While many Catholic hospitals permit the prescription of the emergency contraception drug levonorgestrel for rape victims, some continue to prohibit this practice as a matter of institutional conscience. While the standard approach to this issue has been to offer an argument that levonorgestrel either is or is not morally permissible, we have taken a different tack. We begin by briefly describing and acknowledging that reasonable disagreement exists on this question (part one), and then arguing that the reasonable disagreement itself can serve as a compelling basis for Catholic leadership at hospitals that prohibit emergency contraception for rape victims to accommodate physicians who wish to provide levonorgestrel as a matter of conscience (part two). We end by anticipating and responding to some objections.
ASEC, American Society for Emergency Contraception. 2018. “Not There Yet: ASEC’s 2017 EC Access Study.” American Society for Emergency Contraception.
3.
AustriacoNicanor Pier Giorgioand The National Catholic Bioethics Center. 2007. “Is Plan B an Abortifacient?” The National Catholic Bioethics Quarterly7 (4): 703–707. https://doi.org/10.5840/ncbq2007746.
BakhruArvindMallingerJulie B.FoxMichelle C.2010. “Postexposure Prophylaxis for Victims of Sexual Assault: Treatments and Attitudes of Emergency Department Physicians.” Contraception82 (2): 168–173. https://doi.org/10.1016/j.contraception.2010.01.005.
6.
BergThomas. 2011. “Emergency Contraceptives & Catholic Healthcare.” Westchester Institute White Paper Series2 (1).
7.
BodenJoseph M.FergussonDavid M.HorwoodL. John. 2008. “Early Motherhood and Subsequent Life Outcomes.” Journal of Child Psychology and Psychiatry, and Allied Disciplines49 (2): 151‐160. https://doi.org/10.1111/j.1469-7610.2007.01830.x.
8.
BrummettAbram. 2020. Should Positive Claims of Conscience Receive the Same Protection as Negative Claims of Conscience? Clarifying the Asymmetry Debate.Journal of Clinical Ethics31 (2): 136‐142.
9.
BrummettAbramJamesEric. 2021. Non-Catholic Physicians Should be Permitted to Write Prescriptions for Birth Control in Catholic Institutions: Replying to Giubilini and Wilkinson, and Describing a Permissible Positive Conscience Claim.The Journal of Clinical Ethics32 (3): 265‐270.
10.
BuelSarah M.1999. “Fifty Obstacles to Leaving, a.k.a., Why Abuse Victims Stay.” The Colorado Lawyer, October.
11.
CahnNaomi. 1991. “Civil Images of Battered Women: The Impact of Domestic Violence on Child Custody Decisions.” Vanderbilt Law Review.
12.
CallahanD.1992. “When Self-Determination Runs Amok.” The Hastings Center Report22 (2): 52‐55. https://doi.org/10.2307/3562566.
13.
CataldoPeter J.2017. “Moral Certitude in the Use of Levonorgestrel for the Treatment of Sexual Assault Survivors.” In Contemporary Controversies in Catholic Bioethics, edited by EberlJason T., 127:197–222. Philosophy and Medicine. Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-55766-3_15.
14.
Catholic Medical Association. 2015. “Statement on Emergency Contraception in Cases of Rape,” September.
15.
ChauVan MimiStammCarol A.BorgeltLauraGaffaneyMichelleMooreAliaBlumhagenRachel Z.RuppLeanneToppDanielGilroyChristine. 2017. “Barriers to Single-Dose Levonorgestrel-Only Emergency Contraception Access in Retail Pharmacies.” Women’s Health Issues27 (5): 518‐522. https://doi.org/10.1016/j.whi.2017.03.010.
16.
ChuangCynthia H.ShankLaura D.2006. “Availability of Emergency Contraception at Rural and Urban Pharmacies in Pennsylvania.” Contraception73 (4): 382‐385. https://doi.org/10.1016/j.contraception.2005.11.004.
17.
ClarkeKevin. 2013. “The Emergency Contraception Question: When Is It Licit and When Is It Not? | America Magazine.” America Magazine, March 5.
18.
