Wednesday, January 10, 2007

Oral contraceptives as abortifacients

Daniel Hill writes: "I have been discussing with a friend the possibility that the oral contraceptive pill functions as an abortifacient. See, e.g.,: The Growing Debate About the Abortifacient Effect of the Birth Control Pill and the Principle of Double Effect by Waltet Larimore, MD <http://www.epm.org/articles/pilldebate2.html> Ethics and Medicine (January, 2000;16(1):23-30)

A condensation of the booklet Does the Birth Control Pill Cause Abortions? <http://www.epm.org/articles/bcp5400.html>

Since I don't rule out contraception in general, but do rule out abortion, this is of great interest and concern to me. It may be of less interest to you, but this friend also argued that it was impermissible for somebody using NFP to drink coffee, since coffee can (he said) kill a newly fertilized egg (and, indeed, a foetus). Further, since, he went on, coffee affects the ovum, whether fertilized or not, he argued that it was impermissible for a woman ever to drink coffee (pre-menopause) since she would run the risk of damaging her ova in such a way that when fertilized they would not implant, and, hence, that one would be indirectly (though of course unintentionally) bringing about the death of a fertilized egg, should one later become sexually active.

Have you come across these arguments before? How should one respond to them?"

Respondeo: First, I take it that it is uncontroversial that the conventional 'pill' can act as an abortifacient. A similar thing is true of the 'Morning After Pill': that it can prevent fertilisation, but it also works by preventing implantation. If you take the thing after sex has occurred, the chance of it working (if it works) contraceptively, rather than by causing an abortion, is reduced, and continues to fall as time goes on.

I don't see what NFP has got to do with it.

But the coffee issue is less complicated that it looks. It is conceivable (though highly unlikely) that a woman is drinking coffee in order to cause an abortion, or to mutilate herself with a view to reducing her fertility. That would violate the prohibitions on intending those things.

But if not, then it is simply the familiar question: how much care must a (potentially) pregnant woman take over her health? And the answer is: be reasonable! If drinking coffee increases the chance of miscarriage only by some tiny per cent, and a woman regards giving up as a serious inconvenience, then she's under no obligation to give up. If the danger is significant and the inconvenience small, then she should give up. The same is true of crossing the road.

As it happens I've not heard that about coffee. But every other thing is supposed to be bad for pregnant women, and it's becoming absurd. What is really the worst thing for them, IMHO, is to turn them into neurotic invalids, but that's another story...

What is tricky is whether women taking chemicals advertised as 'contraceptives' ('emergency' or not) are guilty in any sense of abortion. Anyone who cares about it will find out quickly enough that taking those things act as abortifacients, but that doesn't settle the question of whether they intend them to act as such. They may, of course, but if they don't then there's still the wrongdoing of recklessness with an innocent life which the agent in question has a particular duty to protect.

Hope that helps.

8 comments:

djhill said...

Thanks for this, Joseph.

(1) The relevance of NFP is this: if a couple is using NFP then there is a chance that they will have unintentionally caused a pregnancy and then have unintentionally aborted it, e.g. by drinking too much coffee. The same wouldn't apply to, say, the barrier method of contraception because the probability of conception there is much lower.
(2) It's not quite true to say that it is simply the familiar question 'how much care must a (potentially) pregnant woman take over her health?'. The reason why it isn't quite true is that (a) it's the health of the potential child that we are primarily considering here, (b) most people consider giving up coffee etc. only if they are trying to get pregnant -- this would apply even if they are trying to avoid pregnancy, and (c) this goes even for pre-pubescent girls and those that are not engaged in sexual activity -- they may be causing long-term damage to their ova and therefore potential death to a fertilized ovum.
(3) Apart from coffee, my friend tells me that cigarettes, chocolate, and creamy cheese are all carcinogens, and therefore out for all pre-menopausal females. (Maybe he is just giving me those whose names begin with 'c'? Oh no, alcohol too.)
(4) It was the point of wrongdoing of recklessness with an innocent life that I was trying to raise, but do you know what the probabilities are with respect to the oral contraceptive pill? (My guess is that they are too high with regard to the morning-after pill, but I don't know about the OCP.)
(5) As a matter of interest, has anyone ever run the line, do you know, that the intention in using an abortifacient such as the MAP is merely to prevent implantation and not to kill the fertilized ovum? This seems psychologically implausible to me, but I'd be interested to know.

Thanks for your help.

Joseph Shaw said...

NFP: it's relevant just in the sense that we're talking about a fertile couple. A fertile couple not using NFP would be in the same situation, wouldn't they?

Well, it still sounds like the familiar question of how much care (potentially) pregnant women should take of their health. Girls considering marriage should definately not wreck their insides: not very controversial.

