AmericanPapist Comments
Thank you, Thomas, for a very balanced and thoughtful post. Your willingness to examine evidence with an open mind as well as a well-formed understanding of Catholic teaching, is admirable and appreciated. This is especially impressive given that your original impressions re Plan B were understandably more hostile.
Regarding the CT bishops' decisions, I am not as certain about the correctness of the consensus, which by no means should be construed to mean I disagree with such consensus. The problem, for me, is the boundaries of the principle that Catholics should not be coerced to do anything that is would violate their conscience. First, employment is not by nature especially coercive. It is normally a type of voluntary association. Second, all law is coercive in some way. Conscience clauses may be good policy in some instances, but it isn't clear why it would be good policy in this case given the operation and efficacy of Plan B.
What troubles me the most is the state's obvious indifference to the legitimate concerns and interests of Catholics and Catholic hospitals generally. While *current* studies indicate that Plan B is not an abortifacient, this is a mere accident and future studies could indicate otherwise. For this reason, I'm inclined to direct my disagreement toward the CT regulators and legislature, even if I wouldn't go so far as to dismiss them as "corrupt."
All that said, you are providing a great service, Thomas. Thanks.
What also troubles me about this law is that it seems a woman is given this medication BEFORE there has been any proof or conviction of rape. This is very troubling. Doesn't our judicial system operate on the basis of "innocent until proven guilty?" Will we be giving these pills to any woman who comes in and claims to be raped? If so, does this provide potentially misleading evidence when the case is brought to trial? It seems to me the Connecticut Legislature has really jumped the gun on this one. I think much more time is needed to explore all ethical ramifications. Good job Thomas!
Jason,
The presumption of innocence actually cuts the other way. Under the law, it would seem that the hospital must offer the drug as long as the woman claims she has been raped. Such a presumption is neither probative nor relevant for any criminal prosecution, but it is consistent with the proposition that a person requesting such treatment based on a rape assertion should be believed as an element of basic charity. It is implausible to suggest that a woman would check into a hospital and claim rape just to access a prescription drug that is available at any drug store. While it is possible that such a woman might do so in order to deliberately establish a false rape charge, such cases are rare and, as mentioned above, the offering of this drug in accordance with state law would not be probative or relevant in any criminal proceeding.
Thanks for the clarification Mike. I appreciate your honest and respectful feedback. My other concern (and I'll admit here that it comes from my ignorance of the drug) is the CT Bishop’s acceptance of what I understand to be birth control. Isn’t the Catholic Church against birth control in general or does this not apply to rape victims? This concern presupposes that Plan B is a form of birth control - is it? I'm just wondering if someone could clarify this issue for me. a.) is Plan B birth control, if so, b.) is it morally justifiable to give birth control to rape victims?
Jason,
That is a perfectly fair concern. I encourage you to read other Blog entries and their comments on this. Basically, the concept is this: the prohibition against contraception is grounded in the inseparability of the unitive and procreative purposes of the conjugal act, as explained in H-V. Since rape is not unitive, it is appropriate to consider the sperm in the a woman's body to be a continuing act of immoral aggression, for which self defense is morally available. I hope that helps, but if not I believe you can learn more by some fairly simple google searches. I'm off to dinner!
Yes, Jason. You have hit the nail on the head. Plan B is a massive dose of birth control pills. Birth control should not be given to anyone. There are many bad side-effects. To give this drug to a rape victim is to demean them and declare any potenital pregnancy unworthy of life. If it does not potentially cause an abortion, and only prevents ovulation, then would not all Catholic women have a legitimate right to use it? I personally know human beings who were conceived as a result of rape and incest. I have pointed out that the line of thinking in support of giving this drug to anyone is inconsistent with Catholic teaching on this issue. The Pontifical Academy has addressed it thoroughly. It is my hope that Thomas will address it.
Mike,
Where is this thinking explained in a church document(other than in the misguided bishops' statement) ? "Since rape is not unitive, it is appropriate to consider the sperm in the a woman's body to be a continuing act of immoral aggression, for which self defense is morally available." And what does 'morally available' mean exactly?
Jason,
According to the U.S. Catholic Bishops in their Ethical and Religious Directives for Catholic Health Care Services, a woman "who has been raped should be able to defend herself against a potential conception from the sexual assault" (Directive 36). If you take the time to research the matter, you'll find similar statements from various church authorities and theologians. You will not find anything to the contrary.
This is why coitus interruptus and post coitus contraceptive douches are permissible in cases of rape, even though they are normally impermissible.
And by "morally available" I meant "morally permissible."
Hope that helps.
Jason,
While Directive 36 does not explain the theological rationale for its statement, it is commonly accepted that its basis is found in the essential link between the procreative and unitive purposes of the conjugal act as explained in HV. If you are genuinely interested, you can easily research this yourself. Any other position would mean that other contraceptive acts during rape such as coitus interruptus are morally impermissible too -- i.e., a woman being raped cannot try to push of the assailant during the act, which would be a moral absurdity.
SC,
All unborn human beings have a moral right to not be aborted, so your point about children of rape or incest is correct. But contraception involves no unborn person, unlike abortion, so no such right is implicated. And as explained above, the availablity of contraception in cases of rape does not have moral implications for non-rape situations. I encourage you and Jason to undertake some additional reading on these matters, starting with the several posts by AP and their related commentary.
And Jason,
The point of Thomas's post is to clarify after fairly extensive investigation that Plan B is indeed a contraceptive and in all likelihood not an abortifacient.
You might read Thomas's post again -- you appear to perhaps have read it too quickly.
