The state of Plan B and the CT bishop’s decision

This post will provide two services:

• As promised, it will present recent medical findings which make a compelling argument that Plan B does not, in fact, act abortifaciently
• Additionally, it will cite examples of a growing consensus among reasonable commentators that the recent decision of the Connecticut bishops was still not in the best interests of Catholic hospitals in the U.S.

Before I continue I must make this very clear: I am not claiming definitive knowledge about what I discuss. I am in the process of coming to decisions about the moral issues involved here, and I present below my current position on the questions - albeit a position that I have been researching and thinking through at some length. The main purpose of this post is to keep this debate in the public eye and not rest until we are satisfied with the conclusions that have been reached. That said....

First, the medical findings:

I have been corresponding with a practicing family physician who has reviewed the medical literature and concluded that levo-norgestrel as dosed in Plan B is probably not abortifacient, granted that it is very hard in this case to prove a negative. However, what is required here is moral certainty, not absolute certainty. There is the possibility, as yet undiscovered, that Plan B could act against an already-conceived human being. I think one of the problems in this debate is that previous reports, now contradicted, did claim to detect an abortifacient side-effect to Plan B in some cases. If those reports were in fact false, and had never been issued, we would be in a very different frame of mind when viewing this situation now.

First, some summarized background on the medical situation (and several facts you might not necessarily take into consideration immediately without prompting):

• A pre-implantation embryo is invisible, which means absolute moral certainty regardings its presence and survival is difficult to obtain
• While most oral contraceptives, when taken regularly, do in fact reduce the endometrial lining (typically from 5mm to even less than 2mm), Plan B apparently does not have enough time to begin reducing the lining of the endometrium. And since it is only administered once, nor does it have a chance to reduce the endometrial lining after implantation.
• There is also increasing evidence that Plan B operates primarily by preventing ovulation
• Furthermore, its secondary effect of thickening cervical mucus and altering uterine pH levels are also demonstrable
• One of the frequently-cited sources for the claim that Plan B acts abortifaciently has since been shown to have relied on unscientific methods for determining its findings
• Often people claim something to the effect that "clearly Plan B is an abortifacient because it says so on the label!" However, there is plausible reason to believe that this warning was placed on the label to avoid legal complications because the manufacturers did not know (and admittedly, probably did not care) whether the chemical effects the endomitrium.
• Other research into the effects of Plan B [like this notable one] seem to ignore the fact that Plan B, while similar to the contraceptive pill, does not have the same duration of time than the contraceptive pill has to deplete the endometrium.

Here is an extract of the physician's findings:

Plan B, levo-norgestrel does not appear to cause abortion by damaging the endometrium. A 1974 article and extrapolation from daily oral contraceptives have contributed to this common misperception.

Some “emergency contraception” such an IUD’s and mifepristone most likely do prevent implantation.

There is now good evidence that Plan B does prevent ovulation in some women. Plan B, given after ovulation has occurred, may still prevent some conceptions by making the uterine environment unfriendly for spermatozoa.

You can read the two-page summary of the medical findings (as well as a note regarding ovulation testing) in a Word Document here.

I think this short summary reveals that a very serious study of Plan B's effects needs to be undertaken to provide the Catholic medical community with the scientific data it needs to evaluate the morality of proscribing it to rape victims.

As a side-note, I'm also hearing reports than Plan B's effectiveness is drastically below the near-100% figures claimed by the manufacturer (as low as 60%). We can probably expect pharmaceutical companies to eventually develop a "99%" effective pill that may include endometrial thinning as one of the mechanisms for preventing sustained pregnancy. Such a pill, on principle, would have to be resisted once it is scientifically demonstrated that it in fact has the ability to act against an already-conceived human being.

Now, a look at the the emerging consensus:

Having analyzed the recent medical findings on Plan B, we must now take a look at the prudential nature of the CT Bishop's decision from the standpoint of legal precedent, and therefore, within a wider context. After all, this decision did not occur in a vacuum.

As I said at the time, I believe the National Catholic Bioethics Center statement on this question is best. I will re-iterate here the conclusion that I came to in my commentary on the document:

While the NCBC understands the judgement of the CT bishops regarding the claimed moral neutrality, as such, of allowing Plan B, the NCBC also brings up the point that because a) it is immoral to violate one's conscience and b) this law does not allow an exemption of conscience therefore .... c) this law immorally legislates that people violate their consciences.

Simply put, a law which requires Catholic hospital employees to violate their conscience in the practice of their medical profession is unjust. Numerous commentators have agreed.

Fr. Thomas J. Euteneuer, president of Human Life International had this to say:

"Acts of blatant coercion of Catholic consciences are already far advanced and will only continue unless the church is willing to stand up and rebuke the arrogance of these coercive measures and carve out strict realms of conscience which are unreachable by activist courts and corrupt politicians." {Source.}

The Catholic Media Coalition has been especially vocal about reversing the situation of compliance.

More recent related stories:

• Connecticut bishops' stand on emergency contraception draws criticism (CNS)
• Colorado Springs Bishop Says He Does Not and Would Not Permit Plan B in Catholic Hospitals (LSN)
• American Life League Urges Connecticut Bishops to Rethink Plan B at Catholic Hospitals (LSN)
• An Open Letter to the Bishops of Connecticut by Michael Augros of First Things
• A very illuminating historical look at this situation was published in The National Catholic Register.

From the proceeding I conclude:

• Medically speaking, it appears that prior claims regarding the abortifacient properties of Plan B, when administered once, are unable to be substantiated. Indeed, the best review of current research would seem to suggest that Plan B, when administered once, does not render the uterus inhospitable to new human life.
• That said, legally speaking, it is unjust for the Connecticut State Legislature to enact a law that a) contravenes the consciences of Catholic employees, b) legislates restrictions upon what testing may or may not be administered to rape victims and c) withholds pertinent information from these victims at a crucial time in their decision-making process.

As such, and in times such as these, we need to support the CT Bishops in reversing this unjust law.

Previous AmP coverage of this story - starting the day it happened - available here.

Constructive comments are always welcome. Emails receive greater attention and priority.