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BIOETHICS

Emergency Contraception
and Catholic Theology

 

If there is anything more horrific for a woman than getting raped, it may be discovering that she is pregnant with the rapist’s baby.
    Emergency contraception, in the form of so-called morning-after pills (high-dose estrogen, estrogen-progestin combination pills or the progestin mini-pill), can prevent pregnancy if taken within 72 hours of the rape. But a new study co-authored by Dr. Jon Merz, assistant professor in Penn’s Center for Bioethics, reveals that some Catholic hospitals have policies prohibiting emergency-room physicians from prescribing—or even informing patients about—such emergency contraception.


    In the study, which was written up in the September issue of the American Journal of Public Health, 58 emergency-department interviews were conducted. Of the 28 Catholic hospitals contacted, 12 had policies prohibiting discussion of emergency contraception with rape victims (though in eight of them, physicians and staff disregarded the policies); seven had policies prohibiting prescription of emergency contraception; and 17 did not permit their hospital pharmacy to dispense such contraception.
    In the view of Merz, “failure to tell rape survivors about the available treatment is abandonment.” Since most women are unaware of emergency contraception, “you can’t rely on them to ask,” he notes, adding: “Clearly, the uninformed rape victim may think she has received all possible and appropriate medical care.”
    One of the Church’s Ethical and Religious Directives for Catholic Health Care Services states that a woman who has been raped “should be able to defend herself against a potential conception,” and if testing reveals “no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.”
    But Merz and his colleagues maintain that “testing a rape victim to determine whether conception has occurred as a result of the rape is not feasible,” and only an “extremely rough judgment of probabilities” can be accomplished. As a result, a health-care provider “cannot tell whether giving the victim an emergency contraceptive will prevent ovulation and conception or may instead interfere with implantation of a fertilized ovum.” Given that a woman has no more than 72 hours between coitus and conception, time is of the essence.
    Under the principle of “double effect,” Merz and his colleagues argue, prescribing or giving a victim an emergency contraceptive should be permissible under Catholic moral theology as long as the provider “has the intent of preventing ovulation or conception,” even with the “foreknowledge that it might instead cause rejection of a fertilized ovum.”
    But some Catholic organizations, such as the Pennsylvania Catholic Conference, state that the use of any medical procedure, “the purpose and/or effect of which is abortive, is never permissible.”
    Since such restrictive policies leave health-care providers “sailing between Scylla and Charybdis,” Merz and his colleagues write, emergency vehicles should stop taking rape victims to those hospitals that do not want to provide that measure of care. And those hospitals should “reevaluate their policies and practices in light of the directives, which we believe adopt a compassionate and reasoned approach, within the Catholic moral framework, to the treatment of rape victims.”
    While they do not argue that physicians should act contrary to their own moral beliefs, they do advocate “communication and discussion fully respectful of patients’ status as independent moral agents.” What appears to be missing, they add, “is a clear moral analysis of culpability and duty” that would help Catholic and other health-care providers resolve the conflict between their own beliefs and values “and the beliefs, values and, perhaps most important, treatment needs of their patients, including rape victims.”


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