Matthew Lu

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Abortifacients, emergency contraception, and terminating pregnancy

Matthew Lu
By Matthew Lu

April 14, 2014 (Public Discourse) - One of the more controversial issues in the Supreme Court case concerning Hobby Lobby is the company's claim that some of the “emergency contraceptives” demanded by Obamacare and the HHS mandate are actually “abortifacients.” The mainstream denial of this claim, supposedly backed by science, has largely revolved around a tendentious use of terms and a confusion about the real moral issues involved.

The defenders of emergency contraception, such as Guttmacher’s Sneha Barot, like to claim that

major medical organizations . . . as well as U.S. government policy, consider a pregnancy to have begun only when the entire process of conception is complete, which is to say after the fertilized egg has implanted in the lining of the uterus.

So, according to this putatively scientific definition, conception is distinct from fertilization and pregnancy occurs only with the actual implanting of the embryo in the uterine lining. According to this definition of conception, anything that interferes with any part of this process, whether a physical barrier, hormonal regulation of ovulation (or sperm production), the destruction of the embryo prior to implantation, or prevention of successful implantation, can intelligibly be called contraceptive.

Similarly, if pregnancy only occurs once conception is complete with implantation, then it is intelligible to claim that abortion is best understood as the termination of a pregnancy—not the destruction of an embryo. This also explains the medical practice of calling early miscarriage “spontaneous abortion.” Along these same lines, a method could only properly be called abortifacient insofar as it can cause (from the Latin facio) an abortion, which, in turn, is only possible after implantation.

These definitions allow emergency contraception advocates such as the Office of Population Research at Princeton University to make blanket assertions such as: “There is no point in a woman's cycle when the emergency contraceptive pills available in the United States would end a pregnancy once it has started” (emphasis added). Using the definitions of contraception and pregnancy given above, that statement could very well be true, even if the “contraceptive pills” in question directly kill a living embryo or prevent its implantation.

The rhetoric sounds good. Emergency contraception does not prevent “pregnancy,” therefore no “abortion” is involved, and no “abortifacient” methods are used.

However, this tendentious exercise in lexicography leads these advocates to confuse the real issue. Consider Sneha Barot’s claim that

if pregnancy were synonymous with the act of fertilization, all of the most effective reversible contraceptive methods—including oral contraceptive pills, injectables and IUDs—could be considered, at least theoretically, to be possible abortifacients.

Barot apparently takes it as obvious that these methods are not abortifacients, and therefore that pregnancy is not synonymous with fertilization. But, of course, whether some of these methods are abortifacients is exactly what’s in question. It doesn’t matter whether pregnancy is defined as synonymous with fertilization, but whether the methods in question directly kill an embryo or prevent its implantation.

The Principle of Double Effect

Ultimately, the moral question of abortion has little to do with the proper understanding of pregnancy at all. We can see this by reflecting on the fact that terminating a pregnancy is not evil per se. Any time a child is delivered by caesarian section, the pregnancy is terminated, but obviously there is no direct moral evil in that procedure. In fact, some pro-life moralists have even argued that some terminations of pregnancy are morally legitimate even if they result in the death of the child.

This line of argument makes use of the Principle of Double Effect (PDE), which broadly holds that an act is morally permissible insofar as it meets four conditions (this formulation is derived from David Oderberg): (1) the intended effect of the act must not be intrinsically evil (e.g., aiming at the death of an innocent); (2) any evil side effects of the act must be unintended (though they may be foreseen); (3) the good intended effect must be at least as causally direct as any unintended side effect (i.e., one cannot do evil so that good may come of it); finally, (4) the intended good must be proportionate to any unintended evils (i.e., the good must “outweigh” the evil).

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This method of moral reasoning has allowed some of these pro-life moralists to argue that in certain extreme circumstances it is morally permissible to terminate a pregnancy in a way that results in the death of the innocent child, so long as that death is not directly intended. Rarely, an embryo will implant within its mother’s body outside the uterus (an ectopic pregnancy). While there have recently been extremely rare cases of ectopic pregnancy that were safely brought to birth (through caesarian section), it had traditionally been considered a death sentence for both the mother and child. For these reasons, some adherents of PDE have argued that it is permissible to remove the child surgically from the mother (intact) even though this foreseeably results in the death of the child. Simultaneously, these same moralists argue that the use of a chemical abortifacient to destroy the embryo is impermissible.

