Category: Commentary

Emergency contraception a flawed choice

London Free Press
March 19, 2002

Reproduced with permission

Sharon  Osvald

Tomorrow, the first day of spring, a coalition of American national, state and local organizations will take Walt Disney’s Bambi’s notion of “being twitter pated” to a new level.

March 20 is the kick-off to their first annual “back up your birth control” campaign. On that day, women all over the U.S. will be asked, regardless of their need, to request emergency contraceptives (EC) from their doctors. Doctors will promise to tell their patients about EC; pharmacists will talk to their customers about it and activists will lobby both state and federal legislatures in favour of more access and awareness of EC.

Similar campaigns to support what many call the morning pill have been taking place for a couple of years with radio ads, billboards picturing a broken condom and other literature. The Web site has an image of a young working woman flexing her bicep with a heart-shaped tattoo saying EC.

Preven and Plan B are the two emergency contraceptives approved in Canada, but according to pharmacists I’ve talked to, many doctors have been prescribing concentrated birth-control hormones within 72 hours of sex since the 1970s. If taken in time, it prevents fertilized eggs from implanting on the uterine wall. Advocates for EC call it “a  safe, effective back-up birth control method that can prevent pregnancy after unprotected intercourse or contraceptive failure.” Opponents, however, call it an “abortifacient,” believing conception begins at fertilization and the idea of contraception after the fact is nothing more than wishful thinking.

I am certain the intentions of the majority involved in this initiative are good. After all, even the most pro-choice person knows the fewer full-fledged abortions that take place, the better for everyone. Consider the horrible state of the 15-year-old Brampton girl recently charged with second-degree murder after hiding her pregnancy and injuring her baby girl in an unassisted home birth. In contrast, EC pills seem such a neat little compromise. More radical feminists embrace EC as a tool to empower women against the evil oppressor, men, who make us pregnant in the first place and get off scot-free.
However, aside from my personal convictions about when life begins, this campaign and others like it give me the willies. This is because, in the words of Canadian organization, The Protection of Conscience Project, they are so “well-organized, well-connected and well-funded” and “may directly impact some conscientious objectors, especially if activists decide to target objectors or objecting facilities in order to get media coverage or to initiate complaints of professional misconduct.” In short, these groups bully those who don’t see the world from their point of view and trample on objectors’ rights and freedoms.

Secondly, it seems to me the message of emergency back-up plans is cheap. I mean, if a group is going to take time, energy and resources to imprint a message into the psyche of young women, is this the best message we have to give them? Why not teach them to respect themselves, to be responsible for their actions (even mistakes) and how to form monogamous, lasting accountable relationships, instead of ones that create an emergency if you become pregnant when pre-intercourse birth control fails? Why don’t we hand out planned parenting post cards that say, “Don’t waste yourself on a one-night stand,” instead of, “You have 72 hours to erase last night.” Rather than simply empowering women to be in charge of their bodies, why not teach men and women what a wonderful thing sex can be in the right context? Maybe even, heaven forbid, encourage  them to wait? Then we might not only have less unwanted pregnancies, but also women who are emotionally healthy and truly empowered.

Project Letter to Telegraph Journal

New Brunswick, Canada
24 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

Dr. Monica Brewer’s characterization of physician referral for morally controversial purposes as a “black and white” issue is the result of inadequate reflection.(“MD’s Morals Restricting Birth Control Access,” February 9, 2002) Her suggestion that doctors who object to the morning-after-pill and contraception “should pair with doctors to whom they can refer” is a suitable solution only for those whose objections are simply matters of professional judgement or personal preference.

For example: physicians who know that 94% of the women who are sold the morning-after-pill do not actually require it to prevent pregnancy (the numbers are provided by those who support its widespread use1) may be unwilling to prescribe it for that reason. However, they might well refer a patient who wants the drug to a doctor who will.

Similarly, some physicians believe that women’s health and social interests are better served by learning to recognize their natural fertility cycles, so that they need not be dependent upon physicians or drug companies to plan or avoid pregnancy. These physicians may not prescribe birth control pills for ‘ecological’ reasons, but probably wouldn’t object to referral.

Finally, an obstetrician who thinks that aborting Down syndrome infants is a good idea, but finds performing abortions a traumatic experience, would probably welcome the opportunity to refer a patient to another colleague.

The situation is quite different when physicians are asked to refer a patient for something to which they have grave moral objections. They believe that by referring patients they are themselves morally culpable for facilitating the wrong that is done. Strange? Not at all.

Consider Newsweek columnist Jonathan Alter’s suggestion that, since physical torture is “contrary to American values”, the US should turn terrorist suspects who won’t talk over to “less squeamish allies.”2 No one would seriously argue that this would relieve the US of moral complicity in torture.

Of course, moral complicity in abortion, contraception and the morning-after-pill are not issues for people like Dr. Morgantaler and his associate, Judy Burwell, who think these are good things, and that those who think differently are mistaken. But it is surprising that they view freedom of conscience as a problem to be solved by abolishing it, at least for those who don’t agree with them.

