Emergency contraception and sexual assault: Assessing the moral approaches in Catholic teaching / comments

Health Progress, Sep/Oct 2002 by Hamel, Ronald P, Panicola, Michael R, Barron, Margaret, Sulmasy, Daniel P, Et al

One popular version of the ovulation approach is known as the Peoria Protocol, which was first developed in 1995 at Saint Francis Medical Center in Peoria, IL. Like other versions of this approach, the Peoria Protocol rests on the premise that the occurrence of ovulation suggests conception may have taken place, and that this possibility is sufficient to cause caregivers to refrain from offering emergency contraception, which may (or can only) have an abortifacient effect if administered after ovulation. Where the Peoria Protocol goes further than other versions of the ovulation approach is in the assessment of ovulation. In addition to testing for a pre-existing pregnancy unrelated to the recent assault and asking the woman about her menstrual history to ascertain where she is in her cycle, the Peoria Protocol also requires caregivers to conduct (1) a urine dip-stick test to determine luteinizing hormone (LH) surge, which is believed to be a reliable guide to the prediction of ovulation; and (2) a blood test to determine the woman's progesterone level, which is another indicator of ovulation and helps to categorize the timing of the woman's ovulatory cycle. Depending on the results of these tests, the Peoria Protocol directs different courses of actions:

* If the woman who has been sexually assaulted is determined to be in the pre-ovulatory phase of her cycle, emergency contraception may be administered if her menstrual history and findings of a physical exam are consistent with the pre-ovulatory phase, the LH urine test is negative, and the woman's progesterone level is less than 1.5 ng/mL. In this situation, the first dose of the emergency contraceptive should be given immediately and the second dose 12 hours later. If the first dose is not administered immediately, the risk that the medication could have an abortifacient effect increases.

* On the other hand, the woman is determined to be in her midcycle LH surge phase or her early post-ovulatory phase if her LH urine test is positive or her LH urine test is negative but her progesterone level is greater than or equal to 1.5 ng/mL or less than or equal to 5.9 ng/mL and her menstrual history is consistent with midcycle and early post-ovulatory phases (menstruation is expected in more than seven days). In these situations, emergency contraception should not be given.

* The woman is determined to be past the early post-ovulatory phase of her cycle if the LH urine test is negative and her progesterone level is greater than or equal to 6 ng/mL. In this situation, the timing of the sexual assault could not have coincided with the presence of an ovum. Hence, it is morally permissible to administer an emergency contraceptive for the victim's psychological benefit.

* Finally, the woman is determined to be in the late post-ovulatory phase if the LH urine test is negative, her progesterone level is less than 6 ng/mL, and she anticipates menstruation in less than seven days. Here, too, it is morally permissible to administer a contraceptive medication.