Microsoft word - linacre articles template.doc

The ‘Morning-After Pill’, Rape Victims and
Ethical and Religious Directives for Catholic
Health Care Services
Anthony McCarthy
“ 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 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 destruction, or interference with the implantation of a fertilized ovum”.1 constitutes “appropriate testing” or 1 The statement follows the Directives of 1994 and the statement by the Pennsylvania Catholic simple urine dipstick test together with Conference “Guidelines for Catholic Hospitals Treating Victims of Sexual Assault” (April 1, 1993), Origins 22: 81D (May 6, 1993). The Pennsylvania statement (which refers to ovulation testing (see below)) is cited in a footnote to Directive 36 as an example of a policy that tries to respect ethical concerns 2 A simple urine dipstick test can be done for about early human life. In the UK and Ireland statements were made by the Joint Committee triggers ovulation. This test if it gives a on Bioethical Issues of Bishops’ Conferences negative result does not necessarily tell you of Scotland, Ireland, England and Wales: whether the woman is before the cycle’s LH “‘Use of the ‘Morning-After Pill’ in Cases of surge (where drugs can be given to prevent Rape”, Origins (Jan. 31, 1986), 15: 633, 635- ovulation) or just after (in which case sperm 638 (March 13, 1986); Joint Committee on and ovum may have already have joined and Bioethical Issues of the Bishops’ Conference the drug is likely to work as an abortifiacient). of Great Britain and Ireland, “A Reply: Use of the ‘Morning-After Pill’ in Cases of Rape” (1986), Origins 16: 237-238 (Sept. 11, 1986). answer the question of whether conception has This Joint Committee is in the process of taken place. Results from this test, however, investigating further evidence on these issues. The Linacre Centre for Healthcare Ethics The ‘Morning-After Pill’ and Rape Victims
Following this article, and consultation be at all necessary in a given case. This debate, a letter was privately circulated take seriously the possibility that drugs based on “the present state of scientific Pregnancy-only testing
Directive 36.4 However, in spite of this Health Association, Health Progress, the “pregnancy-only-testing” strategy.3 The leaked letter has led to a situation that is troubling, not least because the Health Progress article defending stance on life issues have seized on the Flaws in the Hamel and Panicola
Some have also recommended an ovarian scan as a way of determining the stage of the Theological/Ethical Issues”, Health Progress 3 Ronald P. Hamel, Ph.D., and Michael R. Panicola, Ph.D., “Emergency Contraception http://www.mergerwatch.org/edfund_docs/ec_t The Linacre Centre for Healthcare Ethics The ‘Morning-After Pill’ and Rape Victims
include Levonorgestrel (Levonelle 2), “emergency contraceptive” are purely abortifacient.8 The present evidence for define fertilization as a process ending questionable, not to say worrying, as it b) It is not true that no evidence exists fertilization process (with the lining-up of “pregnancy-only testing” is known “direct effect” in the vast majority of after pill” following rape would be an and rendering it fatally inhospitable to any Evidence suggests that Schering PC4, 8 See Swahn M L et al., “Effect of post-coital contraceptive methods on the endometrium and the menstrual cycle”, Acta Obstetrica et Gynecologica Scandanavica 75: 738-744 produce an abortifiacient effect.7 Other (1996) and also Eugene F. Diamond, M.D., “The Ovulation or Pregnancy Approach in Cases of Rape?” (and citations therein), National Catholic Bioethics Quarterly 3: 689- 6 See the study by R.B. Everett and R.F. Mifepristone (RU486), although not licensed Jimerson, “The Rape Victim: A Review of 117 as “emergency contraception”, can prevent Consecutive Cases”, Obstetrics and conception, but also has an abortifacient effect. 9 See Tonti-Filippini N., “Further Comments 7 Ling W Y et al, “Mode of action of DL- on the Beginning of Life”, Linacre Quarterly norgestrel and ethinyloestraidol combination in 59: 76-81 (1992) and Diamond op.cit. postcoital contraception”, Fertility and Sterility 10 It is a matter of dispute whether the drug’s effects on the endometrium are, in the majority The Linacre Centre for Healthcare Ethics The ‘Morning-After Pill’ and Rape Victims
ovulatory cycle of the rape victim, it is “emergency contraception”13 is offered difficult to say what the “direct effect” after pill” cannot be classified blithely as an “unforeseen” effect of its use. While it is true that a woman, in taking recent rape, need not intend to cause an take into account the risk at which they Ovulation testing
The Linacre Centre for
Healthcare Ethics,
therefore results in the administering of 38 Circus Road,
London NW8 9SE
Tel. +44 (0)20 7266 7410
Fax +44 (0)20 7266 5424
admin@linacre.org
Registered Charity No. 274327
In contrast to this, the ovulation-testing 12 Details of a widely adopted protocol on ovulation testing are outlined in St Francis Medical Centre, “Interim Protocol, Sexual Assault: Contraceptive Treatment Component”, Peoria, IL, (October 1995). 13 It has been suggested that a single, moderate of cases, sufficient for a further abortificacient dose of estrogen may be sufficient to delay ovulation while at the same time being very 11 A further possible abortifacient effect of some drugs is that their use may slow the pregnancy if ovulation had already occurred, transport of the embryo down the fallopian though this requires further investigation. If tube so that it arrives in the womb too late to such were the case, estrogen treatment would be the ethically preferable option. See Tonti- slowing down the embryo’s journey is a risky Filippini N. & Walsh M., “Postcoital procedure, as it increases the likelihood of an Intervention”, National Catholic Bioethics The Linacre Centre for Healthcare Ethics

Source: http://www.linacre.org/Morning%20After%20Pill_final.pdf