Critical Analysis of Emergency Contraception - Coursework Example

This is a critical analysis of Emergency Contraception to establish that it is not an abortifacient. Of all the drugs available for emergency contraception, Plan B which is progesterone only drug has no properties to cause abortion. If taken within 72 hours of unprotected sex, it prevents pregnancy before fertilisation of the egg and before it is being taken to the uterus only after which life is said to begin. Ethical and moral considerations do support the practice of EC since women have rights over their bodies, priorities on their sexual health and there are already natural processes by which opportunities for lives to begin are lost. When religious authorities can tolerate such instances, there is no reason why they should not allow EC to be practiced for practical reasons and without harming non-existent life. Introduction Emergency contraception (EC) is a preventive measure to avoid pregnancy and it is not an abortion though some argue against it. The pill used for EC is popularly known as “the morning after pill” containing the same hormones in larger doses than in oral contraceptive pills. The EC when used within five days of unprotected intercourse (post-coital) significantly reduces the risk of becoming pregnant. Although there were oral contraceptive pills available even earlier but without any medical protocol, it was in 1998 that the first FDA approved the pill “Preven” for EC containing synthetic oestrogen and progesterone was introduced in the market as a post-coital contraception. Next, Plan B containing progesterone alone was approved in 1999 as an improvement in terms of lesser side effects than the previous Preven Another mile-stone was achieved in 2006 by making the Plan B as an over-the-counter (OTC) drug for women of age 18 and above. That year sales doubled form $ 40 million to $ 80 million in the U.S. (Fischer & Goff, 2009, p 48). Not a medical abortion There is a claim that emergency contraception is a medical abortion which is actually not since the contraception is resorted to before pregnancy. EC inhibits ovulation or fertilisation if taken during the appropriate cycle especially in the case of progestin-only drug (Plan-B) which has no effect on implantation. The combination hormone Preven acts against implantation by altering the endometrium. As this does not act against conception, question arises if it is an abortifacient. Pregnancy is considered to occur on implantation and not on conception according to one school of thought. A different school of thought considers that pregnancy occurs on conception. Now that Plan B alone is in use, the question of EC being an abortifacient is ruled out if the latter school of thought is considered correct. Immediate use of EC is advocated to ensure against possible conception. Thus, if EC is taken within 24 hours of unprotected coitus, there are 95% of chances of conception not taking place. If taken within 72 hours of unprotected coitus, then risk of conception is reduced by only 89 %. (Fischer & Goff, 2009., p 49). Problem statement This paper seeks to justify the EC as not an abortifacient. The issue becomes controversial if abortion i.e denying life to person is not necessarily after implantation but even before it. The argument is that it is an abortion even if an embryo with life potential is not allowed to be implanted. Therefore, it is proposed to first argue that EC is not an abortifacient and then why it should be allowed even if EC is akin to abortion in that EC also denies right to life. Given that emergency contraception is a method to prevent pregnancy, it is ethical or philosophical consideration that drives one to the point of determining whether emergency contraception is desirable at all. Before entering the ethical debate, it would be relevant to consider the merits and demerits of EC and abortion. As the name suggests emergency contraception is distinct from abortion. While the former prevents life to begin, the latter prevents life to grow after it is formed. This paper therefore seeks to develop on the thesis that EC is not an abortion and it does not cause abortion. Various methods of EC and practices EC is available in various methods such as Yuzpe, Levonorgestrel (LNG) 1.5 mg, Mifepristone 10 mg and Copper IUD. Percentages of pregnancies prevented from each method were 74, 80, 83 and 99 respectively as per a WHO study. EC also does not cause foetal abnormalities in case of pregnancy as a result of contraception failure (Hertzen & Godfrey, 2009). Its repetitive use has no adverse effect on women’s health and also there is no basis for the notion that teenagers and women tend to become promiscuous because of EC’s availability (Raine et al., 2005). Whereas Yuzpe method’s pill contains a combination of hormones, the second and third methods above have only one hormone and non-hormone respectively. While the first and the third method are said to cause abortion also, the second method has no such controversy or the IUD method. The non-controversial LNG has been approved in over 100 countries yet women in those countries do not have hassle-free access to EC resulting in unwanted