November 10, 2007

The Unsupportable Arguments Against Plan B

[Click on the image above to see the original version at full size.]

In the past couple of weeks, "conscientious objection" to the distribution of certain drugs by pharmacists has again been in the news. As anyone who has read Sensen No Sen from its inception knows - and if both of you are reading this, you have my gratitude - the third post I ever wrote, Personal Belief and Professional Obligation, dealt with this very topic, but I think it's worth re-examining this issue in hope of separating fact from fiction.

One of the medications most often at the center of the conscientious objector debate is Plan B, an emergency contraceptive approved by the Food and Drug Administration (FDA) in 1999, and commonly referred to as the "morning after pill." Those with objections to it, like Washington pharmacists who successfully sued last week to suspend a state law requiring them to dispense Plan B, claim that the drug's effects are tantamount to abortion.

Adding fuel to this fire is Pope Benedict XVI, who told a gathering of Catholic pharmacists in October that conscientious objection was a right that must be recognized by their profession, and that "Pharmacists must seek to raise people's awareness so that all human beings are protected from conception to natural death, and so that medicines truly play a therapeutic role." The pope went on to state that conscientious objection would "enable them not to collaborate directly or indirectly in supplying products that have clearly immoral purposes such as, for example, abortion or euthanasia."

Despite such rhetoric however, Plan B does not cause abortion. From the manufacturer's website:
Plan B works like a regular birth control pill. It prevents pregnancy mainly by stopping the release of an egg from the ovary, and may also prevent the fertilization of an egg (the uniting of sperm with the egg). Plan B may also work by preventing it from attaching to the uterus (womb). It is important to know that Plan B will not affect a fertilized egg already attached to the uterus; it will not affect an existing pregnancy.

Plan B is approved by the FDA and contains the hormone levonorgestrel, the same hormone in the birth control pills that healthcare professionals have been prescribing for more than 35 years. The difference is that Plan B contains a larger dose of levonorgestrel than the amount found in a single birth control pill.

Remember that Plan B is not RU-486 (the abortion pill). Because Plan B is used to prevent an unplanned pregnancy, it will not work if you’re already pregnant. If you take Plan B and are already pregnant, it will not affect your existing pregnancy.
(NOTE: The FDA's Plan B webpage contains the same information. I include the manufacturer's language here because it is clearer and easier to read. Emphasis is mine.)

Essentially, there are two arguments against Plan B. The first is that it causes abortion, and those who believe abortion is immoral should not have to dispense it. The second - which is implicit in Pope Benedict's statements and supported by the positions of the Catholic Church - is that the morning after pill is a contraceptive, and those who believe contraception is against "God's will" should not be forced to fill prescriptions for it. Neither of these positions hold water.

As documented above, Plan B is not an abortifacient, and while some people may "believe" that it is "tantamount" to abortion, it very simply isn't. While it is certainly valid to object to Plan B for some other philosophical reason - opposition to contraception comes to mind - arguing that it causes abortion is completely invalid; this "debate" has been closed for a long time.

Further, giving credence to such erroneous beliefs is essentially the same as considering other ideas wholly unsupported by facts - such as Plan B causing sterilization, sex change, or the growth of enormous reptilian scales that transform potential mothers into lizard women - to have merit. Plan B doesn't do any of those things, just like it doesn't cause abortions, and one is left to wonder how in the world court decisions like the recent one in Washington can be made based on what is easily determined to be complete fantasy.

The anti-contraceptive argument against Plan B is somewhat more opaque, but also readily debunked. To whit, pharmacists dispense numerous forms of birth control, from several versions of The Pill, to spermicides, IUDs and diaphragms. The Catholic Church has been consistent in its position against these and all forms of contraception - however much one might disagree with their tactics, which have included telling African villagers that condoms do not prevent the spread of HIV - but this is beside the point. If Catholic (or other) pharmacists have religious objection to filling prescriptions for Plan B, then they must object to distributing all other contraceptives as well.

While said consistency might be laudable from a philosophical perspective, it clearly amounts to forcing Catholicism on non-Catholics, and calls into question the viability of pharmacology as a dependable element of society. As I wrote in 2006:
The role of a pharmacist is to fill legal prescriptions accurately, ensure that harmful drug interactions do not take place, and answer questions about things like side effects and the consequences of missed doses. This is clear from the moment one enters pharmacology school - or at least it should be – and it should be even more clear that the job of pharmacist does not include a requirement that one’s customers be judged morally. If it is otherwise, then pharmacist Tom Cruise could refuse prescription medication to women suffering post-partum depression – which can lead to infanticide in the worst cases – because of his Scientologist beliefs.
Permitting pharmacists to pick and choose which medicines they want to dispense is plainly unsustainable, and determining court cases based on delusion over established fact ought to be unthinkable. Those with moral perspectives that prevent them from filling certain prescriptions shouldn't be allowed to be pharmacists; judges who issue rulings rooted in fiction should never be allowed on the bench.

When one considers how easy it is to debunk the claim that Plan B aborts a pregnancy, or spends even a short time considering the untenable nature of "morally selective" prescription fulfillment, it becomes increasingly obvious that the argument about Plan B is - if we're honest - clearly not about abortion at all. Since the morning after pill prevents unwanted fertilization, and anyone who wants to stop the abortion of unwanted children - or claims to - should fully support safe, effective means for avoiding unwelcome pregnancies, the Plan B controversy must be about something else. Likewise, any assertion within this discussion that life begins at fertilization can be disregarded because it is completely irrelevant. With Plan B, fertilization doesn't take place, and without fertilization, there is no baby, branding false the claim that this argument is about the life of a child.

In fact, opposition to Plan B makes it completely clear that standing against emergency contraception isn't about the sanctity of life in any way, shape or form - it is about regulating female physiology, and more importantly, sex. That's something to keep in mind if your contraceptive method of choice is something other than abstinence.

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