Rape and Plan B in Colorado: The Ethics of Not Informing
Colorado lawmakers sent governor Bill Owens a bill yesterday that would require Catholic hospitals to tell rape victims about emergency contraception (Plan B pills). House Bill 1042, requires all health care providers in the state to offer information and referrals on how to get pills that let rape victims avoid pregnancy. There is question whether the governor, who is Catholic, will veto, sign or allow the bill to become law in 10 days without his action.
Plan B pills generally do not work by causing an abortion but act by preventing fertilization or implantation of the fertilized ovum in the uterus.
The issue is whether rape victims who are not as yet pregnant should not be given by healthcare providers important information and referred to resources where the pills can be obtained because of religious doctrine against doing so. The ethics is whether the victim should be, in a way, further victimized (healthcare malificence) by becoming unwillingly pregnant. This behavior of the healthcare institution could put the patient in a state where she would be forced to accept the product of the pregnancy or have an abortion, the very act that the Catholic institution erroneously contended that the Plan B pills would accomplish. Are there any arguments by my visitors regarding the ethics of this controversy? ..Maurice.
posted by Maurice Bernstein, M.D. @ 9:08:00 PM
13 comments
13 Comments:
To avoid confusion and rancour, I need to preface my remarks by saying that I think every woman should be able to control her own body. I also believe, however, that physicians, pharmacists and other health care workers should not be compelled to act contrary to the dictates of their consciences, even if I don't happen to share their convictions.
1) Although I'm not catholic, I do know that orthodox catholic ethics is a version of "natural law ethics," so it matters not whether Plan B works by preventing fertilization or implantation rather than by causing an abortion of an already implanted embryo -- if it interferes with normal biological functions, it's viewed as unethical.
2) Failure to act beneficently is generally not equivalent to acting maleficently. And there's a real question about whether "medical" beneficence extends to the provision of services for which there is no "medical justification" (i.e., treatment or prevention of diseases or pathological conditions). Since normal biological functioning is not medically pathological, prevention or termination of a biologically normal pregnancy is usually not "medically indicated."
3) This conflict between the rights of women to access drugs to control their own bodies and the moral convictions of health care workers results from the fact that contraceptives and abortifacients are available "by prescription only." If the FDA would follow the recommendations of its own experts and grant "over the counter status" to these drugs, the problem would largely disappear. Women would have greater access to contraceptives and abortifacients than they now do, AND health care workers would be able to honor the dictates of their consciences. That's called a win-win solution.
Catholics are stuck with the doctrine that Paul VI expounded in 1968 in his encyclical Humanae Vitae. Bottom line: all artificial birth control is wrong. It's probably the single most ignored doctrine. And Bob Koepp, above, is correct about the teaching.
The religious issue may be that preventing implantation is a mechanism of emergency contraception. Some with a religious objection to emergency contraception draw the line between preventing fertilization and preventing implantation-the fertilized ovum is a human life and preventing implantation is an abortion.
5in9years
Here's the official position of the Catholic Health Association:
Catholic Health Association Supports Medically Appropriate, Morally Acceptable Care for Sexual Assault Victims
WASHINGTON, DC (March 21, 2002) – The following statement is being released by Rev. Michael D. Place, STD, president and chief executive officer, Catholic Health Association of the United States (CHA):
The Catholic health ministry, a ministry founded in large measure by religious women known for their service to women and children, is committed to providing personal support and quality medical care for any woman who is a victim of sexual assault. In fact, the Ethical and Religious Directives for Catholic Health Care Services say that "compassionate and understanding care should be given to a person who is a victim of sexual assault [and that] a female who has been raped should be able to defend herself against a potential conception from a sexual assault." If, after appropriate testing, it is considered medically appropriate, approved FDA drugs can be administered in a Catholic hospital for contraceptive purposes for the prevention of fertilization. In a narrow set of circumstances, a Catholic hospital cannot provide these drugs if their effect would be abortifacient: that is, the fertilized ovum would be destroyed. While some would assert that the fertilized ovum prior to implantation is not human life, the Catholic tradition does consider the fertilized ovum to be human life and deserving of the respect and protection due any human being.
So there you have it. Catholic hospitals can provide contraceptives within the hospitals to prevent fertilization. The Catholic hospitals that I'm aware of also take sort of a "don't ask, don't tell" position to the effect that information provided by a practioner to a patient is confidential. If the practitioner (such as an ER physician or nurse practitioner) provides information regarding abortifacients to a rape or incest victim within the framework of the physician-patient relationship there shouldn't be a problem. If, on the other hand, the hospitals themselves are required to provide this information (which I doubt is actually the case), it seems to me there would be an open and shut First Amendment case.
