Ms. Wershler is right about one thing - word games. Hers. [Laura Wershler, "The morning after: Pro-life agenda misrepresents the emergency contraceptive pill, or ECP", Feb. 13, 2004). With unabashed and utter disregard for the health and lives of both women and children - not to mention the objective scientific and medical facts -- Ms. Wershler shamelessly and desperately tries to discredit pharmacist Dr. Maria Bizecki and recent rulings by reframing the "morning-after" pill (MAP) debates solely in terms of "prolife agendas", "religious rights", and "tolerance". Why? Because that's the only route left to her and a failing industry. Enough is enough. People are far better informed about the basic science, and can no longer be fooled or manipulated. Those who persist in trying to massively misinform the public should be held to accountability - for a change.
The word games Ms. Wershler is playing could result in severe pain and suffering for millions of women. Ms. Wershler's games ignore and are contradicted by vast medical data about severe physical consequences for women's physical health as well as social chaos recently documented and submitted to the U.S.F.D.A. - resulting in that agency's extension of time for their own ruling on MAPs.
Ms. Wershler's word games also kill. The objective scientific and medical facts are crystal clear - and it is these that should form the basis of credible and just conscience clause legislation. As even the inserts of MAPs frankly admit, if breakthrough ovulation has taken place, and if fertilization has taken place, then the intentional use of MAP's - which kill new living innocent human beings already hundreds of cells strong before they have time to implant - could factually cause abortions. Any unintentional use of medications which indirectly cause spontaneous miscarriages - such as the NSAIDs Ms. Wershler throws out there for emotional and economic effect - would not raise the same conscience issues. There is no "fine line" there.
In concert with the international nomenclature of human embryology, the following scientific facts should be justly and publicly recorded to insure full "informed consent" by all concerned:
Canadian human embryologists Keith Moore and T. V. N. Persaud, The Developing Human: Clinically Oriented Embryology (6th ed. only) (Philadelphia: W. B. Saunders Company, 1998): "Human development is a continuous process that begins when an oocyte (ovum) from a female is fertilized by a sperm from a male. (p. 2); ... the embryo begins to develop as soon as the oocyte is fertilized. (p. 2); Zygote: this cell results from the union of an oocyte and a sperm. A zygote is the beginning of a new human being (i.e., an embryo). (p. 2); Human development begins at fertilization, the process during which a male gamete or sperm ... unites with a female gamete or oocyte ... to form a single cell called a zygote. This highly specialized, totipotent cell marks the beginning of each of us as a unique individual." (p. 18).
Bruce Carlson, Human Embryology and Developmental Biology (St. Louis, MO: Mosby, 1994): "Human pregnancy begins with the fusion of an egg and a sperm." (p. 3); " ... finally, the fertilized egg, now properly called an embryo, must make its way into the uterus ...." (p. 3).
William Larsen, Human Embryology (New York: Churchill Livingstone, 1997): "In this text, we begin our description of the developing human with the formation and differentiation of the male and female sex cells or gametes, which will unite at fertilization to initiate the embryonic development of a new individual. ... Fertilization takes place in the oviduct ... resulting in the formation of a zygote containing a single diploid nucleus. Embryonic development is considered to begin at this point. (p. 1).
Ronan O'Rahilly and Fabiola Muller, Human Embryology &Teratology (3rd ed.)(New York: Wiley-Liss, 2001): Although life is a continuous process, fertilization... is a critical landmark because, under ordinary circumstances, a new, genetically distinct human organism is formed when the chromosomes of the male and female pronuclei blend in the oocyte. The zygote ... is a unicellular embryo and is a highly specialized cell. ... [I]t is now accepted that the word embryo, as currently used in human embryology, means 'an unborn human in the first 8 weeks' from fertilization. (p. 87) The term 'pre-embryo' is not used here for the following reasons: (1) it is ill-defined because it is said to end with the appearance of the primitive streak or to include neurulation; (2) it is inaccurate because purely embryonic cells can already be distinguished after a few days, as can also the embryonic (not pre-embryonic!) disc; (3) it is unjustified because the accepted meaning of the word embryo includes all of the first 8 weeks; (4) it is equivocal because it may convey the erroneous idea that a new human organism is formed at only some considerable time after fertilization; and (5) it was introduced in 1986 'largely for public policy reasons' (Biggers). ... Just as postnatal age begins at birth, prenatal age begins at fertilization." (p. 88) (Note: O'Rahilly is one of the originators of The Carnegie Stages of Early Human Embryological Development, and has sat on the international Nomina Embryologica Committee for decades).
As a scientist, a medical ethicist, and a woman, I too care, Ms. Wershler, when pro-abortion advocates knowingly and willfully mislead the media and the public into thinking that MAP's "do not cause abortion" - thus blindsiding science and good medicine for ideology and profits. Whose "good" are you really concerned about? Thank goodness for intellectually honest pharmacists like Dr. Bizecki who have had to endure being dragged through such mud and muck for the sake of not just their own sound consciences, but also for the health, life and well-being of us all.
