The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will (...) exist in the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)

For years, the sexual and reproductive health of women with intellectual and developmental disability or disabilities has been insufficiently addressed by institutions and family members due to a lack of information, training, and, sometimes, religious issues. In this context, contraceptive digital pills can enhance the sexual and reproductive control of this population group. Digital pills could help to improve adherence to treatments aimed to prevent unwanted pregnancies, as well as allowing women and their caregivers to exert better drug intake control. (...) However, there are some ethical risks to consider that may outweigh these benefits. This study sets out to explore the ethical considerations that should be taken into account in the case of a potential roll‐out of contraceptive digital pills as a way of improving the sexual and reproductive health of these women. (shrink)

Don Marquis’ future-like-ours account argues that abortion is seriously immoral because itdeprives the embryo or fetus of a valuable future much like our own. Marquis was mindful ofcontraception being reductio ad absurdum of his reasoning, and argued that prior tofertilisation, there is not an identifiable subject of harm. Contra Marquis, Tomer Chaffercontends that the ovum is a plausible subject of harm, and therefore contraception deprives theovum of a future-like-ours. In response, I argue that being an identifiable subject of harm (...) is notsufficient for Marquis’ argument to succeed. In addition, we must also share our identity withan ovum. I show that on the account of personal identity utilised by Marquis’ defenders, weare not identical with an ovum. As a result, Chaffer’s reductio fails. (shrink)

This paper examines incorrect use of oral contraceptives (OCs) in rural Bangladesh by using data from an OC compliance survey. Of the 1031 current users of OCs interviewed, about 13% took their pills out of sequence, while 17% left incorrect intervals between pill packs. Forty per cent of the women reported missing one active pill during the 6 months prior to the survey, and 74% of them took correct action with the missed pill. Of the women who missed two active (...) pills (16%), only 9% took correct action. Multivariate analyses revealed that women's education and their husbands' support helped protect against taking incorrect action with a missed pill. The fieldworker's contact was found to protect against leaving an incorrect interval between pill packs. Women who had membership of non-government organizations were less likely to interrupt their pill use, and more likely to take their pill out of sequence. The present study underscores the need for providing women with more support in their pill use, and advocates that service providers should be the focal point of efforts. Husbands' support is essential to improve the pill-taking behaviour of Bangladeshi women. (shrink)

Emergency contraceptives may sometimes prevent implantation, thereby causing the death of the embryo. According to some positions contrary to abortion, because the embryo is a human animal, there are usually decisive moral reasons not to use them. In this article, I will show that objecting to the use of emergency contraceptives on those grounds is unjustified. If organisms are real existents, then according to the most plausible conception of what is required for a group of cells to compose one, the (...) embryo cannot qualify as a single organism. On the other hand, if organisms are virtual objects, then whether or not the embryo qualifies as one is morally irrelevant. I conclude that even if those positions are right about the morality of abortion, they are not entitled to oppose the use of emergency contraceptives. (shrink)

Pharmacists with religious or ethical objections to prescribing emergency contraception won the latest round in the fight over conscience clauses in a case that could have broader implications for attempts to restrict access to contraception. In Stormans, Inc. v. Selecky, a federal District Court in Washington State granted an injunction to block the enforcement of regulations that would have forbidden pharmacists to refuse to dispense emergency contraception on the grounds of religious or ethical objections. In its decision, (...) the court applied Supreme Court abortion precedent without explicitly ruling whether emergency contraception should be legally categorized as a form of abortion or as contraception. However, the legal status of emergency contraception affects the strength of the defendants’ claims that the law was justified on the grounds of preventing sex discrimination. In neglecting to rule one way or the other, the court not only failed to adequately consider the sex discrimination claim but also may have opened the door to more restrictive regulation on contraceptives generally. (shrink)

The 2012 contraception mandate issued by the US Department of Health and Human Services has intensified the debate over a health care practitioner’s right to conscientiously object to providing contraception. This paper approaches the debate over conscientious objection to contraception from a pharmacist’s standpoint. It shows that contraception is the cause of or a contributing factor to observed psychosocial suffering and is not “preventive health care” as labeled. It argues not only that a pharmacist should have (...) the right to conscientiously object to dispensing contraception but also that, given the mission of the pharmacist as a health care practitioner, a pharmacist is obligated to refuse to dispense contraception. The paper argues that the obligation to refuse to dispense contraception applies to all who are involved in the provision of health care. National Catholic Bioethics Quarterly 12.4 (Winter 2012): 675–696. (shrink)