They reason that the surgical removal of the intact child is a medical treatment directly intended to save the mother’s life. Killing the child is no part of that treatment (even as a means); were the technology available to save the child’s life that would certainly be done. So the child’s death is a foreseeable but unintended side effect of the surgery to treat the mother, and that foreseeable death is proportionate when weighed against the life of the mother. On the other hand, a chemical abortifacient would violate the PDE because, in treating the mother, the death of the child would be directly pursued. In other words, in the abortifacient case, the mother is being treated by means of killing the child. The child’s death is not merely foreseen, it is actively pursued. That is also why the surgeon must remove the child intact; otherwise, the child’s death would be directly pursued as a means.

Whether or not this particular analysis of ectopic pregnancy is ultimately correct, and we must be careful not to misuse the PDE as has sometimes been done, these examples clearly show that the moral defect of abortion lies not with the termination of the pregnancy, but with the direct killing of the child. In fact, one leading pro-life philosopher has argued that the ultimate solution to the abortion problem might lie in the technological development of artificial wombs. This would, at least in theory, allow the intact removal of “unwanted” embryos without necessarily resulting in their deaths.

If we return to the emergency contraception case, then it is apparent that the real issue is the mechanism by which they work, not what counts as pregnancy. While there are good reasons to think that contraception (understood merely as the prevention of fertilization) is itself morally defective, it is clearly a lesser evil than the destruction of an innocent human being. So I will mostly set the contraception question aside and focus on the destruction question.

The Unintended Evil: Killing an Innocent Human Being

On the one hand, the advocates of emergency contraception are quick to claim that “emergency contraceptive pills prevent pregnancy primarily, or perhaps exclusively, by delaying or inhibiting ovulation.” Obviously, if no ovum is released, then fertilization is impossible. In that case, the moral concern is solely with contraception, not homicide. However, as Donna Harrison previously argued at Public Discourse, there are good empirical reasons to believe that some of the methods in question in the Hobby Lobby case “can and do cause embryos to die after fertilization.”

It seems fair to say that the emergency contraception advocates’ hedge that emergency contraception works “primarily, or perhaps exclusively, by delaying or inhibiting ovulation” (emphasis added) reflects lingering doubt about exactly how the methods work, even among those committed to promoting their use. This is a telling hesitation, a kind of residual honesty in admitting the possibility that, in at least some of the cases, these methods directly result in the death of embryos. (Hedging phraseology of this sort occurs on numerous online discussions, including both of those previously linked and the Mayo Clinic. The New York Times approvingly notes a recent movement to remove these hedges.) I suspect this hedging represents a kind of bad faith, and this in turn explains their repeated appeals to authority and attempts to take refuge in medical definitions of pregnancy and abortion that are morally irrelevant.

In the end, of course, none of the linguistic hairsplitting matters. What really matters in the morality of abortion is not whether a pregnancy has been terminated, but whether an innocent human being has been murdered. Understanding the mechanism of how these methods work is an empirical, scientific question about which there seems to be controversy within the medical community itself. However, I think it is significant that even the advocates of emergency contraception admit uncertainty about how the methods work and whether they kill embryos or prevent implantation.

From a moral perspective, if there is any plausible reason to believe that one of the consequences of the drugs is—even occasionally—the death of embryo, then they are morally equivalent to abortifacients that work after implantation. The fact that the intended purpose of the drugs is to prevent ovulation is ultimately immaterial if their actual consequence is to kill living embryos or prevent implantation.

Ultimately, even if one thinks that the prevention of fertilization is morally indifferent, surely it is not worth pursuing at the cost of innocent human life. That is, it would not meet the proportionality requirement (4) of PDE. Furthermore, if contraception is itself an evil, then there is absolutely no good to set against even the possibility of killing an innocent human being, so proportionality would not even enter into it.

Reprinted with permission from Public Discourse


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Jonathon van Maren Jonathon van Maren Follow Jonathon

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Arguments don’t have genitals

Jonathon van Maren Jonathon van Maren Follow Jonathon
By Jonathon van Maren

“As soon as he grows his own uterus, he can have an opinion.”

That was a comment left on The Abortion Rights Coalition of Canada’s Facebook page by a woman who presumably opposes men speaking out against misogyny, domestic abuse, rape culture, and female genital mutilation as well. Apparently, you see, male genitals disqualify people from speaking out on various human rights issues deemed by women who define themselves by their uteruses while protesting angrily against being defined by their uteruses as “women’s issues.”

Which abortion isn’t, by the way. It’s a human rights issue.

To break it down really simply for our confused “feminist” friends: Human beings have human rights. Human rights begin when the human being begins, or we are simply choosing some random and arbitrary point at which human beings get their human rights. If we do not grant human rights to all human beings, inevitably some sub-set of human beings gets denied protection by another group with conflicting interests. In this case, of course, it is the abortion crowd, who want to be able to kill pre-born children in the womb whenever they want, for any reason they want.