Thank you Mike for your feedback. I fully intend to investigate further. I apologize for my ignorance on the matter - my studies have focused primarily on Liturgical Theology and I do not have much background in biomedical ethics esp in complicated issues such as this. Your explanation of Directive 36 makes perfect sense to me and helps me understand much clearer. Thanks. Thanks also to Thomas for addressing these issues to promote such dialogue.
Doubt would require its benefit be given to a potential conceptus, I believe, as having the highest priority because its very life is at stake. We need to know definitively (ie. with sufficient study) whether Plan B 1) is abortifacient 2)can cause birth defects to a conceptus, before we can morally introduce it into the environment of a new conceptus. Or we must be able to test for ovulation. Both Mike and Thomas have clearly enunciated my doubt surrounding the chemical Plan B introduced into the environment of a possible new conceptus. Thomas: "I think this short summary reveals that a very serious study of Plan B's effects needs to be undertaken to provide the Catholic medical community with the scientific data it needs to evaluate the morality of proscribing it to rape victims." Mike: "While *current* studies indicate that Plan B is not an abortifacient, this is a mere accident and future studies could indicate otherwise." We cannot morally proceed without such attainable knowledge.
Also, can someone explain the concern with coerciveness in regards to this particular legislation? If no abortifacient problem is perceived with Plan B, I do not see the conflict with conscience and Catholic doctrine in this particular case.
A quick question: Thomas writes that Plan B doesn't appear to be abortifacient when administered once. However, several online sites mention that the dosing protocol for this drug involves two separate doses administered at something like a 12-hour interval, if I recall correctly. Does the data about the drug's effects when "administered once" refer to the effects if only a single dose of the drug is administered, or does "administered once" include the normal protocol of two doses? In other words, does the drug as generally given in two separate doses have a higher risk of acting as an abortifacient than a single dose, or were the studies done on patients who had taken the normal amount of the drug, the two full doses at an interval?
Mike,
I typed up an overlong reply to your comment and it disappeared from my screen. I am taking that to mean I am to respond briefly. I am a woman currently working in the pro-life field weekly as I have for most of my adult life. I do not claim to be an expert, but I teach about these methods. I have been in discussions with our bishop about this issue have witnessed two Catholic doctors in my city stop prescribing any birth control drugs for any reason. Their decision was directly related to our great bishop’s leadership. These men are ob/gyn doctors, perhaps a bit more experienced than the family physician quoted in the AP megapost. The family physician rendered his opinion, which does not carry the same weight as PAL statement from 2000. The US bishops’ directive 36 does not carry the same weight either as earlier Catholic teaching from the Vatican. I respectfully suggest you do some additional research on this issue. Since we are not arguing the unknowable effects of this drug but the ethics behind the use of Plan B, I send you to two sites for starters. I am grateful for AP complete coverage of this topic. I include the PAL link as well. Yes, this is the short version of my comment.
Matt Bowman at ADF;
http://www.constitutionallycorre.../10/16/
558.aspx
The AMA's 2004 report on Plan B;
http://www.ama-assn.org/ama1/
pub..._hod443_a04.doc
PAL document
http://www.vatican.va/roman_curi...no-
dopo_en.html
the comments and discussion here, and Thomas' analysis are exceptionally well reasoned. and, also to be noted is the civility of the discussion among brothers & sisters in Christ.
I offer this, "thinking out loud," regarding the bloggers conclusion:
"Medically speaking...the best review of current research would seem to suggest that Plan B...does not render the uterus inhospitable to new human life." How valid is the "research?" Is the research sponsored by the "Plan B" mfg? Although the "best review of current research" might be, as he says "the best" could the research itself be skewed, limited, faulty, etc. (GIGO?)
With all respect to the sources site in recent post, papers by Dr. Coxatto and Dr. Marta Durand discuss observed results in female subjects. Not just opinion of experts who may be repeating previous expert opinion. If the Ob-gyns mentioned have more recent data to support their belief, please direct me to it. I know the ACOG site states Plan B may be abortifacient. But the matter is not referenced. Thanks to anyone with data that contradicts.
And, yes, the tone of this posts has been wonderful in our search for truth
As honest people of good will, determination of the effects of Plan B physiologically is the easy part of this situation.
Much more concerning is the fact that a legislative body decided Catholics and others will check their conscience at the door when coming to work.
Anyone who believes in democracy should find this very creepy
SC,
Your links are not helpful. The first is not germane; the second is a political document that makes a disturbing but unsupported reference to implantation; and the third does not not even mention Plan B, but discusses the so-called "morning after pill," which is more commonly understood to be the abortifacient RU-486.
I don't mean to sound impatient, but have you actually read Thomas's posts and related commentary? The issues you raise have all been discussed and addressed. In summary, Plan B is intended to and does in fact work as a contraceptive. A number of scientists have hypothesized that it could also, in some cases, work as an abortifacient. Based on this hypothesis, pro-life groups lobbied the FDA to require that the drug be accompanied by a label warning of the risk of abortion. Testing this hypothesis has been exceedingly difficult, and is perhaps impossible to do with absolute certainty. But several studies have been performed and published in reputable journals, and in each case they conclude that Plan B does not, in fact, act as an abortifacient. If any of these studies were funded by the maker of the drug, I am not aware of it. In any case, the hypothesis appears to be wrong, which is good news -- though some people seem to dislike good news. Now, it is true that these studies cannot be regarded as absolutely definitive. It does seem that it is possible that abortifacient effects might occur so rarely that it was not statistically observable in the studies. But surely rare side effects alone cannot render a drug morally impermissible, even if those effects are grave. Many drugs are taken which can cause liver or heart failure in rare cases.
It is always possible, of course, that future studies will reveal risks that the initial studies did not find. That can happen with any medicine. And if that happens, it would be appropriate, of course, to reevaluate the moral legitimacy of its use.
