A new law passed by the state of Connecticut regarding treatment for victims of sexual assault, and specifically its effect upon Catholic hospitals in that jurisdiction, has created considerable controversy and confusion. Therefore, I asked Fr. Tadeusz Pacholczyk of the National Catholic Bioethics Center (NCBC) for clarification.
Fr. Tad holds a doctorate in neuroscience from Yale and has also completed advanced degrees in theology and bioethics in Rome. He combines fidelity to the Holy See with scientific expertise, so he seemed to be right person to ask. Fr. Tad kindly emailed me the NCBC’s official statement on the matter, which was just published yesterday. Here is the complete text:
NCBC Statement on Connecticut Legislation
Regarding Treatment for Victims of Sexual Assault
October 3, 2007
Recently the Bishops of Connecticut permitted a protocol in Catholic hospitals for the treatment of victims of sexual assault. This action on the part of the Connecticut bishops received national attention and requires some commentary. This is a complex moral matter and does not lend itself to brief explanation. This difficulty was rendered all the worse by inaccurate reporting and inappropriate, indeed misleading, terminology.
Catholic hospitals have always provided contraception for the victims of sexual assault. This was usually done with a medication or medications which would prevent ovulation. If an egg is not released from the ovary, the victim cannot become pregnant. There was a difficulty here, however, because some medications appear to have a negative effect on the lining of the womb that might prevent an implantation of a new human embryo if one is engendered as a result of the assault. This would amount to an early medical abortion that would not be allowed.
In light of these facts, two protocols were generally developed and approved by bishops. One protocol allowed for no use of a medication for contraceptive purposes because it might have an abortive effect.
Another more commonly used protocol tried to take into account the variety of circumstances surrounding a sexual assault in such a way as to allow the use of a contraceptive medication – if it truly worked as a contraceptive.
The protocol with the ovulation test.
A rather simple (ovulation) test is used to determine whether or not a victim has begun to ovulate or has already ovulated. If the victim has not ovulated she is given the drug that will prevent the release of the egg from taking place. If the woman has already ovulated, the drug is not given because (1) it will not have the desired effect of preventing ovulation and (2) it might, if a new life is present, have an effect on the lining of the womb and prevent implantation.
The role of bishops.
Bishops do not write medical protocols; health care professionals and medical institutions do that. If a protocol concerns a procedure that has ethical implications, it will be submitted to a bishop for his ethical judgment reached in consultation with medical and ethical experts. If the bishop is convinced the procedure will not violate the moral law, he will not stand in the way of its being implemented. He will basically grant what is called a “nihil obstat” which basically means there are no moral objections to the implementation of this protocol. Bishops simply do not have the competence to adjudicate between competing scientific claims about the mechanisms of drugs.
The legislature in Connecticut passed a law that mandated that “emergency contraception” be given to any victim of sexual assault upon her request. This law went into effect October 1, 2007. Catholic hospitals do not object to providing emergency contraception because they had been providing it all along. However, under the new law the state would not allow physicians to give a test to determine if ovulation had occurred and then to refuse to give a drug to prevent ovulation on the medical grounds that the drug could not prevent what had already taken place.
The state does allow a pregnancy test. However, this test can have nothing to do with the sexual assault. This test only identifies a conception that had taken place before the assault. It takes an embryo 5 to 7 days to make its way down the oviduct and implant in the womb. Only then does it secrete a hormone, or chemical, which can be detected in the woman’s urine or blood. It is the pregnancy test that detects this hormone. In fact, there are no tests available that can tell us if a woman has conceived right after the assault and during the time the embryo would travel down the oviduct.
The Catholic hospitals and bishops objected to the Connecticut law because it did not allow a physician to do a simple test to see whether or not the medication he or she was considering prescribing would actually have the effect for which he or she wanted to administer it. In other words, the physician would have to administer a drug preventing ovulation even if ovulation had already occurred. Frankly, that makes no medical sense. The state was preventing a physician from exercising his or her best medical judgment about a procedure he or she was considering.
A second objection centered around the fact that the medication(s) might prevent an implantation if a conception had occurred. To intend and to do such a thing is immoral. However, there was considerable debate among medical and drug experts whether or not the drugs actually had that effect. And everyone agreed there was no test even to know whether a new life had been conceived.
Finally, attention should be drawn to the fact that the Federal Drug Administration includes the intra-uterine device as “Emergency Contraception” which is a misnomer since it is known to have an abortifacient effect.
Unlike the state of Colorado, for example, the state of Connecticut would not allow physicians to exercise their best medical judgment and provided no conscience protection to physicians or hospitals to refuse to administer the drug when requested.
The decision of the Connecticut bishops and hospitals.
The Connecticut Catholic bishops and hospitals, under strong protest, have allowed a new protocol to be used that was developed by Catholic health care institutions. Furthermore, they made it clear that if a test were ever developed that allowed one to detect a conception after an assault, and if it became clear (as is not yet the case) that the medication(s) would work as an abortifacient, they could no longer accept the protocol. Finally, the Connecticut bishops pointed out that the Doctrine Committee of the United States Conference of Catholic Bishops had studied this matter for years and could not come to the conclusion that the protocol previously allowed by the Connecticut bishops (the ovulation test protocol) would have to be used by all Catholic institutions.
In matters that have not yet been decided definitively by the Holy See, The National Catholic Bioethics Center has refrained from adopting one or another position on a disputed question. However, in the matter of protocols for sexual assault, there is virtual unanimity that an ovulation test should be administered before giving an anovulant medication. The protocol the NCBC has supported requires the ovulation test because it provides greater medical and moral certitude that the intervention will have its desired anovulatory effect. The NCBC objects strongly to state mandates, such as those passed by Connecticut and Massachusetts, that do not allow health care professionals and facilities to exercise their best medical judgment and which do not protect the consciences of all parties. We also object to state mandates that do not allow the victim of sexual assault to have all the information necessary for a medical intervention so that she might make an informed judgment. However, the NCBC understands the judgment of the Connecticut bishops that the administration of a contraceptive medication in the absence of an ovulation test is not an intrinsically evil act. However, it is immoral to violate one’s conscience, including the corporate consciences of health care agencies, and the unwillingness of the state to allow an exemption of conscience makes the law unjust and onerous.
Next week on this blog we will provide further explanation of the moral principles that govern the administration of contraceptives to rape victims.