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Catholic World News News Feature

Will the White House Make a Stand? February 01, 2004

The US Food and Drug Administration (FDA), on December 16, 2003, was strongly advised by two of its advisory panels (at a combined hearing, by a lopsided vote of 23 to 4) to allow the sale of so-called “emergency contraception” without a prescription. The term "emergency contraception" has been generally adopted by both the medical and pharmaceutical establishments to refer to what is more popularly known as the "morning-after pill."

Since 1998 two types of morning-after pills have been available in the United States by prescription. The proposal to the FDA to allow the "over-the-counter" sale of one of these drugs at pharmacies (that is, without a doctor's prescription) was made by one such drug's manufacturer. The drive to allow the sale of "emergency contraception" without a prescription has been in high gear for some time now. The pills are already sold over the counter at pharmacies in several European countries. Bills to allow this have been introduced into the legislatures of many US states, and enacted into law in Alaska, California, Hawaii, New Mexico, and Washington. The idea behind the FDA hearing in December was to prod the federal agency to approve emergency-contraception sales on a non-prescription basis throughout the United States.

The specific morning-after pill under consideration at the FDA hearing—called “Plan B,” since it is supposed to serve as a back-up for times when regular contraception (Plan A) fails or is not employed—consists of doses of the hormone progesterone, far larger than in regular contraceptive pills. If taken by a woman within 72 hours after sexual intercourse, this pill can work in three possible ways: it can 1) prevent ovulation, or the release of an ovum capable of being fertilized; 2) inhibit the passage of a released ovum through the fallopian tubes; and 3) possibly prevent the implantation in the woman’s uterine wall of an already fertilized ovum (an embryo or blastocyst).

This third type of action, if and when it occurs, would be abortifacient. That is, it would not be merely preventing a pregnancy; it would constitute a form of very early abortion, since it would terminate the life of an embryo or blastocyst: a living human being. Thus the very term “emergency contraception” is not really accurate, since something more than mere contraception—or the prevention of conception—is involved. Today’s medical and pharmaceutical establishments, however, have been willfully dishonest about this fact, insisting on calling the drugs “emergency contraception.” Unfortunately that term has gained wide public acceptance; there is a widespread belief that the public debate about the approval of these drugs is simply a debate about a form of contraception.

DANGERS EXPOSED

In part because of the potential for the morning-after pill to cause early abortions, pro-life organizations such as the Family Research Council and Concerned Women for America argued strenuously at the FDA hearing against allowing such powerful and sometimes lethal drugs to be sold without a prescription and without any medical supervision or restrictions. They noted, for instance, that FDA approval of the pending petition would allow for the drug to be sold to minor girls without their parents' knowledge or consent. A representative of the US Conference of Catholic Bishops argued in the same vein, as did other pro-life speakers. Forty-four Republican House members, including Majority Leader Tom DeLay, wrote a joint letter to the FDA prior to the hearing declaring, among other things, that emergency contraception should not be “as accessible to our nation’s teenage daughters as aspirin or hair spray.”

The opponents of over-the-counter sales were also very concerned about the drug's effects on the health of the women who took it. The long-term effects are not yet clear: a fact that would ordinarily indicate further scrutiny by the FDA prior to approval. The doses of hormones in "morning-after" pills are many times stronger than in regular contraceptive pills. Since the sales of these ordinary contraceptives still require a doctor's approval in light of their potential side effects, it would be odd indeed if the far more powerful "emergency contraceptives" were available without any such requirement.

Finally, opponents of FDA approval expressed concern that the ready availability of "emergency contraception" might further encourage the promiscuity and teenage sexual activity that is already widespread in America. It would be hard to argue that the universal availability of contraceptives has not already contributed greatly to today’s wide-open sexual behavior—with the appalling results that are shown in statistics on out-of-wedlock pregnancies and sexually transmitted diseases. With some 15 million new cases of sexually transmitted diseases being reported in America each year—a fact that was brought out at the hearing—opponents explained their understandable fear that over-the-counter sales of "morning-after" pills would contribute further to the current social pathology.