I apologize for not reprinting links and citations for you. I'm just too busy. But such information is easy to find on the Internet without too much difficulty, and for the most part can be found in Thomas's posts and related commentary.
It seems likely to me that even administered once that Plan B would act on the uterine lining. You have to realize that it is essentially a month's worth of birth control pills! Now that brings up the effect on the mother's health.
Feminists long blocked the usage of it due to the dangerous effects on the mother. Now it is suddenly safe, since a sick or dead woman is deemed better than a pregnant woman.
I once took a the pill for a month and had strange, bad moods and noticeable deposits on some of my bones, before I stopped. Now to take the stuff all at once! It is definitely harmful to a mother's health. Stroke is a definite risk when taking it as a birth control pill. Cancer risk is increased.
Also, a physical is required before taking the Pill. Now why isn't it required when the dosage is 21 times stronger? Advocates of Plan B seem to have the typical pregnancy-is-a-disease mentality. Better that a mother lose her health and possibly her life than to be pregnant!
Pregnancy is generally healthful and beneficial, not only in helping decrease breast cancer risk, but also in providing stem cells to the mother which fight cancer and increasing her intelligence, (not really too surprising!)and of becoming a more mature and loving person.
I wouldn't take it under ANY circumstances.
LvB,
The word "seems" in your first sentence does a lot of heavy lifting. You basically are just repeating the hypothesis that has been discussed and studied.
As for your other points, I agree that all risks should be discussed with a patient to the extent practical, but the point is not whether pregnancy is a disease; the point is whether a rape victim has the right to defend herself from a forced pregnancy. Catholic teaching says she does. As you point out (I wouldn't take it under ANY circumstances), she also has the right not to defend herself.
Please clarify the time period between fertilization and implantation: how are the Bishops protecting a pre-implanted human being from a death sentence?
Linda,
I am not a scientist, but from what I have read it appears that Plan B will not prevent implantation of a zygote. While studies show that longer term use of low-dosage hormonal contraceptives can have this effect -- which gave rise to the Plan B hypothesis mentioned above, which in turn gave rise to various label and other warnings -- recent studies of short term use of high dosage hormones (i.e., Plan B) indicate that such use does not have that effect. (Links to these studies have been made available in Thomas's posts and related commentary). It is currently believed that the changes to the uterine wall that serve to inhibit implantation appear to take place over time, which Plan B does not have this effect.
I repeat: the hypothesis that Plan B would act as an abortifacient by preventing implantation is a serious one; but the outcome of each study that has tested has indicated otherwise. While we cannot know with absolute certainty that the risk of Plan B having a side effect abortifacient property is absolute zero, Catholic moral theology does not require absolute certainty in order to make an appropriate moral decision. The CT Bishops appear to be on solid moral ground here, for the reasons that Thomas explains.
Mike,
So sorry you do not find my links helpful. Mike, Plan B is the morning after pill. Plan B simply a brand name, approved in July 1999 by the FDA. It is a registered trademark of Women’s Capital Corporation. RU486 is not the same but is a series of drugs given up to eight weeks in my state. Yes, I actually read all of Thomas' posts and I have not taken issue with the studies themselves, but I also do not consider them definitive (neither did Thomas). You seem determined to misunderstand my meaning. If I wrote something that irritated you, I am truly sorry. If you are growing impatient, maybe you should take a step back from the computer. To reiterate, I take issue with the ethics of giving any woman a month’s worth of birth control pills (as LvB has so rightly pointed out). The entire approach to rape victims is more of an issue here as well as our attitude toward their possible offspring! I have told you from whom I have received my information on this. I am satisfied with the direction given to all Catholic doctors in my diocese by my wonderful bishop. I respectfully state that I defer to him over you. The morning after pill has been an issue for some time now, and the Catholic Church has spoken. The document I linked to is not a political document; it is from the Pontifical Academy for Life at the Vatican. It is meant for all of us, but especially anyone who may be in a position to offer this contraceptive to women.
One of your statements,” It does seem that it is possible that abortifacient effects might occur so rarely that it was not statistically observable in the studies” seems to beg the question; if an embryo is not statistically observable, is it still worthy of our best efforts to protect it? Pregnancy from rape is rare, and our attitude toward the victims of rape should flow from our respect for life in all its stages. I do not agree with you that preventing a pregnancy by using Plan B, (and let’s at least admit that is the real goal here), is permissible or the best way to treat a rape victim. I think this quote from Mary the family physician applies, “As honest people of good will, determination of the effects of Plan B physiologically is the easy part of this situation.”
Mike,
Thank you for your reply. However, maybe I didn't phrase my query correctly: the question isn't about the abortifacient nature of Plan B (i.e., rendering the endometrium hostile for implantation.) But rather, because we believe life begins at fertilization, how are we protecting the fertilized egg prior to implantation? Correct me if I'm wrong, but my understanding is that Plan B works to expel the pre-implanted fertilized egg (zygote).
Just in case I am sounding redundant, I am concerned with what Plan B does in the zygote stage. Do we know what harm is done if Plan B is taken in that interim period of 6-9 prior to implantation?
Linda,
Great question. According to the available research, we cannot know this. However, we do know that a fertilized ovum is a human being before implantation. No pregnancy test can determine if a rape victim is pregnant (from the rape itself) when she is in the ER after an attack, thus we cannot know if the woman has conceived. Since you are an NFP expert, I would like to know what you think. Does not the fact that women can sometimes ovulate twice in one month raise another issue for Catholic healthcare providers in this situation?
