Ethics

Catholic Hospitals should not dispense Emergency Contraception

1. All current ECs are highly abortifacient.

The currently available forms of Emergency Contraception (EC) are all abortifacient to a high degree. They obtain more than 50% of the effectiveness from post-fertilization mechanisms of action, i.e. by killing the developing embryo.

An article in the journal Contraception, titled “Mechanism of action of the morning-after pill” (Laura Duberstein 2002), concluded that the LNG type of EC is abortifacient:

“This data allows us to conclude that, beyond ideological considerations, and from an essentially medical point of view, the morning-after pill, in a percentage of cases, which very likely exceeds 50%, acts by an anti-implantatory effect, and consequently abortive mechanism.”

An article in the Linacre Quarterly (Rebecca Peck 2016) found that the same chemical contraceptive, LNG, obtains a very limited portion of its effectiveness from mechanism of action prior to fertilization.

“Our analysis strongly suggests that pre-fertilization activity of the drug could, in a routine clinical setting, prevent less than 15 percent of expected conceptions. The drug has minimal effects on cervical mucus or sperm functions and has limited ability to prevent ovulation on the most fertile days of the cycle.”

In a study published in Contraception (Marta Durand 2001), LNG given to women up to 4 days before the expected day of ovulation was ineffective at preventing ovulation. Moral theologians often assume that if an anovulant is given to a woman prior to the expected day of ovulation, it will prevent ovulation. That turns out not to be true, in a large percentage of cases.

Another study published in Fertility and Sterility (Rafael Mikolajczyk 2007), found that, with increasing length of time from intercourse to use of LNG as EC, the chances that the drug will work post-fertilization also increase. If taken immediately after coitus, LNG obtains 89% from pre-fertilization effects. That makes LNG an abortifacient 11% of the time when administered soon after intercourse. By 24 hours later, LNG is an abortifacient 41% of the time. At the 48 hour mark, LNG 71% of its effectiveness is by abortifacient mechanisms of action. By 72 hours, its 84%; at 96 hours, the abortifacient effects are 97%; and at 120 hours (5 days), 100%.

A study in Contraception (Vivian Brache 2013), compared a newer EC (ulipristal acetate) UPA to LNG in their ability to inhibit ovulation. UPA was successful in delaying ovulation for at least 5 days — the length of time needed to prevent conception from the incidence of intercourse for which EC is sought — only 58% of the time. The difference between LNG and a placebo in preventing ovulation, when given in the days prior to ovulation, was not statistically significant.

2. Even when EC is taken within a few hours after intercourse, some percentage of conceptions will have already occurred. This happens when ovulation precedes intercourse, so that the ovum is waiting for the sperm. The time from intercourse to fertilization is then very short:

“Motile sperms have been recovered from the ampulla 5 minutes after their deposition near the external uterine os (see Fig. 2-6B). Some sperms, however, take as long as 45 minutes. Approximately 200 sperms reach the fertilization site….” [Keith Moore, The Developing Human]

The ampulla is that portion of the fallopian tubes where fertilization usually occurs.

According to an article in Fertility and Sterility, with an 80% effectiveness of LNG as EC, when taken soon after intercourse, about 30% of its effectiveness is due to post-fertilization effects (i.e. abortifacient mechanisms of action). (Rafael Mikolajczyk 2007) By 24 hours after intercourse, that abortifacient rate rises to nearly 50%. Yet two-thirds of women present for EC more than 24 hours after intercourse. (Anna Glasier 2010)

3. Mere contraception is moral in cases of rape, because it is indirect (like indirect sterilization, or indirect abortion). However, it is not moral to give any patient a treatment which is inherently ordered toward an abortive end.

The principle of double effect never justifies an intrinsically evil act. EC is abortifacient in its mechanisms of action. Emergency contraception obtains its effectiveness from post-fertilization mechanisms of action which destroy the developing human embryo. The deaths of these human persons are not a side effect; it is the means that is used by EC to attain its goal, prevent the establishment or the continuation of a pregnancy. The moral object of the act of using EC is two-fold: to prevent conception (which is moral in cases of rape), and also to destroy the conceived prenatal human person (which is not moral in cases of rape). Abortion is not moral in cases of rape, and so abortifacients are also not moral. Any single evil moral object makes any act intrinsically evil, regardless of how many other good moral objects there may be.

The intention to relieve the suffering of the rape victims is a good intended end, but it is not the moral object. The circumstances may be dire, in that the woman will suffer emotionally, if she conceives by the rape. But a good intention and a dire circumstance do not justify the intrinsically evil act of killing the innocent prenatal.

4. Catholic hospitals across the U.S. are using EC in cases of rape, with the permission of the U.S. Bishops. This means that the Bishops have authorized a type of abortion, abortifacient contraception, in cases of rape — contrary to Catholic teaching.

The Bishops objected to the Contraception Mandate, in part because it required Catholics to pay for abortifacient contraception. And then they themselves authorized abortifacient contraception to be used in cases where it will often have an abortive effect.

What we need is not a clever theological rationalization, which justifies the deaths of innocent prenatals. Rather, we need to love unborn human persons in their most delicate and vulnerable state of life, and protect them from death by abortifacients. You can find moral theologians who justify the use of abortifacients in cases of rape. But they will be judged by Christ for their callous disregard for the little children, and for the complicity in their deaths.

[Matthew]
{18:5} And whoever shall accept one such little child in my name, accepts me.
{18:6} But whoever will have led astray one of these little ones, who trust in me, it would be better for him to have a great millstone hung around his neck, and to be submerged in the depths of the sea.

{18:10} See to it that you do not despise even one of these little ones. For I say to you, that their Angels in heaven continually look upon the face of my Father, who is in heaven.

{18:14} Even so, it is not the will before your Father, who is in heaven, that one of these little ones should be lost.

by
Ronald L. Conte Jr.
Roman Catholic theologian and translator of the Catholic Public Domain Version of the Bible.

ENDNOTES:
[1] Duberstein, Laura, and L. Finer. “Mechanism of action of the morning-after pill.” Contraception 36 (2002): 465-470.
[2] Durand, Marta, et al. “On the mechanisms of action of short-term levonorgestrel administration in emergency contraception.” Contraception 64.4 (2001): 227-234.
[3] Peck, Rebecca, et al. “Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action.” The Linacre Quarterly 83.1 (2016): 35-51.
[4] Keith Moore, The Developing Human (Kindle Locations 1532-1535). Elsevier Health Sciences.
[5] Mikolajczyk, Rafael T., and Joseph B. Stanford. “Levonorgestrel emergency contraception: a joint analysis of effectiveness and mechanism of action.” Fertility and sterility 88.3 (2007): 565-571.
[6] Glasier, Anna, et al. “Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis.” The Lancet 375.9714 (2010): 555-562.
[7] Brache, Vivian, et al. “Ulipristal acetate prevents ovulation more effectively than levonorgestrel: analysis of pooled data from three randomized trials of emergency contraception regimens.” Contraception 88.5 (2013): 611-618.

Categories: Ethics