Science tells us when human life begins. Pro-abortion dogma is at worst a cynical manoeuvre to sacrifice the lives of pre-born human beings for self-interest, and at best an outdated view that collapsed feebly under the weight of new discoveries in science and embryology. But the abortion cabal wants to preserve their bloody status quo at all costs, and so they make ludicrous claims about needing a uterus to qualify for a discussion on science and human rights.

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In fact, feminists love it when men speak up on abortion, as long as we’re reading from their script, which is why the carnivorous feminists have such a support system among the Deadbeat Dads for Dead Babies set and the No Strings Attached Club.

Male abortion activists have even begun to complain about “forced fatherhood,” a new cultural injustice in which they are expected to bear some responsibility for fathering children with women they didn’t love enough to want to father children with, but did appreciate enough to use for sex. Casual fluid swaps, they whine, should not result in custody hearings.

This is not to mention a genuine social tragedy that has men forcing or pressuring women to have abortions or abandoning them when they discover that the woman is, indeed, pregnant.

Or the fact that abortion has assisted pimps, rapists, and misogynists in continuing the crimes of sex trafficking, sexual abuse, and sex-selection abortion.

And coming against these disgusting trends are thousands of men in the pro-life movement who believe that shared humanity means shared responsibility, and that when the weak and vulnerable are robbed of their rights, we have to stand up and speak out.

We are not at all convinced by the feminist argument that people should think with their reproductive organs or genitals. We think that the number of people currently doing that has perhaps contributed to the problems we face. And we refuse to be told that protecting the human rights of all human beings is “none of our business” and “outside of our interests.”

Arguments don’t have genitals, feminists. It’s a stupid argument trying to protect a bloody ideology.

Reprinted with permission from CCBR.


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Rachel Daly

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Gvmt strikes UK Catholic school admission policy that prefers Mass attendees

Rachel Daly
By Rachel Daly

St. Joseph's Catholic Primary School in Epsom, England, was ordered to change its admissions policy after it was ruled discriminatory by the nation's Office of Schools Adjudicator, according to Your Local Guardian. St. Joseph's reportedly had been granting preferred acceptance to students whose families attended Mass at the affiliated church.

St. Joseph’s School is for students from age 4 to 11 and describes itself as “enjoy[ing] a high level of academic success.” The school furthermore places high priority on its Catholic identity, affirming on its homepage that “We place prayer and worship at the center of everything we do.”

The school states in its current admissions policy that it was "set up primarily to serve the Catholic community in St Joseph’s Parish" and that when the applicant pool exceeds 60 students, its criteria for prioritizing students includes "the strength of evidence of practice of the faith as demonstrated by the level of the family's Mass attendance on Sundays." 

Opponents of this policy reportedly argue that since donations are asked for at Mass, it could allow donation amounts to influence acceptance, and that forcing non-accepted local students to seek education elsewhere imposes a financial burden upon their families. 

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As Your Local Guardian reports, the adjudicators dismissed claims that donation amounts were affecting school acceptance, given that it is impossible to track donations. Nonetheless, the adjudicators maintained that "discrimination ... potentially arises from requiring attendance at the church rather than residency in the parish."

The Office of Schools Adjudicators, according to its website, is appointed by the United Kingdom’s Secretary of State of Education, to perform such functions as mediating disputes over school acceptances. The Office's ruling on St. Joseph's will require the school to release a revised admissions policy, which is expected in the next few days.

Reprinted with permission from the Cardinal Newman Society.


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Carolyn Moynihan

African women at risk of HIV, hostages to birth control

Carolyn Moynihan
By Carolyn Moynihan

Which should be the priority for a health organisation: preventing an incurable disease, or preventing a natural function that might have adverse physical consequences?

Preventing the disease, you would think. But the World Health Organisation would rather expose African women to HIV-AIDS than withdraw its support from a suspect method of birth control, arguing that childbirth is also risky in Africa. Riskier, apparently, than the said contraceptive. And at least one of WHO’s major partners agrees.

This is one of the stories you will not have read in coverage of the International AIDS Conference held in Melbourne last week, despite the fact that WHO made an announcement about it during the conference and the findings of a highly relevant study were presented there.

The story is this: there is increasing evidence that the method of contraception preferred by family planning organisations working in Africa (and elsewhere) facilitates the transmission of HIV. The method is the progesterone injection in the form of either DMPA (Depo Provera, the most common) or NET-En (Noristerat).

Millions of women in sub-Saharan Africa receive the injection every three months. The method overcomes problems of access. It can be given by nurses or health workers. A wife need not bother her husband for any special consideration; the teenage girl need not remember to take a pill.

