February 3, 2012 (LifeSiteNews.com) – Elise Hilton took a strong stand rooted in her pro-life convictions last week when she refused the drug Plan B after her mentally disabled daughter was brutally and repeatedly raped.
After we reported her story yesterday, words of sympathy came flooding in, but many also questioned Hilton’s concern that the drug could cause an abortion. Others outright attacked her and accused her of trumpeting an “anti-choice” myth at the expense of her daughter.
The use of Plan B for rape victims has become the standard practice in health facilities throughout North America – to the point where state legislatures have even forced it on Catholic hospitals. But it’s a hot-button topic within the pro-life movement, and is more complex than it may seem.
There are essentially two key issues: First, is Plan B in fact an abortifacient? And second, if it is an abortifacient, is it possible to administer the drug without the risk of deliberately causing an abortion?
Is Plan B an abortifacient?
The drug’s purported aim is to prevent pregnancy within the first few days after intercourse. It acts firstly by preventing the fertilization of the women’s ovum by either (1) delaying or suppressing ovulation, or (2) inhibiting the transport of the sperm or the ova.
But studies have found that if fertilization has already occurred, the drug can also act by thinning the uterine lining to prevent the newly conceived zygote from implanting, and thus cause an early abortion.
The Food and Drug Administration and even Plan B’s manufacturer, Barr Pharmaceuticals, both recognize the possibility of this “anti-implantation” or “post-fertilization” effect. One 1994 study found that this effect could account for most cases where the drug “prevents” pregnancy.
Recent studies have called this abortifacient function into question, however, leading some pro-life organizations like the Catholic Health Association to dismiss it.
But even the CHA, which supports the use of Plan B for rape victims at Catholic hospitals, still admits the possibility of the abortifacient function. Dr. Ronald P. Hamel, the CHA’s Senior Director of Ethics, wrote in 2002 that “the destruction of a conceptus cannot be absolutely ruled out.” In 2010, when CHA was attempting to justify their stance in favor of the use of Plan B, Hamel still could not rule out an abortifacient effect. He wrote that “virtually all of the evidence in the scientific literature indicates Plan B has little or no post-fertilization effect.”
Furthermore, some studies continue to find evidence suggesting an anti-implantation effect, so the more recent studies are not unanimous.
Of course the wider scientific and bioethical community reject the whole debate about the drug causing an abortion, because they long ago redefined pregnancy to begin at implantation. But obviously that won’t fly for pro-lifers who believe, as the embryologists do, that life begins at conception.
The overwhelming view among those who have not bought into this redefinition is that Plan B carries at least a minimal risk of causing a chemical abortion. Some, including the Pontifical Academy for Life, believe the risk to be far more than minimal.
Can Plan B be taken without the risk of deliberately causing an abortion?
Acknowledging this risk, some Catholic moral theologians have argued that you can avoid the abortifacient effect by simply ensuring the woman is not pregnant when she takes it. They oppose its use in general as a contraceptive, but support the drug in cases of rape, arguing that it’s morally just for the woman to repel the attacker’s semen.
So Catholic doctors have proposed two approaches to testing the victim for pregnancy.
The first involves a simple pregnancy test. But even advocates of this approach admit that all this will do is establish a pregnancy existing prior to the rape. The test only actually shows up positive a week or so after intercourse, so it wouldn’t detect a baby conceived from the rape.
The second approach seeks to determine whether the woman has ovulated or not based on an assessment of her menstrual history, or in the case of the more rigorous Peoria Protocol, also based on a urine test and blood test. If she has not ovulated then she is clearly not pregnant, the theory goes. But even with all of these tests, advocates of this approach admit the possibility of “break-through ovulation” even if the results are negative, meaning the victim could still become pregnant.
The fact that these tests can still fail to circumvent the abortifacient function would be enough for many to rule the drug out. It goes back to the classic hunter in the woods scenario. If a hunter sees something moving behind a bush he can’t shoot until he knows for sure it’s not another person.
But some Catholic theologians argue that the improbability that the drug would cause an abortion raises enough doubt to offer “moral certainty” that an abortion will not occur. They argue that the child’s death would be an unintended consequence outweighed by the broader concern for the rape victim’s psychological state.
But this argument reduces moral certainty to a weighing of probabilities. If we acknowledge even the remote possibility that the drug will “prevent pregnancy” by destroying a human life, then we are directly responsible if it does. We cannot say that we are morally certain a child will not die as a result of Plan B when we admit there is a chance one could die, no matter how improbable we believe that chance to be.
The hunter in the woods can’t settle for probabilities. If we accept that Plan B carries a risk of abortion, there is a reasonable fear that an abortion could take place, and we cannot be morally certain that one will not. Any risk of directly committing an abortion is unacceptable, however remote.
As bioethics expert Bishop Elio Sgreccia, then-president of the Pontifical Academy for Life, told LifeSiteNews in 2008, Plan B “is not able to prevent the rape. But it is able to eliminate the embryo. It is thus the second negative intervention on the woman (the first being the rape itself).”
We must always err on the side of life
I know that this is a heart-wrenching and deeply personal issue, especially of course for women who have suffered rape and taken Plan B on doctors’ advice. I want to emphasize that I am no way intending to make accusations. This is a complex issue, and I am in no position (and have no desire) to judge a decision made in such horribly difficult circumstances.
I’ve made my case against Plan B from the perspective of those suggesting the abortifacient risk is minimal. But many researchers, theologians, and pro-life advocates are gravely concerned that it’s more than a remote possibility, and it’s not my intention to suggest otherwise. My point is that even if we accept the premise that it is simply a remote possibility, that’s still enough to rule it out on moral grounds.
Commenters accused Elise Hilton of jumping into a serious life-or-death decision based on faulty science. But the science is far from settled, and where there is doubt we must always err on the side of life.
I stand with her.
Patrick Craine is Canadian Bureau Chief for LifeSiteNews.com and the president of Campaign Life Coalition NS. He lives with his wife and two children in a rural town in Nova Scotia.