Moral Certitude Needed Before Giving Emergency Contraception
By Monsignor Kevin T. McMahon, S.T.D.
 

A new Connecticut law requires all hospitals that treat rape victims to administer an emergency contraceptive (most commonly Plan-B) after conducting a pregnancy test, but without administering or taking into account the results of an ovulation test. Because it allows no exemptions, this law violates the rights of individual conscience and of religious institutions to follow their own moral teachings. Nevertheless, the Bishops of Connecticut felt compelled to comply with the law and reversed their earlier decision to require a negative ovulation test before allowing Catholic hospitals to administer Plan-B to victims of rape.

The Bishops identify three factors that led to their decision: 1) the inability of an ovulation test to determine that a conceptus is present; 2) doubt that Plan-B causes abortions; and 3) the absence of a definitive Church teaching regarding the testing required before giving Plan-B.

Since pregnancy can be detected only after the implantation of the embryo in the uterus, it is inaccurate and somewhat misleading to say, as the Connecticut Bishops do, that a pregnancy test is used to determine if a woman has conceived. If she has conceived as a result of the rape, this could not be detected by a pregnancy test until several days after conception. An ovulation test detects whether it is possible for the woman to conceive from the rape. Since Catholic teaching allows only those interventions which may prevent conception and not those which may be abortifacient, knowing if the woman is ovulating is important.

 The scientific literature is very clear on the mechanisms of Plan-B. It is said to prevent ovulation and sperm capacitation, delay the transport of the gametes, or, if present, of an embryo within the fallopian tube (There is a reported increase in tubal pregnancies associated with Plan-B.), and to alter the thickness of the endometrium. Two of these effects are possibly abortifacient – delayed tubal transport of the embryo and alterations to the endometrium. If the woman does not ovulate, conception and the possible abortifacient effects are impossible. But, if she ovulates within a number of hours before or after the rape, she may conceive and the abortifacient effects of Plan-B are then possible. Many studies which discount the possible abortifacient effects of Plan-B do so because they do not consider the destruction of a human embryo prior to implantation in the uterus to be abortion. Scientific studies seem to support the view that Plan-B will not interfere with a pregnancy once implantation has taken place.

The Catholic moral tradition definitively teaches that it is immoral to directly intend the death of an innocent human being. This proscription includes the direct intention to take what may be an innocent human life. To be willing to kill what may be a human being is to be willing to kill what is a human being. A hunter may not shoot at a figure moving about in the woods no matter how improbable the possibility that the target is a human being. He must have clear vision of the hunted animal, and so be certain that he is not aiming at a fellow hunter or someone out for a hike. The only way to be morally certain that Plan-B cannot destroy a human embryo is to exclude the possibility of its existence by administering an ovulation test and getting a negative result.

The Connecticut Bishops note that the administration of Plan-B without an ovulation test is not an intrinsically evil act. This is true. If the woman is in the pre-ovulatory phase of her cycle, Plan-B may prevent conception, which is morally permissible as an act of self-defense. But an act does not have to be intrinsically evil to be immoral. Here the circumstances of the act reveal its immorality: To give Plan-B without obtaining a negative result on an ovulation test is to intend all its possible effects, including abortion.

If the administration of Plan-B causes an abortion, then, despite the Bishops’ disclaimer, it is in fact the commission of an abortion. One’s ignorance of the presence of an embryo, or motive to prevent conception, cannot alter the objective reality. Nor can they excuse one’s failure to take the morally required safer course in protecting life.

Today, bishops who wish to follow the safer course by requiring ovulation testing are facing strong opposition from numerous forces. For example, in testimony before state legislatures, Planned Parenthood has argued that all hospitals, including Catholic ones, should be compelled to administer Plan-B after a negative pregnancy test alone. It has cited the writings of an ethicist of the Catholic Health Association who argues against ovulation testing, and the acceptance of pregnancy testing alone by a few state conferences of bishops, as proof that ovulation testing is not required by Catholic teaching. Unfortunately, the Connecticut Bishops’ statement will now be used as evidence that the Church favors pregnancy testing alone.

The Connecticut Bishops reversed their position requiring ovulation testing because they believed the three factors listed above left them with a weak case against the state’s mandate. However, given the Church’s constant teaching that it is immoral to directly intend the death of what is or may be an innocent human being, the Bishops had sufficient grounds to demand an exemption. It is regrettable that the Bishops did not make this argument. It is even more regrettable that they attempted to justify their decision by a statement whose moral argumentation is fatally flawed.
 

(Monsignor McMahon is Episcopal Vicar for Moral and Religious Matters Pertaining to Health Care and Biotechnology for the Archdiocese of St. Louis.)