I'm no doctor, so forgive me for my lack of knowledge of medical terms) thus thwarting implantation of a fertilized egg? If there exists even the slightest possibility, then using this drug is a grave sin.
Whether or not the drug company placed this warning on their label to avoid lawsuits, it's still on their label and their web site. If they were 100% certain that it was not an abortifacient, they would not find it necessary to add it to the warning label or their web site.
Here is a snippet from the bishops' statement: "since there is serious doubt about how Plan B pills work". In other words, they don't know. The majority opinion of Roe v Wade also admitted doubt. However, in absence of other evidence, a course of action must err on the side of the existence of life; any other course is sinful. However, one might also research the findings of the Catholic Medical Association.
Policraticus, if there was ever a time to put your basic reading skills to good use and exhibit a basic level of Christian charity, it is now. I'm sad to see you've taken over the VN position of "resident AmP gadfly." *sigh*
Policraticus, if there was ever a time to put your basic reading skills to good use
If I misread you somewhere, then please show me.
exhibit a basic level of Christian charity, it is now
Is it uncharitable for me to expect better ethical analysis from someone with a theology degree and a wide readership on his blog? Let's not get sidetracked here with a premature pulling of the charity card. You wrote the accusatory post. I only pointed out its inadequacy and holes, as well as your very poor example of creative fidelity to the hierarchy. Please try not to be so sensitive.
I'm sad to see you've taken over the VN position of "resident AmP gadfly." *sigh*
Not sure what you're talking about here, but to play along with your sidestepping of the real issues, don't forget that the Athenian gadfly was usually right...it's a whole lot easier to dismiss or swat violently at the gadfly than to actually inquire into the reason the gadfly is attacking. As Socrates told the Athenian court, the purpose of being a gadfly is "to sting people and whip them into a fury, all in the service of truth." I take your name calling as a compliment, and I anxiously await your turning to the truth.
Your response postdates my comment on your blog responding to each of the things you desire. Please read it.
Politicratus, I happen to be looking at a Plan B package right now. It clearly says, and I quote, "Plan B may also work by preventing attachment to the uterus". That prevention means the stuff can work as an abortifacient. Thomas is right. The fact that it "can" do so makes it morally unacceptable to advocate or permit its use. When doubt exists, we must opt for caution and life.
Janet,
I address that very issue in my post. I,too,have seen the label and quote it in my post.
Thomas,
I have responded to you both there and here.
I've added some more thoughts to add food for debate. Imagine how much simpler this would all be if the CCC or USCCB or even a spokesperson issued some sort of clarification.
Imagine how much simpler this would all be if the CCC or USCCB or even a spokesperson issued some sort of clarification.
Thomas, now here is something that we can certainly agree on. See that, I knew there must be some common ground for two guys who receive the same sacraments and read the same books.
Well then, I do hope for a more fruitful dialogue in future between us that purges my commentary of inaccuracies in service to the truth and the utility of my readership. AMDG.
P.S. I have updated this post to soften my criticism of the document (and in so doing, improving the focus of its critique, i hope). I would ask that in future the tone of external criticism might be more amenable to genuinely pursuing the truth for the sake of the readership. As I have said often, I have no problem revising my posts where there are inaccuracies.
Do the CONN bishops NOT acknowledge that Plan B might work as an abortifacient, and do they NOT say that using Plan B is nevertheless acceptable?
Would they also say, to use the classic example, that if what is rustling in the brush might be a deer and might be a human, it's okay to shot because it might not be a human?
What am I missing here?
I don't want to get into the debate. I am unclear about Plan B and don't understand the complete reasoning behind the recent decision. I would be careful in asking my questions and try to discern what the Bishops are doing in a charitable away (not everyone has done this, as can be seen in the comments).
However, reading the debate that manifested itself overnight -- both here and on VN -- I thought of an analogy which might help everyone. It's not one I would like to use (for various reasons), but I think it can puta a new light some of the issues.
The use of fossil fuels may be causing global warming and leading to weather conditions which will kill innumerable people throughout the world over (and may already be doing so).
Some people would argue "we don't know, therefore it is ok to continue as we are." Others think it would be prudent, because of various pieces of scientific evidence, that the links are more likely than not and therefore prudence would suggest we start changing our behavior. Is this not a similar debate?
