Apr
16
2013

Take Home Lessons from the Furor over Plan B: Symposium on Plan B: Part VI

Editor’s Note: The editors present this series (read part 1, part 2, part 3, part 4, part 5,) on the recent furor over Plan B as an opportunity for our fellow pro-lifers to slow down, step out of activist mode, and enter into the conversation in a prayerful and thoughtful way.

The Church encourages conversation among faithful scientists and theologians as new science comes to light and as we deepen ethical reflection. Typically such conversations occur in academic settings, but since the recent furor pushed the issue into the open, causing much confusion and scandal, we felt it important to present the latest science and moral reflection in a context of faithful discussion.

We offer this series in a spirit of obedience to the Magisterium, and as an opportunity for faithful Catholics and people of good will to come to a greater understanding of the nuances of the Church’s teaching and the complexities of the science and art of medicine in the difficult situations involving the treatment of women who have been raped. There has been no (and will be no) revision in the Church’s teaching concerning direct abortion or contraceptive sexual acts between spouses. Both are morally illicit without exception.

As with all Truth and Charity Forum articles, opinions belong to the author alone and do not necessarily represent the official position of Human Life International.


 

The Furor

In January, Cardinal Joachim Meissner of Germany issued a statement in support of administering a certain type of contraceptive to victims of rape. In February, his brother bishops declared that treatment of victims of rape “can include administration of a ‘morning-after pill.’”

After the Bishops’ statements, a great furor erupted. Secular papers praised the German bishops for being brave enough to thwart the Church’s teaching, or asked if the Church was changing her teaching. Pro-lifers claimed the bishops “caved under intense media pressure” and bloggers criticized the German bishops as having “an ill-conceived notion of ‘kindness.’” Confusion has reigned.

Now that the furor (caused by both misplaced elation and condemnation) has died down, the Truth and Charity Forum has hosted a discussion on this important matter. In the spirit of Christian Charity united as it always must be, with Truth, we have grappled with the issues at hand in hopes of becoming better informed. This is the last article of the series.

Two Essential Principles

Rape is a vicious attack on the dignity and rights of the innocent victim. In treating victims of rape, two principles are vital: 1) The victim has a right to, in the words of the German bishops, “human, medical, psychological and pastoral help as a matter of course” and 2) Assistance to victims may not include abortion, which creates another innocent victim.

The Bishops’ Proper Role

The Church and the bishops have received the charism and duty of teaching in matters of faith and morals. Bishops are not scientists and when they speak on scientific issues, they rely upon research and knowledge of scientists. The Church has no scientific authority. On bioethical questions the bishops inevitably base their moral conclusions – derived from unchanging moral principles – on the science they have before them. The science can be in error, which may lead to incorrect conclusions, but the substance of Church teaching remains intact.

Stopping Fertilization Following Rape is Not Immoral

The Church teaches that rendering the marital act infertile is a grave sin. In shorthand, we tend to say that contraception is an intrinsic evil. This teaching, however, specifically addresses intercourse within marriage and not non-marital sexual acts. Rape is an act of violence, not a marital act – that is, it is not a gift of self between two freely acting spouses.

Recourse to a contraceptive can be, in principle, morally licit in cases of rape because sperm are an extension of the attacker and thus a contraceptive thwarts the completion of the grievous act. As the bishops of the United States have written: “A female who has been raped should be able to defend herself against a potential conception from the sexual assault” (ERD n. 36). Cardinal Meissner echoed this long-standing teaching when he wrote “[if] a medication that hinders conception is used after a rape with the purpose of avoiding fertilization, then this is acceptable in my view.”

Abortion as Treatment?

Direct abortion is the deliberate killing of an innocent human being, willed either as an end or a means, before birth. It can involve both the murder of a child already implanted or it can involve willfully preventing the fetal human being from implanting. Such direct abortions are mortally sinful and lead to an automatic (latae sententiae) excommunication.

The U.S. bishops state that following rape “[i]t 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.” Again, the German bishops echo this teaching, “Medical and pharmaceutical methods which result in the death of an embryo still may not be used.”

Deceptive Definitions of Life, Conception and Pregnancy

Life begins at the moment of fertilization (conception) when sperm and egg are united. Some researchers and activists who promote contraception and abortion have redefined pregnancy (and even conception) as beginning once the child has fully implanted in the uterus, ignoring that the woman is with child as soon as fertilization occurs. It can take approximately two weeks after conception for implantation to occur at which point there is an “established” or “clinical” pregnancy.”

Any act that willfully prevents the nascent human being from implanting is a direct abortion. We must be wary of deceptive definitions of “conception” and “pregnancy.” The question is, does a particular intervention prevent a developing human being from living? Is it embryocidal?