pregnancies. Hence, the presence of EC has no co-relation with reduction in number of abortions in any country (Raymond et al, 2007). As no single contraceptive method is 100 % effective, the EC should be available to women as a last minute chance to avoid pregnancy (Hertzen & Godfrey, 2009). Preven being a combination of oestrogen and progestin stated elsewhere is no longer manufactured. Levonorgestrel or Plan B which is a single dose regimen is now the gold standard for EC (Olin-Jenkinson & Sachs, 2005). EC now plays an important role in women’s sexual health. In the U.S., use of EC prevented over 50,000 abortions in the year 2000. And between 1994 and 2000, EC contributed to decline of abortions by 43 %. Apart from EC, there are birth control methods such as abstinence, condoms and birth control pills. While abstinence is seldom observed, condoms and birth control pills are not 100 % fool-proof (Olin-Jenkinson & Sachs, 2005). With this background, EC is “the perfect back-up for these methods and not an abortifacient” (Olin-Jenkinson & Sachs 2005, p 11). After the embryo has entered the uterus what is called implantation, EC cannot interfere with the pregnancy that has already started (Olin-Jenkinson & Sachs, 2005). Mifepristone is a known abortion causing agent and is a progesterone antagonist. Progesterone, a hormone, is required for maintenance of pregnancy. It converts endometrium into secretion so as to facilitate implantation. The hormone also relaxes the myometrium which is also essential for pregnancy. Thus, with its antiprogesterone properties, Mifepristone causes abortion. In fact, it is all the more effective as an emergency contraceptive agent (Tang & Ho, 2006). A WHO paper says that in spite of media publicity, emergency contraception is not widely known in many parts of the world. A survey among the New York City school adolescent students revealed only less than half of them had known about EC. In the UK, though 91 % of women knew of EC, only 7 % used them. In France, the abortion seeking women had never known the risk of pregnancy when they had intercourse (Westley & Glasier, 2010) Discussion The controversy that surrounds EC is its possible effect as an abortifacient. It can be patently called abortifacient only if it causes abortion. Barring all other drugs stated above, plan B drug which is non-controversial will be the subject of critical analysis as a method of EC. Protagonists maintain that it is immaterial whether it causes abortion or not. If chances of life coming into being are eliminated even without an abortion, the drug or what ever method used is to be considered as abortifacient. It is proposed to discount this extremist approach as misconceived in the following passages. Opposed to EC are the Catholic hospitals, pro-life doctors and the religious institutions. The Polycarp Institute, The National Catholics Bioethics Centre and The Nishmat Centre which religious institutions hold the view that since EC prevents implantation which is the stage of life beginning, it is an abortion. The prominent Vatican associated Pontifical Academy for Life declares in their website statement dated 31 October 2000 that EC, whether a combination or progesterone alone, functions by preventing the possible fertilized ovum from being implanted in the uterine wall by modifying the wall itself. They also maintain that abortions lead to cancer which claim has already been disproven. Just as this claim is without a scientific basis, they take a similar stand on EC without a scientific scrutiny (Purdy, 2009). Tadeusz Pacholczyk, a Christian scholar says that laws relating to EC are not ethical in that they do not allow health care professionals to carry out appropriate medical tests before a particular treatment is decided in respect of pregnancy. What he means is the moral decision for treatment which in the eye of some religious institutes is an abortion (Pacholcyzk, 2007). On the other hand, health care institutions maintain that there are three possible mechanisms of actions by the EC. The U.S. Department of Health and Human Services (2006) states that EC prevents ovulation, union of spermatozoon and egg and implantation. Some of them still believe that it does not prevent implantation. For instance, an American Family Physician under the aegis of The American Academy of Family Physicians has said that scientific studies are not clear about the cumulative effects leading to implantation as the histologic and biochemical changes are not strong enough to prevent pregnancy. This is probably based on the fact that EC causes changes in the uterine wall though it can only suggest and assert that it prevents implantation. The position of the Catholic school of thought is that EC can never be justified it as kills the existing embryos by preventing implantation. At the same time, they take a moderate position in favour raped woman that EC could be administered for her if she does not already harbour a fertilized egg. It all depends upon the notion when the life actually begins or rather when the right to life begins. While the theologians believe that life begins when an egg is fertilised by a spermatozoon, medicine hold that pregnancy starts only