Thinking ethically about emergency contraception

An excellent article in the Journal of the Catholic Health Association of the United States by Ron Hamel, PhD, examines the controversy over the use of emergency contraception in Catholic hospitals for victims of sexual assault.

Noting that at the heart of this controversy is the question whether ‘medications used for emergency contraception have an abortifacient effect’, Hamel argues that ‘much hinges on accurately understanding how these hormonal medications work’. Good moral judgments, he states, depend in part on good facts. Unfortunately, in the case of emergency contraception (EC), good facts are not always present:  ‘In many instances, critics base their moral judgments on prevailing beliefs or assumptions about mechanisms of action that may be based on drug manufacturer labelling, or on outdated scientific literature, or on mere supposition’.

Hamel examines the science of hormonal EC - known in the USA as Plan B - and concludes from this that ‘the preponderance of scientific evidence strongly suggests that Plan B does not have an abortifacient effect’. From there he discusses the issue of moral certitude, as opposed to absolute certitude. The evidence stops short of providing absolute certitude that EC is not an abortifacient - but, he asks, ‘is absolute certitude needed?’

Hamel explains:

‘In the Catholic moral tradition, what is required of an agent when he or she makes a moral judgment is that he or she have moral certitude about the correctness of the action ... Moral certitude means that the agent has excluded all reasonable possibility of error. It stands between mere probability, where alternative opinions are equally plausible, and absolute certainty, where any theoretical possibility of error is not only excluded, but is impossible.’

In relation to the question of whether EC should be given to victims of sexual assualt, Hamel argues that the scientific evidence its mechanism of action, and the high probability that there is no fertilised egg present subsequent to the sexual assault [as ‘the incidence of a pregnancy after rape is between <1 percent and 5 percent'], the 'requisite moral certitude exists that a fertilised ovum would not be destroyed by the administration of Plan B'.

In conclusion, Hamel argues:

'The administration of emergency contraception to women who have been sexually assaulted is a matter of utmost seriousness since it touches on human life. It is also a matter of utmost seriousness because it touches on the well-being of women who have been subjected to one of the most heinous of crimes. Any decision about whether or not to permit the dispensing of emergency contraceptive medications in Catholic hospitals and about the protocols for their administration has profound consequences.

'Those who make such decisions, whether bishops, hospital executives, emergency room physicians, nurses or others, have a grave moral obligation to take seriously one of the first rules in making good ethical judgments, namely, to obtain adequate and accurate information about the matter at hand. To do any less is not only to shortchange the moral process, but also to risk significant harm to others. And once the best possible information is obtained, those making the decisions need to keep in mind that the use of emergency contraception for women who have been sexually assaulted is a matter about which moral certitude is sufficient. Given what is currently known about Plan B from scientific research, Catholic hospitals can respond with sensitivity, compassion and assistance to women who have been raped and are in need of care, while being confident that they are also remaining true to Catholicism’s fundamental commitment to respect for human life.'

Ron Hamel is senior director, ethics, Catholic Health Association of the United States.

This article is reproduced in full here.