Culpability of doctors in prescribing The Pill

Discussion in 'The Law of God' started by SRoper, Jun 24, 2008.

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  1. SRoper

    SRoper Puritan Board Graduate

    I was surprised to learn recently that it is difficult to find a pro-life physician who also refuses to prescribe chemical contraceptives as birth control. My initial thought was that this is a no-brainer. Chemical contraceptives can cause an abortion (let's not debate that here), doctors should strive to prevent abortion, so doctors should not prescribe chemical contraceptives as birth control. Where is the difficulty here?

    I then thought about the argument that the doctor is just giving the patient access to pharmaceuticals, and the patient's autonomy in making her own healthcare decisions removes any culpability from the physician. Can this situation be likened to, say, an employee at a book store? Is the sales clerk culpable when he rings up a patron's purchase of p0rnography? What about a sale of the latest Joel Osteen?
  2. danmpem

    danmpem Puritan Board Junior

    In terms of chemical contraceptives, are we talking about the "morning after" pill or the general pregnancy-prevention pill?
  3. smhbbag

    smhbbag Puritan Board Senior

    In most situations, the roles are different - the doctor would most often be actively recommending or proposing the sinful thing, rather than merely ringing up a purchase of Osteen.

    Yet, there are probably physicians who will not recommend or propose such pills, but would be willing to 'ring up the purchase' so to speak. This may apply more to pharmacists than GP's.

    And in that case, I have a very strong immediate reaction that even that course is unacceptable, though I am having trouble being consistent in my reasoning.

    I would (grudgingly) ring up an Osteen book, but refuse a purchase of p0rnography, and would not work at a store that carried such. Likewise, I would hope doctors refuse to prescribe the pill even a the direct insistence of the patient.

    To be consistent, I would have to deny the Osteen purchase also. That doesn't really bother me all that much :), but I'd want to hear other opinions before actually taking that hard of a line.

    An elder at our church has been a pharmacist for 30+ years, and has come very close to losing his job many times over this exact issue. He works at a major retail/drugstore chain, and has somehow managed not to budge an inch and have that respected.
    Last edited: Jun 24, 2008
  4. smhbbag

    smhbbag Puritan Board Senior

    Actually, now that I think about it - there appears to be a fundamental difference between the Osteen book on the one hand, and p0rnography and the pill on the other.

    The pill and p0rnography, In my humble opinion, are sinful in and of themselves and have no possible God-honoring use.

    Whereas, the Osteen book is certainly filled with drivel and sinful theology - the act of possessing and reading the book can have a God-honoring purpose, namely to be prepared to defend the gospel and the hope that is within us. It could also be used sinfully by respecting it/him as an authority on the Word of God.

    In that case, how the material is used, and the culpability for it, lies solely with the reader. In the p0rnography or pill case, there is culpability on both parties regardless of how they are used.
    Last edited: Jun 24, 2008
  5. Pergamum

    Pergamum Ordinary Guy (TM)

    Let's not debate that here?

    That issue is THE vital issue. If the Pill causes abortions then there is one answer. If the Pill is merely contraceptive and not an abortive pill than the answer is different.

    But that question is the crux of the whole issue.

    Are you assuming that all forms of contraception for all reasons are sinful?
    Last edited: Jun 24, 2008
  6. Pergamum

    Pergamum Ordinary Guy (TM)

    The abortion pill (RU486) cannot be given by a Christian to anyone without sin I believe.

    But I believe that the birth control pill can (at least some kinds...the older kinds are clearly not abortifacients, but some newer kinds might have abortifacient effects).

    Therefore a Christian pharmacist or docter could prescribe the birth control pill to a patient nder certain circumstances.

    The birth control pill can be taken by Christians without sin under certain circmstances. It regulates periods and provides a uterine rest for a while while a mother recovers from hard birth.
  7. smhbbag

    smhbbag Puritan Board Senior

    This is an important thing to note, regardless of what one believes about the pill causing abortions.