Linda,
Not sure I can answer that. I would just say that if Plan B does work to expel an egg after it is fertilized, then it would be an abortifacient, in which case I don't see how its use can be morally justified, unless this occurs rarely and can be regarded as an unintended secondary effect (under a proper application of the principle of double effect, which is not germane to this comment). My non-scientific understanding, however, is that the studies that have been undertaken indicate that Plan B does not act as an abortifacient -- i.e., does not impair the development of an egg at any time after fertilization (i.e., post conception), which is why impairment of implantation was considered. All that said, let me be the first to say that my knowledge of the science in this area is limited to the summaries of the studies. I have never read the studies themselves, and in all likelihood they are above my pay grade. This is an elliptical way of saying you might know more than me.
What I will say is that we should all be able to agree that post rape contraception is morally permissible, but intentional abortion is never permissible. Whether Plan B acts as an abortifacient in such a way that it can never be used as a post rape contraceptive, requires an understanding of science first, with an application of moral law to follow.
SC,
I am acquainted with the PA's 2000 Statement, and I just don't find it very helpful. Its reasoning is morally correct, of course, but only if one assumes that Plan B does in fact operate as an abortifacient. The Statement cited no studies, as I recall, but just made summary claims, such as the pill operates by preventing implantation of a fertilized egg. To my knowledge, there are no studies that corroborate this, but several that reach contrary conclusions.
I do have a question for you: do you or do you not agree that it is morally permissible for a woman to contracept in a case of rape? Bear in mind, we can all agree that intentional abortion is always wrong, so we are talking about contraception only.
Possibility of death to a conceptus, freedom from coerced pregnancy. Which is more morally urgent? If we do not definitively know the answer to the "serious hypothesis" re the effects of Plan B, , in this situation of death vs having to bear an unwanted child, I think that the Church does require absolute certainty. Only look at the two potential outcomes, three if you count possible birth defects. Death is the more grave outcome when compared to carrying an unwanted baby. Mike repeats: "Now, it is true that these studies cannot be regarded as absolutely definitive. It does seem that it is possible that abortifacient effects might occur so rarely that it was not statistically observable in the studies. But surely rare side effects alone cannot render a drug morally impermissible, even if those effects are grave." In other words, we risk a human's death, not to save another's life, but to save them from a coerced pregnancy. The two ends are not morally equal, and the calculus of "double effect" does not favor the administration of Plan B without first administering ovulation and pregnancy tests.
SC,
Interesting question. Because a possible double ovulation would occur within 24 hours of the first, we have the same concern as with the first possible ovulation.
But an ovulation test given prior to any administering of Plan B would solve a lot of these " what ifs"! :(
Mike,
I do not agree with your analysis of the studies available, which you admittedly have not even read. To answer your question, given my experience, I do not agree that contraception is permissible in the case of rape. This is my opinion which I have reached after much research and discussions with minds far greater than my own. Because I work in the pro-life ministry, I cannot afford to be ill-informed or to vacillate. Lives depend upon it. Many Catholic hospitals will not give Plan B for reasons Thomas posted already. I work with women who do not want to carry the lives they have growing within them for many reasons, sometimes because of incest, rape, or both. I would not give contraception to rape victim because I believe any child who could be conceived is worthy of life. Indeed, he carries half of her DNA! I also believe it would damage her in many ways to have to take the drug. What if she conceived a child with her husband only a day or two before, which we have absolutely no way of determining? Several other factors are the lack of safety of Plan B, and what I consider to be sleeping with the enemy: paying money to the pharmaceutical companies who produce this deadly cocktail. I believe I have taken up enough time on this great blog, so I yield to others. I appreciate the opportunity to share my thoughts!
Oops! I meant to say that 'half'of the child's genetic information comes from the mother, which you all know. Sorry!
Linda,
So are you saying that a woman can't push a rapist off to interrupt coitus, or that post rape douches are not permissible? These, after all, are both examples of contraception. Please understand that your position is not one required by the Church.
John,
I honestly don't think absolute certainty is a Church requirement. If so, then stop whatever you're doing immediately. Because there is no absolute certainty that it won't kill some one.
In the particular dilemma that Plan B presents, considering the inequality of the seriousness of outcomes, ie the moral urgency of preventing death as opposed to preventing a survivable though distressing situation, yes I would say the Church and the calculus of "double effect" require absolute certainty. Many people, including the Connecticut bishops themselves, say that uncertainty exists about the effects of Plan B and that there is a possibility that further studies could reveal an abortifacient effect. Also as you say, "It does seem that it is possible that abortifacient effects might occur so rarely that it was not statistically observable in the studies." We know that rarity does not impute morality. I agree with Thomas' statement: "I think this short summary reveals that a very serious study of Plan B's effects needs to be undertaken to provide the Catholic medical community with the scientific data it needs to evaluate the morality of proscribing it to rape victims." Until then, we must err on the side of life.
Clarification: the above quote re the rarity of abortifacient effect was Mike's in an earlier comment.
John,
I don't think a careful analysis pf the principle of double effect would require absolute certainty even in matters as grave as life and death. I think if you reflect on this carefully, you'll agree with me on that. As to whether in this case we know enough about Plan B for it to pass moral muster, I agree that reasonable Catholics can differ. It is a tough and close call, but close questions cannot be resolved simply by reference to a rule of close calls go to A or B, since there will always be the question of the close call as to whether it is a close call. One must simply apply principles to the merits as we best understand them. And the principles include evealuating honestly the comparative gravities of risks as well as comparative likelihoods.
Oh, and my previous post was directed to SC rather than Linda.
