January 1990 XI/5
TREATMENT OF RAPE VICTIMS
Two recent events bring the question of ethical treatment of rape victims into consideration. First, the development of a true "morning after pill," RU486, and extremely effective method of terminating pregnancy within the first 9 weeks of gestation. (1) Secondly, an appellate court in California ruled that Catholic hospitals have the responsibility "to provide information concerning, and access to, estrogen prophylaxis for rape victims." (2) Since the court case involved Catholic hospitals, this essay will consider the proper treatment of rape victims from the perspective of Catholic teaching.
Principles
A victim of rape should be given the most sensitive and charitable care possible. victims often complain justifiably that they are treated, by the police and medical personnel alike, as though they were responsible for provoking the attack, thus compounding the grave injustice from which the woman has suffered. Hospital procedures for treatment of rape victims should be designed to accomplish four things:
This last point, preventing pregnancy, raises special ethical problems. Avoiding pregnancy is a very serious concern for a rape victim and she deserves every help that medical professionals can give, provided that help is ethical. In many cases, it will be possible to determine that conception is not feasible, for example, if the woman is taking contraceptive drugs or if an examination of cervical mucus shows she is not in a fertile phase. If pregnancy is a possibility, however, since the victim is in no way responsible for the possible pregnancy, she has the right to avoid conception. A woman who has consented to intercourse takes responsibility as a free person to use the sexual act in keeping with its intrinsic significance of love and procreation. The rape victim has no such responsibility because she has not consented to the sexual act. Once a woman has conceived however, she cannot take any direct action to abort or to destroy a fertilized ovum or request others to do so. Because a fertilized ovum is a human being, albeit in incipient stage, it deserves the respect due human life. Ethical problems arise then when methods to prevent conception are utilized, which may have the effect of preventing conception, but which also may cause the destruction of a fertilized ovum if conception has already occurred.
- To offer the psychological support and counseling which the woman needs to work through the trauma of the attack and its aftermath.
- To provide medical care for injuries or abrasions that might have occurred.
- To gather evidence to be used if the rapist is apprehended and prosecuted.
- To provide treatment to prevent possible venereal disease and pregnancy.
Discussion
In the United States, most hospital rape protocols recommend the administration of antifertility drugs such as Ovral in large dosage (100mg) within 72 hours of the rape; a second dose being taken 12 hours later. The rape protocols specify that Ovral or other estrogenic hormones should not be administered until a test is given to determine if the woman is pregnant. If the test is positive, the pregnancy occurred before the rape and treatment with Ovral may injure the embryo. May rape protocols which call for the administration of Ovral be utilized in a Catholic hospital? Ovral and similar estrogenic compounds have two effects: they inhibit ovulation, but they also impede implantation of the embryo fi fertilization has already occurred. Hence, if Ovral is given with the intention of inhibiting ovulation and preventing conception, its use is acceptable, provided it is given at a time in the woman's cycle when it could prevent ovulation, or impede the motility of the sperm, and thus prevent fertilization. Moreover, any antifertility medication must be given within 72 hours of the rape. Otherwise the effect of the mediation would be useless in preventing conception because the sperm would be inactive or dead. If the antiovulatory mediation is given at a time in the menstrual cycle when its only effect would be to prevent implantation of the fertilized ovum, then its use would not be acceptable. The principle of double effect justifies the use of Ovral or similar medications if the intention is to avoid conception and, the medication is given at a time in the woman's cycle when ovulation has not occurred.
What if there is doubt as to whether or not the woman has ovulated, a situation which would be true of many women who present themselves for treatment after rape. A Catholic ethics committee in Great Britain asked this question and responded, rightly it seems, that if there is doubt as to whether ovulation has occurred within the present menstrual cycle, antifertility drugs may be use with the intention of preventing ovulation because the probability that fertilization has occurred is minimal. (3) The doubt in question concerns the fact of ovulation, not the fact of conception.
Notice that Ovral and other estrogenic hormones which inhibit ovulation are entirely different from RU486, the true "morning after pill." When used after intercourse, RU486 has only an abortifacient effect. RU486 produces its effect by blocking the normal action of the hormone progesterone, thus preventing implantation of the fertilized ovum. Hence, in care for rape victims, RU486, the true "morning after pill," is not an alternative for Catholic hospitals. At present, RU486 is sold commercially only in France and China; how long it will be unavailable in other countries is a question. much confusion has been generated by courts, lawyers and health care professionals who use the term "morning after pill" to refer to medications which are utilized with the intention of preventing conception. A firm distinction should be made between antiovulatory medications, such a Ovral, and RU486.
Conclusion
What is the import of the decision of the California appeals court insofar as Catholic hospitals are concerned? First, the California court declared the responsibility of the hospital to provide "information concerning, and access to, estrogen pregnancy prophylaxis" for rape victims. It allowed the hospital to fulfill this responsibility "by instructing the patient concerning the options for pregnancy prevention and by transferring the patient to another medical facility or another physician." (2) However, it seems Catholic hospitals are justified in offering direct service to rape victims. Hence, every Catholic hospital should have an explicit policy which delineates the circumstances in which antifertility medications may be used to help rape victims avoid conception. Secondly, the concept of abortion put forward by the California Appeals Court is not acceptable from the perspective of Catholic teaching. The court considers efforts to prevent implantation of a fertilized ovum to be "birth control", while Catholic teaching considers this to be abortion. A better effort to present to the court the scientific evidence maintaining that a fertilized ovum is a human being, even before implantation, seems to be in order.
Kevin O'Rourke, OP
Footnotes 1. Science 9-22-89; p. 1319.
2. Second Appellate District; Brownfield vs. Daniel Freeman Marina Hospital, 3-2-89.
3. Origins, 3-13-86; p. 633.
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