The very ease of obtaining "emergency contraception" without a prescription was itself a factor in the arguments against FDA approval. Once such an easy remedy for unforeseen “mistakes” becomes conveniently available, some women will no doubt instantly adopt it as a reliable fail-safe method of contraception, regardless of its possible effects on their health.

As a matter of fact, that is exactly the argument that proponents of approval for "Plan B" presented. They argued that the drug provides a convenient and reliable "fail-safe" contraceptive of last resort. Why, they asked, should any woman who finds herself suddenly burdened with a "problem" following unplanned intercourse have to go to a doctor for a prescription? Why should she even have to ask a pharmacist (in those states where it is already legally available in pharmacies), rather than simply pick it up off the shelf?

Proponents pointed out that the "morning-after" pills work more effectively when they are taken promptly after an act of "unprotected" sexual intercourse that might lead to an unplanned pregnancy. Hence, they reasoned, the pills should be available without restriction (and without medical supervision), so that women could pick them up as quickly as possible. The matter-of-fact tone in which these arguments were raised simply assumed that the standards of conduct sought by the sexual revolution have now become the norm for sexual behavior in America.

Although they undoubtedly did not intend to use any arguments that would encourage references to abortion, the proponents of the "morning-after" pill almost automatically slipped into the kind of rhetoric that has become only too familiar since the legalization of abortion was visited upon America by the Supreme Court in 1973. For example, it was stoutly maintained that a woman surely always must be able to control “her own body” effectively. The fact that another human being is present once conception has taken place was no more recognized than it has been since the abortion debate began some 40 years ago.

The American health and medical establishment is notorious for having acquiesced in—when it has not actively promoted—legalized abortion in the United States. Hence it was no surprise that removing prescription requirements from the morning-after pill was favored at the FDA hearing by the American Medical Association, the American College of Obstetrics and Gynecology, the American Academy of Family Physicians, the American Academy of Pediatrics, and of course Planned Parenthood. Who could possibly have been surprised when the two FDA advisory panels voted to approve by a large majority a proposal favored by all these prestigious professional groups?

NO ORDINARY CASE

The final decision as to whether or not the current prescription requirement should be lifted for the morning-after pill now rests with FDA Commissioner Mark B. McClellan, who is being pressed by proponents of the measure to make a quick decision. Ordinarily a final decision might take several months, but this is not an ordinary case; the pressure for approval is considerable.

The FDA is not bound by the recommendations of its advisory panels, although it usually does follow them. And in this case, with the massive force of the medical and pharmaceutical establishments behind the measure, it would be difficult for McClellan to buck the tide, despite what would seem to be the equally massive evidence against taking such an unwise, unprecedented, and harmful step. Opponents of the Brave New World and the culture-of-death mentality today find themselves at an enormous political disadvantage, as mainstream professional organizations fall into ranks with Planned Parenthood to press for unlimited access to emergency contraception without any restrictions.

What we are faced with, in the FDA hearing, is another demonstration that in American public life the consequences of the sexual revolution are simply accepted, with the demands of unfettered sexual license trumping all other considerations: moral, legal, or medical. Especially since the Supreme Court's decision in the Lawrence v. Texas case, handed down in June 2003, forbidding the state from considering moral constraints on any kind of sexual behavior whatsoever, it should not be regarded as surprising that two FDA panels would opt for maximum sexual “freedom” as well. The unrestricted availability of "emergency contraception" would henceforth be seen as just one more of today's conveniences, enabling individuals to enjoy the triumph of the sexual revolution.

Strong arguments—arguments that would once have been considered compelling—no longer count. Once proponents managed to gain acceptance for the term "emergency contraception," the eventual approval of the pills was surely inevitable, since virtually no one in American society is prepared to oppose contraception in the public arena.