Mike, I think you have spelled out the dilemma perfectly. Your explanation reflects the basis on which I apply the principles to the situation as we best understand it, as you say. What principle? To err in favor of an outcome of life, when other outcomes do not involve death. In that light, is this situation really a close call? In considering the possible outcomes of all the options, we measure how close they are in importance, ie moral weight, and the outcomes are found to be morally unequal. We have evaluated, honestly, the comparative gravities of risks and outcomes, to the best of our current ability, and are still left with, as far as scientific evaluation of Plan B: "We don't know definitively." However we do know definitively by natural and moral law, and by Church teaching, that we must opt for human life, corporeally and spiritually, against all other less critical outcomes. Not much in life is certain, but this principle of opting to protect human life against lesser outcomes is. On this, reasonable Catholics may not disagree. Therefore neither is this conclusion based on a simple reference to rules A or B, but is a fundamental viewpoint of the Catholic faith. We are obliged to make our tough decisions thus informed. The immediate outcome to ourselves of following this principle may ironically fatally impact us, but the principle still applies. The good news is that in Christ we have strength.
John, then you would agree that no Catholic can in good conscience drive a motor vehicle given the statistical possiblity, however remote, that it could lead to death, even if not intended. Please explain how the use of Plan B is different assuming right intent, which we both agree is necessary in all matters.
I see some serious, serious moral confusion in some of these posts.
The Principle of Double Effect has no application in the question of using "Plan B," because the end (preventing a pregnancy) that is sought is not at all proportionate to what is being risked: the death of an innocent person. One could argue that, desirable as it may be to prevent a pregnancy resulting from rape, since the pregnancy is not in itself an evil condition, preventing it is not "good in itself." But the disproportionality between the evil of causing the death of a person and the good of preventing a nine-month imposition on the woman renders that moot. The use of "Plan B" is flatly immoral.
Is fighting off a rapist "contraception"? No. The sin of contraception lies in the SEEKING of venereal pleasure outside of a marital act whose full integrity is intact. A woman being raped who manages to interrupt that act is not committing the sin of contraception! Just as the famous nuns in the Congo, who were given permission by Rome to use The Pill because of the danger of rape, were not committing the sin of contraception. The sin does not lie in the act of SWALLOWING The Pill! It is only the illegitimate SEEKING of venereal pleasure that constitutes ANY sin against the Sixth Commandment.
Fr. Vince,
I fully agree with your second paragraph, but of course that would be equally applicable to the use of Plan B in case of rape. What complicates the calculus is the introduction of the risk of abortion, which leads back to your first paragaraph.
As to the first paragraph, let's test it in a different context -- my desire to drive to a theater this afternoon to see a movie. In this case, it would seem that the end of seeing a movie would not be proportionate to the risk of causing a death by car accident, rendering my drive morally impermissible. The absurdity of this result is prevented by the fact that the principle of double effect requires an assessment not only of comparative gravities, which you acknowledge, but also of comparative probablities, which you overlook. This is precisely where the Plan B debate needs to settle, and it is admittedly tricky given the imperfect research, which is why reasonable Catholics can probably differ. But what is plainly not true, is that the question is settled simply by claiming, or even acknowledging, a hypothetical risk of abortion.
As I'm sure everyone here is aware, it is permissible to administer a medicine or perform a surgery to restore a woman to health, even if it is certain that the medical treatment will kill a child in her womb. That's because restoring her health or saving her life is a good. Pregnancy is not a disease. A non-pregnant woman is not "healthier" than a pregnant woman. So, preventing pregnancy is not a good that can be proportionate to the evil of killing a child. I don't think the use of Plan B can be justified unless it is shown that it never works after conception.
"The Principle of Double Effect has no application in the question of using "Plan B," because the end (preventing a pregnancy) that is sought is not at all proportionate to what is being risked: the death of an innocent person. One could argue that, desirable as it may be to prevent a pregnancy resulting from rape, since the pregnancy is not in itself an evil condition, preventing it is not "good in itself." But the disproportionality between the evil of causing the death of a person and the good of preventing a nine-month imposition on the woman renders that moot. The use of "Plan B" is flatly immoral."
I agree.
Whether or not the proportionate risk of driving cars is outweighed by the necessity of driving them, I do not today know. Perhaps one could make a convincing case for that. I do know that everything, including existence itself, is risky, in that corporeal death is a constant possibility and an eventually inescapable reality. We are called to weigh risks and act accordingly. Having done that regarding Plan B, this day it is clear that the possible death of a conceptus is not worth all the other possible outcomes.
If we hold with the Principle of Double Effect, comparative probabilities themselves can be subordinate to the relative gravity of the outcomes, especially when one of the outcomes is death.
We could easily solve the dilemma by insisting on ovulation and pregnancy testing before administering Plan B. Compliance is the problem here.
John,
"If we hold with the Principle of Double Effect, comparative probabilities themselves can be subordinate to the relative gravity of the outcomes, especially when one of the outcomes is death."
The key words are "can be," which means that your formulation adds nothing to clarity.
"We could easily solve the dilemma by insisting on ovulation and pregnancy testing before administering Plan B. Compliance is the problem here."
No, Jonn, we cannot, at least under your idiosycrantic understanding of double effect, since such testing less than absolutely 100% accurate.
Fr. Vince,
You persist in posing the question as one only of comparing the proportionate goodness and badness of the effects, when that is not a proper application of the principle of double effect. And you further err when you suggest that the avoidance of a continuing assault on a raped woman by the products of the rape is not a good effect. You are suggesting that the defense from assault is a morally neutral act; I would say it is a good act.
Re my last comment:
To be more precise, the termination of a continuing assault is a good effect, and there is absolutely no moral duty to permit conception in the event of a rape.
"Can be" in view of the particular issue involved -- I think that is pretty clear in the context of this discussion.
