I am grateful to Bishop Lori for his invitation to speak to you this morning. It is an honor to reflect with you on how everyone in the Church, and especially health care providers, can best shine the light of the Gospel of Life on every human person. All of us are called to shine the light of the Gospel of Life especially where people of our times and our culture need help to see human life is there at all -- life where it is smallest and most vulnerable.

The Church rightly celebrates Jesus' passionate concern for the human body. We share that concern. The ministry of health care carries on Jesus' concern and healing touch. The Church further recognizes that every physician, every health care worker, is an evangelist-one who proclaims the kingdom in their words and deeds. In fact, the earliest of those commissioned to proclaim the kingdom were intimately linked to the health care profession. We read in Luke Chapter 10: After this the Lord appointed seventy (-two) others whom he sent ahead of him in pairs to every town and place he intended to visit. He said to them, Whatever town you enter and they welcome you, eat what is set before you, cure the sick in it and say to them, "The kingdom of God is at hand for you." The Lord sent those who cure to announce the kingdom. And he sends them still. He send you.

The Church can neither proclaim nor practice the Gospel of Life without you. Recently I worked on a draft of the statement for the Maryland Bishops on end of life issues. When it was completed, I was presenting it as part of a panel of speakers. The lead speaker praised the document, but then said, "it has a flaw….it would have been much better had it reflected the expertise of medical professionals and not just theologians, lawyers, and ethicists. ….." He was right! To proclaim the Gospel of Life does not take a village, it takes a Church. It takes the voices of everyone here.

Rape Protocols

I can think of few questions recently discussed in the Church which call for more collaboration in holding up the torch of the Gospel than the question of rape protocols.

Why is this an area of darkness that needs the Gospel light? Is it that we have such a great number of rape pregnancies? Well, any is too many, but this issue concerns statistically few actual cases. One website, AbortionFacts.com puts the number of assault rape pregnancies in the United States at under 400 per year. I do not have statistics at my fingertips and do not pretend to be able to judge the statistics offered on this website, but I suspect that the number of rape victims who seek help at our Catholic hospitals is not large. But it is not the number, I suspect, that generates the concern.

It is about legislation and lobbying efforts. Pro-abortion groups and the ACLU teamed to form what amounts to a national lobbying effort to promote mandatory emergency contraception to all victims of sexual assault. (National Catholic Register, Nov. 2007). Today, at least 18 state legislatures have passed legislation, including Connecticut. Catholic health care facilities and Catholic dioceses must respond to legal pressure to provide Plan B. The legislative initiatives and the debates that surrounded them were painted as laws protecting the assault victim. And Catholic resistance to these bills based on concern for the unborn was instead characterized as a denial of woman's rights and as a punishing of the victim of sexual assault.

Debate in Catholic circles abounds as well. It stems, in some degree, from the variety of interpretations of the Church's teaching on the treatment of rape victims. The 2001 Ethical and Religious Directives for Catholic Health Care Services, 2001, #36 recognizes the right of a victim to defend against possible conception. It allows for the use of medications to prevent ovulation, sperm capacitation, or fertilization. It forbids treatments which have as their purpose or direct effect the removal or interference with the implantation of a fertilized ovum.

Three positions emerged regarding the use of emergency contraception in the event of rape. Each of these three positions on Plan B had in common the acceptance of a medical premise, namely, that Plan B can interfere with nidation.

The First View: "Prohibitionists"

The first view argues that emergency contraception should never be given, especially not in Catholic hospitals. Those who hold this view take this strong position because they judge that one ought never risk the death of an innocent human life. They reason that since Plan B may interfere with the nidation of a newly conceived human life by rendering the endometrium hostile, this is precisely the risk one ought never take. Prominent Catholic leaders have taken this stand including Msgr. William Smith, the Academic Dean of St. Joseph Seminary in Dunwoodie, NY, and Judie Brown, president of American Life League of Stafford, VA. She is quoted in a recent issue of the Human Life Review as saying "Realizing that there is no test capable of proving with one hundred percent accuracy that a preborn baby has or has not been conceived, it is clear that there is never a circumstance in which a Catholic hospital should provide Plan B. Not only is the provision itself against Catholic teaching on the subject of contraception, but it is well known that the pill kills preborn children." (Quoted in the article in Human Life Review article by Stephen Vincent "In Cases of Rape," Summer 2007, which has proven very helpful in the preparation of this talk.)

This first view takes a strong stand. It does not deny that a victim has the right to protect herself, but once it judged that Plan B may be abortifacient, it concluded that the only safe way to proceed is to forbid the use of Plan B absolutely. Any treatment which has any degree of abortion risk must be outlawed. We may call those who hold this view as prohibitionists.