Committee on Health Care for Underserved Women. 2017. “Committee Opinion No. 707 Summary: Access to Emergency Contraception.” Obstetrics and Gynecology130 (1): 251‐252. https://doi.org/10.1097/AOG.0000000000002155.
19.
DavisThomas J.2017. “Evaluation of the Mechanism of Action of Anti-Fertility Treatment in Cases of Sexual Assault: Moral Certitude and Human Acts.” In Contemporary Controversies in Catholic Bioethics, edited by EberlJason T., 127:223–54. Philosophy and Medicine. Cham: Springer International Publishing. https://doi.org/10.1007/978-3-319-55766-3_16.
20.
EberlJason T.2019. “Protecting Reasonable Conscientious Refusals in Health Care.” Theoretical Medicine and Bioethics40 (6): 565–581. https://doi.org/10.1007/s11017-019-09512-w.
21.
GisladottirAgnesLuque-FernandezMiguel AngelHarlowBernard L.GudmundsdottirBerglindJonsdottirEyrunBjarnadottirRagnheidur I.HauksdottirArnaAspelundThorCnattingiusSvenValdimarsdottirUnnur A.2016. “Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence.” Plos One11 (3): e0150726. https://doi.org/10.1371/journal.pone.0150726.
22.
GrecoDonnaDawgertSarah. 2007. “Poverty and Sexual Violence - Building Prevention and Intervention Responses.”
23.
GrimesD. A.RaymondE. G.Scott JonesB.2001. “Emergency Contraception Over-the-Counter: The Medical and Legal Imperatives.” Obstetrics and Gynecology98 (1): 151‐155. https://doi.org/10.1016/s0029-7844(01)01412-0.
24.
HamelRonaldPanicolaMichael R.2002. “Emergency Contraception and Sexual Assault. Assessing the Moral Approaches in Catholic Teaching.” Health Progress83 (5): 12‐19, 51; discussion 14.
25.
HamelRonald. 2010. “Thinking Ethically about Emergency Contraception. Critical Judgments Require Adequate and Accurate Information.” Health Progress91 (1): 62‐67.
26.
HarrisonTeresa. 2005. “Availability of Emergency Contraception: A Survey of Hospital Emergency Department Staff.” Annals of Emergency Medicine46 (2): 105‐110. https://doi.org/10.1016/j.annemergmed.2005.01.017.
27.
HochNataline. 2017. “The Real American Horror Story: Overcoming the Hurdles to The Real American Horror Story: Overcoming the Hurdles to Terminate a Rapist’s Parental Rights Terminate a Rapist’s Parental Rights.” Valparaiso University Law Review. Valparaiso University. School of Law.
28.
HornerClaireCampo-EngelsteinLisa. 2020. “Dueling Definitions of Abortifacient: How Cultural, Political, and Religious Values Affect Language in the Contraception Debate.” The Hastings Center Report50 (4): 14‐19. https://doi.org/10.1002/hast.1161.
LawTara. 2019. “Doctor Fired After Suing to Provide Aid-in-Dying Medication.”TIME, March 9.
32.
LeppertP. CNamerowP. B.BarkerD.1986. “Pregnancy Outcomes among Adolescent and Older Women Receiving Comprehensive Prenatal Care.” Journal of Adolescent Health Care: Official Publication of the Society for Adolescent Medicine7 (2): 112‐117.
33.
Lira-AlbarránSaúlDurandMartaLarrea-SchiavonMarco FGonzálezLeticiaBarreraDavidVegaClaudiaGamboa-DomínguezArmandoRangelClaudiaLarreaFernando. 2017. “Ulipristal Acetate Administration at Mid-Cycle Changes Gene Expression Profiling of Endometrial Biopsies Taken during the Receptive Period of the Human Menstrual Cycle.” Molecular and Cellular Endocrinology447 (May): 1‐11. https://doi.org/10.1016/j.mce.2017.02.024.
MozzanegaBrunoNardelliGiovanni B.2019. “UPA and LNG in Emergency Contraception: The Information by EMA and the Scientific Evidences Indicate a Prevalent Anti-Implantation Effect.” The European Journal of Contraception & Reproductive Health Care24 (1): 4–10. https://doi.org/10.1080/13625187.2018.1555662.