Now we view the dilemma in its entirety. If indeed the current testing methods for ovulation and pregnancy are less than 100% accurate, then my same arguments would apply, definitely yes. Let me be unequivocally clear about this -- unless we are 100% certain that our introducing the chemical components of Plan B into the uterine environment will not result in the death of a conceptus or embryo, it is not moral to take the risk. None of all the possible outcomes is more urgent than the outcome of preserving human life, unless the death of the mother is a real possibility in which case the mother should decide. The conceptus is almost invisible to us, and its existence is only a possiblilty, but that very real possibility obligates us to do nothing that would endanger its life, except to save another's life.
"the termination of a continuing assault is a good effect, and there is absolutely no moral duty to permit conception in the event of a rape."
Yes, but this good effect is outweighed by the good effect of saving a human life, ie taking all possible measures to do so.
Mike Petrik: I restricted my comments to the issue of due proportion because I assume that everyone here knows the other conditions required by the Principle of Double Effect.
John,
Under the principle of double effect, comparing the gravity of the effects only is the complete calculus only if the probablities are identical. What we have here involves weighing the likelihood of pregnancy (statistically remote) against the likelihood of abortion (statistically either zero or much much more remote, depending on the weight one attaches to the studies that have tested the abortion hypothesis).
It simply is not a proper application of the principle of double effect to weigh the gravities of the two effects only. If it were, it would not be morally permissible to drive to a movie or take any medicine that might have a mortal side effect in rare cases. This simply is not Catholic teaching. Similarly, the idea that one can *never* risk an unintended abortion, no matter the circumstances or the degree of risk is not Catholic teaching.
Fr. Vince,
I regret that I did not make myself clear. The element that I was suggesting you were overlooking was comparing the likelihoods of the risks. This is a key part of the analysis; without it we could not live practical lives, such as drive to a movie, since we can all agree that the bad effect of accidentally killing someone in a car crash trumps the superficial entertainment value of a feature film. I agree that we can all assume satisfaction of the requirements of right intention, etc.
Not so, Mike. Probability of options is in some cases subordinate to the relative moral gravity of options, as in this case, regardless of whether or not the comparative probabilities equal. Once again, the protection of possible human life trumps all other possible goods we have been considering, even weighing the relative probabilities of all possible outcomes. This is Catholic teaching in its essence as it informs the Principle of Double Effect.
I do not think we should be viewing this dilemma in light of other risks we may take as these risks, such as driving a car, are not comparable in all aspects. They might present a discussion for another day. That said, however, to cause death by car is always an accident, the intent of driving being transportation; the intent of Plan B is to prevent a possible pregnancy, with the accepted, thus, I would submit, partially intended, possibility of terminating an existing or immanent pregnancy. Driving a car, like other such necessary risks, is several steps away from causing a death, because the intent of driving is not to impact upon pedestrians or other drivers. Introducing potent chemicals into the environment of a possible conceptus has the sole intent of impacting directly on the ovum by hindering its appearance, and possibly by allowing the prevention of implantation after fertilization. In other words, you can perform an action that is far removed from a deleterious effect, which action can be judged moral; likewise an action almost in direct connection to an unwanted death would be seen as not permissible, if the goals were anything less than to save the life of another.
John,
Just because "probability of options is in some cases subordinate to the relative moral gravity of options," does not mean that only relative gravity is examined as part of the calculus; instead it means it is assigned greater weight, but that alone does not mean that gravity always trumps probability. It means that the probablity disparity must be greater in order to compensate. The driving the car analogy is instructive on this. Plainly, the good effect of receiving wholesome entertainment is dramatically outweighed by the bad effect of causing a death; yet driving to the theater is plainly permissible.
That said, I do agree with you that intention is very much relevant here. The use of Plan B is permitted only if the intention is solely to prevent conception; it is not permitted if the intention is to prevent a birth regardless whether by contraception or abortion. In analyzing the moral permissibilty of Plan B we normally cannot know the intention of the woman, and neither the Church nor a hospital can presume an illicit intention. Charity requires that we normally assume a permissible intention, just as we assume that a person driving a car to the theater intends to arrive at the theater without killing anybody. The calculus changes, however, if the person knowingly drives an unsafe car or if he knows he is an incompetent driver, because this means the probability of a bad effect increases.
In addition, Plan B does not work quite the way you describe; instead it works through delaying or preventing ovulation, by interfering with fertilization (inhibiting the movement of the egg or the sperm through the fallopian tube). The concern raised is whether it can also have the secondary effect of in some cases altering the environment so as to prevent implantation in cases where it failed in its contraceptive efficacy. Studies suggest that this concern is unfounded in that the putative secondary effect either does not occur or occurs only in exceedingly rare cases. For the reasons I've expressed I continue to view absolute zero risk as morally unnecessary. If I thought otherwise, I'd never drive my car except to avoid a life threatening situation.
I continue to agree with Thomas that the CT Bishops were solid and orthodox in their directive.
Mike, again, the close correlation of the intended actions of Plan to all its possible outcomes makes the car analogy fail, as the correlation of the intent of driving a car and killing someone is very much less. Also these two dilemmas are incomparable in other aspects, such as choices made by the car's victim (innocent perhaps, but made by him), while no choice in any aspect is made by a conceptus; the lesser degree of helplessness and vulnerability of the car's victim, the more likely less drastic effect of adverse events on the car's victim due to his or her more developed physiology, and so on.
To delineate the terms of the (historically much debated and revised, by the way) Principle of Double Effect which render the use of Plan B, without knowing whether or not one is causing the death of a conceptus, impermissible:
- "The good effect must be of equal or greater proportion to any evil effect which would result," ie
saving a hospital, or job, or whatever else may be sacrificed is not reason enough to introduce an element we are not certain may not cause a human death.