Some prohibitionists sought support for their view in the Church's teaching on abortion. The 1974 document De Abortu, they argue, said that it is morally wrong to risk murder. But this is not actually what the document says. De Abortu was not arguing against taking any risk, rather it was addressing those who wondered if there was a human person present from the earliest moment of conception. It taught, "From a moral point of view this is certain: even if a doubt existed concerning whether the fruit of conception is already a human person, it is objectively a grave sin to dare to risk murder."

De Abortu was not addressing Plan B. Nonetheless, the prohibitionist position seems appropriately cautious given its presupposition that emergency contraception will kill or at least risks killing the unborn.

The Second View: The Peoria Protocol, or the Ovulation Approach

The second position to emerge also presumes that Plan B puts unborn children at risk. It seems a bit more sophisticated, however, because it recognizes that there may be risks which are so minimal that the standard of care does not require us to act only in a way which absolutely rules out any possible abortion, but only requires us to take every reasonable precaution. If we do this we can be morally or reasonably certain that we are not taking an immoral risk of harming an unborn child.

We may, this view contends, administer Plan B as a treatment aimed at preventing ovulation. To be sure that this is what we are actually doing, we must administer the drug only at a time when it can suppress ovulation. True, the Ethical and Religious Directives rule out treatments that intend to interfere with nidation, but if anovulants are given before ovulation, might we not have moral certitude that we are doing something which prevents conception rather than attacks the newly conceived human person? The protocol developed was called the Peoria Protocol. It was adapted in that diocese as well as by the Connecticut bishops and the Pennsylvania bishops and others (in one form or another).

Dr. Eugene Diamond, writing in NCBC 2003 argued that one could administer Plan B when one is reasonably sure that it is being given as an anovulant. "Ovulation method approaches such as the Peoria Protocol are real world ethical methodologies," he concludes. "They are good faith attempts to protect human life and to give Catholic witness to our commitment to the sanctity of even microscopic human life." (quoted by Vincent in Human Life Review). As Msgr. McMahon puts it (Ethics and Medics, NCBC, 2002) this "ovulation approach "is clearly directed toward preventing conception. …It seeks to protect the life of any child who may be conceived as the result of rape by limiting the use of contraceptives to cases in which one is morally certain that their effect is not abortifacient. … [and] it works to ensure that Catholic hospitals will not perform an abortifacient act."

As Steven Vincent explains, the key term in this analysis is "morally certain." Msgr. McMahon admits that ovulation tests are not 100 percent accurate and that emergency contraception may not prevent ovulation in all cases. There is a small possibility that even under the ovulation approach, the administration of EC may cause an abortion. It is a reasonable risk.

The Third View: Minimal Risk

But a third view emerged. The Catholic Health Association did not advocate the Peoria Protocol, sometimes called the ovulation approach. It was more persuaded by the arguments of Franciscan Brother Daniel Sulmasy, a medical doctor and head of ethics at St. Vincent's Medical Center in New York City. Dr. Sulmasy argues (KIEJ, December 2006) that standard medical care does not require the level of certitude implied either by the prohibitionists nor by the ovulation/Peoria Protocol. "If we are morally bound never to act whenever we risk indirectly causing human deaths, then most medical procedures would need to be banned," he writes. Advocates of the ovulation approach are inconsistent, he claims, because they do not call for ovulation tests before X-rays or the administration of medications such as antibiotics that could possibly harm a preborn child. In these cases, a pregnancy test is thought by most to be a sufficient precaution. "The degree of certitude that some demand is simply incompatible with the physical, intellectual, and moral finitude that characterizes the human condition." (Quoted by Vincent, article by Sulmassy: see http://muse.jhu.edu/journals/kennedy_institute_of_ethics_journal/v016/16.4sulmasy.html)

The presupposition of Brother's argument is that the use of Plan B does run some risk of interfering with nidation. There is some risk of an abortifacient effect of emergency contraception. However, he asserts that risk must be balanced with benefit in every medical decision. It is not immoral to take risk. Treatment designed to benefit a rape victim by protecting her from pregnancy must be balanced against the minimal, even rare case in which Plan B causes an abortion of a newly conceived innocent human life. He calculates the probability. "If EC drugs do cause indirect abortions, the proportion of cases in which these events occur if one uses the ovulation approach instead of the pregnancy approach will be on the order of 0.004 percent instead of 0.04 percent of cases" (Vincent, Human Life Review).

In good medical practice, prudential medical judgment must consider the risks, but minimal risk alone is not determinative. He did not think that those who advocate the Peoria Protocol were acting unreasonably, but he insisted that their degree of caution was not significantly different than his approach which was to give Plan B regardless of the LH surge test.

In sum, one group of thinkers on this subject argued that there is a risk to the use of Plan B. Their conclusions varied. The first sub-group said that no risk was acceptable; the second sub-group said that some risk was acceptable but held that only pre-ovulation administration of Plan B reduced risk sufficiently; the third sub-group agreed that minimal risk was routinely accepted in medical practice and that ovulation testing does not make a statistically significant difference in reducing a potential interference with the nidation of a newly conceived human life.