36.
MunuceMaría JoséGómez-ElíasMatías D.CailleAdriana M.BahamondesLuisCuasnicúPatricia S.CohenDébora J.2020. “Mechanisms Involved in the Contraceptive Effects of Ulipristal Acetate.” Reproduction159 (3): R139‐R149. https://doi.org/10.1530/REP-19-0355.
37.
NovikovaNataliaWeisbergEdithStanczykFrank Z.CroxattoHoracio B.FraserIan S.2007. “Effectiveness of Levonorgestrel Emergency Contraception given before or after Ovulation--a Pilot Study.” Contraception75 (2): 112‐118. https://doi.org/10.1016/j.contraception.2006.08.015.
38.
PeckRebeccaWalterRellaTudelaJulioAznarJustoMozzanegaBruno . 2016. “Does Levonorgestrel Emergency Contraceptive Have a Post-Fertilization Effect? A Review of Its Mechanism of Action.” The Linacre Quarterly83 (1): 35‐51. https://doi.org/10.1179/2050854915Y.0000000011.
RitterAmanda H.IsaacsChristine R.LeeStephanie M.LeeAlan J.2018. “Single-Dose Levonorgestrel Emergency Contraception and Silent Barriers to Its Access: Is It Really Just One Step?” Journal of Women’s Health27 (5): 646‐650. https://doi.org/10.1089/jwh.2017.6345.
43.
SamsonFernand D.LorenRebeccaDowningNickiSchroeppelSarahKellyPatricia J.RamaswamyMegha. 2013. “Availability of Emergency Contraception in Rural and Urban Pharmacies in Kansas.” The Journal of Rural Health29 (1): 113‐118. https://doi.org/10.1111/j.1748-0361.2012.00429.x.
44.
SatkoskeV. B.ParkerL. S.2010. “Emergency Contraception Policy: How Moral Commitments Affect Risk Evaluation.” Law, Probability and Risk9 (3‐4): 187‐199. https://doi.org/10.1093/lpr/mgq009.
45.
SifferlinAlexandra. 2014. “Timeline: The Battle For Plan B.” TIME Magazine, June 11.
46.
SmugarS. S.SpinaB. J.MerzJ. F.2000. “Informed Consent for Emergency Contraception: Variability in Hospital Care of Rape Victims.” American Journal of Public Health90 (9): 1372‐1376. https://doi.org/10.2105/ajph.90.9.1372.
47.
TeminElizabethColesTaraFeldmanJames A.MehtaSupriya D.2005. “Availability of Emergency Contraception in Massachusetts Emergency Departments.” Academic Emergency Medicine12 (10): 987‐993. https://doi.org/10.1197/j.aem.2005.05.036.
48.
ThomsonJudith Jarvis. 1976. “A Defense of Abortion.” In Biomedical Ethics and the Law, edited by HumberJames M.AlmederRobert F.Boston, MA: Springer US. https://doi.org/10.1007/978-1-4684-2223-8_5.
49.
TollefsenChristopher O.2013. “Protecting Positive Claims of Conscience for Employees of Religious Institutions Threatens Religious Liberty.” The Virtual Mentor : VM15 (3): 236–239. https://doi.org/10.1001/virtualmentor.2013.15.3.pfor2-1303.
50.
TooleyMichael. 1972. “Abortion and Infanticide.” Philosophy & Public Affairs, 37‐65.
VrettakosChristinaBajajTushar. 2021. “Levonorgestrel.” In StatPearls. Treasure Island FL: StatPearls Publishing.
55.
WicclairMark R.2009. “Negative and Positive Claims of Conscience.” Cambridge Quarterly of Healthcare Ethics : CQ : The International Journal of Healthcare Ethics Committees18 (1): 14‐22. https://doi.org/10.1017/S096318010809004X.
56.
WilkinsonTracey A.FaheyNishaShieldsChristineSutherEmilyCabralHoward J.SilversteinMichael. 2012. “Pharmacy Communication to Adolescents and Their Physicians Regarding Access to Emergency Contraception.” Pediatrics129 (4): 624‐629. https://doi.org/10.1542/peds.2011-3760.