- "The foreseen beneficial effects must not be achieved by the means of the foreseen harmful effects, and no other means of achieving those effects are available," ie the potential pregnancy is stopped (the beneficial effect) by abortion (ie by means of the harmful side effect -- that is a direct correlation of action to outcome) if indeed Plan B is abortifacient.
- "Acts that have morally negative effects are permissible only when truly necessary, i.e., when there are no other means by which the good may be obtained," ie a possible pregnancy must be charitably responded to in a multitude of possible ways, if prevention includes the possibility of terminating it.
I remain convinced that the outcome of possibly taking a human life in the process of obtaining goods that are not as important is wrong.
P.S. Mike, I think I have always described the workings of Plan B as you have. If doesn't seem so, I do agree with your description of how it is meant to work. It is what you term the "putative secondary effect" ie the death of a human being, which concerns me. That this death can occur at all, even if "only in exceedingly rare cases" as you state, is reason enough to take all precaution as nothing else, in the wider picture, is that important. There is nothing more to say, I think.
There is nothing more that I can say, I mean.
Genesis 18:23-33
Dear all,
Since an ovum in a woman's body cannot be visualized once it is released from the ovarian follicle, we cannot be 100% certain that taking penicillin or even eating pizza, could not impact the possibility of successful implantation of a conceived human.
We have to use our best evidence and common sense to conclude these activities are probably benign. But our conclusion is always a "probably", never an "absolutely".
The actual science on observed effects, not repeated "expert opinion" does not show problems with implantation, but does show anti-fertiization effect.
To use the Hunter in the Forest analogy;the hunter has to take reasonable precautions before shooting. And if uncertain, may not fire his gun. But the precautions required are the reasonable ones.
He doesn't have to destroy all the trees to allow a clear view of the ground to be sure that a hermit hasn't dug an underground cave with an entrance to the surface hidden by a tree. He can reasonably proceed with the assumption a long lost, underground hermit isn't about to emerge from a hidden tunnel.
Looking at the scientific papers, I think we can reasonably conclude that many have looked very diligently and honestly for an abortifacient effect and have been unable to find it. Those who conclude otherwise have lumped Plan B in with differnt drugs or doses or used statistics based on studies with gaps in data.
Again, happy to look at the study that says otherwise.
Thanks, Mary, I agree completely. The 100% certainty standard is simply not practical and not in accord with Catholic teaching. It actually is more fundamentalist in impulse, and is a departure from the Catholic embrace of reason.
Mike, do you really mean to label as irrational and fundamentalist those who disagree with you? I think your comment is probably a mis-statement that only reads that way.
Mary, a pizza going into the stomach and penicillin going through out the system are quite different from a massive onslaught of a drug aimed directly at the environment of a possible conceptus. As for hunting,
if humans were so small that you could not see them or otherwise not observable yet your bullet could still hit them, then yes, you would be obliged to cut down all the trees, or, more practically speaking, not hunt at all. Is catching prey worth taking the chance? No.
Is avoiding killing a human being worth taking the safer route and not interfering with the uterine environment? Yes.
Is any other good that might be realized by using Plan B worth taking a human life? No.
We are taking a massive amount of hormones and introducing them into the very place where human beings are conceived and hoping, just hoping that we don't kill anyone. For what good purpose?
I keep getting presented with the same arguments. Is there any new fact that would alter my discernment on this situation? Because if not, I have nothing more to add.
But thank you, Mike, Mary, Fr Vince, Linda, SC, LvB, Fr William J Kuchinsky, Thomas, and all who have discussed this issue on this and other threads. It has been very, very helpful for me to go to a forum and see all the arguments presented so that I could understand the issue and clarify my own position in my mind. Thomas is doing us a great, and it seems, laborious, service hosting this blog and keeping it updated.
Mary,
I don't believe eating pizza or taking penicillin is for the specific reason to ensure a women does not become pregnant. Plan B is for that specific purpose.
What John14v15 said.
I love my bishop and pray for him, but I cannot find any rationale for what he did to that one invisible zygote. Out of sight, out of mind?
Respectfully,
Linda
Linda,
But Catholic teaching allows a woman to undertake an action for the specific reason of not becoming pregnant as the result of rape, so I'm really uncertain as to your point. Did you ever respond to my 10/20 12:24 a.m. post?
Linda, for Catholics treating rape victims,the point of Plan B is not to prevent pregnancy but to stop an ongoing attack. We agree we can't give this medicine if we have reason to believe it interrupts a new life by preventing implantation. John, Plan B, like penicillin and pizza enters circulation via the stomach. And like penicillin and pizza, it has not been shown to cause damage to the environment of a developing human. It took us a while to check on that, because as you point out, it would not be entirely illogical for this drug to have such an effect. But, when looking at the tissue involved, we cannot find such an effect.
Humans are invisible sometimes, due to big trees, hiding underground. As Mike points out, and as I hope my paraphrase describes clearly, God, via the Church doesn't expect us to go to an absurd level to be sure on morality of our actions. Given the evidence we have on Plan B, I think we have a sound moral defense in giving it to a rape victim, if she wishes to take it. Please, take a look at Dr. Durand's work. She could not find "interference with the uterine environment." Which is actually good news because we have a tool to serve the good of helping a patient to defend herself against an ongoing attack, not against a zygote but against spermatozoa.
Mike and Mary-
"What I will say is that we should all be able to agree that post rape contraception is morally permissible, but intentional abortion is never permissible."
What I'm trying to say is a simple ovulation test can detect the LH surge, thus solving the problem of whether to adminster Plan B. I am not arguing the fact that by Catholic thought, doctrine or whichever, (I'm not an apologist or theology major)we are obliged to stop the ongoing assault. I am not in SC's camp (which is where Mike hastily put me by mistakenly addressing me). But I am in the camp that protects the possible existence of a zygote being killed.
