The U.S. Roman Catholic Church has long struggled to balance two moral commitments in its medical care for women who have been raped.
Church teaching permits Catholic hospitals to give a “morning-after” pill to rape victims if its effect is contraceptive, but not if it aborts a fertilized egg.
Policy concerning the pill has been oft-debated within the church. The crux of the question is what to do when it is uncertain whether a fertilized egg exists or whether the woman has just ovulated and fertilization by the rapist’s sperm may be imminent.
In such cases, Catholic hierarchy has largely acceded to physicians’ discretion in administering the pill.
But one church leader, Bishop John Myers of the Peoria diocese, has decided that is not good enough.
Myers has turned the ethical issue up a notch, igniting controversy and angering abortion rights advocates.
The bishop has said the only Catholic hospital in his diocese that offers rape victims a morning-after pill should quit doing so because in some cases the drug-called Estinyl-is more likely to cause abortion than contraception.
St. Francis Medical Center is continuing to make Estinyl available while it seeks to respond to Myers’ interpretation.
Last week was the hospital’s deadline to answer Myers’ directive of last November. The hospital said it is exploring alternatives such as extensive blood testing to determine whether eggs have been fertilized in rape victims. Myers has informed the hospital that current policy remains “appropriate” while it is being revised.
In the Chicago archdiocese, where three of 22 Catholic hospitals said they give the pill and do so in keeping with Catholic guidelines that forbid abortion, Cardinal Joseph Bernardin has issued no specific directive against the pill’s use.
St. Francis treated 58 rape victims last year, according to a hospital spokesman, who said it kept no records of how many women were given Estinyl.
But Dr. Gerald McShane, a staff physician and chairman of the hospital’s ethics committee, ventured that “the majority were given the pill, particularly those who were not using contraceptive devices at the time of the rape.”
He and other hospital officials contend that 99 percent of rapes do not result in pregnancy-either because of the woman’s cycle or use of contraceptives-so Myers’ action affects a statistically negligible situation.
And, they added, state law requires the hospital to inform rape victims where they can obtain the pill even if St. Francis discontinues offering it.
But Joyce Harant, executive director of Planned Parenthood of Greater Peoria, sees it differently:
“I think the bishop’s action is dramatic. For Catholic hospitals to impose their religious belief in this kind of traumatic situation is horrendous.
“They are victimizing the woman as much as the rapist did.”
Monsignor Steven Rohlfs, who advises Myers on moral theology, agrees that there is a larger societal question, but not the one cited by Harant.
“The real issue here is whether Catholic hospitals can be autonomous and act on their religious convictions,” Rohlfs said. “We cannot assist a woman in having an abortion.”
If a woman impregnated by a violent non-consensual attack seeks church guidance about an abortion, Rohlfs said, “we have to say there are now two innocent victims, herself and the baby.”
McShane and Joseph Piccione, corporate ethicist for the Order of St. Francis-Catholic sisters who run seven hospitals in Illinois and Michigan, including four in the Peoria diocese-defended Myers’ action.
“He is saying the abortifacient issue must be answered by clear fact, not merely an answer to a rather quick and routine question by an operating physician,” Piccione said.
Said McShane: “I think the bishop is forcing us to be as honest as we can be medically as to where the woman is in her cycle, not just having a physician make an emotional decision. The bishop is not the bad guy here.”
But Colleen Connell of the American Civil Liberties Union of Illinois said, “I question the morality of denying a woman a way to avoid pregnancy in this traumatic situation.”
Connell, director of the ACLU reproductive rights project, said that whenever a hospital is part of a trauma network, as St. Francis is, “police would bring a rape victim there whenever it was the closest hospital.”
“So here we have police taking a woman who needs help to a Catholic hospital where she may not get access to treatment that will substantially reduce or totally eliminate the possibility that she will become pregnant as the result of a violent invasion of her body,” Connell said.
Linda Woods, director of Peoria’s Center for Prevention of Abuse, said that if St. Francis changes its policy, “the victim of a crime, who is in a state of shock or trauma, would be subjected to yet another stress . . . to find out that what was once available no longer is.”
Connell suggested that the urgency of information given about the pill might not be understood by the traumatized victim, particularly within the 72 hours in which the pill should be taken.
Catholic teaching prohibits abortions and instructs that human life begins at the moment an egg is fertilized inside the woman. That is a possible condition with a rape victim. In such a case, Catholic hospitals’ guidelines say the pill is “abortifacient,” or causing an abortion, and should not be given.
