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Guest Viewpoints

The Right to Choose?

August 2, 2018
John Athanasatos

For the past week or so much of the nation, especially in New York, has been in uproar over President Trump’s Supreme Court nominee, conservative Judge Brett Kavanaugh. We see the televised campaign advertisements of Governor Andrew Cuomo claim that “Roe v Wade is on the chopping block.” Cuomo vows as part of his gubernatorial re-election bid to protect women’s reproductive rights. The right to choose, this is what is at stake. However, what is disturbing is that women are not properly informed by health professionals about contraceptives in order to choose properly. Drugs such as emergency contraceptives and hormonal contraceptives are not properly discussed with female patients. They are referred to as contraceptives but do have abortifacient capabilities.

So what are emergency contraceptives? It is a high dose progestin (progesterone containing drug) that is taken immediately after unprotected sex, up to 72 hours thereafter. It is also taken in the event a condom broke during intercourse. It is sold Over-the-Counter without a prescription behind the pharmacy counter. So what does it do? It prevents ovulation, it causes cervical mucus changes that inhibit sperm reaching an ovum and it causes endometrial changes which prevent implantation. The first two mechanisms of action are contraceptive but the third is debatable as contraception or abortion. There have been instances when married women who were using a condom as a form of birth control which malfunctioned, went to the local pharmacy in search of emergency contraception with the presumption that all it would do was prevent a pregnancy, specifically prevent fertilization. Is it possible that many of those same women, if they were properly informed of what the drug actually does, would have still purchased it? Common trade names for emergency contraceptives are: Plan B, Next Choice and Take Action.

Contraception pills either progestin only or combination estrogen-progestin products have the same capabilities as emergency contraceptives. So do drugs like Provera which is an injection or the progestin-containing IUD (Inter-uterine device). There is an argument to be made with these drugs as well, that many married women might have chosen not to use them had they been properly informed of what they actually do.

The Orthodox Church as well as the Roman Catholic Church and many of the Protestant denominations uphold that life begins at conception. So anything that prevents conception would be contraception, however, anything that follows after conception such as the prevention of implantation can be viewed as abortifacient. Abortifacient means the capability to cause an abortion. The above mechanisms of action or clinical pharmacology are listed in very small print in the package insert that is accompanied with the drug. It is the responsibility of the prescriber and pharmacist to explain what all medications do, their adverse effects, drug interactions, contraindications, etc. Not to advise or counsel a patient is a violation of his or her autonomy. Autonomy is the capacity to make an informed, un-coerced decision. Simply said, the failure of the health care professionals whether intentional or not to inform patients of the specifics of these drugs is a clear violation to their autonomy.

The right to choose. Is that not what the uproar is all about? There are many women that if they were properly informed would not take or continue to use such products. Whether or not an individual woman may view these drugs as contraceptive or abortifacient, she still has the right to be informed and properly counseled on what these drugs actually do before she makes the decision to take them or not. If the concern is truly to protect women’s rights, thus their autonomy, then it should not only be about the right to choose an abortion but also the right to choose a birth control according to one’s beliefs. This can only be done with full disclosure.

So what drugs or devices are contraceptive only? Spermicides, condoms, diaphragms, basically any barrier that prevents the union of sperm and ova. Non-hormonal IUDs, although a barrier, may prevent implantation. The Catholic Church condemns the use of any contraceptives with the exception of rhythm method (refraining from sexual intercourse 5-7 days prior to and during ovulation). The Orthodox Church on the other hand does permit the use of contraceptives among married couples for the planning and spacing of children, certainly not for the prevention of any children. However, it is always best for someone to discuss these issues with their spiritual father or confessor.

The right to choose. This should include every woman’s right to be properly informed in order to make a decision suitable to her beliefs. It is the responsibility and ethical duty of every health care professional to properly disclose all information concerning a medication, device or procedure to a patient in order to safeguard that patient’s autonomy. What each woman ultimately chooses to do is not for us to judge, all we can do is provide the necessary information so that every woman can choose according to her beliefs. It is also important that our clergy be informed as well on what the aforementioned products do so that they can properly guide their flock.

John Athanasatos, PharmD, MDiv, Pharmacist, attended Long Island University and St. Vladimir’s Orthodox Theological Seminary.

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