The author discusses the effects of contraception, which have borne out the predictions of Pope Paul VI's encyclical Humanae Vitae: the explosion of out-of-wedlock births, lack of respect for women, STD's, HIV/AIDS, etc. The overpopulation claims that fed the acceptance and promotion of contraception have been discredited by demographers; now the social costs of underpopulation are increasingly apparent. Acceptance of contraception has now also led to an embracing of morally objectionable technologies like cloning. This is the latest (...) consequence of the separation of sex and reproduction signaled by the acceptance of contraception. (shrink)

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the (...) right of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)

The Obama administration’s HHS mandate to force Catholic and other religious organizations to provide insurance coverage for morally objectionable practices has been the source of a great deal of controversy. While the religious liberty question has received the most attention, the mandate reveals a yet deeper problem in the mainstream acceptance of contraception and even abortion as a normal part of medical practice. The author argues that these practices constitute a deep corruption of medicine itself, away from its original (...) meaning as a kind of restorative justice grounded in a substantive understanding of the human good and towards a formalist emphasis on preference satisfaction and patient autonomy. (shrink)

Combined oral contraceptives have been demonstrated to have significant benefits for the treatment and prevention of disease. These medications also are associated with untoward health effects, and they may be directly contraceptive. Prescribers and users must compare and weigh the intended beneficial health effects against foreseeable but unintended possible adverse effects in their decisions to prescribe and use. Additionally, those who intend to abide by Catholic teachings must consider prohibitions against contraception. Ethical judgments concerning both health benefits and (...) class='Hi'>contraception are approached in this essay through an overview of the therapeutic, prophylactic, untoward, and contraceptive effects of COC and discussion of magisterial and traditional Catholic teachings from natural law. Discerning through the principle of double effect, proportionate reason, and evidence gathered from the sciences, medical and moral conclusions are drawn that we believe to be fully compliant with good medicine and Catholic teaching. (shrink)

L’article se propose de voir comment ont été promus par les gouvernements de la Ve République la contraception et l’avortement en Guadeloupe et Martinique entre 1964 et 1975. La volonté de différencier la métropole (politique nataliste) des Antilles (politique néo-malthusienne) a été battue en brèche par le refus de l’Église et de certains partis politiques antillais. Les féministes ont dénoncé ces différences de politique. La contraception a été par ailleurs encouragée par des associations et des médecins soucieux d’améliorer (...) la vie des femmes en limitant les grossesses à répétition. En fin de compte, ce sont les femmes elles-mêmes qui ont décidé (ou non) de limiter les naissances. (shrink)

