BY: DANIEL O'BRIEN, PhD, and JOHN PAUL SLOSAR, PhD
Ascension Health, St. Louis
As the authors point out, Directive 36 is ambiguous. As we interpret it in
the context of the tradition, this directive requires that one only have moral
certitude that the act of giving emergency contraception (in the care of rape
victims) would not have an abortifacient effect. Moral certitude of this nature
could be established in two ways. One way is to have more reason to believe
that anovulatory medications do not have effects that would destroy or interfere
with the implantation of a fertilized ovum than to believe that they do. In
the absence of such certitude, a second way is to have more reason to believe
that a fertilized ovum is not already present as a result of the sexual assault
than to believe that one is present. The latter, however, is only necessary
if one does not already have moral certitude concerning the former. In light
of the inconclusive medical data regarding the first issue,* we suggest that
neither the "pregnancy approach" nor the most restrictive "ovulation approach"
is the only acceptable option. Although we agree that both approaches can be
consistent with the tradition, we also believe that neither approach sufficiently
acknowledges that the determination of whether and when moral certitude has
been obtained properly belongs to the physician and patient, in accord with
the norms of conscience.
In our opinion, therefore, an appropriate protocol would (1) require testing
for a pre-existing pregnancy per the medical standard of care; (2) allow for
the administration of anovulatory medication, given moral certitude that either
the medication does not have abortifacient effects or, lacking that, that a
conceptus is not present; (3) identify the limits of moral certitude beginning
with the "constellation of factors that coalesce" to support the "pregnancy
approach" and terminating with a variety of possible indicators that would preclude
the possibility of conception having occurred (medical and menstrual history,
LH surge test, progesterone test, etc.); and (4) provide physicians with the
necessary information to make a decision — in collaboration with the patient — in
good conscience. Such a protocol would be consistent with respect for human
life and would appropriately respect the physician-patient relationship, the
institutional conscience of Catholic health ministries, the right of the victim
to advance her own welfare through informed consent, and the morally sound practice
of medicine.
Copyright © 2002 by the Catholic Health Association of the United States
For reprint permission, contact Betty Crosby or call (314) 253-3477.