A TEST FOR PRO-LIFE GROUPS

Most pro-life organizations, for example, will not touch the question of contraception. The National Right to Life Committee (NRLC) has long and quite pointedly taken “no position” on that issue. Even the US Conference of Catholic Bishops does not attempt to oppose such measures as government funding for so-called “family planning” services, although the Catholic Church has not ceased to oppose the use of contraception as morally wrong. In the current climate, an attempt to mount public opposition to contraception would have about as much chance of success as attempting to rally opposition to, say, air-conditioning or the use of cellular phones. So much has contraception—once universally condemned in the Christian tradition—come to be seen as an indispensable convenience of modern life. Getting "morning-after" pills labeled “emergency contraception” was a stroke of public-relations genius—a move every bit as effective as having legalized abortion labeled as a question of “choice.”

There still remains the issue of the possible abortifacient action of this so-called contraceptive. Those who raised this question at the FDA hearings were not so much answered as they were simply ignored. Nevertheless the standard scientific description of the action of the morning-after pill does include this possible lethal action. To be consistent, the National Right to Life Committee should have been present at this FDA hearing, opposing emergency contraception along with the other pro-life voices that were present. The Washington Times was absolutely correct in its December 16 editorial criticizing the NRLC “for taking its eye off the ball” concerning this proposal to allow a pill with abortifacient properties to be sold freely over the counter. NRLC’s “no position” stance on contraception surely should not apply to the morning-after pill merely because it is called emergency contraception.

Actually, the organization’s position is apparently based upon the view that the drug’s abortifacient properties have not been scientifically proven beyond any reasonable doubt, and therefore it is not necessarily required to oppose the morning-after pill strictly on pro-life (or anti-abortion) grounds. When a bill to allow emergency contraception without prescriptions was introduced into the Virginia General Assemby a few years ago, the NRLC’s Virginia affiliate, the Virginia Society for Human Life, did not oppose it; and when many of the group's members and supporters protested, the organization cited a scientific paper by 22 pro-life physicians denying that the evidence for the morning-after pill’s abortifacient action was conclusive. Although the paper admitted that the drug does verifiably cause changes in the uterine wall creating a “hostile endometrium,” it nevertheless claimed that the fertilized ovum, in the blastocyst stage, is capable of implanting in various kinds of tissue, whether “hostile or not,” and thus it is not certain that the pill actually functions as an abortifacient.

There is no way a purely scientific question such as this can be settled except by the presentation of irrefutable scientific evidence. In the meantime, however, it is perhaps worth pointing out that these 22 pro-life doctors—sincerely pro-life as they undoubtedly are—nevertheless seem to have accepted a form of one of the old arguments that used to be raised back at the beginning of the pro-life movement, when the question of whether or not an embryo or fetus was truly “human life” was regularly debated. Shouldn’t the deer hunter refrain from shooting, pro-lifers then unanimously agreed, if there were even any doubt about whether his target was a deer or not? In those days, pro-lifers consistently and rightly held that the presumption in favor of possible human life ought always to be given the benefit of a doubt.

The NRLC’s 22 physicians, however, seem to have reversed this standard pro-life position, and seem to be arguing that the deer hunter should be able to fire at will until it is conclusively proved that the target is not a deer but another hunter. We can only wonder if they would be prepared to argue that the morning-after pill is never abortifacient in its action, or that the blastocyst can always implant in an admittedly “hostile endometrium.” Surely this would be an untenable position for the nation’s premier pro-life organization to maintain. Surely it is time for the NRLC to drop its “no position” stance on the issue of birth control, where so-called emergency contraception is concerned, and to join the effort other pro-lifers are engaged in, combating this latest evil being promoted by America’s anti-life forces..