This essay seeks to establish that Catholic community pharmacists should refuse to verify, dispense, and counsel on hormonal medications used for contraception on the grounds of professional and personal beliefs as these services constitute immoral immediate material cooperation. In this controversial area of patient care, pharmacists are more frequently being called upon to facilitate medication use for contraceptive purposes. Contraceptive acts are believed by some healthcare providers to be morally harmful to a patient’s well-being. Pharmacists who hold beliefs that (...) contraception does not promote positive patient outcomes are professionally bound to refuse immediate cooperation through providing pharmaceutical services related to contraception. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Extramarital Contraception in the Catholic Faith:A Call to Action from a Physician and EthicistCara BuskmillerIntroductionDefinitionsBefore proceeding to a discussion of extramarital contraception, it is relevant to lay a foundation of definitions and limitations of this essay. Here, "sex" and "sexual act" will refer to acts of penile–vaginal intercourse and acts meant to lead to such intercourse, respectively. Other acts which are rightly called "sexual" are not relevant (...) to this essay, as the focus here is on encounters that could result in fertilization.The traditional natural law theory with its analysis of object, intention, and circumstances is at play in this essay, with a hylomorphic understanding of nature and ethics. In this understanding of ethics, the names of many acts include not only an object but an intention and circumstances (e.g., murder specifies an illegal type of killing with premeditation). Likewise, "contraception" here refers to the use of any drug or device which temporarily lowers fertility (object), to prevent fertilization (intention) due to presumed-fertile sex (circumstance). Such drugs or devices are called "contraceptives" in this essay. In this essay, "contraception" is not committed solely by intending to avoid fertilization, so acts such as trying to avoid fertilization by timing sex during infertile parts of a menstrual cycle are not contraception, and the pastoral term "contraceptive mindset" does not apply. "Contraception" is also not solely defined by the use of particular medical products, since the intention to avoid fertilization is part of the definition in this essay. Thus, [End Page 1245] prescribing or taking a birth control pill for polycystic ovarian syndrome, in the words of Pope St. Paul VI in his 1968 landmark encyclical Humanae Vitae (HV), is not at all illicit, here because such treatment is not contraception, and the problems of contraception do not apply (§15)."Marriage" in this essay refers principally to sacramental matrimony, made by the consent of a baptized man and a baptized woman.1 Civil marriage, cohabitation, long-term affairs, sex in dating, short-term hookups, prostitution, and sexual assault represent a spectrum of falling away from matrimony. This essay assumes that matrimony is God's one true plan for sex, fertilization, and childrearing. This essay also makes heavy use of the Scholastic-personalist perspective of HV on the unitive and procreative dimensions of sex. As sexual relationships "fall away" from matrimony, they lose resemblance to these dimensions."Consent" is here defined as a free act in which a person agrees to do, accept, or reject something.2 Consent is an act of the will, and it may be partial or total. Only when consent is total is a person held fully responsible for his or her actions; for example, only when consent is total can a person commit a mortal sin. Consent is different from assent, which is not of the will, but of the mind.3 In this paper, sex without consent is termed "sexual assault"—the status of the act as an assault is solely determined by consent. These definitions allow for a sexual assault in which a victim withholds consent and yet does not resist an attack,4 which is different from past legal and colloquial definitions.5 This definition also allows for assault victims that have positive emotional responses to or physical arousal from an attack. These responses from a victim do not make the assault consensual or desired, [End Page 1246] and in fact make post-traumatic recovery more difficult.6 Simply put, consent is of the will, and this is not diminished by whether the body follows suit; this differs from some legal definitions of consent in canon law, where the will of the person agreeing to a contract is signified by externals, even if there was no intention to fulfill the duties of the contract.7 Consent will be central to this essay, since it helps make the spectrum of relationships that "fall away" from marriage intelligible in two sets: one with consent, and one without."Intellectual disability" in medical and ethical literature refers to a large spectrum of differences in mental and behavioral performance, but this essay is only considering intellectually disabled persons who would be unable to... (shrink)

: On the grounds that rape is an act of violence, not a natural act of intercourse, Roman Catholic teaching traditionally has permitted women who have been raped to take steps to prevent pregnancy, while consistently prohibiting abortion even in the case of rape. Recent scientific evidence that emergency contraception (EC) works primarily by preventing ovulation, not by preventing implantation or by aborting implanted embryos, has led Church authorities to permit the use of EC drugs in the setting of (...) rape. Doubts about whether an abortifacient effect of EC drugs has been completely disproven have led to controversy within the Church about whether it is sufficient to determine that a woman is not pregnant before using EC drugs or whether one must establish that she has not recently ovulated. This article presents clinical, epidemiological, and ethical arguments why testing for pregnancy should be morally sufficient for a faith community that is strongly opposed to abortion. (shrink)

This is a response to James Dubois’ “Is anesthesia intrinsically wrong?” I do not address many of the claims in this article but only DuBois’ use of the moral evaluation of the medical use of anesthesia as a counter example to two lines of reasoning developed to defend the traditional Catholic prohibition of contraception. Elizabeth Anscombe's dialectical defense of this teaching does not imply that such a defense must logically apply to the use of anesthesia. John Finnis’ defense of (...) this teaching on the basis of a natural law argument does not imply that consciousness is a basic human good. (shrink)

In the essay I argue that the routine use of contraception is morally tantamount to early-term abortion because it produces the same result: namely, it prevents the creation of a human life that would have otherwise probably taken place. Because it can be shown that contraception is ethically acceptable, it follows that early-term abortion is as well.

