9/15/2010

Catholic Culture : Library : A Moral Dile…

A Moral Dilemma
by Thomas A. Szyszkiew icz

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When a woman is raped and is taken to the emergency room of a Catholic hospital, it creates a moral dilemma for the hospital: Will she be given socalled emergency contraception (EC) or not? While the answer may appear to be simple — Catholic teaching forbids the use of artificial contraception, and so-called emergency contraception is known to be abortifacient — the reality is not so simple. Here's what the Ethical and Religious Directives for Catholic Health Care Institutions (ERDs) from the United States Conference of Catholic Bishops say about it:

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Privacy 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.

A hospital in the Diocese of Peoria, Illinois, developed a protocol for Catholic hospitals that face this situation. Called (appropriately enough) the Peoria Protocol, it was put together by the staff at OSF St. Francis Medical Center and theologians in the diocese working under then-Bishop John J. Myers. That protocol calls for emergency room (ER) personnel to determine through various tests whether the woman has ovulated. If she hasn't, then the protocol calls for the woman to be given emergency contraception. If she has, then nothing is to be done because ovulation within close proximity to a rape could bring about a conception and the contraceptive would actually act as an abortifacient. In 1998, the Pennsylvania Catholic Conference issued a similar protocol for use in that state's Catholic hospitals. "The deliberate destruction of an innocent living human fetus — no matter how conceived — is unjustified," the conference wrote. "Sexual intercourse involved in the act of rape, on the other hand, is an unjust assault and a non-consensual act. Therefore, appropriate means may be used in treating the rape victim to prevent conception. These means, as used, may not have the effect of an abortifacient." This protocol also calls for an indication of whether ovulation has occurred. The controversy arises because oral contraceptives, both the regular and "emergency" types, are
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but on sabbatical until next year at the National Institutes of Health in Maryland doing research on natural family planning. then give her the emergency contraceptive and suppress the ovulation.org/culture/…/view. A request for comment from the Pennsylvania Catholic Conference was also declined. Some studies indicate that contraceptives do not always succeed at suppressing ovulation. According to a 2002 article in the Annals of Pharmacotherapy (vol. it can change the lining of the uterus "regardless of when in the cycle it is used. even when it's given prior to ovulation. the article. Myers said he "simply did not know what to do. "Catholic hospitals that do allow hormonal EC use prior to ovulation may wish to reassess their policies given the findings that EC use does not consistently stop ovulation and has the potential of causing a postfertilization effect even when used prior to ovulation. and Walter Larimore. Additionally. and Larimore is an Evangelical who was once vice president for medical affairs at the Focus on the Family organization. 36. Stanford is a Mormon based in Salt Lake City. no. New Jersey. now in Newark.9/15/2010 Catholic Culture : Library : A Moral Dile… supposed to work by suppressing ovulation. "The evidence to date supports the contention that use of EC does not always inhibit ovulation" even if it is used prior to ovulation. The trio wrote to Archbishop Myers. . then. it is well known that oral contraceptives have a secondary effect. But Kahlenborn reports that Myers told him that his experts think Kahlenborn is "alarmist" and. it cannot be ethically employed by a Catholic physician or administered in a Catholic hospital in cases of rape. Rather. "'Emergency contraception' is a misnomer as it does not consistently prevent fertilization" and that since it "has the potential to prevent implantation . It should only be a question. thin and therefore impeding the proper implantation of a newly fertilized ovum and causing the child to die due to a chemical abortion." A Fine Line of Morality There are some who contend that the question of whether a woman has ovulated should not even be entertained. But the evidence was enough to convince the Catholic Medical Association to pass a resolution at its 2003 annual meeting that said. asking him to consider changing the Peoria Protocol in light of the research they did. Joseph Stanford. then the child will die because the endometrium is too thin. with the effect persisting for days. However. called the endometrium. they say that the USCCB directive clearly states it's a matter of whether or not the woman is pregnant.cfm… 2/5 . according to Kahlenborn. Chris Kahlenborn. that of making the uterine lining. 465-470). . But there are those who are questioning whether any contraceptive should be given at all if a rape occurs early in a woman's cycle. catholicculture. pp. of timing. co-authored by Drs. 3. Because of these effects. as in the Pennsylvania Protocol: Find out where the woman is in her cycle and if she hasn't ovulated yet. Kahlenborn is the only Catholic. calls into question whether Catholic hospitals should use EC at all." So if ovulation is not suppressed and a child is conceived." Of the three." Archbishop Myers did not return calls from CWR requesting comment.

