By Christine M. Williams, Anchor Correspondent
FALL RIVER, Mass. — In Washington, D.C., the United States Conference of Catholic Bishops is insistently urging the inclusion of a conscience clause in the national health care reform bill. One of the reasons why they are doing so is that state laws are already beginning to force violations of the consciences of Catholic medical personnel.
One such violation occurs in state laws requiring the dispensing of so-called emergency contraception in emergency rooms. Eighteen states, including Massachusetts, mandate hospitals, including Catholic hospitals, to issue the morning after pill, called Plan B, when a sexual assault victim requests the drug.
This pill contains high doses of an analog of estrogen, progesterone or both, the same synthetic hormones found in birth control pills. The morning after pill is meant to be taken to prevent pregnancy after sexual intercourse when no contraceptive was used or when it failed. The primary way in which the morning after pill works is to prevent ovulation, but a secondary effect of the drug is that it may thin the lining of the uterus, which could prevent an embryo from implanting, thus causing an abortion.
There are only limited circumstances when the drug can morally be given, according to Father Tadeusz Pacholczyk, a priest in the Diocese of Fall River and director of education for the National Catholic Bioethics Center in Philadelphia.
In an interview with The Anchor, Father Pacholczyk said that a rape victim can morally take emergency contraception if she has not yet ovulated. This is permissible because the woman is entitled to protect herself from the attacker’s sperm, the continuing activity of which can be seen as an extension of the original assault. As long as the drug will work by preventing ovulation, rather than causing an abortion, its use will be permissible following sexual assault, he said.
He noted that a physician should have “moral certainty” that a woman has not yet ovulated before administering the drug. A simple, non-invasive urine test for leutinizing hormone can contribute to achieving such certainty, along with other steps like obtaining a menstrual history, he said.
“There are circumstances where the use of emergency contraception would be morally licit for sexual assault victims,” he said. “It is reasonable to use Plan B, when requested by the woman, after appropriate testing for where she is in her cycle.”
He added that only in this limited set of circumstances, when the morning after pill would reasonably be anticipated to have a contraceptive effect, should Catholic hospitals or Catholic medical personnel in non-Catholic hospitals dispense the drug.
Father Pacholczyk recognized that such testing cannot determine with absolute certainty where in a woman is in her cycle, noting, “We don’t have absolute certainty about anything in this life, but in the presence of God, we do need the level of certitude known as ‘moral certainty’ in order to choose to act humanly.”
The United States Conference of Catholic Bishops document, “Ethical and Religious Directives for Catholic Health Care Services” states, “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.”
In 2000 the Pontifical Academy for Life released a statement on the morning after pill that voiced concerns about its abortifacient nature: “It is clear, therefore, that the proven ‘anti-implantation’ action of the morning-after pill is really nothing other than a chemically induced abortion. It is neither intellectually consistent nor scientifically justifiable to say that we are not dealing with the same thing,” the statement said.
Father Pacholczyk stressed that women who are sexually assaulted have the right to try to counteract the effects of an attack, but they do not have the right to end the life of an already conceived child, who is an “innocent bystander.” State laws, such as the one in Massachusetts, force hospital workers to provide emergency contraception upon request, without allowing the physician to determine whether its use is appropriate to the medical circumstances, thereby violating that professional’s conscience, he added.
They do not allow health care professionals to verify that a woman has not ovulated before administering the drug. And the drug’s primary effect, delaying ovulation, cannot be achieved if ovulation has already occurred. The law forces emergency room doctors to act without evaluating whether the morning after pill will even be able to achieve its intended effect, he said. Strong medications with powerful side-effects should never be given to patients unless there are good grounds for supposing they will be effective, and physicians, not lawmakers, are the experts in this arena.
Father Pacholczyk said state legislatures are meddling in the affairs of emergency room doctors and telling them how to practice medicine.
“The state is preempting the better judgment of the physician here,” he said. “He is being pressured by the state to participate in a kind of medicine that, in certain circumstances, could be intrinsically immoral.”