Wednesday, April 05, 2006

Can we apply some logic to the issue of emergency contraception?

Probably not. Still, it's worth a shot.

Over in Slate, William Saletan is considering how emergency contraception works. He gives an excellent overview of the subject, heavily linked to references. I pretty much recommend it.

But, he ends the piece with an effort to show how pro-choice and anti-choice people are both equally extreme, and should make more effort to find common ground (Yeah, like there's so much common ground to be found with SD's law, where the only legal option for abortion is self-defense. Now there's a compromise position).

Who's right? Does EC kill some embryos, or doesn't it? The answer is, we don't know. We can't know, because, as the Catholic Health Association explains, "There is no current method for ascertaining that an ovum has been fertilized until implantation." It takes a week and a half for hormones to register in pregnancy tests. To verify fertilization before then, you'd have to open the woman up. And that would kill the embryo.
That "current" (my emphasis) sounds as if there may be some kind of test any day now. But there is no envisioned test, either. No theoretical framework for any such test. The blastocyst is not interacting with the female host. The only way to know that an ovum has been fertilized is to take it out of the woman, put it in a petri dish, and introduce it to some nice, friendly sperm. Not that the anti-choice position likes in vitro fertilization, either.

I know I'm a freak, but when I want to answer questions of medicine or science, I ask medical professionals or scientists. Oddly enough, I do not expect a group with rather obvious religious bias such as The Healing Ministry of Catholic Health Care to answer questions of fact.

Each side spins the uncertainty its way. Opponents of EC say pharmacists are entitled to refuse to sell drugs "suspected" of causing abortions.
Here's the equivalency, again. And doesn't that position sound reasonable? Except that there isn't anyone saying that pharmacists are entitled to refuse to sell any other kinds of drugs, certainly not because of "suspicions". Once we start conceiving of pharmacists as people with moral concerns that inhibit their ability to fulfill their job, then what's to stop a Scientologist pharmacist from refusing to fill any prescription? Remember Tom Cruise saying Brooke Shields should have used vitamins instead of Paxil? You want that kind of interference from your pharmacist?

Proponents demand a "presumption" that Plan B does no such thing. If you're troubled by the moral or factual ambiguities, each side offers the simplifying comfort of semantics. Proponents say EC can't abort a pregnancy, since "medical authorities" define pregnancy as beginning at implantation. Opponents reply that "embryologists" define pregnancy as beginning at fertilization. Everybody wants to give you an authoritative answer, when there isn't one.
I'm a proponent of EC. But I'm not very demanding. Just as I cannot prove to you that the leprechauns aren't hiding pots of gold at the end of every rainbow, I cannot prove that EC isn't preventing fertilized ova from implanting left and right. What I can say is that public policy and law should not be based on possibilities. I say that "medical authorities" are people with medical degrees and training who practice medicine and that the "embryologists" Saletan mentions are a construct of the imagination of The Concerned Women of America who neither name nor cite these "embryologists" who define pregnancy at fertilization. That's because defining pregnancy at fertilization has no practical use. Look at the wording of the CWA says "Embryologists have long believed that a pregnancy begins at fertilization". This is philosophy, or religion, not any sort of science.

Probably the most compelling argument for the "EC can't abort a pregnancy" issue, is the copious research that demonstrates that EC will not terminate an established pregnancy. Saletan links to Plan B's web site, and to James Trussell, to argue against Planned Parenthood that EC does affect implantation. But both of those links will only tell you that it may prevent implantation, not that it does. Likewise, newspapers and web sites may decide to hire women to write about abortion-related issues, but it hasn't been proven yet.

Anyway, here's the best reason to continue to call EC contraception, rather than abortifacient: "It is important to know that Plan B® will not affect a fertilized egg already attached to the uterus; it will not affect an existing pregnancy."

If there is an actual, demonstrable, provable pregnancy, EC will not end it.

If the two camps were to stop spinning and listen for a moment, they might learn something from each other. Proponents of EC, who talk so much about choice and information, might realize that their denials of any abortion risk from Plan B, through semantics or stretching of the evidence, deprive women of informed consent. The right to choose a pill that's probably birth control but possibly abortion includes the right to know that's what you're choosing.
Really? By not telling women an unprovable, purely theoretical possibility we're depriving them? Is it part of informed consent to tell organ recipients that they may, after surgery, suddenly start acting like the person who's heart they're getting? We can't prove that it won't happen, but the possibility was raised in a movie once, so maybe we should include it.

Opponents of EC might realize that the risk of abortion depends on when the drug is taken. The odds that it will abort an embryo, rather than prevent an embryo's creation, are very low. The earlier you get the pill, the lower the odds are. And every successful EC intervention spares a woman the greater danger of ending up with a surgical abortion. Plan B should be available over the counter so it can be what its advocates hope for, not what its enemies fear.
Yeah. The opponents of EC are going to be fine once they are told that "The odds that it will abort an embryo... are very low." No odds are acceptable. The anti-choice position is strict, it's zero tolerance. How did Saletan miss this? Here's a clue: the odds of complication from pregnancy and delivery are greater than the odds of complication from surgical abortion. Does anyone in the anti-choice camp care? No, hell, no. The enemies of choice don't care what's best for women. They have made a fetish out of "innocent life" such that it doesn't matter if real women die to protect it. This is not a just-slightly-right-of-center position. This is extreme.


Elizabeth M. said...

I don't know what happened to Saletan, but in the last few months he's been on this kick where he bends over backwards to be "fair and balanced" on abortion. It's very irritating. Every column is about 90% rational, and then he throws in some arbitrary bone for the anti-choice radicals.

Kaethe said...

It's not just him, though. I see it all over the place, this effort to present an image of balance even when dealing with views that are extreme.

What can we do?