I suppose I take a different approach than many e-journalists when I comment on the decisions of priests, bishops, and cardinals. I cannot bring myself to criticize their decisions because 1) it seems backwards to mistrust a man who authoritatively speaks in the name of Christ, and 2) as a lay person, I realize that I have much to learn from them and that they are also interested in learning from lay people’s experiences. Lumen Gentium explains that if a bishop is “teaching in communion with the Roman Pontiff,” he is “to be respected as a witness to divine and Catholic truth.” The bishop speaks in the name of Christ, and in matters of faith and morals we are to accept his teaching and “adhere to it with a religious assent.”
So when I heard about the decision of the German bishops to allow Catholic hospitals to use the morning-after pill or other contraception in rape cases, I was concerned about communication, but not critical of the decision. This is an opportunity for clearer communication, not crisis-style panic, finger-pointing, and insinuating that our bishops are ignorant. We have enough of that in the misguided secular media already.
The bishops were clear that the drug is only acceptable to treat rape victims if it is used as a contraceptive and not as an abortifacient. That means it can be used before the rape victim ovulates to prevent ovulation so that the sperm of the rapist cannot fertilize her ovum. The morning-after pill cannot be used during or after ovulation because there is a possibility that fertilization will occur, an embryo will exist, and the drug would function as an abortifacient because it renders the womb inhospitable to that life that has already begun. The decision was catalyzed by the claim of a 25-year-old rape victim who was allegedly refused treatment at two Catholic hospitals in Cologne.
I don’t know why such criticism has followed from the Catholic and pro-life communities. This decision is the same decision the United States Conference of Catholic Bishops (USCCB) issued in the 2001 Ethical and Religious Directives for Catholic Health Care Services, number 36:
“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.”
There already are guidelines for testing whether or not the woman has ovulated, and they are outlined in the Pennsylvania Catholic Conference Guidelines for Catholic Hospitals Treating Victims of Sexual Assault from 1998:
These guidelines include a sample protocol to use to determine if contraceptive intervention is clinically indicated and which protocol is designed to determine that such intervention would be truly contraceptive, and not abortifacient.
- If the pregnancy test is positive, no antiovulant drugs may be used.
- If the pregnancy test is negative, then needed clinical determinations would be based on the following:
- A menstrual history provided by the victim.
- Hormonal levels as determined by a blood test to categorize the timing of the woman’s ovulatory cycle, and
- Results of a urine test which is a reliable guide to the prediction of ovulation.
- If the urine test is negative, that may be an indication that the LH surge has not been initiated, and a contraceptive intervention would be appropriate.
- If the urine test is positive, that would indicate the hormonal shift that leads to ovulation has begun. The use of a contraceptive steroid intervention could be abortifacient and is therefore not permitted, even though there might be no evidence that conception has occurred.
It seems to me that the German bishops followed the rather long-standing protocol of the United States bishops, so that there is clarity for medical professionals in Catholic hospitals faced with treating women who have suffered rape.
What are my concerns? Well, they are concerns I have as a patient who has had negative experiences in Catholic hospitals. Pills and devices have become the mainstay of obstetric and gynecological (OB/GYN) care, and when a woman seeks to speak in terms of Catholic ethics, it is rare to find a doctor able to do so. Why is this? It is because most (if not all) Catholic hospitals in the United States have doctors providing care in them that are not Catholic and may or may not be bound to Catholic ethics depending on the contractual arrangements of the hospital with the diocese. A Catholic woman is in the unfortunate position of teaching, defending, and insisting on Catholic ethics to doctors more articulate in the use of pills and devices to solve OB/GYN issues than the ethical solutions we seek. It is frustrating, discouraging, and sometimes even frightening.
Without fail, under the roofs of Catholic hospitals, I have been asked what type of contraception I use, I have been offered genetic testing so I can “chose” whether or not to abort a Down Syndrome baby, and I have even been urged to abort because I have too many children. My experiences are not unique. Many Catholic women have to deal with the same things.
So I understand the concern of fellow Catholics. It is not difficult to imagine a woman arriving at an emergency room in need of care after being raped and all this Catholic discussion of preventing ovulation, sperm capacitation, and abortifacient effects being completely ignored. It is entirely possible that handing out the morning-after pill will become the routine treatment for rape without any consideration of menstrual history. Once the woman takes the morning-after pill and leaves the hospital, there is no way to know whether she ovulated or not, whether an embryo was created or not, whether a human was killed or not. How many times has this happened already? That is the point. We will never know.
While I appreciate the guidance of our bishops and acknowledge that in theory they are correct, I encourage them to further consider practical implications. How will anyone know whether hospitals follow the ethical protocol? I also encourage laity to communicate upwards with bishops in the spirit of charity, because as I have also pointed out repeatedly, our dear priests, bishops, and cardinals do not frequent gynecological offices. We need to tell them what happens, and we need to respect their decisions — as if we were all on the same team.
Perhaps this current dialogue will produce clarity regarding these pills and tests for ovulation, which will in turn improve the overall care given to a woman who is truly in the midst of a life-changing crisis, a goal we all share.