    It cannot cause abortions in believing, pure women who are single, and there can be many very helpful uses of the pill to them in that context.
  8. SRoper

    SRoper Puritan Board Graduate

    I was careful to say that the use of the chemical contraception was for birth control. Obviously use by a celibate woman to treat something like PCOS is acceptable.

    For the sake of argument I am assuming that the Pill and other chemical contraceptives occasionally cause abortion. I do believe this is the case, and the people I have been discussing this with agree that it is the case. The disagreement is does this means that it can't be prescribed.
  9. Leslie

    Leslie Puritan Board Junior

    I regularly prescribe chloroquine and quinine for malaria and both are known to cause abortion. However, malaria is more likely to cause abortion than the pills in question. Therefore in prescribing these, I'm actually, over many patients, preventing abortion.

    It depends on when human life begins, whether these things involve abortion. That is a matter of opinion.
  10. danmpem

    danmpem Puritan Board Junior

    I'm trying to phrase my words carefully, because talking about the various sides of the life of an unborn child is not that easy for me.

    I am unfamiliar with the times in which it can cause an abortion. Are the situations in which it happens known? Or is a woman who takes the pill more likely to miscarry?
  11. jogri17

    jogri17 Puritan Board Junior

    i'm confused. Can the "normal" birth control pill cause an abortion (i.e. killing an embryo)? if there is a chance then it seems to me that a no is a no brainer.
  12. TimV

    TimV Puritanboard Botanist

    Replace abortion with something else. If the pill is sinful because it may cause abortion then anything that causes a side effect that harms anyone is sinful.

    Any medicine, sport, exercise, pipe smoking, etc.. is sinful, because they can all cause harmful side effects.

    Really, folks, I do tree removal and bee and wasp exterminations. Monday I had to climb a huge oak tree that was too big for my safety harness to kill some aggressive bees 40 feet up. The chance of me hurting myself is a degree of magnitude greater than a married women who for reasons she and her husband believe are for her health takes responsible chemical birth control for a limited time.

    It shouldn't be that difficult.

    Ask yourself the question. On those grounds, that the pill could as a rare side effect cause abortion, would you make a complaint to the Session about it, and demand church discipline take place if the family doesn't desist?
  13. satz

    satz Puritan Board Senior

    Treading carefully, and being open to correction, I do think the answer depends to some extent, on exactly how often the pill in question causes abortions.

    A pill that is meant to prevent contraception from even occurring but which occasionally has a small statistical probability of causing a miscarriage or abortion instead to me is a very different situation from a pill which is designed and will most likely or in all cases cause an abortion.

    In the former scenario, it seems to me there is very little difference in selling a pill which has a small, statistical chance of causing an abortion and selling say, a car which has a small, statistical chance of causing a death.

    I want to be wary of speaking hastily on matters like these, but what exactly is the difference?
  14. ColdSilverMoon

    ColdSilverMoon Puritan Board Senior

    This is a somewhat ridiculous argument to me. Is it wrong to sell matches because they can be used for arson? Should the internet not be used because there is **** on the web? Should narcotic pain killers not be prescribed because they can lead to addiction? Really, this situation is no different from any of the above.

    However, I do agree with some of the above posts that it all depends on intent. If a doctor is prescribing a contraceptive pill for the intent of inducing an aborting or preventing implantation, then yes, that is wrong and the doctor is culpable. Likewise, if he prescribed the RU-486 or another drug that causes abortion, then again, he is culpable. On the other hand, if he is prescribing a standard contraceptive at standard doses to prevent fertilization, I see nothing wrong with it.

    Just to note, the RU-486 pill is not the same thing as the "morning after pill." The morning after pill is basically a double dose of a standard oral contraceptive, with the goal to prevent implantation of the embryo in the endometrium not to prevent conception. Taking two standard oral contraceptive pills at the same time is effectively the same as taking a morning after pill.
    Last edited: Jun 25, 2008
  15. Zenas

    Zenas Snow Miser

    It's my opinion hum,an life begins at 14 years old. That'll give me enough time to sort my kids out or start over without being held liable for murder.

