Saturday, November 10, 2007

"Emergency Contraception"

I was chatting to an A&E doctor recently, who used the phrase "emergency contraception", and it struck me just how bad a phrase it is. Here are some basic dictionary definitions (from wiktionary):

contraception - the use of a device or procedure to prevent conception as a result of sexual activity

conception - 3. The initiation of an embryonic animal life; the fertilization of an ovum by a sperm to form a zygote

So contraception is acting to stop the sperm fertilizing the egg as a result of sex.

"Emergency contraception", however, is a hormone pill given to women after sexual activity, commonly called the "morning after pill". As far as I recall, the hormones don't actually do much to the egg or sperm cells; it's much more likely that they act by preventing implantation of the fertilized egg cell. And that isn't contraception.

"Emergency contraception" is what those machines on the walls in pub toilets are for (as far as I can tell). If a doctor was to provide emergency contraception, it would be as a result of someone running in saying "Quick, give me something. I think I've pulled"...

So why use a misleading term? Simple - "contraception" sounds a heck of a lot better than "abortion" or "termination", which themselves are nicer names for embryocide, just the same as "family planning" sounds like something sensible rather than being largely about planning families by killing unwanted members, which is what it often ends up as.

People would doubtless argue that using language like "emergency contraception" means that the choice becomes less emotionally charged, which is true. But is being emotionally uncharged a good thing? Surely if calling a spade a spade leads to decisions being emotionally charged, then it's right that they should be.

An extreme example. Someone who shoots innocent people without experiencing some degree of emotional charge is a psychopath. That is a bad thing. Some decisions, especially decisions involving ending life, should be emotionally charged. So call a spade a spade.


Anonymous said...

Liberals have a way of using misleading words. It helps them get what they want. I just had to laugh the other day when a genius told me in a discussion about embryonic stem cells that "an embryo is not a fetus." It took every ounce of restraint I could muster to keep from praising him for his keen observation.

John said...

It's worth adding that another doctor who reads this blog has e-mailed to say they agree with my analysis of the situation, and that even the phrase "morning after pill" is falling into disuse.

Anonymous said...

I'm also an A+E doctor, and have worked in sexual health clinics, and am also a GP; what is your take on coils and the like? and those pills that are "abortifacient" - all these methods of contraception work at least in part by preventing implantation of a conceptus. So a lot of "contraception" not just "emergency contraception" isnt techinically contraception at all. Its worth remembering to be gracious and aware of the huge ethical challenges for those of us on the provider end. I struggle daily with the ethics of this. Do I refuse to provide the morning after pill, coils or some progesterone pills and leave women to have "abortions" at a later stage, when in fact the at least half of all conceptuses never implant, the vast majority of emergency contraception doesn't actually turn out to have been necessary, and you lose the trust of a patient who will never come back to you for counselling over a request for a termination.. its such a complex issue..

Anonymous said...


If you believe that the conceptus is a human being, then I think it is your duty to refuse to provide the morning after pill. If the woman decides to have an abortion at a later stage, that is her choice, not yours. Basically you're saying, should I kill the unborn child now or let someone else do it later? That doesn't really make any sense to me, personally. If it turns out to have been unnecessary, then you didn't need to give it out in the first place.

John said...


I acknowledge it is a difficult issue, and that there can be complex, messy, and unforseen consequences of our actions.

But I don't think that changes the basic responsibility to do what is right in the present situation and let the consequences worry about themselves. And if we're not just loving but communicate that we're loving, that helps too.

I'm not an expert on the precise functioning of contraceptive devices - I'm a physicist not a biologist (though am technically qualified to teach Biology A-level, but wouldn't do so).

I know a Christian doctor who is involved with this sort of situation regularly, and their policy is to avoid methods of contraception which are essentially abortofacient. I know there are then complex questions about the Pill and so on, and to what extent it's abortofacient at certain points in the cycle; I personally don't have the information to make those decisions and am not currently in a position to do anything about it.

My usual technique for dealing with the difficulties would be "given all the data that I know, which decision would I regret less in the long run?" And in situations like this, that's probably sticking to things we know not to be abortofacient.

Anonymous said...

my only other comment is that as a Christian doctor on the front lines I have a huge opportunity to counsel women who would probably never hear much ethical debate about this issue anyway. The vast majority of my colleagues do not discuss these issues with the women who turn up to A+E or surgeries or GUM clinics and just hand it out/sign the forms. I could go down the route of letting it be known that "i don't do that work" and lose a very valuable chance to change things for the better. If I refuse to prescribe, the patients will get it somewhere else and without having to think about what they are doing. Isn't it just as much being involved in abortion by ignoring the issue and letting someone else "do the dirty" by default? I don't think God would say I was innocent from my refusal to be at all involved.. We are all guilty by implication, and I don't want to give up my chance to counsel by refusing.. have spent years thinking about this.

John said...

You're right of course, in that it is wrong for a doctor to avoid the decision entirely (well, unless they are an orthopedic surgeon or some type of doctor who doesn't have anything to do with abortions). If they're in A+E or GP or obs&gynae or whatever, it seems that it is right to try to counsel people about it, and explain stuff, and wrong to just let it go on and ignore it.

I know GPs who will go through the options in detail, then explain why they won't sign the form for an abortion, but GPs don't tend to get people sent to them on the basis of something being their speciality. I don't know the A+E system - it seems quite conceivable that the doctor a patient is allocated to depends on what their comparative specialisms are, in which case there is then another level of complexity.

And it would be possible to argue - I don't know if you do this or not - that if the woman has thought the issue through with the data about the options, and still decides to abort, then that's her problem.

On the other hand, I read somewhere that there's now a shortage of gynaecologists who are willing to perform abortions...

John said...

And it would be possible to argue - I don't know if you do this or not - that if the woman has thought the issue through with the data about the options, and still decides to abort, then that's her problem.

could equally well be used as a justification for being a Christian hit-man, which suggests it's a bad argument.