About two months ago the German bishops made the news with a statement on the Morning After Pill and rape. I was dissatisfied with basically all sides’ knee-jerk reactions but also too busy to explain lots of details. So here’s my “it’s complicated” post on a question essentially nobody cares about anymore.
First some cultural background. In Germany, abortion is not a matter of intense political discourse. The law is that a woman can get an abortion within 12 weeks of conception after a forced counseling session. Often the government will pay for it. Abortions later in pregnancy are available for health reasons. There is an increasing psychology-creep in those health reasons, but mostly they are still either fetal deformities or actual health reasons. Technically abortion is illegal but not punished, but most Germans aren’t even aware of that distinction. You might notice that this is pretty much the wishy-washy situation large parts of the United States would end up with if the question was up for democratic decision. That’s exactly what happened in Germany decades ago, and while the result is totally incoherent it also enjoys so broad popular support the question has basically dropped off the public agenda. Of course the Catholic Church is opposed, but then it isn’t particularly fond of divorce either, and political discourse pays about equal attention to both positions.
With most people not caring and most of those who do care fighting more realistic battles the cranks tend to stand out among those who remain. When I was at the March for Life a year and a half ago (I was too sick this year), I was very uncomfortably aware of the large-sign-guy whose reason for opposing abortion actually is that the race will be harmed if women aren’t forced to breed. Of course there were more than two thousand protesters more sane than that guy as well as a few dozen counter-protesters less sane than him, but still the cranks stand out in a small movement. And even on the comparably normal side the evaporative cooling is very noticeable. For example, I returned home from that march in a bus full of Evangelicals. There was a young girl running up and down the bus, and when she saw my rosary she squealed “coooool chaiiiin” and wanted to touch it. I let her, but I sat there scared stiff, because if she had taken it to her parents they probably would have thought I was seducing her into idolatry. Or maybe I’m just paranoid, but then I had been spending the last hour talking to seat neighbors who weren’t quite sure if Catholics can be saved. This is a very unusual experience for a German.
So basically the pro-life movement is very small and even many good pro-life people wouldn’t want to stand too close to it. I think the bishops should try to take it over rather than standing there without any plausible course of action, but then that’s a different question.
The point here is that there basically is no abortion debate in Germany. And if you can’t even get a hearing on the simple cases, there is very little pressure to sort out the details of hard cases. So while all German bishops are honestly pro-life, until a few months ago most of them probably hadn’t spent as much as ten minutes thinking about what consequences that may have for the Morning After Pill in cases of rape. The average German bishop probably knows a lot less about this than the average Catholic blogger in America.
On to the medical background, the Morning After Pill’s primary effective mechanism is preventing ovulation, i.e. the egg actually becoming available for fertilization. In cases of rape, that mechanism is totally OK with Catholic teaching. The bad thing about contraception is the separation of the unitive and procreative aspects of sex, but that’s clearly not what a rape victim is trying to do. In more modern words, the Catholic church knows that rape isn’t sex and has known so long before that particular question arose. For example, celibate nuns in dangerous countries are allowed to use the normal Pill in case they might be raped. Some trads are grumpy about this, but they are just ignorant of actual magisterial teaching.
The problem is that the Morning After Pill probably also has a secondary effect of preventing implantation. That leads to the baby’s death and is not something we can set out to do.
The gray area is the question of double effect. Basically it is OK to do something good even if one is aware that some unintended bad side effects can occur. We actually apply that logic to pregnancy already. For example, a pregnant woman can drink coffee for enjoyment, even if there is a very small risk of that contributing to a miscarriage. Depending on the probabilities of the two effects of the Morning After Pill, the same logic might be applied to it. If a woman takes it with the good intention of preventing ovulation, the risk of killing a fertilized egg can be acceptable. The same thoughts apply to the doctor prescribing it in that situation. Of course the situation is entirely different if they know only the bad effect is relevant, which would be the case if they know ovulation has already occurred. I hear this can be tested, but I got conflicting information on how invasive the test is. If it actually requires a second vaginal invasion I think that wouldn’t be proportional to the risk involved and it would be OK to go without the test. If it’s basically doing a two second test on blood already drawn for other purposes I would think that a morally mandatory precaution. If it’s somewhere between those extremes, the question gets very hairy. So, bottom line, the Catholic rules on the Morning After Pill in cases of rape are more complicated than yes or no.
