During the debate about the morning-after pill, including the important yet gap-filled discussion in Parliament, different proponents spoke of women’s experiences and rights, embryo rights and matters of life and death, and other matters related to values by which we should live.
Through this, Anthony Serracino Inglott maintained that the Medicines Authority, which he leads and represents, makes its decisions only on the basis of science. No guidance, therefore, is now to be expected from the Medicines Authority on matters of ethical, professional and cultural values, including matters of conscience, seeing that these matters are considered to be outside the interests and competence of his authority.
Representatives of both the medical and pharmacy professions have asserted a right to conscientious objection to prescribing or providing MAP. The Medicines Authority’s efforts to persuade these professionals that science has proved MAP to be a pure contraceptive does not seem to have been enough.
It may have been insufficient because certain professionals might have a conscientious objection to contraception. Looking at surveys of the Maltese population, we have a result that shows, I believe, a majority who answered a Church survey saying that Church teaching is “too difficult to follow”, and a majority in another survey who say they hold that there is nothing morally wrong with contraception.
Probably very few professionals would object to contraception as such – though no research has been done on that as yet – especially seeing that contraception does not seem to violate the rights of any existing individual or person.
So it seems that the objection in the conscience of these professionals has to be because they are not fully persuaded that the MAPs in question do not cause abortion. I do not quite blame them. The evidence to be sifted is enormous. So, in the end, you will have to go very largely on how far you trust those who compile and evaluate (some people nowadays even use the not-so-reassuring word ‘interpret’) the evidence for you and the snippets of it they actually show you.
When we have to make life decisions, we need to end up putting the many considerations that crop up ‘in a nutshell’. In putting the evidence in a nutshell, top authorities have made declarations that sounded at one and the same time to be sure and categorical, yet hedged with what sounds like ‘not really sure’ escape clauses.
One eminent evaluator summed it up in two sentences: first one saying that you can never be sure to exclude an abortifacient effect, second that ‘the best evidence’ is that all that happens because of contraception.
Not to make doctors – or pharmacists or medicine authorities – the guardian of women’s consciences is a good step but this leaves a gaping void
Serracino Inglott’s ‘nutshell’ argument was to tell the doubters that they are simply wrong because they are scaring people where good philosophy and logical argument gives you nothing to be scared about. “This is a case where one should not call fire where there is no fire. The attitude of calling fire because there is the presence of wood does not make sense. Calling an oral contraceptive abortifacient is similar to calling a fire engine because there is the presence of wood,” he said (August 18, Times of Malta).
Well, I beg to differ. This is rather a case where we know there very often is a fire, but we do not know whether it was caused by the hay or the wood. We are sure that in a proportion of the cases, the fire has been caused by the hay – in our case, that birth control has succeeded through contraception.
But, in the case of MAP, authorities do not go as far as telling us that we can be sure that the wood is not responsible – in our case, that birth has been stopped by preventing implantation. Admittedly, from what I gather, there is one interesting experiment that recorded that unimplanted embryos were not more numerous when MAP was used – very interesting, but that, for me, does not quite close the case.
Serracino Inglott says basically, that these experts who assure us MAP is pure contraception are all honourable men (and women). Unfortunately there have been cases of dishonourable men around too. But, if I were to stick my neck out, subject to revision, I would say that the probability that MAP acts as abortifacient is indeed very small – a case of it probably never happens, but we cannot be quite sure. Still, while keeping in mind the local expert’s remark that ‘science may change’ as more evidence comes in.
When a woman has had the harrowing experience of rape, or when the prospect of a pregnancy and birth is more or less inevitably to result in very severe hardship for her or to her family, I can understand and would support a decision that the risk of an abortion is so small that the risk can be justified by the principle of double effect.
When a doctor prescribes morphine to allay excruciating pain in terminal cancer, she or he is not brought to court for knowing that this will result in an earlier death. Similarly, if I am driving in an emergency, I am morally excused if I speed beyond what is prudent in ordinary circumstances – and that moral excusing continues to count even if somebody gets injured or worse.
In fact, there are dangers to life in so many things we do every day, but the risk is so small that we are justified in ‘life going on’. In this light, I insist one must in conscience acknowledge that such an improbable danger to a life is far overweighed in cases of vast and certain dangers and distress to the woman concerned.
At the other end of the scale is the continuous reliance on MAP as a contraceptive combined with promiscuity. For society to give the message that this is okay flies in the face not only of the increased danger of HIV and STD (which condoms prevent), but also the immense multiplication that turns a small risk of possible unintended abortion into one that is much higher than what would be morally acceptable.
Not to make doctors – or pharmacists or medicine authorities – the guardian of women’s consciences is a good step but this leaves a gaping void. Women – and men – young and old, have the need and right to know and to be responsibly guided in their conscience and it is no solution to, in effect, okay indiscriminate use.
Youth leaders, counsellors, social workers, priests and other religious guides, as well as teachers and educators and experts of ethics have their delicate professional ethics and skills that must be respectfully and reliably brought into play, within systems and climates developed to make this effective.
This is much broader than just science, deeper than a right to be free of all constraint, and with much more embedded consequences on society than throwing a pail of water on a fire.
Charles Pace is a specialist in social policy.