Avoid Ad-Hominem Responses

In response to this series, some have claimed that because some scientific studies are performed by people who are pro-contraception or pro-abortion, their data is necessarily tainted. This is a fallacious response that we have to avoid. While we should certainly consider the source and read with a wary eye, we need to evaluate the scientific evidence on its own merits. If it is faulty research it should be critiqued on that basis. If the conclusions do not follow from the results of the study, this should be critiqued as well. But a researcher’s scientific analysis cannot be rejected simply because he is pro-contraception or pro-abortion. This is an ad hominem attack akin to one that pro-lifers often hear when bringing up embryological science, and should be avoided.

Mechanism of Action of Plan B and Ella

Plan B (levonorgestrel) has not been shown to disrupt established pregnancies (post-implantation) and it may work by preventing ovulation. The FDA notes, however, that it may affect the endometrial lining of the uterus and thus discourage the child from implanting.

Here it is important to take notice of an important fact. 1) “May” affect the endometrial lining does not mean that this is always possible or likely. Nor does it necessarily mean it is ever possible. It could mean that it definitely causes abortions at certain times or it could simply indicate that not every possible abortion inducing mechanism of action has been ruled out by research. Such language is ambiguous and does not prove that Plan B causes early abortions.
Next page: Conclusions About the Science–>


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  • Dr. Dom Pedulla

    This is somewhat disappointing, because I have previously enjoyed Nichols’ work. Here he tries to be fair to everyone, and risks being fair to no one, least of all the truth. It would be good to recall several points:

    (1) even though it’s true that the 2010 Noé and Croxatto study showed Plan B does not suppress ovulation, the pre-existing evidence that Plan B could suppress ovulation had not exactly been stellar (I ought to know since I had been among those foolishly duped by this propaganda!). Why did we so easily accept it? And why after 2010 did many who had accepted it start searching for alternative, non-abortifacient explanatory mechanisms, no matter how far-fetched, rather than change their tune?

    (2) Prudential certitude is not absolute certitude — certainly not — but that inequality is being misused here. As the eminent moral theologian Msgr. William Smith has said regarding “emergency contraception”, one must err on the side of life and not merely settle for a prudential probability because in the mind of the Church’s moral magisterium whenever the weighty rights of a third party are jeopardized one may not resort to probabilism but must rather err on the side of a well-founded concern for those (life). Similarly, precisely because the right to life of an innocent third party (the embryo) is at least potentially in jeopardy, it is also wrong to invoke Aquinas, as Austriaco has done (S.Th., II-II, Q. 70, Art. 2), permitting “imperfect certitude” in favor of allowing Plan B after sexual assault. In fact, a proper interpretation of Thomas is that it is precisely because some matters do involve contingent knowledge (and do not allow absolute or demonstrative certainty), that if grave issues of justice such as innocent human life are at stake we must not merely consider the “probable opinion” but rather err on the side of life.

    (3) Nichols says a prudential caution in favor of life is justified by considerations not merely reasonable but “compelling”. What consideration could be more compelling than the discovery that taken during the fertile phase, Plan B is proved 100% effective yet without relying on any known or speculative prefertilization mechanism? If this does not constitute a “compelling” consideration pointing towards a post fertilization (embryocidal) mechanism, what possibly could?

    (4) It is true the bishops are not men of science. But shouldn’t they be the first to know it? And yet, we see that somehow or another they are being poorly served by whomever assist them in the ambit of science and medicine. In the future it would seem to be beneficial for them to be better advised and so make statements that avoid even the slightest appearance of dangerous and even deadly scientific misadventures.

    (5) Nichols says opinions on Plan B are not necessarily disqualified by investigators’ opinions on the liceity of contraception and abortion. The Master wants us to be simple, but must we be näive? Almost the entirety of Austriaco’s argument seems predicated on trusting the papers of those who regularly publish in the journal Contraception, whose views are not only overwhelmingly favorable to contraception but who in many cases are powerfully motivated in their research to exonerate contraceptives and abortifacients, as they themselves tell you in their papers, not even beginning to imagine it is a conflict of interest. And it is often precisely in these papers that we see the weirdest and most disingenuous use of data. Yet we can take their papers at face value? We can disregard their a priori philosophical attachments, however corrupt?

    (6) Maybe most disappointing of all, we see the ovulation test being validated as if still in harmony with an updated understanding of Plan B’s mechanism of action. By no means! That test lived under the misunderstanding of Plan B as an anovulant — a suppressor of ovulation — and those days are now over. Now it would be bad enough were the test merely useless, but even worse it now appears to be dangerous, because its use will give the false impression of no risk to embryos when ovulation is remote (now thought to be the riskiest time), and possible risk only when ovulation is proximate (now known as the time of neither effectiveness nor risk). In other words, the ovulation test is now obsolete, and will have us zigging precisely when we ought to be zagging, something very grave where new life is concerned.