That conflicts with many medical definitions of when human life begins: Some term fertilization a process of 20 to 24 hours rather than a moment, some contend that life begins when the fertilized egg attaches to the uterine wall, and some say it begins when a neurological system is formed some two weeks after fertilization, said Laurence O’Connell, president of the Chicago-based Park Ridge Center for the Study of Health, Faith and Ethics.
Administering the morning-after pill within 72 hours of fertilization prevents the egg from attaching and thereby prevents pregnancy.
Catholic guidelines for offering the pill to rape victims have been written at various levels-from the National Conference of Catholic Bishops to a convocation last fall of Illinois’ six chief bishops, including Bernardin and Myers.
In their guidelines, the Illinois bishops added that the pill may be used as a contraceptive before the woman ovulates, but not thereafter.
There is no official church teaching on treating rape victims. But “a body of theological opinions going back to the 1950s allow anti-conceptive measures as self-defense for victims of such violent attacks,” said Peter Cataldo, director of research at the Pope John XXIII Medical-Moral Research and Education Center in Braintree, Mass.
In his interpretation to St. Francis Medical Center, Myers judged that since Estinyl would prevent a fertilized egg from attaching to the uterine wall, its effect could be an abortifacient, even if the physician intended it to be contraceptive.
As a result, he said, when it can no longer be ascertained whether an egg has been fertilized, the pill should not be given.
Rev. Michael Place, adviser to Bernardin on moral theology, said all the Illinois bishops, including Myers, agreed to the guidelines they adopted last fall, “which leave the decision as to when a drug is contraceptive or abortifacient to the individual physician.”
“In Chicago, we believe at this time that the guidelines that exist are sufficient,” Place said.
Particularly, he noted, they enable Catholic hospitals to meet a city ordinance requirement that hospitals provide “anti-conception” treatment to rape victims who want it.
“Bishop Myers has taken a step beyond what our guidelines do,” Place said. “He has chosen to apply the principles with a specific directive. He’s making an ethical judgment as to whether the pill’s practical effect is more likely to be abortifacient than contraceptive.
“He has said if there’s doubt, you can’t use the pill. He has the jurisdiction to do that.”
In licensing hospitals to offer rape assistance, the Illinois Department of Public Health cites a “right of conscience” provision in state law that says no hospital can be required to provide a service that “conflicts with its moral beliefs.”
State regulations require hospitals to give rape victims information on pregnancy and how to avoid it, but allow the institutions to comply by referring the victims to another source, and do not require hospitals to offer morning-after pills, said Health Department spokesman Tom Schafer.
If St. Francis changes its policy on the pill, he said, it would not alter the hospital’s trauma center designation.
Hospitals don’t have to provide the state with details of their rape assistance programs, so the Health Department does not know how many or which offer morning-after pills, Schafer said.
The pill is commonly given in non-Catholic hospitals with the proviso, as stated by a Cook County Hospital spokeswoman, that “we use the morning-after pill only in rape and sexual assault cases.”
Of Catholic hospitals in the Chicago archdiocese contacted by the Tribune, three said they do offer the pill.
“Our philosophy is that the morning-after pill prevents (conception) if it is given early enough after the rape,” said Dr. Helene Connolly, chairman of the emergency medicine department at Mercy Hospital and Medical Center on the Near South Side.
She estimated that 60 rape victims are brought to Mercy each year, and most of them are given the pill.
Alexian Brothers Medical Center in Elk Grove Village and St. Joseph Hospital and Health Care Center on the North Side said they offer the pill only as permitted by the archdiocesan guidelines.
Loyola University Medical Center in Maywood does not offer the pill, but counsels patients on its availability, a spokeswoman said. “We’re trying not to have to split hairs on whether the egg is fertilized or not, and we don’t want to debate this issue each time we’re caring for a rape victim,” she said.
Dr. Eugene Diamond, chairman of the ethics committee at St. Francis Hospital and Health Center in Blue Island, said Catholic hospitals and most others in the Chicago area don’t offer morning-after pills.
But, he added, “there are probably individuals functioning in these and other Catholic hospitals who, exercising their own right of conscience, might offer the pill.”
In Peoria, Bishop Myers did not “just ferret this issue out,” said Monsignor Rohlfs.
“He began researching this in 1990, after a question that the pill might be problematic was asked by Peoria Catholic Social Services,” Rohlfs said.
By thrusting himself into the decision-making process, Myers has put his diocese into the spotlight of an issue that has vexed his church for many years.
Its intricacy was revealed again this week in a statement released by a leading theologian at the Vatican: Rev. Gino Concetti wrote that it is grounds for excommunication if a Catholic woman induces abortion by use of drugs.
However, he added, women who use the morning-after pill would not be excommunicated because it was impossible to know if an abortion had occurred in such cases.
