Thursday, June 27, 2013

EC and Catholic Hospitals

An unattributed item on your web site rightly indicates that there is no substantial difference in the positions of the German bishops and the American bishops, with regard to treatment of individuals identifying themselves as victims of sexual assault:
    "Recently the secular media again has insisted that there is a disparity among the teachings of the Catholic Bishops. They cite the recent statements by German bishops concerning sexual assault protocols in Catholic hospitals. However, on a closer examination, it is clear that their position is consistent with the Ethical and Religious Directives for Catholic Health Care Services (ERDs), as promulgated by the U.S. Conference of Catholic Bishops.... 
     

    "With appropriate testing, as indicated by the ERDs, emergency contraception may be provided to sexually assaulted women, and should be [emphasis added].  Manufacturers of emergency contraception indicate that it has three potential functions: to prevent ovulation, so that fertilization cannot occur; to alter the woman’s cervical mucus to slow the speed of the sperm reaching the egg (ovum); and to alter the uterine lining to prevent the embryo from implanting and receiving the nourishment it needs to survive....

    "Credible research tells us that altering sperm mobility and its capacity to fertilize the egg cannot occur quickly enough when these hormones are taken for emergency contraception.[7] Sperm can be at the point of fertilization in a woman in five minutes.[8] Thus, the only function of emergency contraception that does not involve the destruction of the newly conceived human being, that can occur quickly enough, is the prevention of ovulation....

    "There is no test to determine if conception has occurred until up to 16 days after the embryo has been conceived.  However, there is a simple test to determine if the emergency contraception can be given at a time that may prevent ovulation....Thus, Catholic hospitals can use this test as part of a sexual assault protocol to determine if pregnancy can be prevented.  The test is usually positive only for one day, and the egg usually only lives for one day, so there is a very limited period of time in which the emergency contraception should not be administered in order to prevent its potential abortifacient effect (prevention of implantation, which manufacturers indicate is a potential action)....
     

    "In all such cases, the patient is provided with all the information she needs for informed consent as to why such testing should be done, and all of the manufacture’s stated potential actions of the emergency contraction.  This is just good medicine.  And if the patient, after being stabilized and provided all of the excellent care available to her at our Catholic hospitals, wishes to be transferred safely to another provider of her choice, the transfer of care is safely provided for her....The position of the German and American bishops constitutes compassionate and pastoral care of the victim of sexual assault who has the right to protect herself from the unjust aggressor, by preventing conception, as it is accurately defined.  Both statements clearly indicate that anything that is used to cause the death of the embryo after conception is inconsistent with respect for human life. Thus, both the positions of the American bishops and that of the German bishops are totally consistent and do not represent any new teaching of the Catholic Church" ("There is No Inconsistency: German and American Bishops’ Treatment of Sexual Assault Victims," NCBC, 3/13/13).

Dr. Haas, I suspect that many faithful Catholics are missing much of what is being said and much of what is NOT being said in the above.  For example, 
  • Many are unaware that there is no comparable guidance from the Vatican, outlining situations for supposedly moral use of EC (In fact, documents such as the Statement on the So-Called "Morning After Pill" and Dignitas Personae indicate NO morally acceptable use of EC.);
  • The above protocol makes no guarantee that the use of EC will not be abortifacient;
  • The scientific assumptions are questionable.
With all respect, I assume that the above was not written by a physician, as there are no physicians on your staff.  I am confident that you are aware of the recent writing of Fr. Juan VĂ©lez, who is an Opus Dei priest with a doctorate in dogmatic theology and an M.D.  Along with Rebecca Peck, M.D., Fr. Juan writes:
"All physicians who value life, and especially Catholic healthcare institutions, have a duty to re-examine the available scientific information on Plan B. We think the data shows a small anovulatory effect and suggests a significant post-fertilization or abortifacient effect. Given this information, the Peoria Protocol, and other rape-based protocols should be abandoned, as use of Plan B during the critical fertile period, would not be expected to prevent ovulations in a majority of cases, and in fact, would lead to a significant possibility of post-fertilization effect.

"Moreover, as newer emergency contraceptives with better efficacies emerge, the precedent has been set for allowing agents with abortifacient mechanisms of action" ("Plan B’s Main Mechanism of Action: The Case for a Post-Fertilization Effect," Human Life International).
In the words of Human Life International, I pray "that Catholic bishops and those who advise them in these issues will see the urgency of revisiting the approval of Plan B for treatment of women who have been raped. These women deserve the absolute best life-affirming care possible, and this care should not include drugs that only compound the violence already suffered by causing abortions."

