There is No Inconsistency: An NCBC Ethicist Addresses the Emergency Contraception Debate

The National Catholic Bioethics Center's Director of Bioethics and Public Policy, Marie Hilliard, has addressed the controversy that flared up in The U.S. media in the last few weeks:

 There is No Inconsistency: German and American Bishops’
Treatment of Sexual Assault Victims

Recently the secular media again has insisted that there is a disparity among the teachings of the Catholic Bishops. They cite the recent statements by German bishops concerning sexual assault protocols in Catholic hospitals. However, on a closer examination, it is clear that their position is consistent with the Ethical and Religious Directives for Catholic Health Care Services (ERDs), as promulgated by the U.S. Conference of Catholic Bishops. 

Cardinal Joachim Meissner stated on January 31, 2013, concerning compassionate care of sexual assault victims, that if “a medication that hinders conception is used after a rape with the purpose of avoiding fertilization, then this is acceptable in my view.”[1]  As a follow-up to this statement, the matter was reviewed by the German Bishops Conference, which issued a statement affirming what sexual assault victims may receive from Catholic hospitals treatments: "That can include prescription of the `morning-after pill,' insofar as it has a preventive and not an abortive effect. Medical and pharmaceutical methods which result in the death of an embryo still may not be used."[2]

• [1] FIAMC,  “H.E. Meisner´s contraception statement, manipulated:”Available at http://www.fiamc.org/news/h-e-meisner%C2%B4s-contraception-statement-manipulated/. Last accessed March 8, 2013.

• [2] German Bishops Conference, “Statement of February 21, 2013:” Available at http://www.foxnews.com/world/2013/02/21/german-bishops-ok-emergency-contraception-in-rape-cases/#ixzz2Myw2E6mt. Last accessed March 8, 2013.

This is completely consistent with the US Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services:

36. Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum.[3]

• [3] U.S. Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 4th ed. (Washington, D.C.: USCCB, 2009), n.36.

A woman has the right to protect herself from the unjust aggressor and from becoming pregnant by this terrible act of aggression. Specifically, the ERDs state that compassionate care must be provided to the victims of sexual assault, including physical, psychological, and spiritual; that the hospital must support law enforcement; and that the woman has the right to defend herself against a potential conception from the sexual assault. In fact, Catholic hospitals have had compassionate sexual assault protocols in place long before secular hospitals, because of their awareness of the potential for two innocent victims: the victim and potentially her newly conceived child.

However, despite secular trends to redefine conception to mean implantation in the uterus of the conceived human being,[4] it is a biological fact, contained in any biology textbook, that the new human being has been conceived at fertilization, which occurs five to twelve days before implantation.[5]  The newly conceived embryo needs his or her mother’s womb to be nourished and to grow.  Thus, drugs which have the potential to prevent implantation of the conceived human being are abortifacient, regardless of the deceptive language used to describe their function.

• [4] “Conception” historically and more accurately referred to fertilization. See American College of Obstetricians and Gynecologists, Committee on Terminology, Obstetric-Gynecologic Terminology, with Section on Neonatology and Glossary of Congenital Anomalies, ed. Edward Hughes (Philadelphia: F.A. Davis, 1972).
• [5] Asgerally T. Fazleabas and J. Julie Kim, “What Makes an Embryo Stick?” Science , 299, no. 5605 (January 17, 2003): 355-356. Available at  http://www.sciencemag.org/cgi/content/summary/299/5605/355 or DOI: 10.1126/science.1081277.  (Last accessed June 1, 2011).

With appropriate testing, as indicated by the ERDs, emergency contraception may be provided to sexually assaulted women, and should be.  Manufacturers of emergency contraception indicate that it has three potential functions: to prevent ovulation, so that fertilization cannot occur; to alter the woman’s cervical mucus to slow the speed of the sperm reaching the egg (ovum); and to alter the uterine lining to prevent the embryo from implanting and receiving the nourishment it needs to survive.[6]

• [6] The manufacturer’s webpage for Plan B One-Step states that if administered within 72 hours after sexual intercourse, “Plan B® One-Step works primarily by: Preventing ovulation[,] Possibly preventing fertilization by altering tubal transport of sperm and/or egg[,] Altering the endometrium, which may inhibit implantation.” See http://planbonestep.com/plan-b-prescribers/how-plan-b-works.aspx.

Credible research tells us that altering sperm mobility and its capacity to fertilize the egg cannot occur quickly enough when these hormones are taken for emergency contraception.[7] Sperm can be at the point of fertilization in a woman in five minutes.[8] Thus, the only function of emergency contraception that does not involve the destruction of the newly conceived human being, that can occur quickly enough, is the prevention of ovulation. 

• [7] Natalia Novikova et al., “Effectiveness of Levonorgestrel Emergency Contraception Given Before or After Ovulation: A Pilot Study,” Contraception 75.2 (February 2007): 112–118.
• [8] L. Speroff, et al., Clinical Gynecologic Endocrinology and Infertility (Baltimore: Williams and Wilkens, 5th edition, 1994), p. 232.

There is no test to determine if conception has occurred until up to 16 days after the embryo has been conceived.  However, there is a simple test to determine if the emergency contraception can be given at a time that may prevent ovulation, and that is a simple, non-invasive urine test for the Luteinizing Hormone.  Research clearly indicates that if this test is positive, emergency contraception cannot stop ovulation.[9]  Thus, Catholic hospitals can use this test as part of a sexual assault protocol to determine if pregnancy can be prevented.  The test is usually positive only for one day, and the egg usually only lives for one day, so there is a very limited period of time in which the emergency contraception should not be administered in order to prevent its potential abortifacient effect (prevention of implantation, which manufacturers indicate is a potential action).

• [6] Natalia Novikova et al., “Effectiveness of Levonorgestrel Emergency Contraception Given Before or After Ovulation: A Pilot Study,” Contraception 75.2 (February 2007): 112–118.

In all such cases, the patient is provided with all the information she needs for informed consent as to why such testing should be done, and all of the manufacture’s stated potential actions of the emergency contraction.  This is just good medicine.  And if the patient, after being stabilized and provided all of the excellent care available to her at our Catholic hospitals, wishes to be transferred safely to another provider of her choice, the transfer of care is safely provided for her.  In this way the truly informed rights of the patient as well as the sacrosanct rights to religious freedom of health care providers, so critical to the very reason this country was founded, are respected.

 

The position of the German and American bishops constitutes compassionate and pastoral care of the victim of sexual assault who has the right to protect herself from the unjust aggressor, by preventing conception, as it is accurately defined.  Both statements clearly indicate that anything that is used to cause the death of the embryo after conception is inconsistent with respect for human life. Thus, both the positions of the American bishops and that of the German bishops are totally consistent and do not represent any new teaching of the Catholic Church.