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Where's the Catholic Voice?

Silence Greets Emergency Contraceptive Bill

By Skip O'Neel

Unnoticed in a legislative session which has focused on a record-breaking budget deficit and minivan auto emissions, is a bill that could have a great impact on our nation's abortion debate. That such a bill should go unnoticed is strange: one would expect pro-life groups and the Catholic Church in the state to take a stand on such a bill. But, to date, most pro-life groups and every official Catholic organization have been silent.

The bill (AB 1860) by Assemblywoman Carol Migden (D-San Francisco) would require that physicians who treat rape victims inform them about the possibility of using "emergency contraception." It further stipulates that if the patient requests such treatment, the physician must provide it to her. In her "author's statement," Migden asserts, emergency contraception "can safely prevent pregnancy within 72 hours after a rape and can reduce the risk of pregnancy by as much as 95%. Despite its safety and efficacy, recent studies have found that many hospitals do not provide information about or access to emergency contraception even to women requesting it. This bill would ensure that rape victims get the care and support they desperately need" [emphasis added].

In its description of the legislation, Planned Parenthood notes just who it is that Migden means by "many hospitals": "While more than 32,000 women become pregnant as a result of sexual assault each year, 82 percent of Catholic hospitals do not offer emergency contraception, even in the instance of sexual assault."

Given the fact that Migden's bill could have serious ramifications on culture of life issues, one would have expected Catholic Healthcare West, the California Catholic Conference, and the California ProLife Council to come out opposed to the measure. The only recorded opposition, however, came from the non-partisan Committee on Moral Concerns. The California Catholic Conference would not comment about why they have not opposed the Midgen bill. Sources inside the state capitol say that the ProLife Council is following the lead of its parent organization, the non-sectarian National Right to Life League, in staying neutral on bills dealing with contraception.

More perplexing was the lack of opposition to the measure by Catholic Healthcare West. After all, emergency contraception is perceived by many Catholics to be another way of saying, "abortion." Since the Church expressly prohibits abortion, most would expect Catholic Healthcare West to oppose Migden's bill.

To explain why they have not opposed the bill, Catholic Healthcare West officials point to the Ethical and Religious Directives for Catholic Health Care Services, issued by the United States Conference of Catholic Bishops. According to the Directives, "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."

Furthermore, according to Catholics United for the Faith in Steubenville, Ohio, "Rome has in practice upheld that pregnancy-impeding interventions in anticipation of rape or after the assault are morally licit. [This is] not because they seek to be contraceptive, but because they represent the just intervention to repel the unjust imposition of intimacy by the rapist and associated consequences. Thus, a barrier to semen may be used, as well as a post-coital removal or killing of semen; but once life is conceived, no action to end that life may be taken."

This is what makes the Migden bill so interesting for many faithful Catholics inside the state capitol and elsewhere: if a Catholic health care organization may use extraordinary means to prevent conception after a rape, but may not resort to abortion, isn't "emergency contraception" (commonly understood to be abortifacient) inimical to Catholic beliefs? As indicated above, many see no functional difference between the "abortion pill," RU-486, and "the morning-after pill" (i.e., emergency contraception).

According to moral theologian Monsignor William Smith, who teaches at St. Joseph Seminary in Dunwoodie, New York, "it's wrong to say you can use anything that has abortifacient properties. 'Emergency contraception' is double talk. It's what I call 'verbal engineering.' Catholic hospitals are not free to prescribe or provide anything with abortifacient properties without contradicting their witness. If they don't see a problem with that, someone's playing a game."

On its face this is a compelling argument; and to understand why, it helps to know exactly what is typically meant by the term "emergency contraception."

As stated on the American Life League's web site, "Emergency contraception (also known as the morning-after pill) is a high dosage of the birth control pill. It is recommended [for use] after sexual intercourse, over a period of 72 hours, to achieve the goal of preventing or ending pregnancy. There are three different ways birth control pills are currently being promoted for this use: progesterone alone, estrogen alone, or both of these artificial steroids together.

"The emergency contraceptive/morning-after pill has three possible ways in which it can work: 1. ovulation is inhibited, meaning the egg will not be released; 2. the normal menstrual cycle is altered, delaying ovulation; or 3. it can irritate the lining of the uterus so that if the first and second actions fail, and the woman does become pregnant, the tiny baby boy or girl will die before he or she can actually attach to the lining of the uterus."

Progesterone-only drugs, says Dr. Eugene Diamond, director of the Catholic Medical Association's Linacre Institute, accomplish the third result listed above by blocking the uterus' receptor sites. This prevents implantation of the embryo in the uterine wall. In this way, the embryo starves and dies. Estrogen, on the other hand, alters the menstrual cycle or prevents ovulation from occurring.

In keeping with the Directives' admonition to do appropriate testing and thus prevent these unwitting abortions, the Catholic Health Association in St. Louis observes that two doctors in Illinois have recently devised a method known as the "Peoria protocol." Using this process, doctors can accurately measure whether and when a woman has ovulated. "[T]he obstetrician first gives the rape victim a progesterone level test and then uses a urine 'dip stick' (Ovu Kit) to test for the presence of luteinizing hormone (LH). If the LH test is negative and supported by progesterone level findings, ovulation is not occurring and Ovral [a type of emergency contraceptive containing synthetic progesterone and estrogen that delays ovulation] may be used. If the LH test is positive, the process of ovulation is under way and Ovral should not be used. The method seems to obviate the quandary that occurs when a rape victim is unsure whether she has ovulated."