PaulG, thanks for the info. How do you think a Catholic health institution would defend a criticism that a woman is being doubly victimized, first by the rapist and secondly by the institution not willing to provide assistance to prevent a rape produced pregnancy and assistance to its prompt termination? This seems not to provide comfort or beneficence to the victim. ..Maurice.
Maurice -
I think your concern about a woman being "doubly victimized" is well placed, but it needs to be understood in a manner alluded to in point (2) of my earlier message; i.e., "Failure to act beneficently is generally not equivalent to acting maleficently." The parallel point now would be that, except in special circumstances, a failure to comfort or otherwise benefit a victim should not itself be regarded as an act of victimization.
Many Catholic hospitals do in fact offer a specific medication to women who have been raped which prevents fertilization or ovalation. The drug must be given within 72 hours after the rape or it is ineffective. The test given the women is a pregnancy test because if she is pregnant it is not from the rape, but from a previous sexual encounter. Since medications can only be given with a physician prescription, this is part of the patient-physician interaction but the nurses do dispense the drugs since taking the drug as soon as possible is very important. The staff knows this is available upon doctor's order. If there is an element of secrecy about this it comes from 2 reasons. First, the ER doesn't want to see a lot of women coming in on Sat or Sun morning claiming date rape just so they can get the pill because they had unprotected sex. Second, the hospital doesn't want to be harassed by the extreme right to life people who see this as wrong even though the drug given is not an abortificant because the liklihood of conception in the 72 hour framework is very low.
Bob, the definition of victim by Webster is "someone or something killed, destroyed, injured, or otherwise harmed by, or suffering from, some act, condition, or circumstance." The action of the Catholic medical institution is not a matter of failure to comfort or otherwise benefit the raped woman (such as emotional including analgesic/tranquilizer support), it is consciously permitting a process of injury (consequences of rape) already begun to further develop (into an unwanted pregnancy) despite access to the means to stop it. ..Maurice.
Maurice -
While I share your view that an unwanted pregnancy resulting from rape is injurious (even if not an injury constituting a medical pathology...), not everybody does. And at least some of those people with whom you and I disagree are thoughtful, caring people who are sincerely trying to live according to their moral precepts. To claim that _they_ harm/victimize the rape victim by their inaction is very problematic in both legal and moral terms. In both the law and ethics, action and inaction, commission and ommission, are treated differently.
Bob, on a similar issue, what do you think about the current development of a bill in the California legislature to require pharmacists to fill legal prescriptions despite their moral values against the medication or its use? ..Maurice.
I view laws like this one as very problematic, because I think there are better ways to resolve the conflict between pharmacists' conscientious objections and the right of women to control their own bodies. As I suggested in my first post, women could have greater access than is presently the case to the drugs they need without requiring the cooperation/assistance of pharmacists. To use the law to compel pharmacists to act contrary to their sincere moral beliefs when a less drastic approach is available is, as I said, very problematic.
Also, from a purely political perspective, turning these pharmacists into martyrs is likely to be counter-productive. I think, though, that this political consideration is almost insignificant compared to the moral problems that arise if we resort to compulsion when it is not strictly necessary.
I agree with Bob Koepp's view about the law regarding pharmacists. In fact, in California our laws allow for physicians to refuse to carry out any treatment which goes against the physician's moral values. The physician, however, cannot abandon the patient and must attempt to find another physician to provide the treatment. If this permission is available to physicians who probably have a greater trust relationship with their patients than a pharmacist, one should expect that a pharmacist be treated by state law similarly. ..Maurice.
I don't know about the proposed law (other than what I have read here), but regarding one of PaulG's comments above, this wouldn't be an "open and shut First Amendment case" finding the law unconstitutional.
Certainly, this is compelled speech and, as such, raises First Amendment concerns. But, regulation of professional-client speech is, generally speaking, an unsettled frontier. Moreover, the big concerns in this area lie where speech is prohibited; here, it at least looks like the doctor could inform the patient of the drug and then voice their ethical/moral concerns. Doctors are required to tell their patients lots of things.
Moreover, any impacts on free exercise of religion are purely incidental to ensuring that rape victims are well informed of all available options. I'm not an expert, here, but I would be surprised if the law were found unconstitutional.
-Just a law student
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