Respectfully submitted,
Prof. Dr. Dianne N. Irving, M.A., Ph.D.
Scientist, Medical Ethicist
5108 Randall Lane
Bethesda, MD 20818
301-229-4176
DNIrving@aol.com
The Calgary Herald
Friday, February 13, 2004
Page: A21
Section: Comment
Byline: Laura Wershler
In his recent column, Nigel Hannaford discussed the case of Calgary Co-op pharmacist Maria Bizecki who declined "to fill a prescription for an abortion drug." ("When rights collide," Feb. 7). Complaints against her were filed with the Alberta College of Pharmacists. She was investigated. Negotiations, which lasted nearly three years, brought a happy ending for the pharmacist, the college and the Co-op.
In a written agreement, Bizecki acknowledged the public's right to have a prescription for a legal drug filled by a pharmacist; her employer agreed to make sure she was always part of a two-person dispensary so she would not have to compromise her pro-life beliefs.
This is as it should be. I agree Bizecki's experience serves as a fine example of how religious rights can be respected and accommodated in a tolerant country. What is disconcerting and worthy of note is that Hannaford used her story to play word games.
According to the pro-life website Repression of Conscience (http://www.consciencelaws.org), the "abortion drug" the pharmacist was asked to provide is the emergency contraceptive pill, or ECP. Formerly known as the "morning after pill," ECP does not "effect abortions," though pro-life advocates want the general public to believe it does.
The only legal abortifacient in Canada is methotrexate. This drug is administered, solely by physicians in hospitals or clinical settings, to terminate pregnancies under seven weeks. It is not and has never been available by prescription. The assurance Bizecki received from her employer was that she would not be obliged to fill prescriptions for ECP.
If taken within 72 hours of unprotected intercourse or barrier method failure (e.g. the condom broke or slipped), ECP acts in one of three ways to prevent pregnancy. It may prevent ovulation and thus fertilization. It may thicken cervical secretions to impede sperm from reaching the egg and thus prevent fertilization. Or, when ovulation and fertilization have already occurred, the changes the drug makes to the lining of the uterus prevent implantation of the fertilized ovum.
While all of the above modes of action are considered either immoral or the equivalent of abortion to many people with pro-life beliefs, none of the above are considered abortion by the medical community. In fact, if a woman who takes ECP is already pregnant -- a fertilized ovum has implanted in the lining of her uterus -- the drug will not disrupt or abort her pregnancy.
Here is the fine line this tale of tolerance walks. Birth control pills work similarly to ECP. Some pills suppress ovulation. Those with a progestin-only formulation inhibit sperm mobility and prevent implantation. Hannaford's piece failed to acknowledge whether or not the pharmacist is also excused from filling prescriptions for birth control pills. In all likelihood, she is.
I don't care if pro-life pharmacists decline to provide ECP or birth control pills, despite the fact that neither are "abortion drugs." I support their right not to be compelled to do so, as long as there is another pharmacist standing with them behind the counter who will. But I do care when pro-life advocates, wilfully or not, mislead the media and the public into thinking that ECP "effects abortions."
These pharmacists may soon have some other drugs to worry about. Those, such as Bizecki, who are dedicated to not becoming "an accessory to murder" may want to start declining to fill prescriptions for a family of medications called nonsteroidal anti-inflammatory drugs (NSAIDs).
NSAIDs include readily available acetylsalicylic acid (A.S.A.) and ibuprofen and the prescription drugs Celebrex, Voltaren, Lodine, Nalfon, Indocin and Vioxx. The use of these drugs has been linked to significantly high rates of miscarriage.
Although more research is needed, it is quite possible that NSAIDs are drugs that actually do act as abortifacients, however inadvertently.
Last August, an article on www.healthfinder.gov reported on a study by the Kaiser Foundation Research Institute involving 1,055 pregnant women. Researchers found that the use of NSAIDS during pregnancy increased the risk of miscarriage by 80 per cent. The association was stronger if the initial NSAID use was around the time of conception or if usage of the drug lasted more than a week.
Anecdotally, I know one woman who suffered several early miscarriages while taking a prescribed NSAID during her recovery from orthopedic surgery. Would Bizecki, spokesperson for Concerned Pharmacists for Conscience, consider the pharmacist who filled her prescription to be an "accessory to murder?"
If pro-life pharmacists are truly committed to not dispensing drugs that, in their view, "effect abortions," then NSAIDs may soon have to be added to their list of verboten medications.
It is, to borrow Hannaford's phrase, "a pickle of contending rights and obligations." But enough word games.
Pharmacists have never been asked to fill prescriptions for "abortion drugs." ECP is what it is -- emergency contraception. It prevents unintended pregnancies and therefore it prevents abortions.
Laura Wershler is a sexual and reproductive health advocate who writes and speaks on a wide range of issues relating to sexuality.
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