The Catholic Health Association also mentions measuring mucus levels as an appropriate test for ovulation: "this can be done with a test called 'ferning,' that assesses the capability of the mucus for transmitting spermatozoa. If the mucus is sticky, it will not allow the sperm to penetrate the reproductive tract. But if the mucus is stringy, that is a sign that ovulation has occurred, enabling the sperm to penetrate. Unfortunately, few emergency room physicians are adept at discerning the texture of cervical mucus, so ferning is not the standard of care followed in emergency rooms."

Why is testing for the possibility of ovulation important? Because, experts say, no pregnancy test will be wholly accurate after a recent rape. Indeed, it usually takes ten days before one can take a reliable pregnancy test. Thus, if there is no chance that a woman is fertile, physicians can administer a drug such as Ovral, which will very likely delay ovulation.

"But if it's anywhere near the fertile period," says Dr. Robert Saxer, president of the Catholic Medical Association, "you don't want to use these drugs. Once fertilization or conception occurs, then it takes a little while for the embryo to migrate down the fallopian tube. Having had emergency contraception, by the time the embryo gets down into the uterus for implantation into a possibly hostile uterine lining, that is taking a chance that you will abort that baby."

Nonetheless, there are deep disagreements about the exact abortifacient qualities of these medications, with many strongly pro-life doctors arguing against the position staked by people such as Monsignor Smith and Dr. Saxer. This is another reason why the California ProLife Council has decided to stay neutral on bills dealing with any form of contraception.

It is also why a source at Catholic Healthcare West, who would not speak for attribution could say, "emergency contraception does not equal RU-486. Emergency contraception is a large dose of the birth control pill. It is not an abortion; it is the prevention of conception. When the element of choice is removed, then emergency contraception is licit."

"There is a discussion that has been going on for a number of years about the clinical properties of certain drugs [used in emergency contraception] so that it is a clinical debate and not an ethical debate," says Father Michael Place, president of the Catholic Health Association. "And in the absence of any authoritative interpretation of that issue, the debate remains an area to be decided by the competent moral authority. [Thus,] the local institution would consult theologians with a known fidelity to Church teaching in order to gain guidance. And right now there are different perspectives amongst theologians who are faithful to Church teaching about the advice they would provide."

One faithful theologian who comes down squarely on the side of emergency contraception as abortifacient is Dr. Germain Grisez, professor of Christian Ethics at Mount St. Mary's Seminary in Emmitsburg, Maryland. He claims that douching with spermicide as an immediate post-rape intervention would be morally licit since such means are not abortifacient in nature.

However, in volume two of his book The Way of the Lord Jesus: Living a Christian Life, he writes, "while the victims of rape try to prevent conception, considered [to be] the ultimate completion of the intimacy wrongly imposed on them, if the attempt fails, there is no justification for abortion, because a new person then exists with his or her own life and right to it. Hence, it would be wrong for a woman anticipating [the possibility of a] rape to use an abortifacient, such as an intrauterine device, or for a physician to do a dilatation and curettage on a victim of rape to prevent the implantation of an embryo if there is one."

How do all of these issues play out for Catholic health care in California? For instance, does Catholic Healthcare West use only steroid contraceptives or does the company's hospitals also employ means such as spermicides? Do Catholic Healthcare West officials consider all forms of "emergency contraception" to be morally licit, or do they think some are abortifacients? The answer is unknown because a call to an ethicist at Catholic Healthcare West headquarters to ascertain that corporation's protocol for treating rape patients went unreturned.

However, as noted by Father Place, who oversees an association of 61 Catholic health care systems -- including Catholic Healthcare West -- throughout the United States, "a Catholic facility may never directly provide medication that would intentionally bring about a death of human life. Secondly, according to [the Directives], Catholic health care institutions can provide a rape victim medication that would impede or preclude fertilization. The Directives go on to balance those two positive statements by saying that provision of contraceptive service medication can only take place after appropriate testing. That testing is the responsibility of the local institution if there has not been any guidance from the diocesan bishop. So across the country there is a consistent pattern of testing to make sure there has not been prior pregnancy and there are appropriate clinical evaluations to arrive at an informed clinical judgement that there is not an existing pregnancy."

Whatever the nuances of the Catholic Church's teaching on the matter, Carol Migden's bill is progressing at a steady pace. It passed off the assembly floor by a 50-3 vote, with at least 12 Catholics voting for it, and no Catholics voting against it. (There were 27 abstentions.) From there it moved to the state senate, where it awaits a hearing by the senate public safety committee. Given that committee's overwhelmingly liberal make-up, it seems a sure bet to move to its next step, the equally liberal senate appropriations committee. From there it will move to the senate floor, where it will likely pass on a party-line vote. It will then move back to the assembly for concurrence in any amendments the senate may have added. By late summer, it should be on the governor's desk, where the incumbent Gray Davis, eager to show his pro-abortion bonafides, will likely sign it into law.

In the meantime, says one capitol source (who spoke on condition of anonymity), "it would be nice for some prominent Catholic group -- be it Catholic Healthcare West or the Catholic Conference -- to start talking about some of the problematic elements within this bill. We need a Catholic voice to be heard. We can't expect to change the culture -- to turn our culture of death into a culture of life -- if what passes for the hierarchy in this state won't offer some clear-cut, compelling guidelines. That's what the Florida bishops and Florida Catholic Conference did with a similar bill in that state, and they defeated the bill. Folks here won't have the same success, obviously, but couldn't they at least try? It'd be better than the deafening silence we're getting now."

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