I hope I do not sound hysterical, but I am simply horrified by the decision of the bishops and to me, the whole discussion is beyond belief. There is a crystal clear statement from the Pontifical Academy for Life that these pills are abortifacient and administering them is morally equivalent to procuring an abortion. Now, some commenter (in good faith, I have no doubt) has stated that there are new scientific articles which might call into question the effect of the "pill". I have not read those articles nor am I a physician. But the one moral principle that is also crystal clear is that when a reasonable doubt remains, under no circumstances is someone allowed to act. In that case, he commits a sin even if effectively no harm has been done. Where it is, as here, a question of life or death of a human being, the consequences become grave. Since the Bishops do not adduce any new science (which in any case, according to what we heard here, is one new study, which questions what is so far accepted by everyone and has explicitly been declared by the Pontifical Academy and can thus not possibly cause moral certainty that there is no abortifacient effect), but admit verbatim "doubt about how Plan B pills and similar drugs work" (which doubt in itself seems quite shaky given the views and judgments published so far, as pointed out), the most basic moral principles obviously demand that this drug be not administered.
The deer analogy of Dr. Peters is most apt, and I still have difficulty believing that this should actually have been declared by Bishops.
Berolinensis, you hit the nail on the head. We may never act on a doubtful conscience, only a certain one. The Bishops' statement admits of doubt; on that shaky basis, they reverse their prior position to Plan B. Their reversal just happens to coincide with the change in law up there.
Joe, Your question of the "smallest possibility" that Plan B creates a hostile uterine lining is the question I had a few months ago. 20 yr.s ago, we didn't know the pills could block ovulation and we didn't know some of the specific timing relating to intercourse, ovulation and conception. So, we assumed the pills had to be abortifacient. More recent data, specifically examining the uterine lining after women took the pills does not show change that would be expected to cause abortion. In a study of monkeys that mate only when ovulation has occurred making pregnancy more likely, monkeys given Plan B were not less likely to have established pregnancies than monkeys not given Plan B. We can't do the same test in humans, obviously. I can't perfectly prove that there is absolutly no way Plan B could be abortifacient, but the same is true for penicillin in pregnancy. The evidence is that it is safe. My understanding is that honestly using the best evidence availble is all the Church expects. Package inserts are written for lawyers, not physicians.(Apologies to scrupulous lawyers who may read this blog) In U.S. courts, it is very possible to lose a malpractice case because a jury believes something that is not true. In med. school, they taught us about a driver who lost a case because a jury believed a patient's Down Syndrome was caused by an auto accident.
So, I wouldn't trust the insert on this. But I would certainly change my practice if scientific evidence emerges that convincingly contradicts the papers I mentioned.
We all passionatly agree that a human life from its first moments is to be protected. I don't in any way dispute that. What I dispute is an older understanding of how these particular drugs in these particular doses act on the body.
Well then, I do hope for a more fruitful dialogue in future between us
Me, too. My sincere apologies for my earlier tone. You're one of the good guys, Thomas.
Mary,
Please know you have my serious admiration. Your thoughtfulness and patience in the face of contemptuous and uncalled-for ridicule are exemplary.
And Joe, you don't know me, and your post of 8:51 yesterday was unChristian and out-of-line.
As a "scrupulous lawyer" I agree with Mary's assessment of the label. It is not irrelevent, but it is not nearly as probative as what the actual science says.
There has been some excellent medical research (very thorough) done by Drs. Kahlenborn, Larimore, and Stanford on the post-fertilization effects of contraceptives ("emergency" and "otherwise"). Their studies, one that was published in JAMA's Archives of Family Medicine and the other in the Annals of Pharmacotherapy, are available at www.polycarp.org.
Anonymous,
I've read the work by Kahlenborn et al and agree birth control pills are sometimes abortifacient. But their conclusions on Plan B is an extension of information on the pills, and I think their conclusions don't jive with what has since been observed with the post-coital therapies.
There is all this talk about pill being either a contraceptive or an aborifacient. I'm confused, because aren't both wrong? If the woman is not pregnant, why is it okay in this one instance to use contraception to block her becoming pregnant - if, for example, God would allow such a thing to occur after rape? I know that the woman has been violated and victimized, but doesn't the child still have a right to live? I'm just asking - please don't think I'm being a jerk - I'm just sincerely troubled by this issue.
I know that the woman has been violated and victimized, but doesn't the child still have a right to live?
Once the child is conceived, he has a right to live. Before the child is conceived he doesn't exist so he doesn't have any rights. Otherwise not raping, not fornicating, not cloning, and not conceiving children through IVF, etc would be violating all those non-existent but theoretically possible embryos right to exist.
Yes, but what would we do if contraceptives didn't exist?
Mary-
I was researching the blood test required to detect ovulation. The only thing I could find was one to detect progesterone. An elevated basal body temp can determine that. As you know, the ovulation predictor kits detect LH, and are not particularly expensive. Wouldn't that be a better option- or are there more extensive tests, and what do they measure?