This article builds on existing feminist literature on obstetric violence in the context of childbirth to argue that there is a continuum of obstetric violence that also includes that perpetuated in relation to pregnancy prevention and termination, as well as antenatal healthcare and birth. This structural violence is highlighted in relation to conscientious objection, the reporting of people suspected of illegal abortions by their healthcare providers, and contraceptive coercion. Recognizing the limitations of criminal and human rights approaches to obstetric violence, (...) this article takes Martha Fineman’s vulnerability theory as the foundation for the transformative structural change of healthcare institutions. (shrink)

The Islamic government of Iran recently passed and announced a new law titled “Rejuvenation of the Population and Protection of the Family.” This legislation is a noteworthy example of biopolitics‐influenced biolaw. In terms of abortion, contraception, prenatal screening, and population control, this law clearly contrasts with women's fundamental rights and freedoms and has significant health‐related consequences for different sectors of the population. A historical review of the population policies of the Islamic Republic of Iran shows the occurrence of multiple (...) abrupt and radical changes in such policies over the past four decades. This new law, promoted by religious biopolitics, is the most recent example, and places stringent limits on abortion. According to it, all decisions concerning abortion must be made in courts rather than in health clinics. Such courts are typically presided over by male religious scholars. This law also limits prenatal screening to the degree that will increase the rate of genetic defects, especially in the population's lower socioeconomic strata. By strictly limiting access to contraception, this law will increase the rate of unwanted pregnancies and sexually transmitted diseases. This paper argues that such an influence of biopolitics on biolaw contrasts with the principles of bioethics. Still, Iran's current institution of bioethics cannot address it effectively. Therefore, a new model of interaction between bioethics, biopolitics, and biolaw is needed to prevent the detrimental consequences of such pieces of legislation. Such a paradigm shift is demanded by the current “Woman, Life, Freedom” movement of the Iranian people. (shrink)

Contraception works by preventing fertilization of an egg or preventing implantation of a fertilized embryo. For those who believe pregnancy begins at implantation, contraceptives preventing implantation are not abortifacient. However, for those who assert that pregnancy begins at fertilization, any agent causing the intentional loss of an embryo, even prior to implantation, is abortifacient, both morally and for lack of a different term to describe the postfertilization, preimplantation loss. In the debate on this topic, much of the discourse on (...) both sides wrongly focuses on the opposing side's perceived ignorance in denying scientifically proven definitions rather than on the substance of the conflict. Indeed, both sides accuse the other of prioritizing its “subjective” views over “objective” facts. In this essay, we unpack the scientific, cultural, and religious factors that underlie this debate. We argue that the only way to move forward is to clarify our terminology and engage with the substance of the argument, rather than merely the rhetoric. (shrink)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

This article argues that practitioners have a professional ethical obligation to dispense emergency contraception, even given conscientious objection to this treatment. This recent controversy affects all medical professionals, including physicians as well as pharmacists. This article begins by analyzing the option of referring the patient to another willing provider. Objecting professionals may conscientiously refuse because they consider emergency contraception to be equivalent to abortion or because they believe contraception itself is immoral. This article critically evaluates these reasons (...) and concludes that they do not successfully support conscientious objection in this context. Contrary to the views of other thinkers, it is not possible to easily strike a respectful balance between the interests of objecting providers and patients in this case. As medical professionals, providers have an ethical duty to inform women of this option and provide emergency contraception when this treatment is requested. (shrink)

This study aimed to determine the factors influencing the use of spacing contraceptive methods in India, particularly from men’s perspective. Data were obtained through a semi-structured interview schedule from 2687 married men aged between 18 and 40 years from central Mumbai City, India, during 1999. Chi-squared tests and binary logistic regression analysis was carried out to determine the relationship between various variables and the likelihood of a couple using spacing contraceptive methods. Of the 2687 couples, 1395 (51·9%) were using one (...) or other method of spacing contraceptives and 1292 (48·1%) were not using any method at the time of survey. Male participation in contraceptive use was 23% (condom and withdrawal). The results indicate that the use of spacing contraceptive methods was significantly higher among those couples where the men desired one or two children (OR=4·3), had knowledge of five or more contraceptive methods (OR=1·9) and discussed with their wives obtaining family planning information (OR=3·2), spacing (OR=2·7) and permanent (OR=2) contraceptive methods. Age, income, desired number of children, knowledge of a greater number of contraceptive methods, inter-spouse communication regarding obtaining family planning information, spacing and permanent methods were found to be strong predictors of the use of spacing contraceptive methods. The study underlines the importance of intervention programmes aimed at promoting a small family norm, increasing the number of contraceptive choices available and encouraging inter-spouse communication. Hence, policymakers and programme managers should encourage interventions in this direction, targeting couples to enhance the use of spacing contraceptive methods. (shrink)