After all, Dr. Morgantaler justified his defiance of Canadian abortion law in a 1970 article titled, “A Physician and His Moral Conscience.” 3

Notes (provided for editorial verification)

1. “In 16 months of ECP services, pharmacists provided almost 12,000 ECP prescriptions, which is estimated to have prevented about 700 unintended pregnancies.” Cooper, Janet, Brenda Osmond and Melanie Rantucci, “Emergency Contraceptive Pills- Questions and Answers”. Canadian Pharmaceutical Journal, June 2000, Vol.133, No. 5, at p. 28. See also Valpy, Michael, “The Long Morning After”, Globe and Mail, 15 December, 2001)

2. Alter, Jonathon, “Time to Think About Torture”. Newsweek, 5 November, 2001, p. 45.

3. The article appeared anonymously in The Humanist. Quoted in Pelrine, Eleanor Wright, Morgantaler: The Doctor Who Couldn’t Turn Away.  Canada: Gage Publishing, 1975, P. 79

Project Letter to the National Post

Toronto, Ontario, Canada
23 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

A doctor caring for patients in four Ontario cities may be driven from the profession, or from the country,  because he refuses to practise medicine in accordance with the policies of Planned Parenthood (“MD under fire for denying birth control,” National Post, 22 February, 2002). Welcome to the world of single-issue ethics.

Professor Laura Shanner asserts her personal belief that a physician “absolutely must” help patients obtain drugs or procedures to which the physician objects for reasons of conscience. But there is no self-evident reason why her morality should be imposed upon dissenting physicians under threat of  professional excommunication. Nor do mantras like “standard of care” provide useful guidance when the morality of the ‘care’  itself is in issue. Dr. Morgantaler’s standard of care is, in some  respects, markedly different from that of Physicians for Life. The standard of care in Oregon includes assisted suicide, and in the Netherlands, euthanasia.

On the other hand, John Hof is mistaken in his suggestion that conscientious objectors may refuse to  prescribe contraceptives in order to meet the “spiritual needs” of their patients. People do not go to the doctor to  satisfy their spiritual needs, and physicians should not assume the role of spiritual director.

Conscientious objection arises from concern about one’s own moral culpability, not that of others. It is a matter of personal integrity, not an attempt to control someone else’s behaviour. The unfortunate situation in Barrie may be the result of an infelicitous explanation that failed to make this clear.

Project Letter to the Barrie Examiner

Barrie, Ontario, Canada
22 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

Continuing attempts to suppress the freedom of conscience of health care workers like Dr. Stephen Dawson (“Doctor’s Faith Under Scrutiny,” The Barrie Examiner February 21, 2002) give the lie to the claim, oft repeated by Canadian politicians, that protection of conscience legislation is unnecessary. Perhaps their complacent attitude reflects the influence of rigid party discipline that only rarely permits them  the ‘privilege’ of voting according to conscience.

Professor J.R. Brown of the University of Toronto appears to covet the role of party whip, ready to lash or to exile recalcitrant ‘scum’ like Dr. Dawson for daring to let their beliefs affect their public behaviour.

Yet Professor Brown’s private beliefs affected his public behaviour when he asserted that people like Dr. Dawson should “find another job.” Will Professor Brown take his own advice? Or will he continue to speak, act and live in accordance with his own beliefs, even as he denies the same freedom to others who think differently – those whom he characterizes as ‘scum’?

Thoughtful readers will recognize that their relationships and their political and social activities are almost always governed, not by an analysis of empirical evidence, but by deeply held convictions about human dignity and equality, about good and evil, and other equally fundamental concepts. Some of these beliefs may be religious, others not, but all are beliefs. There is no reason, apart from anti-religious bigotry, to allow only atheists and agnostics the freedom to act on their beliefs in public life.

Project Letter to the BC Medical Journal

British Columbia, Canada
16 February, 2002

Sean Murphy, Administrator
Protection of Conscience Project

The cover of your  January/February 2002 edition highlighting Dr. Roey M. Malleson’s article on ‘emergency contraception’ was unexpected: a brawny, half-naked, Aryan warrior, eyes glinting murderously from under his horned helmet, wielding a copper IUD, crouched to spring and slaughter.

I would like permission to  post the cover on the Project website, and would appreciate it if you would send me seven copies of the issue. The cover is a splendid  illustration of the usual basis for conscientious objection to  potentially abortifacient devices and drugs, and the article provides  an excellent example of moral obfuscation masquerading as science.

Dr. Malleson clearly  believes, as a matter of faith (for it cannot be science), that it is not immoral to destroy an early human embryo by preventing implantation. However, the article fails to explain why this belief should be forced upon those who do not share it. The Journal of the Society of Obstetricians and Gynaecologists, cited to support Dr. Malleson’s threatening accusation of negligence, is not widely acknowledged to be an infallible authority on faith and morals, nor is Dr. Malleson.

Finally, astute readers will recognize that the law is more complex than suggested by the article. Freedom of conscience is recognized as a fundamental freedom that must be accommodated. It is imprudent and unhelpful to publicly incite civil actions against colleagues in order to secure their submission to the moral outlook so aptly expressed by your cover.