May victims of rape be administered a “Plan B” (levonorgestrel-only) contraceptive?
Catholic bishops, ethicists, and researchers have given a variety of answers to this question. Some forbid its use entirely, others permit it only after certain tests are done, still others allow it every time a victim of rape seeks care. This disparity in policy is primarily a result of the status of the science that continues to explore how this drug works. Recently a furor over the announcement by the German bishops that Plan B was approved for use at Catholic hospitals seemed to end with widespread confusion and a deepening of divisions between those who disagree on the issue. We believe that such a resolution on so important a question is completely unsatisfactory.
Given the findings of the latest science that Plan B may very well have an abortifacient or embryocidal effect, it is Human Life International’s position that all use of Plan B in Catholic hospitals should be discontinued. We respectfully request that all bishops and those who advise bishops on these matters reconsider as soon as possible the approval of Plan B for use in Catholic hospitals.
Picture_-_Austriaco_Article_041013The Church’s moral teaching regarding this matter is summarized by the Bishops of the United States in the Ethical and Religious Directives for Catholic Health Care Services:
A female who has been raped should be able to defend herself against a potential conception from the sexual assault…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. (36)
With this moral principle in place, the question then becomes, Does Plan B cause early abortions? We set out to explore this through a series of articles published on our Truth and Charity Forum (part 1, part 2, part 3, part 4, part 5, part 6). By publishing some of the strongest authors on the subject, all of whom approach the relevant science through the lens of orthodox Catholic moral theology, we wanted to provide a resource for bishops, and for those who advise bishops on the question of Plan B. Having researched the question and completed the series, HLI makes the following conclusions:
1.    Recent large and robust studies indicate that Levonorgestrel-only contraceptives such as Plan B rarely block ovulation, and most likely do result in the death of the embryo if administered during the first 4-5 days of the fertile window.*
2.    A Luteinizing Hormone (LH) protocol – a test whose outcome has been understood to determine whether a drug can be administered based on where the victim is in her cycle – cannot in fact detect that a woman is in these first days of her fertile window. Therefore a negative LH test may well encourage administration of Plan B precisely when it is most likely to cause an early direct abortion.**
3.    Because recent scientific studies have provided very strong data that indicates Plan B rarely has any contraceptive effects and is likely to have embryocidal effects, a medical practitioner cannot attain moral certainty that administration will not lead to early abortion.
4.    Since one cannot attain moral certainty that abortion will be avoided, protocols and policies that currently permit Catholic health care providers to administer Plan B need to be reconsidered by the appropriate diocesan authorities and hospital administrators. Nations in which abortion is illegal should be aware of this potential abortion-inducing effect and should prohibit the administration of these drugs.
These are our conclusions pending any developments in scientific research. Further, it appears that no contraceptive exists that is known to meet the reasonable criteria expressed by the Church above.
The urgency of addressing this matter comes to light when one considers the Church’s teaching regarding abortion expressed most recently in Dignitas personae:
It must be noted, however, that anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived, and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion. … Therefore the use of means of interception…fall within the sin of abortion and are gravely immoral. (23)
Here we have considered the use of a contraceptive following the unjust act of rape. We must, however, also reaffirm the Church’s unchanged and unchangeable doctrine on both abortion and the contraception of the marital act – both remain morally illicit without exception. As Pope Paul VI wrote in Humanae vitae, “it is necessary that each and every marriage act remain ordered per se to the procreation of human life.” (11)
We hope that Catholic bishops and those who advise them in these issues will see the urgency of revisiting the approval of Plan B for treatment of women who have been raped. These women deserve the absolute best life-affirming care possible, and this care should not include drugs that only compound the violence already suffered by causing abortions.
Further, we ask those concerned both for women who suffer rape and for nascent human life to approach bishops on these questions with respect, and pray for our shepherds that these and all answers to questions about human life and dignity may express, in the words of Dignitas personae, “a great ‘yes’ to human life.”
__________________
* There is a distinction in the scientific community between an abortifacient effect, which disrupts a pregnancy after implantation, and an embryocidal effect, which is “interceptive” or prevents implantation. Plan B appears to have the latter, embryocidal, effect. Since a human life is destroyed in either case, the distinction is not moral but technical, so we have stayed with the common language term and note here the difference.
** Previous scientific statements on Plan B’s mechanism of action declared Plan B to work mainly by preventing ovulation. Recent scientific evidence suggests, however, that Plan B does not work by preventing ovulation. Moreover, recent scientific evidence also shows that Plan B has no effect on cervical mucus or sperm function. Finally, as suggested in Point 1, recent evidence suggests that due to shortening of the luteal phase and other indicators, Plan B may likely prevent the new embryo from implanting into the uterine wall, resulting in an embryocidal effect.
- See more at: http://www.hliworldwatch.org/?p=2464#sthash.H8dPXw9K.dpuf
May victims of rape be administered a “Plan B” (levonorgestrel-only) contraceptive?