    Humbly madam, that's rediculous.
  16. Craig

    Craig Puritan Board Senior

    Do your patients contract malaria so you can prescribe chloroquine and quinine in order to terminate their pregnancies? If not, you are treating an illness and not murdering a child.

    Did you really just say that?
  17. Pergamum

    Pergamum Ordinary Guy (TM)

    I strongly agree with your first paragraph and strongly disagree with your second paragraph.

    The first paragraph shows that one can take or give birth control pills without sin.

    THe second paragraph, however, says that when life begins is opinion, which is a very dangerous position.
  18. ColdSilverMoon

    ColdSilverMoon Puritan Board Senior

    Agree completely, especially with your last point. All medical school text books say life begins at conception. Only secular philosophers and politicans would seek to define it otherwise.
  19. Davidius

    Davidius Puritan Board Post-Graduate

    One obvious difference between this question and your examples is that an abortion ends the life of another individual. If you choose to put your life in danger by taking certain medications or participating in certain activities, then at least it is you who are responsible for your own death, should the unthinkable occur. If the pill causes abortions, then an innocent child's life is at stake because of its parents' alleged needs.

    I'm not sure that the jury is out on the pill question. A new couple in my congregation, one of whom is in academia and has degrees from Harvard and Princeton, the other an MD, have stated that it would be impossible for a researcher to get the funds to do the necessary investigation, and that anyone who tried would probably lose their job, because of the ramifications of the research. Think of what a blow it would cause to the industry if there were peer-reviewed studies showing a link between hormonal birth control and abortion. For now, as far as I know, the allegations are hypotheses based on the fact that the morning after pill merely administers a higher dosage of the same hormones, but not based on some empirically derived amount which is known to surely stop implantation. We simply don't know at what dosage the effects include not merely the stopping of fertilization, but also the damage of the uterine wall to the point where implantation cannot occur during that cycle.
  20. Theoretical

    Theoretical Puritan Board Professor

    The key distinction, from what I have gathered from those who would call it an abortifacient, is that part of the modern Pill's specifically designed functionality is to prevent the implantation of a fertilized embryo in case the contraceptive components fail.

    The ethical question is not one of "can it possibly cause an abortion as a side-effect", but rather "does this pill have an abortive 'fail-safe' mechanism as part of its a deliberate design".

    My question is whether there are still any of the older contraceptive-only Pills available for those worried about the possible abortive design.
  21. TimV

    TimV Puritanboard Botanist

    It's obvious if abortion is really the only sin worth marching on Washington about. Read through the larger catechism on murder and then tell me that there is an obvious difference.
  22. ColdSilverMoon

    ColdSilverMoon Puritan Board Senior

    I think you've hit the key point, which is the intent of the pill. Most oral contraceptives do NOT have a fail-safe mechanism to prevent implantation at standard doses. Taken at supra-therapeutic doses, the pill can prevent implantation, but it is not really designed to do so. So if an abortion happens it is a rare side effect rather than design.

    The point of my original post is that just because the pill can be used improperly by certain individuals doesn't mean doctors shouldn't prescribe it. If used as intended, I see nothing wrong with prescribing an oral contraceptive at a standard dose.
  23. Davidius

    Davidius Puritan Board Post-Graduate

    Administering the hormones found in normal hormonal birth control (oral or otherwise) causes a change in the endometrium, no matter what the dosage. This means that the endometrium is being affected in the same way by the regular Pill as well as the morning after pill, though not to the same extent. This is why women who use the pill have lighter periods. The endometrium does not thicken as much as it normally would in preparation for the implantation of a fertilized egg. What we don't know is just what dosage of hormones is required to assuredly keep the endometrium from thickening to the point which would allow implantation.