The New View: The Connecticut Bishops

A new twist was coming. The Bishops of Connecticut protested in May to the state legislature against the requirement that rape victims be given Plan B without regard to ovulation testing. The bishops asserted that Catholic hospitals would provide EC when that medication can act as a contraceptive by preventing ovulation, but not when the woman is already in the ovulation stage of her cycle as determined by appropriate LH surge testing. In their statement of September 27, 2007, the Connecticut bishops indicated that they would comply with the law that they had previously protested.

They did not, however, accept the Sulmasy position which argued that ovulation testing did not significantly reduce the risk of hindering nidation. Rather, a new approach was taken. Rather than a calculation of acceptable risk, the bishops correctly note that there is a medical question if there is any risk at all.

They are not alone in this view. In summer 2007, the Catholic Health Association stated that a survey of recent research on Plan B concluded that the studies were either inconclusive or the findings insufficient to prove that Plan B had post ovulatory effects on the endometrium. This is a significant suggestion that a risk alone approach may be unfounded. Most recently, Dominican Fr. Nicanor Austriaco (NCBQ Winter 2007) has attempted to respond to those who claim that it is certain that Plan B is an abortifacient. He writes, "For example, Fr. Thomas J. Euteneuer, president of Human Life International, has urged the Connecticut bishops to reconsider their position because there is no doubt that Plan B is an abortifacient: Fr. Euteneuer bases his certitude, it would appear, on the Barr Phamaceutical product insert which states that Plan B may prevent attachment of a fertilized egg to the uterus (implantation)." Fr. Austriaco critically reviews the scientific literature (not counting on the product insert) and concludes that there "is mounting and recent evidence-several important papers were published only in the past six months-that suggests that this emergency contraceptive has little or no effect on post-fertilization events." Although they may be challenged, I am impressed by Fr. Austriaco's finding.

Nevertheless, the NCBC as an organization has not yet changed its risk-based position of Oct 3, 2007. . "…, in the matter of protocols for sexual assault, there is virtual unanimity that an ovulation test should be administered before giving an anovulant medication. The protocol the NCBC has supported requires the ovulation test because it provides greater medical and moral certitude that the intervention will have its desired anovulatory effect."

Call for Collaboration

There are, in sum, still many Catholic ethicists taking risk views of various kinds.

I do not believe, however, that there is any virtual unanimity. At least there is doubt, given the findings of Nicanor and others.

Even though the bishops will comply with it, the law in Connecticut is nevertheless flawed. I agree with the NCBC that it does not let physicians put into practice their best medical judgment, especially if the physician concludes that Plan B is likely abortifacient if administered after ovulation. It is flawed law which does not allow victims of sexual assault to have all the information necessary to make an informed decision about taking Plan B. It does not respect the collective conscience of Catholic Health Care facilities to make policies which reflect their corporate conscience. It does not recognize the authority of religious leaders like the Bishops to teach the practical consequences of faith without state interference. It does not provide for a conscience exemption. (See the full statement of the NCBC: http://www.ncbcenter.org/07-10-03-Connecticut.asp).

The Bishops' statement deserves careful reading and respect. It correctly points out that there is no definitive Catholic teaching on this matter neither from the National Conference nor from the Holy See. It correctly points out, despite claims of other groups who have been critical of the decision, that there is legitimate medical/scientific debate that Plan B is abortifacient. Finally it stresses how important these two presuppositions are: if either of these two conditions change, the matter will be reopened.

Let me close by reading part of their statement:

Since the teaching authority of the Church has not definitively resolved this matter and since there is serious doubt about how Plan B pills work, the Catholic Bishops of Connecticut have stated that Catholic hospitals in the State may follow protocols that do not require an ovulation test in the treatment of victims of rape. A pregnancy test approved by the United States Food and Drug Administration suffices. If it becomes clear that Plan B pills would lead to an early chemical abortion in some instances, this matter would have to be reopened.

This is a call for collaboration. The Church relies on the scientific community to read and conduct studies in the light of the Gospel of Life. Some are now proposing other drug protocols in place of Levenorgestrel, such as gonadotropin releasing hormone antagonists. Others are, sadly, experimenting with human embryos cultured to the blastocyst stage to observe attachment behavior in the presence of Levenorgestrel.

We need clearer research, we need medical consensus. The American College of Obstetricians and Gynecologists of Nov. 2007 insists that appeals to conscience must be based on solid science.

But most of all, we need each other as proclaimers of the Kingdom, of evangelists sent by Christ. For the Gospel of Life can neither be convincingly taught nor effectively implemented without the unity in faith we have just celebrated in this year's White Mass.