Catholic bishops, ethicists, and researchers have given a variety of answers to this question. Some forbid its use entirely, others permit it only after certain tests are done, still others allow it every time a victim of rape seeks care. This disparity in policy is primarily a result of the status of the science that continues to explore how this drug works. Recently a furor over the announcement by the German bishops that Plan B was approved for use at Catholic hospitals seemed to end with widespread confusion and a deepening of divisions between those who disagree on the issue. We believe that such a resolution on so important a question is completely unsatisfactory.
Given the findings of the latest science that Plan B may very well have an abortifacient or embryocidal effect, it is Human Life International’s position that all use of Plan B in Catholic hospitals should be discontinued. We respectfully request that all bishops and those who advise bishops on these matters reconsider as soon as possible the approval of Plan B for use in Catholic hospitals.
Picture_-_Austriaco_Article_041013The Church’s moral teaching regarding this matter is summarized by the Bishops of the United States in the Ethical and Religious Directives for Catholic Health Care Services:
A female who has been raped should be able to defend herself against a potential conception from the sexual assault…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. (36)
With this moral principle in place, the question then becomes, Does Plan B cause early abortions? We set out to explore this through a series of articles published on our Truth and Charity Forum (part 1, part 2, part 3, part 4, part 5, part 6). By publishing some of the strongest authors on the subject, all of whom approach the relevant science through the lens of orthodox Catholic moral theology, we wanted to provide a resource for bishops, and for those who advise bishops on the question of Plan B. Having researched the question and completed the series, HLI makes the following conclusions:
1.    Recent large and robust studies indicate that Levonorgestrel-only contraceptives such as Plan B rarely block ovulation, and most likely do result in the death of the embryo if administered during the first 4-5 days of the fertile window.*
2.    A Luteinizing Hormone (LH) protocol – a test whose outcome has been understood to determine whether a drug can be administered based on where the victim is in her cycle – cannot in fact detect that a woman is in these first days of her fertile window. Therefore a negative LH test may well encourage administration of Plan B precisely when it is most likely to cause an early direct abortion.**
3.    Because recent scientific studies have provided very strong data that indicates Plan B rarely has any contraceptive effects and is likely to have embryocidal effects, a medical practitioner cannot attain moral certainty that administration will not lead to early abortion.
4.    Since one cannot attain moral certainty that abortion will be avoided, protocols and policies that currently permit Catholic health care providers to administer Plan B need to be reconsidered by the appropriate diocesan authorities and hospital administrators. Nations in which abortion is illegal should be aware of this potential abortion-inducing effect and should prohibit the administration of these drugs.
These are our conclusions pending any developments in scientific research. Further, it appears that no contraceptive exists that is known to meet the reasonable criteria expressed by the Church above.
The urgency of addressing this matter comes to light when one considers the Church’s teaching regarding abortion expressed most recently in Dignitas personae:
It must be noted, however, that anyone who seeks to prevent the implantation of an embryo which may possibly have been conceived, and who therefore either requests or prescribes such a pharmaceutical, generally intends abortion. … Therefore the use of means of interception…fall within the sin of abortion and are gravely immoral. (23)
Here we have considered the use of a contraceptive following the unjust act of rape. We must, however, also reaffirm the Church’s unchanged and unchangeable doctrine on both abortion and the contraception of the marital act – both remain morally illicit without exception. As Pope Paul VI wrote in Humanae vitae, “it is necessary that each and every marriage act remain ordered per se to the procreation of human life.” (11)
We hope that Catholic bishops and those who advise them in these issues will see the urgency of revisiting the approval of Plan B for treatment of women who have been raped. These women deserve the absolute best life-affirming care possible, and this care should not include drugs that only compound the violence already suffered by causing abortions.
Further, we ask those concerned both for women who suffer rape and for nascent human life to approach bishops on these questions with respect, and pray for our shepherds that these and all answers to questions about human life and dignity may express, in the words of Dignitas personae, “a great ‘yes’ to human life.”
__________________
* There is a distinction in the scientific community between an abortifacient effect, which disrupts a pregnancy after implantation, and an embryocidal effect, which is “interceptive” or prevents implantation. Plan B appears to have the latter, embryocidal, effect. Since a human life is destroyed in either case, the distinction is not moral but technical, so we have stayed with the common language term and note here the difference.
** Previous scientific statements on Plan B’s mechanism of action declared Plan B to work mainly by preventing ovulation. Recent scientific evidence suggests, however, that Plan B does not work by preventing ovulation. Moreover, recent scientific evidence also shows that Plan B has no effect on cervical mucus or sperm function. Finally, as suggested in Point 1, recent evidence suggests that due to shortening of the luteal phase and other indicators, Plan B may likely prevent the new embryo from implanting into the uterine wall, resulting in an embryocidal effect.
- See more at: http://www.hliworldwatch.org/?p=2464#sthash.H8dPXw9K.dpuf

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I am an enormously blessed husband and dad. In regard to my Catholic theological background, I have a certificate in social ministry & a master's degree (moral theology concentration), as well as a catechetical diploma from the Vatican's Sacred Congregation for the Clergy (Nope, I am not now - nor have I have ever been - a seminarian, deacon, or priest.). I feel particularly proud to have a mandatum. I also have a doctorate in Christian counseling psychology.

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