An Issue of Moral Certitude

September-October 2002


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
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