Thanks for your expertise,
Linda
Linda, The LH can rise before actual ovulation by 8hr.s to at least two days. So, during the window when anti-ovulatory could work. The progesterone test is more specific and done when LH is postitive to double check if it is likely the ovum has already been released. But, many hospitals run that test only once every 24 hours or even less ofteen. The temp. rise is very accurate in many women but, the question of using Plan B in Catholic hospitals is in an emergency setting for an assault victim, so any time of the day.
If Plan B were either anti-ovulatory or anti-implantation, knowing ovulation status would be crucial. But I think the evidence that is doesn't interfere with implantation is good enough that withholding med.s to check for ovulation just slows the process and makes it less likely the pills will be taken in time to stop ovulation or sperm capacitation.
Since Plan B does not prevent pregnancy in a significant number of cases, it might be comforting to some women to do lab testing afterwards to find they weren't ovulatory at the time of the assault. That would of course not be comforting to someone who was ovulatory.
Hope this is helpful, if someone has more detailed info. on testing , please chime in.
I am hearing, on other lists, from Catholic pharmacists who now find their standing under state conscience clauses jeopardized by this ridiculous statement of these bishops. On the basis of this statement, permission for them to refuse to dispense Plan B can be revoked. These poor pharmacists have now been thrown under the bus because these bishops have cowtowed to political pressure. As long as there is the slightest possibility that Plan B will abort, its usage is utterly unacceptable - pure and simple.
The risks associated with Plan B® (Levonorgestrel) are very real.
Contrary to the statement of the Connecticut Catholic Bishops that there is “serious doubt” about how Plan B® (Levonorgestrel) works, the prescribing information is very clear.
The product is a synthetic progestogen (female hormone) which slows tubal transport of sperm to the ova. The product works by preventing sperm from getting to the ova.
However, if sperm have already reached the ova, slowing tubal transport also may have the effect of causing an ectopic pregnancy. Up to 10% of pregnancies in women taking this product are expected to be ectopic. This means that this product increases, by 500%, the risk of ectopic pregnancy.
Additionally, if sperm have already reached the ova and the fertilized ovum has already made it through the tubes, the product also alters the endometrium and may inhibit implantation. Once the process of implantation has begun, the product has no effect.
I suspect that the State of Connecticut threatened to stop Medicaid or CHIP funding to any hospital that did not use emergency contraception in their sexual assault protocols.
I certainly hope that His Eminence, Justin Cardinal Rigali and the country's prolife office are made aware of this sad development.
Gil Garza,
Could you post your references?
Thanks.
"As long as there is the slightest possibility that Plan B will abort, its usage is utterly unacceptable - pure and simple."
Really? If that is the standard I would think that pharmacists should be put out of business. Period. Read most any label on any prescription drug, and note the parade of horribles. Remote possibilities to be sure, but if the standard is "any" possiblity, then there you go!
Look, if the risk that Plan B acts as an abortifacient is substantial, then I think that the principle of double effect probably does not justify its use, given the gravity of the risk. But it is astonishing to me how many people are so quick to object to the Bishops' decision without any knowledge regarding the science. Catholic moral theology cannot be applied to a vaccum; it can only be applied to facts -- and facts are established by science, not emotion and hypothetical slippery slopes.
As for me, I'm reading the posts by Gil and Mary. They actually seem to have some knowledge re the science (I don't really care about Gil's unsolicited speculations as to the Bishops' motives) instead of just uninformed opinion.
Mike, the labels on all the prescription drugs that I've taken mention not a peep about possibly aborting a baby. I think that places the Plan B question in its own light.
Janet,
But many mention the risk of liver and heart failure (i.e., death). Is death by abortion a separate category under Catholic moral theology?
Really, the notion that only zero risk is tolerable under any circumstances cannot withstand moral scrutiny.
I suggest you might consider St. Thomas's principle of double effect.
One weighs the risks of taking medication versus risks of not taking it. In the past, I have opted not to take medication because I believed the risks outweighed any benefits. An admitted risk of Plan B is the possible death of another human being. What alleged "benefit" of Plan B outweighs the risk of taking the life of another innocent human being?
Janet,
That would depend on how great the risk is, wouldn't it?* Which is the whole point.
*If you are inclined to answer no, remember that we have no more a right to cause our own death than to cause the death of another.
Mike, that doesn't answer my question. Again, what possible benefit from Plan B would outweigh the possible risk of aborting a baby?
Mary,
It seems that there are a few newer studies that confirm that the primary effect of levonorgestrel is to inhibit ovulation. However, there is very little to suggest that the drug will not affect the endometrium - especially considering that we have 40+ years of data for IUD's that use the same chemical. A prevalent side effect of "Plan B" is bleeding.