at implantation since the woman’s body begins to nourish life that is developing and this is the stage at which a pregnancy can be detected (Purdy, 2009). In the first fourteen days of coitus, there is no developmental event taking place which means no moral person has come into being. Further, a fertilised egg can split into two and two fertilised eggs can become one or merge so there is no basis for the religious claim that a life is created at this point. In addition, the fertilised egg has still to develop support structures such as placenta which are not part of the potential being and this position does not support the claim that a human life has started at this point of time. Further, it is beyond comprehension why would God allow 80 % of embryos to die without being implanted or rejected by the women’s bodies during the initial days of pregnancy unless they are potential human beings (Purdy 2009). Baird (2007) says that scientific evidence shows that EC does prevent fertilisation and the known effects or ovulation, sperm motility etc are adequate evidence to explain short-circuited pregnancies. Further, breast feeding is believed to interfere with fertilisation due to changes in the endometrium. The religious thinkers do not take serious note of it and advocate against breast feeding. Sulmasy (2006) and (Card 2007) admit that EC was thought to hinder implantation and hence was known as abortifacient some twenty years ago and that recent medical evidences weigh against such claims. Catholic authorities, who exhort service providers to follow their conscience, do not tell women who are responsible for and right over their bodies to follow their conscience (Purdy 2009). Card (2007) cites a case of Dana L who was denied EC by the service providers as a result of which she became pregnant and was forced to undergo an abortion. Hence, women have their own freedom for contraception or abortion on religious grounds. Purdy (2009) says that prohibition of EC on the grounds of abortifacient is morally indefensible considering children’s welfare and overpopulation through unwanted pregnancies. Religious thinkers cannot be expected to appreciate the normal human beings’ concern over their responsibilities as the former remain celibate and in a way they also prevent lives coming in to existence. There is no denying the fact that EC is predominantly related to women’s sexual health issues. Sexual health is women’s priority. A woman is free to decide when to have children and when to avoid pregnancy depending on life priorities including her possible deterioration of health due to unwanted and unplanned pregnancy. A raped woman needs EC lest she would have to bear an unwanted child on whom she would never develop affection and neither the child out of rape nor the mother would have peaceful life without a natural father or husband. Conclusion The above critical analysis would show that EC in proper from does not prevent implantation and hinder life once egg is fertilised. EC resorted to immediately after coitus has nothing to with abortion. The word “emergency” should carry the message that it is a prophylactic act and not a therapeutic one which is abortion. References Baird, D.T., (2007). Emergency contraception: mechanisms of action. Third International Conference on Science and Ethics, 1–2 November 2007, Berlin. Card, R.F., (2007). Conscientious objection and emergency contraception. The American Journal of Bioethics, 7 (6) 8. Department of Health and Human Services. (2006). Emergency contraception. Retrieved from www.4woman.gov/faq/econtracep.htm. Fischer, K & Goff, S. R., (2009). Health and medical Aspects of Abortion in Martinelli- Fernadez Susan A, Baker Sperry Lori and Mcllvaine-Newsad Heather, , Interdisciplinary views on abortion, North Carolina, McFarland. Hertzen, v. H., & Godfrey, M. E., (2009). Emergency contraception: the state of the art Ethics: Bioscience and Life, 4 (1) 28-31. Olin-Jenkinson, A, & Sachs, C., (2005). Emergency Contraception: A Brief Review Israeli Journal of Emergency Medicine, 5 (3) 9-12. Pacholcyzk, T., (2007). Making Sense Out of Bioethics: Getting It Right ‘The Morning-After’. Retrieved from www.ncbcenter.org/FrTad_MSOOB_29. Asp. Purdy, L., (2009). Is emergency contraception murder? Ethics, Bioscience and Life, 4 (1), 37-41 Raine, T.R., Harper, C.C., Rocca, C.H., et al, (2005). Direct access to emergency contraception through pharmacies and effect on unintended pregnancy and STIs: a randomized controlled trial.Journal of American Medical Association 293, 54–62. Raymond, E.G., Trussell, J., Polis, C.B., (2007). Population effect of increased access to emergency contraceptive pills: a systematic review. Obstetrics and Gynecology 109, 181–188. Sulmasy, D., (2006). Emergency contraception for women who have been raped: must Catholics test for ovulation, or is testing for pregnancy morally sufficient? , Kennedy Institute of Ethics Journal, 16, 305–331. Tang, O. S., & Ho, P. C., (2006). Clinical applications of Mifepristone, Gynecological Endocrinlogy, 22(12): 655-659. Westley, E., & Glasier, A., (2010). Emergency contraception; dispelling the myths and misperceptions, Bull World Health Organ; 88 (4) 243 | Read More