But for 30 years evidence has been accumulating that, for all its “effectiveness” in controlling the number of births, the jab may also be very effective in increasing the number of people with HIV.

Three years ago at another AIDS conference in Rome, researchers who had analysed data from a number of previous studies delivered the disturbing news that injectables at least doubled the risk of infection with HIV for women and their male partners.

That study had its weaknesses but one of the experts present in Rome, Charles Morrison of FHI 360 (formerly Family Health International, a family planning organisation that also works in AIDS prevention), considered it a “good study” and subsequently led another meta-analysis that addressed some of the issues with previous research.

Last week at the Melbourne conference he presented the results. His team had re-analysed raw data on the contraceptive use of more than 37,000 women in 18 prospective observational studies. Of these women, 28 percent reported using DMPA, 8 percent NET-En, 19 percent a combined oral contraceptive pill, and 43 percent no form of hormonal contraception. A total of 1830 women had acquired HIV while in a study.

The analysis showed that both injectables raised the risk of infection by 50 percent:

Compared to non-users [of any hormonal contraceptive], women using DMPA had an elevated risk of infection (hazard ratio 1.56, 95% CI 1.31-1.86), as did women using NET-En (1.51, 95% CI 1.21-1.90). There was no increased risk for women using oral contraceptives.

Similarly, comparing women using injections with those using oral contraceptives, there was an elevated risk associated with DMPA (1.43, 95% CI 1.23-1.67) and NET-En (1.30, 95% CI 0.99-1.71).

Morrison also noted:

The results were consistent in several subgroup and sensitivity analyses. However, when only studies which were judged to be methodologically more reliable were included, the increased risk appeared smaller.

Morrison acknowledged that observational studies such as the FHI analysis depended on have their limitations. He is looking for funding to conduct a randomised controlled study – something that, after 30 years of suspicions and evidence, still has not been done.

So what is his advice to the birth control industry? Stop using this stuff in regions with a high prevalence of HIV until we are sure that we are not feeding an epidemic?

No.

One reason is that FHI is at least as interested in contraception as it is in HIV prevention. Though its website reflects a broad range of development activities, its core business is integrating birth control programmes with HIV prevention. The WHO – one of its partners -- describes the US based, 83 percent US government funded non-profit as “a global health and development organization working on family planning, reproductive health and HIV/AIDS.”

Another reason is that FHI 360 has a vital stake in precisely the kind of contraceptives that are under suspicion. Its annual report refers to:

Our trailblazing work in contraceptive research and development continues, as we develop and introduce high-quality and affordable long-acting contraceptives for women in low-income countries. Research is under way to develop a new biodegradable contraceptive implant that would eliminate the need for removal services. We are also working with partners to develop an injectable contraceptive that would last for up to six months. Currently available injectables require reinjections monthly or quarterly, which can be challenging where health services are limited.

That project is funded by the Bill and Melinda Gates Foundation and USAID.

So Morrison did not argue in Melbourne for restrictions on the use of injectables, and neither did the WHO, whose representative at the conference outlined the UN body’s new guidelines on contraception and HIV. Mary Lyn Gaffield said a review of studies up to – but not including Morrison’s – did not warrant a change to WHO’s policy that DMPA and NET-En should be available, without restriction, in areas of high HIV prevalence.

The most WHO will advise is that women should be informed of the risk:

“Women at high risk of HIV infection should be informed that progestogen-only injectables may or may not increase their risk of HIV acquisition. Women and couples at high risk of HIV acquisition considering progestogen-only injectables should also be informed about and have access to HIV preventive measures, including male and female condoms.”

Condoms? How do they defend such cynicism? By equating the risk of HIV with the risks of motherhood – complications of pregnancy or childbirth, maternal death and the effect on infants... And yet motherhood remains risky precisely because 90 percent of the world’s effort is going into contraception!

Seven years ago a meeting of technical experts convened by WHO to study the injectables-HIV link showed the reproductive health establishment worried about that issue, to be sure, but also concerned that funding was flowing disproportionately to HIV-AIDS programmes, setting back the cause of birth control. The integration of family planning and HIV prevention spearheaded by FHI 360 looks like they have found an answer to that problem.

Whether African women are any better off is very doubtful. They remain pawns in a game that is, above all, about controlling their fertility. They and their partners are encouraged to take risks with their health, if not their lives, while researchers scout for funds to do the definitive study.

FHI had an income of $674 million last year, most of it from the US government. Couldn’t it give Charles Morrison the money to do his research today?

Reprinted with permission from Mercatornet.com.


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