A Catholic physician practices in a world that condones the use of contraception. In the effort to be morally consistent, Catholic physicians are faced with questions about the extent to which their participation in providing contraceptives constitutes immoral cooperation in evil. Particular challenges face resident physicians, who practice under attending physicians and within the constraints of local and specialty-wide training requirements. The author examines the nature of the moral act of referring for contraception and argues that, in limited (...) cases, there is a moral distinction between a referral and an intra-residency patient transfer, and the latter may be morally licit according to the principle of material cooperation. National Catholic Bioethics Quarterly 12.2 (Summer 2012): 283–309. (shrink)

In 2014, the American Academy of Pediatrics published its policy statement on contraception for adolescents, which provides, in effect, a mandate to temporarily sterilize all adolescents with long-acting reversible contraceptives for five to ten years. The author reviews the AAP guidelines and their effects on Catholic adolescents, their families, and adolescent health care providers. He then discusses medicolegal issues raised by the policy, outlines Catholic strategies for combating it, and proposes a diocese-based physician-led program for teaching and counseling elementary (...) and high school students. (shrink)

La contraception était généralement condamnée dans le judaïsme comme dans le christianisme des premiers siècles, avec plus ou moins de sévérité ou de tolérance, en tant qu’atteinte à la Loi divine, qui fait un devoir à l’homme de procréer. Mais il existe aussi une autre forme de condamnation des pratiques contraceptives, liée à l’interdiction de verser le sang. Peu présente dans le judaïsme rabbinique, on la trouve exprimée différemment chez les premiers Pères, selon qu’il s’agisse de condamner le retrait, (...) l’usage de potions stérilisantes ou le recours à des abortifs précoces - étant entendu que les Anciens distinguaient mal entre un abortif précoce et un contraceptif. Le terme d’homicide est employé – très inégalement - pour chacune de ces pratiques, sans qu’il soit véritablement tenu compte des différentes doctrines de l’animation de l’être humain : dès l’expulsion de la semence (dans le cas de l’onanisme), dès la conception, au fur et à mesure de la croissance de l’embryon ou même seulement à la naissance. (shrink)

Feminist scholars have identified how race and gender discourses influence the creation and implementation of school-based sexual health education and the provision of health care, yet there are few studies that examine how race and gender work in sexual health promotion as it occurs through community-based public health efforts. Drawing on three years of ethnographic research in a low-income Puerto Rican community, this article demonstrates how a gendered racial project of essentializing Latinx culture surrounding young women’s sexuality and reproduction works (...) to both obscure and reinforce race and racism in sexual health promotion. Professional stakeholders mobilize culture as an explanation for high birth rates among young Latinas in the city and reproduce a “Latino culture narrative” in which Latina gender and sexuality is understood as deterministic and homogenous. Simultaneously, an ideology of colorblindness enables the uncritical promotion of long-acting reversible contraception and obscures the history of reproductive oppression experienced by women of color. I consider how colorblindness and culture narratives allow stakeholders to abdicate responsibility for gendered racial inequality and conclude by advocating for the incorporation of racial and reproductive justice frameworks in sexual health promotion. (shrink)

Moralna prihvatljivost kontracepcije kao metode kontrole radjanja usko je povezana s pitanjem moralnog opravdanja reproduktivne autonomije, odnosno s pitanjem treba li pojedincima dopustiti da autonomno i slobodno odlucuju o tome hoce li imati djece, kada i koliko. Razvoj medicinskih i znanstvenih tehnologija doveo je do upotrebe umjetnih metoda kontracepcije koji sprjecavaju zacece s ciljem odgadjanja i planiranja radjanja djece. U prvom dijelu clanka analiziram bioeticke argumente koji se iznose u raspravi o reproduktivnoj autonomiji, a koji bi mogli biti mobilizirani protiv (...) dopustanja upotrebe umjetne kontracepcije. U drugom dijelu, usporedjujem bioeticke argumente s daleko razradjenijim argumentima protiv umjetne kontracepcijekoji se pojavljuju u raspravama u filozofiji seksualnosti. U trecem i posljednjem dijelu, iznosim argumente protiv stavova G.E.M. Anscombe i J. Finnisa koji opravdavaju upotrebu prirodne metode kontrole radjanja, ali ne i umjetnih sredstva na nacin da ukazujem da nema moralno relevantne razlike izmedju ove dvije metode kontrole zaceca i radjanja. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 40-41, July 2012.

Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case (...) at hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)