Kahlenborn and his co-authors quote a study that estimates between 13.5 percent and 38 percent of EC cases worked by some other mechanism than suppression of ovulation. in Hamel and Panicola's view. senior director of ethics at the Catholic Health Association based in St. a chemical abortion. they find no evidence of what is called a postfertilization effect. The percentage of pregnancies resulting from rape is estimated to be between one and five percent. Ron Hamel. EC works only to suppress ovulation and / or to inhibit the movement of sperm from the cervix to the fallopian tubes. who is in charge of ethics at SSM Health Care in St. the two spell out the differences between what they call the "pregnancy" approach and the "ovulation" approach. However. Louis. The pregnancy approach tests to see if the woman is pregnant and. but "here you are conditionally intending abortion. "Y ou may not intend evil. "[T]he intention in administering emergency contraception is to prevent conception and not to inhibit implantation.700 rapes reported in Florida in 2003. The problem with the ovulation approach. 127 died. and Michael Panicola. In a 2002 paper published in the CHA's Health Progress. Hamel and Panicola say that this is essentially the principle of double effect — doing something that is good but that has an unintended and evil consequence. that would mean anywhere between 67 to 335 pregnancies resulted from these rapes. is that. "Conception does not occur immediately after the ovum is expelled from the ovary." Father Kevin McMahon. according to the American Civil Liberties Union.cfm… 3/5 . or what Kahlenborn. If a conceptus is present.org/culture/…/view. while at a maximum. Stanford. that allows for the hospital staff to administer EC. this would be an unintended and even an unforeseen effect. then they cannot. "This would not do two effects — it's either one or the other [suppress ovulation or abort]. nine children conceived in rape could have been aborted through the use of EC in Florida in 2003. with the possible result being a conceptus. To keep this in perspective. said that he would like to see stronger evidence to back up what Kahlenborn and his colleagues wrote. Louis." he said. but fails to be implanted and ultimately is destroyed." But William May. And you catholicculture. And in their review of the scientific literature. In that case. said one "cannot exclude" the possibility that this can result in abortion from the moral consideration. it can only be achieved after fertilization is complete. Assuming a pregnancy rate for rape between one and five percent. If she is. there were 6. he also agrees with May and believes this is not a case of double effect. if not. This is important if one recalls that fertilization is not a moment but rather a process that unfolds over at least a 24-hour period.9/15/2010 Catholic Culture : Library : A Moral Dile… This is the position held by. Hamel and Panicola claim that from their review of the literature. given the extremely low likelihood of conception occurring as a result of the sexual assault and the lack of evidence supporting abortifacient effects of the medications. Charles Borromeo Seminary in Philadelphia. that mechanism being." Their view is that the possibilities are too remote even for pregnancy in the case of rape. among others. and Larimore name as early abortion. in their view. at a minimum. a moral theologian at St. such as removing an ovary because of an ectopic pregnancy. considered one of the foremost moral theologians in the US and one of the most well-regarded in the world.

for instance. Stanford. which Planned Parenthood criticizes on its website as being too few." she said." But Stanford doesn't think there's a whole lot to that argument. in turn." Another 47 percent are inconsistent in their offering of it. But what the CFFC survey doesn't reflect is the number of Catholic hospitals that refer rape victims to rape victims' centers who then. six percent don't do it at all. the tests will only pick up reactions to what the body is doing. When he was at the University of Utah hospital. refer their clients to physicians or hospitals that will dispense EC. Dr. According to the Miami Herald. If a hospital is committed to this. Practical Measures One ER physician in Washington. that in medicine "no matter what you do. But he did concede that for a rural Catholic hospital it would be a difficult financial proposition to have all of that available. 28 percent of Catholic hospitals offer EC. he said. and those reactions take time." For instance." Black and white "just won't happen in medicine." The difficulty is. Szyszkiewicz writes from Minnesota and is a frequent contributor to CWR. no matter how much testing is done. the ACLU published a report showing that the majority of hospitals in Florida do not provide EC consistently. "there is no such thing as receiving 'stat' progesterone level information. The reactions of Catholic hospitals to this controversial issue are mixed. wrote in Health Progress that she had been unaware there was even a debate on the matter. DC. he could get a progesterone level test back in one day. © Ignatius Press catholicculture. "In most hospitals.9/15/2010 Catholic Culture : Library : A Moral Dile… don't even know if the good effect (suppressing ovulation) is going to take place. So if there is no elevated progesterone level. "Thirty-five percent of hospitals and treatment centers said they consistently provide rape victims with emergency contraception. For him. they will find ways to be sure they have the equipment and staff on hand to do a proper evaluation. According to the proabortion group Catholics for a Free Choice. that doesn't necessarily mean that ovulation hasn't taken place because it takes a few hours before that increase shows up in the bloodstream.cfm… 4/5 . and the remaining 12 percent didn't know what their policies were. Margaret Barron at Providence Hospital said that the Peoria Protocol calling for tests of progesterone levels and other similar measures is simply too cumbersome. there will always be some grey area. Thomas A. Still many faithful Catholics may be left wondering why the use of emergency contraceptive in Catholic hospitals should be shocking when complaints about them distributing contraceptives and doing sterilizations abound around the country. it's more a matter of logistics rather than practicalities.org/culture/…/view. In June. But that may actually be a close reflection of what happens in hospitals generally. according to Dr. And yet there seems to be no effort from US bishops to seek a change on that front anywhere on the horizon.

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