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

The fourth concern is that the ovulation approach, especially more rigorous versions such as the Peoria Protocol, seems to seek a degree of certainty more akin to absolute rather than to moral (no reasonable fear of error). It does so by insisting that emergency contraceptive medications cannot be administered if the woman is about to ovulate or has ovulated recently because conception is then a possibility and the medications would not be capable of inhibiting ovulation but instead might harm or destroy a conceptus. However, the risk that a conceptus will be destroyed seems to be extremely small, if it exists at all, given the facts that most ovulatory menstrual cycles do not result in conception, that the rape-related pregnancy rate is extremely small, and that emergency contraception most likely acts by preventing conception, not inhibiting implantation. Even this small or nonexistent risk, however, seems to be too great for proponents of the ovulation approach. We shall return to the matter of moral certainty and risk later.

The final concern is that proponents of the ovulation approach do not accurately characterize the moral object when contraceptive medications are administered either immediately before or after ovulation has occurred. They view the moral object in such circumstances as the destruction of a conceptus (in other words, the act is viewed morally as an abortion) because they presume that emergency contraceptive medications may (or can only) have an abortifacient effect if administered at these times. However, as previously noted, the evidence does not seem to support this assumption.

THE PREGNANCY APPROACH AND ITS MORAL JUSTIFICATION

Given these concerns with the ovulation approach, we believe that it is not the preferable or only permissible moral approach to treating women who have been sexually assaulted. Rather, we find the pregnancy approach to be both morally permissible as well as morally preferable. As the name suggests, the pregnancy approach tests only for a pre-existing pregnancy. The underlying rationale is that no tests presently available or personal information supplied by the woman can provide evidence of conception from a recent sexual assault, and this being the case, the most that can be done is to rule out a prior pregnancy unrelated to the recent assault. Under this approach, emergency contraceptive medications are offered to the woman if her pregnancy test is negative.

We believe the pregnancy approach is morally justified for several reasons when taken together as a whole. First, prior pregnancy is always ruled out, and once this occurs, nothing is done that would directly harm a developing embryo or terminate a pre-existing pregnancy. This is assuming, of course, that emergency contraception actually has a teratogenic or abortifacient effect on a developing embryo or fetus, neither of which has ever been proven convincingly.

Second, once a prior pregnancy is ruled out, moral certainty exists sufficient to justify administering emergency contraceptive medications to the woman upon her request, even if she has ovulated recently. This moral certainty is rooted in a constellation of factors that coalesce to support this action. First, the risk of pregnancy resulting from a sexual assault is very small (less than 1 percent to 5 percent). Second, the scientific literature indicates that emergency contraceptive medications most likely act by preventing ovulation or fertilization and do not have post-fertilization effects sufficient to prevent implantation. Third, given these two considerations, the probable direct effect (or moral object) of administering the medications is prevention of a conception from an act of unjust sexual aggression rather than bringing about the demise of a conceptus.* Fourth, the intention in administering emergency contraception is to prevent conception and not to inhibit implantation. If a conceptus is present, but fails to be implanted and ultimately is destroyed, this would be an unintended and even an unforeseen effect, given the extremely low likelihood of conception occurring as a result of the sexual assault and the lack of evidence supporting abortifacient effects of the medications. Finally, a proportionate reason exists for administering emergency contraceptive medications, namely, the prevention of pregnancy resulting from the sexual assault and its subsequent impact on the overall well-being of the woman.