I am not in this league of lofty thought, I simply teach NFP and TOB as a layperson with the Diocese of Bridgeport. I love and pray for my Bishop, but I cannot in my own conscience defend his and the other Bishops' reasoning. Until (or if) we get news from Rome, we can argue this forever.
Linda,
Thank you for your response, and thank for your good and important work. I apologize if I misunderstood or misaddressed you. I agree that an ovulation test is sensible and Catholic hospitals should be free to refuse to administer Plan B without it; but given that they legally cannot require such tests, I remain unconvinced that the limited use of Plan B in the case of rape is morally impermissible. We have absolutely no scientific evidence that Plan B ever acts as an abortifacient. We have only an hypothesis to that effect, which has been tested in several instances, and those tests all suggest that Plan B is not an abortifacient. Unless some science can actually confirm the existence of a real risk, I don't think that women should be denied Plan B simply because of an hypothesis that when tested has been found incorrect.
John,
I think we'll just have to disagree. for the reasons Mary explained, I do not believe that absolute certainty is the standard.
Mike and Mary,
Has Thomas cited Chris Kahlenborn's research? Postfertilization Effect of Hormonal Emergency Contraception
He is reputable pro-life physician and researcher whose study should be as critically regarded as any other.
His conclusion from the link above reads as follows:
CONCLUSIONS: Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at times by causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications in such areas as informed consent, emergency department protocols, and conscience clauses.
Yes, Linda, he did, in the last bullet presented in his Oct 16 post, to wit -- "Other research into the effects of Plan B [like the Kahlenborn one] seem to ignore the fact that Plan B, while similar to the contraceptive pill, does not have the same duration of time than the contraceptive pill has to deplete the endometrium."
Dr. Kahlenborn has told me that this research I cited is not as recent and will be reviewing and making conclusions on newer studies.
Linda,
The LH test has merit, but, it delays treatment. And treatment delay means less possiblity to avert ovulation or possibly thicken cervical mucous and waylay spermatazoa. (You'd be amazed at who slow things can be in a hospital.) And the LH test is not perfect. It can precede ovulation or be positive in a woman who will not actually ovulate that cycle. Although certainly helpful for couples trying to conceive, not helpful in this situation, unless Plan B causes abortion, the LH test doesn't change anything. Have read Dr. Kahlenborn's paper but found it was based on daily OCP's, not Plan B. Looking forward to his update. Hope he gets time to look at Dr. Durand's work.
Hello:
We should not act not because there is not absolute certainty but because we cannot dispel the theoretical doubt that would even enable us to form anything close to practical moral certainty to act by administering the drug without the ovulation test.
When forming a practically certain conscience if there is a necessary attainment an end, i.e., valid matter for a sacrament, a right of another, or the safety of another, one must choose the path that is more certain if one cannot dispel the theoretical doubt or choose the opinion according to which the child would certainly be protected from harm.
It does not matter that not to give an ovulation test before administering Plan B is not intrinsically evil, since we do not know for sure the effects of Plan B, as our Fathers claim. The fact that we do not know for sure the effects of Plan B are precisely what forbid us from administering the drug it without an ovulation test.
Respectfully,
Tim+
Mary,
Dr. Kahlenborn told me he would send me links to the studies next month, and his conclusions would be published in early 2008.
I have read the following from Deacon Tom Davis (bioethicist, lawyer and moral theologian) regarding the ovulation test (written prior to our new legislation):
The Connecticut protocol identifies the likely mode of Plan B operation by testing for the presence of leuteinizing hormone (LH), which, if positive, indicates that a woman has entered the LH surge of her cycle. Once a woman enters LH surge, ovulation is highly likely to occur, regardless of the administration of Plan B. LH surge is measured by a simple urine dip test. The onset of LH surge may be any-where from 12 to 24 hours prior to actual ovulation, and a positive LH test does not indicate how far into the LH surge a woman is. Nonetheless, what is clear is that a positive LH surge test negates the likelihood, previously existent, that Plan B will suppress ovulation, and its new principal mode of action is most likely that of impeding implantation. But even in that case, Connecticut Catholic hospitals will inform a victim about Plan B and its availability at other locations and will facilitate transfer of the patient to a secular hospital emergency room. Since there is a secular hospital emergency room within 10 minutes of every Catholic hospital in the State, it is evident that no compelling government interest supports the burden on religious freedom embedded in the pending legislation. In fact, whatever government interest may exist can be met by such transfers or by a mobile intervention team that can provide Plan B to a rape victim off-site of Catholic hospitals.
Mary,
Once the sperm have entered through the cervix, I don't believe that the drug can thicken the mucus quickly enough to inhibit the stronger sperm, only to work on the sperm that have lodged in the cervical crypts.
I also believe we should assume the majority of women within normal childbearing years will certainly ovulate unless they 1) have a fertility problem, 2) are already on the Pill or some kind of BC (then they won't need Plan B anyway), or 3)are in menopause.
Linda,
It turns out the early arriving sperm are not the ones that accomplish conception, since they haven't been capacitated. So, delay may, in theory, be useful.
Agree, LH surge generally correlates with impending ovulation, but not 100%. Rapists don't generally discriminate against infertility patients or women not aware of fertility problems. In my practice, almost everyone seems to have an occassional anovulatory cycle or run of cycles. Of course, I'm not usually checking LH tests but do know the test can be a false positive. Would make me very reluctant to withhold a medicine that may give a patient some comfort without a good reason to do so.
Appreciate the Deacon's comments. Maybe his ER is more smoothly run than the ones I've been affiliated with. What is understandably "simple" in his world is not necessarily simple in that world.
Again, looking forward to hearing more from Dr. Kahlenborn. Glad you are following so closely with him.
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