    Here's an FAQ from Pharmacists for Life International.
  24. Leslie

    Leslie Puritan Board Junior

    Are you saying that preventing a fertilized egg from implanting is indeed equivalent to murder morally? Then the only contraceptives that are morally acceptable are barrier-type--diaphragms, male condoms, female condoms, and permanent surgical sterilization.
  25. SRoper

    SRoper Puritan Board Graduate

    There are several important differences, though. The first is there exist several alternatives to using chemical contraceptives that have no risk of causing an abortion. The couple is risking their offspring merely for the convenience of a pill form of birth control. People often make this into a false dilemma between using the Pill and using no birth control at all. The second is the intention of using birth control is to not have children for the duration that the BC is used. The fact that the intention to not have children is intimately tied with the effect that children may be killed is rather significant.
  26. ColdSilverMoon

    ColdSilverMoon Puritan Board Senior

    First of all, when dealing with hormones and dosages, you have to realize it's a very individualized phenomenon. Every woman requires slightly different dosages and regimens of oral contraceptives - some women have the dosages adjusted numerous times before they hit the right balance, so to speak. Very few universal statements can be made regarding the side effects of oral contraceptives, especially something like "women who use the pill have lighter periods." This may be true for some women, but certainly not all. Likewise, some women (not all) may have thinning of the endometrium, but all to varying degrees. The point is, if the intended use of most OCPs is not to prevent implantation. If that happens it is an unintended side effect.

    Second, there are a wide variety of pills available of different hormonal make-ups. So the degree to which a woman risks an unintended abortion is based on the exact composition of the pill she's taking and her individual response to it. Again, at standard dosages the pill is intended to prevent fertilization (by preventing ovulation), not to prevent implantation.
  27. Pergamum

    Pergamum Ordinary Guy (TM)

    Me and my wife personally came to these conclusions:

    --We went off The Pill due to a lack of light on the subject of whether the newer-generation pills indeed prevent implantation or not. We see the Pill as helpful for single girls in preventing other problems.

    --We would not tell another person they are sinning by taking the Pill but for us we think that even a slight chance that the Pill prevents implanation of an already fertilized eggs demands that we not take any a slight chance.

    --We also do not take any medications that have abortion as a possible and proven side-effect. My wife limits her malaria prevention due to this, but the Lord has blessed her with health.

    --We still believe, however, that it is consistent with Biblical stewardship to be able to space your children within limits, but that a desire not to have children entirely is questionable. The concept of birth control or spacing is not per se wrong, however, and we cannot automatically condemn it. There just needs to be good reasons (besides convenience) for its practice. In general Christian families like kids but fertility cannot be linked to holiness.

    --Since the Pill is questionable and IUD's prevent implantation, the options left would be the poor discontinued sponge or condoms.

    --If we distributed medications, we would NOT give RU486 but we would give the Pill.
  28. Davidius

    Davidius Puritan Board Post-Graduate

    Not to be rude but that's not an argument. If he were to say "Yes, those are the only available methods" would you respond as if that somehow has bearing on the question whether life begins at conception? When do you believe that life begins, if not at conception (an important term in scripture)?

    Furthermore, you are wrong about those being the only methods. Fertility Awareness Method/Billings Ovulational Method/Sympto-Thermal method is becoming very popular. Peer reviewed studies have been done on it and it has been shown to have an extremely high (99+%) method efficacy. See the Couple to Couple League.
  29. ColdSilverMoon

    ColdSilverMoon Puritan Board Senior

    If some type of method is used (morning after pill, IUD's, etc) that intentionally prevent implantation of fertilized egg, then yes, it is murder, because it is taking a life just like abortion does. But this is not the intent of the pill, it is a rare side effect, and thus I wouldn't consider it murder.
  30. Davidius

    Davidius Puritan Board Post-Graduate

    You're speaking about the intent of the pharmaceutical manufacturers. I'm speaking about chemistry.

    It doesn't matter what the pill is "intended" to do. Chemicals are chemicals, and the chemicals cause thinning of the endometrium. As you said, it may be in varying degrees, but if the effects of these chemicals are so relative then it's a surprise the things are so popular and effective.
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