On the intention of MAP: it depends on what the patient believes and desires, of course. But for someone who knows the facts, John Finnis has argued, for the Catholic bishops no less (he's an advisor to the Bishops' Conference) that the MAP can licitly be given to rape victims, with the intention of preventing fertilisation, taking accout of the forseen chance of it preventing implantation. The timing here is crucial: I don't remember the details but within a couple of days the chance of it contracepting are high enough for Finnis, although you also need to take the woman's cycle into account.

Finnis relies on the fact that contraception strictly so called is permissible if the act of sex (anticipated or past) was not willed. What is impermissible is to intend a contracepted act of sex. (Cf. the 'Nuns in the Congo' I mentioned in a previous post.)

Finnis has got a point here but it's pretty close to the knuckle. I'm inclined to think that the scandal of such a policy rules it out.

djhill said...

Thanks for this, Joseph.

(1) 'NFP: it's relevant just in the sense that we're talking about a fertile couple. A fertile couple not using NFP would be in the same situation, wouldn't they?'
Well, not if they were using barrier contraception, as per my example.

(2) 'it still sounds like the familiar question of how much care (potentially) pregnant women should take of their health'
I think that you're right: the questions weren't as different as I'd thought. But my friend's comments still add something: even if a couple is practising NFP and don't wish to have any more babies then the woman should still be careful about drinking coffee etc., not so much because of wrecking her insides, but because of the possibility of killing unawares a newly fertilized ovum.

(3) I agree entirely with Finnis over the issue of intention, but the question is whether the risk of unintentionally killing a fertilized ovum is so great as to outweigh the possible good gained. I am inclined to think it is in the case of the MAP, but in the case of the OCP I just don't know.

djhill said...

On further reflection, even if it sounds like the familiar question of how much care (potentially) pregnant women should take of their health, it still provides a more important motivation. It's bad to wreck one's insides, but it's a lot worse to take an innocent life.

djhill said...

I've been thinking a bit more about the Finnis. What's the relationship between the following two sentences of yours?
'Finnis relies on the fact that contraception strictly so called is permissible if the act of sex (anticipated or past) was not willed. What is impermissible is to intend a contracepted act of sex.'
Suppose a woman has sex intending to get pregnant, and then changes her mind, and takes the MAP. She then didn't intend a contracepted act of sex, although it was a willed act. Yet surely Rome wouldn't condone her taking the MAP.

Again, if someone took the pill just in case she got lucky, that wouldn't involve intending a contracepted act of sex, although the sex would be willed.

Each of these examples involves intending that if there should be a particular act of sex then that particular act be contracepted, but that intention of a conditional state of affairs is also common to the nuns in the Congo and the rape victim of Finnis's example.

djhill said...

In my last comment I gave examples of cases permitted by the second of your sentences describing Finnis's view, but not by the first:
'[. . .] contraception strictly so called is permissible if the act of sex (anticipated or past) was not willed. What is impermissible is to intend a contracepted act of sex.'
I now want to give an example of a case permitted by the first of your sentences, but not by the second. I believe that Rome does not approve of a rape victim's saying to the rapist 'if you must rape me at least use a condom' even though the act of sex is not willed (and even though the intention is only that a conditional state of affairs obtain). Is that right?

Joseph Shaw said...

Post-coital contraception (strictly so called): you are quite right, I can't talk about willing a contractepted act of sex; I should say (and Finnis says, I think) simply that both the sex is intended and the contraception is intended (it is intended the the natural fertility of the act of sex be impeded). It is this double intention which is forbidden. It is in relation to a single act of sex, but the two intentions can be made at different times.

If contraception is taken in advance, on the off-chance that one will decide to engage in sex, this is a conditional intention to have sex ('I'll have sex under certain circumstances'), and counts as an intention to have sex.

Cf. a conditional intention to commit murder ('I'll murder him if he comes this way') is an intention to commit murder.

'If you must rape me at least use a condom': I can't see anything wrong with this, as long as it doens't constitute consent. Compare: 'If you must kill me, use a bullet rather than an atom bomb which would kill a million other people too'; 'if you must be a prostitute, at least have regular blood tests'; 'if you must refuse to bring up your natural child, at least allow another person to adopt him.' Without intending either evil, we avoid the worse evil for the lesser evil.

Some arguments of this form fail to establish the licitness of certain things, for reasons such as those I discussed on Aids and condoms. But I don't think those considerations (eg scandal) are likely to apply in your case.

uyazi said...

Hi peps,

Please tell me this,

If a woman e.g gets raped, then takes oral contraceptives the after 24 hours (to prevent herself from getting pregnant)... will the contraceptives work in preventing the pregnancy,even though it was after?????

Im confused