Catholic ethics

Cardinal Joachim Meisner apologizes for the lack of physicians at the St. Vinzenz and Heilig Geist hospitals in Cologne. One thing he will not apologize for, though, is a lack of the "morning-after pill," which he rejects categorically.

The pill's effect is, in medicinal jargon, "anti-ovulatory." It prevents ovulation and thus the chance that an egg cell will be fertilized, resulting in conception. The active hormonal ingredient, levonorgestrel, is comparable to traditional birth-control pills but is simply taken in higher, post-coital doses.

"The Catholic Church already had a problem with that one," says Antonio Autiero, a professor of moral theology at the University of Münster, in a reference to the traditional pill. "Artificial contraceptives" have been prohibited by the Catholic Church ever since Pope Paul VI published an encyclical, "Humanae Vitae," in 1968. "Nothing has changed doctrinally to this day," Autiero said.

That said, those regulations are a subject of much debate among Catholics. Many do not adhere to them. And since the issue is "only" one in which life is prevented from being created in the first place, it is considered less problematic.

When does life begin?

Yet what happens when ovulation occurs just before unprotected sex and the pill's "anti-ovulation" effect doesn't serve its purpose? Then the pill's "anti-nidative effect" comes into play, preventing the fertilized egg from settling on the surface of the uterus. "Whether the morning-after pill inhibits ovulation or nidation, it still lacks a final safety mechanism. If that's the case then we're heading more toward abortion," Autiero said.

"The doctrinal outlook is very clear in that the fusion of egg and semen cells constitutes life and human dignity. That is why it is seen as a form of abortion when one prevents fertilized egg cells from nidating," Autiero said.

Abortion, or the ending of human life - even a life so tiny - is something with which the church doctrine can find no accord. "There's no room for discussion within Catholic doctrine," Autiero said. The termination of a pregnancy would never be carried out at a Catholic hospital - not even in the first few hours or days of a pregnancy.

Ethical absolutes

Or that is the principle, at least. So are there exceptions? What happens in cases of extreme bodily harm or emotional emergencies, such as when a woman has been raped?

"For the church the answer is clear," Autiero said. "Abortion and contraception are condemnable in and of themselves, and there is no situation where they can be ethically justified."

This "normative ethic," which allows no exception to the highest principles, has "radicalized" over the years, he said.

Yet in moral theological science there is also an ethical counterweight that "depends on objectives and the context of an action." And this is where, beyond the untouched highest principles, even more questions come into play.

They relate to concrete medicinal and emotional situations, human empathy, companionship, one's own conscience and professional ethics. "Are we a church of ethics or are we a church of compassion?" Autiero asked.

A practical difference

In practice, however, it is likely to be a very different experience. In Cologne the church's response is based on principle - with particular regard to protecting hospital employees, Autiero said.

"A few months earlier a female doctor had some legal problems because an ultra-conservative 'informer' denounced her. That makes people more scared."

For Autiero, it would therefore be a "huge sign from church leadership" if concrete case-by-case decisions would result in "no legal measures." "That would also take seriously the conscience and professional ethics of individuals," he said.

That there is huge uncertainty in Catholic hospitals is a fact well known to Markus Jüngerhauns. He's the head of the Catholic hospital association for the Osnabrück diocese and is responsible for 19 hospitals. Among them are eight gynecological departments.

"At this point I'm not aware of any rule that's written in stone in terms of how to handle the morning-after pill," he said. That has advantages for case-by-case decisions, yet also carries a disadvantage in that "physicians may stand on their own with that case." Jüngerhans said he believes that the hospitals' ethics commissions need to "intensify the discussion and work on recommendations."

For the church, the line is drawn clearly at drugs that carry out an abortion. "We don't have those," Jüngerhans said.

He does see room to maneuver, however, with drugs that prevent ovulation after intercourse. "Depending on severity and situational necessity the application of such medicines can be medicinally and morally justified," he says.