    Make no mistake; Plan B is not a contraceptive, and so if it prevents recognizable pregnancy it cannot be by pre-fertilization mechanisms, and cannot but be by post-fertilization mechanisms. That, in turn, must be allowed to change our approach to the care of victims of sexual assault, because we cannot have the requisite moral certainty of avoiding embryocidal effects.

    • Arland Nichols

      Thank you, Doctor Pedulla for your comments. Please find my response to each criticism below. Blessings.

      (1) This is a valid question, but I am unsure that it is a critique of anything I wrote in the article.

      (2) I think this is a legitimate criticism of Father Austriaco’s use of certitude. I do not endorse or share his articulation or application of either moral or scientific certitude. I do not believe I “misused” the “inequality” between absolute and prudential certitude. I merely offered an important qualification to Allison LeDoux’s articulation of what I agreed was an “important principle” – when in doubt choose life. I am afraid you are reading Fr. Austriaco’s view into mine.

      (3) The life of an unborn human being is a compelling reason. As Dc. Davis has written in the pages of the NCB Quarterly, “Judgments of moral certainty properly encounter a higher threshold where human life is at risk than when the good at stake is of lesser value…” I assumed the reader would grant me that, in principle, human life is a compelling reason. Perhaps I should have made this explicit.

      I ended this section on certitude with posing a question: “The essential question is does the data presented in this series (and elsewhere), especially by Drs. Peck and Yeung, present a concern which would prevent a hospital or practitioner from dispensing Plan B?” It is a question I did not directly answer, in part because, as I note, it is primarily the moral responsibility of Bishops, hospital administrators, and (with qualifications) practitioners to answer this question.

      My answer: The current state of the science compels me to say that Plan B should not be administered in Catholic hospitals. I remain unconvinced that the LH test can prevent early abortions because an LH test reads negative during the first few days of the fertile window which is precisely when Noe et al. indicate
      abortions are likely to occur. Further, it appears to be useless when
      administered elsewhere in the cycle. Unless there is a sea-change in the science, I do not think administration of Plan B can be pursued in good conscience. I will amend my article to this effect.

      (4) As I said in the article, I agree that bishops should be well informed.

      (5) To borrow from David Bentley Hart in the May issue of First Things, “Who for God’s sake, advocated for” naivete? I specifically encouraged the reader to “consider the source” and read “with a wary eye.” I encouraged criticism of bad science and ideologically driven interpretation of that science. Again, I think your disagreement is with Fr. Austriaco.

      (6) Yeung and Bame both make it clear that it does not suffice and that, as you note, it gives the false impression of no risk at the very time in which it is most risky. You claim that I “validated” the LH test. I did no such thing but rather wrote, “It seems that the Noe et. al. study, explained by both Drs. Yeung and Peck and
      their co-authors necessitates a reconsideration of this protocol.”

      • http://www.facebook.com/erika.vandiver Erika M Vandiver

        I am the blog author of the so-called article “criticizing” the bishops. I did not criticize the bishops. In fact I defended them by explaining the fallacies in the so-called research refuting the abortive effect of Plan B (and other emergency contraceptives). Additionally, the founder of my blog would not allow me to criticize the bishops.

        From my reading of this article I gathered that the author defends the use of emergency contraceptives because they “may” not cause early abortions. Reading this comment gives me a different idea on the author’s stance. In other words, I’m confused about what the author means to say about the use or non-use of emergency contraceptives.

        As I concluded in my articles (there were actually two), the bottom line is whether we think all newly conceived life deserves the same respect and care. The use of emergency contraceptives in the case of rape without a definitive ovulation test indicates that lives conceived in rape are worth less than those conceived in other ways. As Catholics or pro-lifers we must stay strong in our defense of ALL newly conceived (and all stages thereafter until natural death) life. If we don’t, then we are being die tenuous & straying from the Truth as taught to us by the Church.

        In addition, there are two separate scientific uncertainties at play in this discussion: the actual effects of emergency contraception and the accuracy of detecting the exact phase of ovulation. Medical science has not answered both of these questions sufficiently if we are truly respecting and caring for ALL life regardless of method of conception or stage. That is the true teaching of the Church through the Magesterium, guided by the Holy Trinity.

        • Arland Nichols

          Erica, this is what you wrote: “The German bishops, in their ill-conceived notion of “kindness” for a woman impregnated by an attacker, draw a line that neither science nor morality can draw.” I characterized this statement as criticism and I think that is a just characterization. Also, I never defended “the use of emergency contraceptives because they “may” not cause early abortions.” In the section where I discuss the FDA’s use of the word “may” I simply indicate that the FDA’s statement really doesn’t prove anything. There is a tendency to quote the FDA and then declare the discussion over. I think this is not the way to engage in debate about this issue again, because the word is ambiguous and can be interpreted in various ways. I agree that every life is precious and is made in His image and likeness and deserves to be protected.

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