Of the ten articles which compose Msgr. Kevin McMahon, STD's "Moral Issues in Catholic Health Care" (2004), I found Eugene Diamond, MD's "Post-Rape Medications" to be the most thought provoking and challenging. Inclusion of this one article makes the overall text exceedingly more valuable than its list price! It raises issues that must be of concern to Catholic health care institutions and individual Catholics in health care, as well as to all who should care about human life and honesty.
As per Directive # 36 of the U.S. Catholic Bishops' Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition (2001), "Compassionate and understanding care should be given to a person who is the victim of sexual assault. Health care providers should cooperate with law enforcement officials and offer the person psychological and spiritual support as well as accurate medical information. A female who has been raped should be able to defend herself against a potential conception from the sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medications that would prevent ovulation, sperm capacitation, or fertilization. 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" (Of note, there does not seem to be anything comparable, in the Vatican's "Charter for Health Care Workers" (1995).). As per Dr. Diamond, "application to the concrete world" of this seemingly simple directive "is more complex and demands a far more detailed grasp of the factors involved" (p. 36). Ensuring that post-rape treatment is absolutely not abortifacient poses a tremendous challenge.
There are grave "conflicts for Catholic institutions for the use of the so-called `morning-after' pill in rape protocols...[whether] in dispensing [the medication]...or referring [outside to others who will]....The crux of the matter is whether the `morning-after pill' is an abortifacient through its preventing implantation or whether it can be a contraceptive through an effect of preventing implantation when given early enough in the cycle" (p. 37). "Larimore and Sanford...have demonstrated rather conclusively by a review of the relevant literature over the past thirty years that oral contraceptives of both the combined and progestin-only form do indeed have post-fertilization or abortifacient effects....the weight of the evidence is so formidable that it is truly dishonest to dismiss the abortifacient effects as `not proven' and therefore readily to be dismissed or not considered....The American College of Obstetrics and Gynecology now defines pregnancy as beginning with implantation; but this manipulation of language is not related to modern scientific understanding so much as it is to the need to fulfill a political agenda....the logistics of the real life situation of the aftercare of a rape victim are such that the only relevant effect of postcoital hormonal agents is their ability to prevent implantation" (pp. 38 - 43).
Dr. Diamond notes that there is a far "lower than expected incidence of pregnancy following forcible rape" (p. 44). Covering reports of thousands of forcible rapes in 1.) Minnesota (1977), 2.) Cook County, Illinois (1967), 3.) Erie County, New York (1967), and 4.) Cuyahoga County, Ohio, not a single pregnancy was reported. "There is no litigated case in which denial of `morning-after' pills following rape has resulted in a greater risk of pregnancy (pp. 45, 46).
If a woman has ovulated, administration of a "morning-after" pill gravely risks being abortifacient. If a woman has not yet ovulated, administration of a "morning-after" pill MIGHT have a placebo effect. As reported by A. Glasier et al in the New England Journal of Medicine (527: 1041, 1992), however, "most women do not keep records of their menstrual periods and it is well-recognized that estimated dates are likely to be inaccurate." As per Dr. Diamond, "in all likelihood the woman is not going to become pregnant in the first place. Thus, what reasons could be given for taking any risk of an abortifacient side effect of the Ovral treatment?....it seems that there is no meaningful contraceptive effect postcoital for Ovral or similar treatments. By the time the woman presents herself for treatment, the `sole immediate effect' of Ovral is to render the endometrium hostile to a possible fertilized egg....It seems disingenuous for Catholic moralists to promote the Ovral treatment for its reputed contraceptive effect s when in fact doctors neither prescribe it nor do women take it for such purposes in the post-rape scenario" (pp. 47, 48).
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