To my Fathers in Christ, the Catholic Bishops of Connecticut,
I approach you, in the form of this letter, with a mind troubled by the words of your statement read at Mass in my parish on Sunday, September 30, regarding Plan B and the four Catholic hospitals in our state. Surely we, the lay faithful, are bound to you in gratitude for the countless good works you have done for the Church. Nonetheless, your statement on the matter has given me pause, and it is only with an eye to being of some service to you that I here outline my concerns.
1. First, your own reversal from strong opposition to compliance is an occasion of confusion and possible scandal in your flock.
2. Second, your statement that to administer Plan B pills without an ovulation test is not an intrinsically evil act, while possibly true, does not appear satisfactory. Neither is it an intrinsically evil act to fire a gun. And yet to do so under circumstances in which it might destroy innocent human life might well be evil, and mere uncertainty about whether anyone will be killed by our behavior will not absolve us¯particularly when we have some special reason to believe that at least in some instances such behavior will destroy human life. This question of doubt and certainty brings me to my next concern.
3. Your statement that the administration of Plan B pills in this instance [in Catholic hospitals and to victims of rape and after a pregnancy test] cannot be judged to be the commission of an abortion because of such doubt about how Plan B pills and similar drugs work and because of the current impossibility of knowing from the ovulation test whether a new life is present is puzzling to me. That is, I wonder how the matter can be as doubtful as you suggest. Is there really any doubt that Plan B is at least believed by medical experts and lawmakers to act in what Catholics must consider an abortifacient mode if it acts after fertilization but prior to implantation? In an article in the July 6, 2006, New England Journal of Medicine entitled Plan B, Reproductive Rights, and Physician Activism, Rebekah E. Gee, M.D., wrote about her involvement in suing Wal-Mart for refusing to stock Plan B. And she offers this reflection:
Given concerns about unintended pregnancies, it is striking that Plan B has been so controversial. Wal-Marts politically motivated refusal to stock it was probably predicated on the debate over the mechanism of action of Plan B, which is often confused with the abortifacient mifepristone. In reality, Plan B is thought to operate in a manner similar to hormonal contraceptives which can prevent ovulation and possibly render the endometrial environment less habitable for implantation. These methods do not interrupt an intrauterine pregnancy after implantation and thus do not cause an abortion according to any common definition. The American College of Obstetricians and Gynecologists (ACOG) defines pregnancy as beginning at implantation, as does the U.S. government. Some who take issue with Plan B believe that life begins at fertilization and that any interference with implantation therefore constitutes an abortion¯or is, at least, equally reprehensible.
On the FDAs Center for Drug Evaluation and Research website, there is a Q&A section on the FDAs decision regarding Plan B. Under question 3 (How does Plan B work?), it reads:
Plan B acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.
Now, why would the lawmakers of Connecticut wish to outlaw the administration of an ovulation test prior to administering Plan B? And why would anyone wish to test for ovulation prior to administering Plan B?
Presumably the reason in both cases is that If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation)¯that is, if a woman has ovulated, and from the released egg an embryo has been formed after sexual intercourse or rape, then Plan B might prevent implantation of the embryo. By a common sense (and Catholic) definition, that would constitute a chemical abortion, a chemical barrier to the normal development of an already-existing and developing human embryo.
Testing for ovulation is an attempt to ensure, with some degree of moral certainty, that this abortive effect will not take place; Plan B, however, merely prevents ovulation or fertilization. Thus the push for the ovulation test. On the other hand, it is precisely because it is hoped and believed, by many doctors and lawmakers, that Plan B will help prevent implantation when an embryo has already formed that there has been a (now successful) push to outlaw the ovulation test.
It is certainly possible that new information has come to light, of which I and the general public know nothing, showing that Plan B almost surely does not prevent implantation of an already-existing embryo. If this be the case, then I urge you, our teachers, to make it known to the faithful.
And yet I fear it is not the case, since you say that if it becomes clear that Plan B pills would lead to an early chemical abortion in some instances, this matter would have to be reopened, as though any lingering doubts about the abortifacient potency of Plan B give us license to use it without taking precautions to avoid that effect until further notice¯a notion seemingly at odds with sound moral teaching. In any event, is it not in fact likely that Plan B does have such an effect, at least in some instances, especially given that the medical community and the lawmakers seem to think it does, and very much hope that it does? That is a point the laity cannot fail to note.
You further announced that a pregnancy test to determine that the woman has not conceived is sufficient. But how soon after fertilization will a pregnancy test reveal the presence of a developing zygote? And however soon after fertilization it may do so, is it not possible for a woman to test negative for pregnancy, then take Plan B, and just before it enters her bloodstream, for sperm to meet egg (beginning the long process of fusing), with Plan B now working effectively as an abortifacient (in the sense of condemning to death an already-existing and developing human embryo)?
Moreover, Dr. Gee (cited above) says that the American College of Obstetricians and Gynecologists (ACOG) defines pregnancy as beginning at implantation. If this is the common definition of pregnancy in the medical community, as it surely appears to be, then does it not stand to reason that medical tests for pregnancy do not generally reveal the presence of an embryo prior to implantation? And if that is so, how can the administration of a pregnancy test be sufficient?
4. While I believe these questions are important and worrisome, in some ways they are of secondary concern. The larger point relates to religious freedom. The political climate in our country is not growing friendlier to the Catholic Church and her moral doctrines, particularly those touching human sexuality and procreation. Is it wise to implement an appeasement policy in response to attacks on our liberties? Are we not sending the message to lawmakers that they can, when they please, tell Catholic hospitals exactly what norms to follow, and are we not, to all appearances, admitting that Catholic teaching and Catholic conscience have no place in a Catholic hospital except at the say-so of the governor and the legislature?
Suppose the governor of Connecticut signed into law an act forbidding anyone to teach that homosexual behavior is immoral, making this a hate crime, with no special clause exempting Catholic parishes or schools or parents. What would be your response? You might respond by saying, much as you have done in the present case, that to teach morality without talking about homosexuality is not an intrinsically evil act. We could continue to run our Catholic schools and parishes without teaching anything false, while complying with such a law, simply by ignoring the whole question of homosexuality. That policy would get us out of immediate political trouble, perhaps, but would come at the cost of the fullness of the truth and would embolden the legislature to infringe more and more on our religious freedoms. The state has no business dictating how Catholic schools or hospitals should be run except in accord with the precepts of natural law. On short, it has no authority or right whatever to regulate or suppress what is specifically Catholic.
Such are my thoughts, for what they are worth. Having voiced my concerns, I beg you to receive them in the spirit in which they are offered. Be assured of my prayers.
Michael Augros is professor of philosophy at the Center for Higher Studies in Thornwood, New York.