A TEST FOR THE PRESIDENT

Then there is President George W. Bush. The President has repeatedly said that he is pro-life, and he certainly courted pro-life votes assiduously in the course of his election campaign. Since being elected, he has usually continued to speak in pro-life terms, and has confirmed his general pro-life stance with such steps as his most welcome signature on the recent partial-birth-abortion ban as well as on other pro-life legislation. Yet his decision in August 2001, to allow federal funding of even limited embryonic stem-cell research, was most distinctly not pro-life!

In the present case, in order to maintain his sincere pro-life credentials, President Bush needs to remind FDA Commissioner McClellan, who is a political appointee of the President’s, that this Administration is a professedly pro-life Administration, and that this fact should be reflected in the decisions made by department and agency heads including the FDA. When signing the partial-birth-abortion ban, President Bush remarked that he did not believe the country was ready to ban abortion generally. That probably is the case. Indeed pro-lifers may understand better than others what we are still up against; we can certainly grant the essential accuracy of the President’s observation. It is not easy to move public opinion, especially on a subject as volatile as abortion—although public opinion is increasingly moving in a pro-life direction. Nor would it be easy, or perhaps even possible, to move a recalcitrant Supreme Court, at least in the short run. Nor, certainly, is it possible at this time to enact a constitutional amendment guaranteeing Fifth and Fourteenth Amendment rights to the unborn, given the existing state of public opinion.

Every little bit helps, though. Even small actions which demonstrate the sincerity of the President’s and his Administration’s pro-life position can, among other things, help to sway public opinion. And in this connection, it needs to be emphasized that the decision the FDA commissioner has to make on the morning-after pill is discretionary. He is not bound to follow the advice of his panels. No legislators or justices need to be convinced of his position. Public opinion, on the whole, is probably not generally in favor of the kind of thinking unfortunately exhibited in this case by the medical and pharmaceutical establishments in favoring and promoting over-the-counter emergency contraception. Nor would a decision by the FDA commissioner not to allow it be in any way arbitrary or irresponsible, since serious and convincing arguments against allowing it were amply brought out at the FDA hearings. Where it has a chance to act, the US government should not be in the business of favoring or promoting even possible chemically induced early abortions.

Thus President Bush, in keeping with his own declared pro-life convictions, surely does need to remind FDA Commissioner McClellan that this is a pro-life Administration. Perhaps he should do more than that: perhaps he should direct him to reach a decision in conformity with the Administration’s announced pro-life stance.

After all the President, along with his political advisors, needs to ask himself what incentives the members of his current strong pro-life electoral base have for continuing to support him, if the discretionary decisions of his Administration typically reflect little more than the current views of today’s Brave-New-Worlders and votaries of the culture of death. This is where the importance of action by well established lobbying organizations such as the National Right to Life Committee comes in; their contribution is badly needed to help hold the Administration’s feet to the fire.

It will not do just to praise to the President because he declares that he is pro-life, or even when he approves limited pro-life legislation such as the partial-birth-abortion ban. The latter is most welcome, as the first time since Roe v. Wade was handed down that Congress has actually moved to restrict abortion in any way (except by denying federal funding to the procedure). The ban was thus a milestone pro-life victory of huge proportions. But as everyone knows, the ban also became instantly embroiled in litigation that may go on for years before it actually becomes effective.

Meanwhile, the battle to secure the rights of the unborn goes on, and on more than one front. In this war on many fronts, the President needs to be consistently pro-life, in a way that is consistent throughout the actions of his Administration. The President’s stem-cell research decision disillusioned many pro-lifers, who have not forgotten, and who are correspondingly less eager than they might have been to turn out for him and his Administration in the course of his re-election campaign and on election day. A pro-life decision by the FDA commissioner on so-called "emergency contraception" could serve to demonstrate the President’s and the Administration’s continuing bona fides, and would definitely help re-energize a pro-life political base that could be essential to the President’s re-election.

[AUTHOR ID[ Kenneth D. Whitehead is the author, among other books, of Political Orphan: The Pro-Life Movement after 25 Years of Roe v. Wade. He writes from Falls Church, Virginia.

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