But one certain fact is that the Church has always proscribed this drug. The Bishops must present some case for allowing it - a better case than "gosh this is really confusing stuff - and who can tell levonorgestrel from dextronorgestrel from progesterone anyway?"
Um, Janet. Anonymous was not me. (Gheesh.)
The substantial likelihood of a raped woman being impregnated against her will (a very important benefit it would seem to most raped women) could outweigh a very slight possibility of an abortion (an even more important risk). Under the principle of double efffect, one cannot just weigh the gravity of the benefit against that of the harm, but also must weigh their respective likelihoods.
That said, a lot of thinking must go into an application of the principle of double effect, especially regarding both intention and the actual mechanics of operation of Plan B. I am not an expert on Plan B and know only what I have read (i.e., summaries of medical journal findings).
Janet, it seems to me that you are probably assuming that conception is an absolute good. HV doesn't say that. But it is true that we must behave prudently when it comes to created human life, especially when good ends tempt us to entertain bad means. For example, we are not permitted to deliberately target innocents in a war, even if it might bring the war to a faster end. But we may target enemy installations knowing it is possible that innocents will die if the conditions of double effect are satisfied.
Michaelus,
Maybe I'm reading you too literally. I don't think the Church proscribes any certain drug but using the drug knowingly for evil intent. For instance, levo-norgesterol or even standard birth control pills should be okay to control abnormal uterine bleeding, as long as there is no pregnancy that could be endangered.
The study on endometrial effect that most impressed me was by Dr. Marta Durand and published in 2001. She actively looked for endometrial change in women who had taken the pills (as given post-coitally, not as daily oral contraceptives) and couldn't find it. Similiar ultrasound testing on women taking oral contraceptives daily does show changes. The studies I came across that described significant change are from 1974. At about that same time, other authors were saying they couldn't reproduce those results.
Again, this all applies only to Plan B, the progestin, not to harsher drugs like danazol that have close to 100% effect, meaning they are almost certainly abortifacient in some circumstances. Hormone excreting IUD's have a longer term daily effect, like the birth control pills.
A drug that can stop ovulation, is going to alter the ovarian site that would have released the ovum. This site, after ovulation provides some hormonal regulation that supports the endometrium and so spotting is not surprising. This is what often happens to women who are having anovulatory cycles for whatever reason. But it is not the same as direct damage to the endometrium and doesn't mean that the endometrium isn't functioning well when hormones remain in sync. when ovulation occurs.
Prudently, we have to use the best evidence we have. We aren't expected to be perfect in protecting life. If we were, we'd never get in a car for travel, let alone, bring innocent children with us. Not that we can drive drunk.
Mary,
The problem with the medical literature is that when a typical MD says that somethng is not abortifaciet he means that it does not cause the destruction of a foetus whereas a Catholic means it does not cause the destruction of a blastocyst (I love that term).
A good example are these comments by Dr. Leon Speroff (ref. OB/GYN Clincal Alert 21, Jan 2005):
"The mechanism of action for emergency contraception is not known with certainty, but it is believed with justification that this treatment combines delay of ovulation with a local effect on the endometrium and prevention of fertilization. How much a postfertilization effect contributes to efficacy is not known, but it is not believed to be the primary mechanism. ... Clinicians, pharmacists, and patients can be reassured that treatment with emergency contraception is not an abortifacient."
Dr. Speroff references the Durand study BTW. "Postfertilization effect" means chemical interference with a conceived child as far as I can tell...
Michaelus,
I agree that reassigning the meaning of the words pregnancy and abortion makes careful reading all the more important.
If Dr. Speroff got down to the specifics of why it is "believed with justification" that levo-norgestrel has sufficient change on the endometrium to prevent implantation, even though tissue and ultrasound examination haven't shown such an effect, it would be clarifying.
I'm curious about your comment on the term blastocyst. Do you love it because it's sort of cute to think of someone so small having a "blasting" power or am I missing your irony?
Mary, thanks for your posts -- they are measured and edifying.
Mike,
Thank you. Appreciate your keeping us focused on the questions at hand.
Mary,
"Do you love it because it's sort of cute to think of someone so small having a "blasting" power"
Yes- partly - "blast" has a strong connnotation in English. In Greek a "blastos" is a sprout - so maybe we ought to refer to the blastocyst as the "little human sprout ball" LOL!
Also it is hard for people to really comprehend a thing called a blatocyst - cysts are things we have removed not things we like. Like using the old latin word fetus instead of baby - or even using the term abortion instead of child murder - the terminology helps desensitize us...
Well, unless you want to call everything human and preborn a "baby" I think the scientific-precise terminology is useful as long as we don't let it get in the way of our fundamental understanding that each term applies to a sequence in one long continuum between conception and birth.
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