Ethics Question

[DrBuzzLightYear]

So in med school we were doing a mock interview which had a woman coming into the Dr's office about 24 hrs after being raped. She's absolutely TERRIFIED that she might be pregnant. Over the course of the interview however you find out that she's also Catholic and believes that abortion is a sin. I let her know that there's emergency contraception available to her and she is immediately tremendously relieved and pleads to be given it. However, it occurs to me that one of the many ways emergency contraception might work is that it might prevent implantation of the putatively fertilized egg. My question is, should I try to explain this to the girl?? In the mock interview she was still in high school and had no idea about the physiology of conception/implantation. And frankly, she was in no state to sit through a lecture on the topic. But she did say that abortion is a sin... So am I obligated as a physician to say that some hyper-religious pro-lifers (whom I detest) also consider this to be a sin? I know that more than anything in the world right now she just doesn't want to get pregnant, and would hardly be relieved if I convinced her not to take the emergency contraception. ALRIGHT, SO WHAT WOULD YOU HAVE DONE??

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[deeq]

in my own 4th year med student opinion, i would have explained to her all her options. then let her rationally or irrationally, whatever the case may be, make up her own mind. those are her ethics, not neccesarily yours. and if you feel comfortable giving the emergency contraception, then give it. but i do see your point. how to explain, or even if to explain the more definitive version of the 'birds and bees' talk to this obviously distressed young woman so that she may be better equipped to make a decision compatible with her faith. but often in high school, come on, so many of us believe what our parents/peers believe. but yes, this is a tough call given our current level of training.....

 

[DrBuzzLightYear]

yeah, i tried to explain how the emergency contraception worked, but she kept giving me this frustrated and perplexed look and saying, "i just cant get pregnant...i just cant get pregnant..." in the end i gave her the perscription and a pamphelet on how it works, but didnt end the appointment feeling quite satisfied.

 

[starayamoskva]

So in med school we were doing a mock interview which had a woman coming into the Dr's office about 24 hrs after being raped. She's absolutely TERRIFIED that she might be pregnant. Over the course of the interview however you find out that she's also Catholic and believes that abortion is a sin. I let her know that there's emergency contraception available to her and she is immediately tremendously relieved and pleads to be given it. However, it occurs to me that one of the many ways emergency contraception might work is that it might prevent implantation of the putatively fertilized egg. My question is, should I try to explain this to the girl?? In the mock interview she was still in high school and had no idea about the physiology of conception/implantation. And frankly, she was in no state to sit through a lecture on the topic. But she did say that abortion is a sin... So am I obligated as a physician to say that some hyper-religious pro-lifers (whom I detest) also consider this to be a sin? I know that more than anything in the world right now she just doesn't want to get pregnant, and would hardly be relieved if I convinced her not to take the emergency contraception. ALRIGHT, SO WHAT WOULD YOU HAVE DONE??

Emergency contraception cannot end a pregnancy. According to the Food and Drug Administration (FDA), "Emergency contraceptive pills are not effective if the woman is pregnant; they act by delaying or inhibiting ovulation, and/or altering tubal transport of sperm and/or ova (thereby inhibiting fertilization), and/or altering the endometrium (thereby inhibiting implantation)" (FDA, 1997). A recent study found that most often, ECPs reduce the risk of pregnancy by inhibiting ovulation (Marions, et al., 2002). A more recent study suggests that ECPs only work by preventing ovulation or fertilization, and have no effect on implantation (Croxatto, et al, 2003). Emergency contraception reduces the risk of pregnancy and helps prevent the need for abortion; it itself is not a form of abortion (Grimes, 1997; Guillebaud, 1998; Hughes, 1972; Van Look & Stewart, 1998).

You could ask her a few questions regarding the timing of her last period so that you could determine the likelyhood that she was ovulating at the time of the attack. Given that she was not near ovulation at the time, I would not worry too much about going into the physiology of reproduction, I would be more inclined to tell her it isn't likely that you will become pregnant from this attack but I can see how distressed you are. I will give you this emergency contraception which will prevent a pregnancy in the unlikely event you ovulated and give you something to bring your period on now so that you can relax. Now that we have taken care of that concern, I would like to talk to you about seeing a counselor to deal with the emotional impact of the attack.

That being said, if she is a devout catholic it doesn't matter whether the ECP is going to cause an abortion or not, it is my understanding that devout catholics do not believe in ANY contraceptive methods.

 

[DrBuzzLightYear]

Thanks, I wasnt aware that, "A more recent study suggests that ECPs only work by preventing ovulation or fertilization, and have no effect on implantation (Croxatto, et al, 2003)." I was never thinking that ECP cause abortions, but I was vexed by how to explain that they might work by preventing implantation. If the pt believes that life begins at the fusion of egg and sperm, then preventing implantation has the same ethical problems as abortion. But I'll check out the article, if its legit then it would certainly simplify things.