Medical experts, pro-life advocates, and women's groups are once again debating the moral questions raised by so-called "morning-after" pills. On June 17, an advisory panelrecommended that the FDA approve anemergency contraceptive known as "ella" for prescription use. Ella differs from Plan B, an emergency contraceptive FDA-approved for over-the-counter use, because it is effective for up to 120 hours after a woman has unprotected sex, while Plan B is only effective up to 72 hours after sex.
The controversy over ella centers on scientific uncertainty about its mechanism of action—whether it only delays ovulation, thereby preventing fertilization altogether, or whether it might also prevent implantation of a fertilized egg. The manufacturer has conducted studies showing that ella can delay ovulation. They have neither studied, nor do they plan to study, whether ella can also prevent implantation.
Because ella is a close chemical relative to RU-486, a pill that can terminate an early pregnancy,pro-life groups oppose FDA approval of ella because of its potential capacity to prevent implantation. Advocates for ella argue that the FDA should take a "just the facts" approach that solely evaluates whether the drug is safe and effective for its intended and studied use—preventing pregnancy after unprotected sex by delaying ovulation.
Given the potential for ella to prevent implantation, it makes sense for pro-life groups to oppose the drug's approval. But in reading news coverage of the debates, I was struck by the tenuous nature of moral arguments centered on inconclusive scientific data. Both opponents and proponents of ella are focused on what science hasn't yet made clear—whether or not the drug can prevent implantation. Without that crucial bit of knowledge, the ethical debate is reduced to the two sides stating and restating their competing interpretations of scientific data. Such a debate is unlikely to change anyone's mind or lead to consensus.
I became interested in reproductive ethics for very personal reasons: Eight years ago, my husband and I underwent preimplantation genetic diagnosis (PGD, which is in vitro fertilization with genetic screening) to try to conceive a child who would not inherit my disabling bone disorder. In an e-mail discussion at the time with a theologian friend about the ethics of PGD, we explored theological perspectives on whether fertilized eggs have the moral status of human beings. Some theologians use scientific criteria to inform those views. For example, some argue that during the time after fertilization when it is possible for embryos to split and form twins, an embryo cannot be classified as a human being because it is potentially several people, rather than a single, unique person.
After several e-mails in which my friend and I tossed bits of scientific minutiae about embryonic development back and forth, he suggested that science provided an insufficient framework for examining the moral status of embryos. Approached from a scientific perspective, the question of whether a fertilized egg is a human being can be answered in different ways depending on the information we have and how we interpret it. The more important question, my friend argued, is whether we approach embryos reverently, as gifts whose worth is determined by the nature of the God who gives them, or empirically, as bits of flesh whose worth is determined by our scientific understanding of their particular traits at particular times.
Medical technology perpetually offers us new ways to have or not have babies and determine what kind of babies we do have. The vital questions raised by reproductive technology both incorporate and go beyond scientific data about how human bodies and medical science work. These questions have to do with our bodies as both mortal flesh and the dwelling places of those made in God's image, and our status as both God's dependent creatures and God's beloved children. They have to do with intentions, world view, and context.Answering such questions requires significant reflection and engagement, which may not be easy, but holds potential for our culture to actually decide on some acceptable guidelines for reproductive medicine, rather than opposing sides continually talking past each other, trading different interpretations of unclear scientific data.
Ellen Painter Dollar is a writer who focuses on Christian reproductive ethics and disability theology. She is writing a book for Westminster John Knox Press (forthcoming in 2011) about the ethics and theology of assisted reproduction and genetic screening. She blogs at ChoicesThatMatter.blogspot.com and Five Dollars and Some Common Sense.
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