In 2013 the German Bishops approved the use of Plan B in Catholic Hospitals in cases of rape with Vatican endorsement when this acts only as preventing ovulation. Pro-life organisations have often criticised this decision saying that research shows that this pill can also be abortifacient. In this interwiew, Dr John A. Di Camillo from the National Catholic Bioethics Center(NCBC), USA replies to questions about this matter.
1. Is there a difference between the morning after pill Plan B and EllaOne?
There is a significant difference between Plan B and EllaOne. EllaOne’s direct effects is to prevent implantation (it is a progesterone antagonist like RU-486 and works up to 5 days after intercourse) whereas the data on Plan B (which is levonorgestrel, a synthetic progestogen that works up to 3 days after intercourse) suggest that it may be anovulatory and not abortifacient when given at certain times in the woman’s cycle. So for practical purposes, EllaOne should never be administered even in the context of self-defense following sexual assault, whereas there may be grounds for administering Plan B under certain conditions.
2. What about research quoted by some pro-life organisations that the morning after pill Plan B could be abortifacient?
There has been and indeed continues to be debate concerning the mechanism of action of Plan B and in particular whether there is any time at which it could be given which would exclude the abortifacient mechanism. It has for some years been the understanding of NCBC, based on the existing scientific literature, that administering Plan B prior to the LH surge in a woman’s cycle (shortly before ovulation) could in fact prevent ovulation rather than preventing implantation. As such, NCBC has held that it could be licit to administer Plan B following sexual assault with appropriate testing to ensure the proper timing. The NCBC has been considering recent data on the topic that seem to suggest otherwise and hopes that more data continues to emerge, since these are questions of scientific and medical fact which are the basis on which moral conclusions can be drawn. The fact is that the data themselves, obviously including the more recent data, are the subject of debate.
If new data convincingly overturn the previous data about the expected action at different times in the cycle, then it may be that Plan B should not be administered at all in Catholic facilities. This does not yet appear to be the case.
3. So what is the guiding principle in the morning after pill Plan B debate?
Regardless of the outcome of this scientific debate, the guiding moral principle elucidated in n. 36 of the USCCB’s Ethical and Religious Directives for Catholic Health Care Services remains the same: a drug which prevents ovulation following a rape (and thereby prevents conception, defined as fertilization of the ovum, days before implantation of the resulting embryo) could be legitimately administered to a woman following a sexual assault as an act of self-defense.
If administration of Plan B is allowed, it should be under conditions that would provide at least moral certitude of the anovulant (not abortifacient) mechanism of action. NCBC has a protocol for this which is currently being updated.
Note: In January 2017, internationally renowned obstetrician Profs Bruno Mozzanega explained in a lecture given in Malta that Plan B could also be abortifacient if taken before ovulation.
Further reading: Vatican Statement on the morning after pill, 2000.
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