The final piece of necessary background is the turn of events that gave rise to the bishops statement:
A few months earlier some of the pro-lifers I would prefer not to stand so close to me visited Catholic hospitals in Cologne pretending they had been raped and demanded and got the Morning After Pill. Then they started a trad-media campaign about Catholic hospitals dispensing abortifacients. They have some flimsy excuses for this being OK Catholicism-wise but basically this is the one serious sin involved in the whole affair. For a while it seemed to work: the diocesan authorities instructed the hospitals not to dispense abortifacients including the Morning After Pill. At that point I think nobody seems to have thought about non-abortive effects. In consequence of that decision Catholic hospitals got dropped from the government-sponsored rape evidence preservation network, which requires dispensing the Morning After Pill, and then no longer had rape evidence preservation kits.
Then in January a raped woman visited a government-run emergency room on a complex of buildings that also hosts a Catholic hospital. The doctor on duty prescribed the Morning After Pill and then called the hospital to arrange sending the patient over for evidence preservation – which it of course no longer could provide. Then she called another Catholic hospital and got the same response. After getting the patient admitted to a non-Catholic hospital she contacted the media. And the story immediately got shortened to “Two Catholic hospitals refuse to admit rape victim because of Morning After Pill concerns”. And there was a great shit-storm.
This is probably the first time the matter really came to any German bishop’s attention. And while Cardinal Meisner – one of the most conservative German bishops and the one in whose diocese all this had happened – consulted the experts real quick the story seems to have gotten mangled. While actually the pill has two effects he seems to have understood there were two pills, one working against ovulation and one against implantation. And then he announced the (obvious in Catholic moral theology) conclusion that the ovulation-preventing pill was OK while the implantation-preventing one wasn’t. He also noted that a Catholic hospital could also give out honest information on what was available elsewhere, provided the Catholic position was also explained without exercising pressure.
And then, a week later, the German bishops’ conference discussed the same matter. And then they announced this:
The plenary assembly affirmed that women who have been victims of rape of course will receive human, medical, psychological and pastoral help in Catholic hospitals. This can include the administration of the “morning-after pill” as long as it has a preventive and not an abortive effect. Medical and pharmaceutical methods which result in the death of an embryo still may not be used. The German bishops trust that in facilities run by the Catholic Church decisions on the practical treatment will be taken on the basis of these moral and theological guidelines. In every case, the decision of the woman concerned must be respected. In addition to first statements on the “morning-after pill”, the plenary assembly recognizes the need to study in more detail other implications of this issue – also in contact with those responsible in Rome – and to make the necessary differentiations. The bishops will have talks on this issue with Catholic hospitals, Catholic gynaecologists and consultants.
Now that trust in Catholic hospitals figuring it out seems a bit optimistic, given that even the bishops haven’t figured it out yet and doctors in Catholic hospitals aren’t moral theologians or even necessarily Catholic. So basically it boils down to “We’re starting to work on the guidelines now and until we’re done it’s all up to the individual doctor”. It’s reasonable to suspect that some doctors might decide according to very different standards. To be honest, I think that is a bit of a cop-out. But then it is quite obvious the bishops didn’t have a clue about the practical side of the question and couldn’t get one in time. So it’s not very satisfying, but I don’t see much better options either. Of course nobody payed any attention to the part about making the necessary differentiations later. And the part about the doctors deciding until then essentially got shortened into “German bishops allow the Morning After Pill”. And that is the story that went around the world.
The fairly obvious part of the moral is that consequentialism backfires even on consequentialist grounds. The false rape victims triggering this entire chain of events thought fighting for a policy that might save lives was well worth braking the 8th commandment, so they did evil that good may come from it. Not only did they fail, they also caused great harm to the Church while doing so.
Other than that, I didn’t find any sides reaction convincing. The liberal reaction was basically “Great, so now that’s settled”. No, it isn’t. Absolutely nothing changed about Catholic moral theology, trying for the abortive effect is still a no-no and all the hard questions are still hard. But then what I heard from most conservative Catholics wasn’t much better. A lot of them announced that we basically must go back to a total ban because the good pill Meisner talked about doesn’t exist and we can never be 100% sure the Morning After Pill doesn’t prevent implantation. Which is equally wrong, because it totally ignores the doctrine of double effect. And almost everyone is glad that the shit-storm is over. That kind of misses the question what will happen when the differentiations are made and the media discovers the “everything permitted now” narrative isn’t quite right. So basically everyone reacted to caricature versions of the story and my reply to basically everyone is “it’s more complicated than that”.
Kind of boring for a moral, huh?