Plan B

[wired]

http://theboard.byu.edu/questions/69861/

I thought Eirene did a good job. I submitted a comment that is waiting for approval that differs slightly.

Mainly, I thought it would be useful to point out that the definition of pregnancy has changed over time. The current definition arose in the mid-1960s, changing it from "conception" to "implantation." That change was motivated, at least in part, by a desire to broaden the types of procedures or medication that would be legally and socially acceptable. If you use the pre-1965 definition of pregnancy, than Plan B does "abort" a pregnancy.

That being said, I think reasonable minds can differ on whether individuals ought to use Plan B and because there is no explicit Church doctrine or policy on it, I think it should be left up to individual couples or women. But I also think it's less clear than the "everyone should feel fine using it" conclusion.

[Eirene]

There actually isn't any convincing evidence that Plan B interferes with implantation, just with ovulation (check out the references at the Wikipedia article). So although there are differences in side effects, effectiveness, and cost, Plan B's mechanism of action is really not substantially different from typical daily oral contraceptives.

[wired]

Help me understand what happens. Suppose no contraception taken. Egg is fertilized. 10 minutes later, woman takes Plan B. What physiologically will happen if Plan B does what it is supposed to?

[Eirene]

Nothing at all, in that case--Plan B only works if no ovulation (and hence, no fertilization either) has occurred yet. If ovulation has already happened, then there's no evidence that it can do anything to interfere with fertilization or implantation. That's why it's only like 80-90% effective from the start, and that's also why its effectiveness declines the longer you wait to take it after having unprotected sex (because the longer you wait, the more likely you are to have already ovulated, and then it won't help you).

Since sperm can survive in the female reproductive tract for several days waiting for an egg, Plan B is still effective at preventing pregnancies that would have occurred if there had been any ovulation in the days after having unprotected sex.

[wired]

Gotcha. (Let me restate to make sure I understand.) So Plan B is really for the interval between insemination and the time that fertilization would occur. So fertilization never actually happens.

I think I was thrown off by the line in your response where you say, "If a fertilized egg has already implanted and pregnancy has begun, then using emergency contraceptives will not affect the pregnancy." I focused in on the "implanted" part of that equation, assuming you meant that only if the fertilized egg had already implanted to the uterine wall would it be in the safe zone. But if I understand you right, it actually extends past that to the time of fertilization (and potentially days to almost a week before implantation occurs).

[Eirene]

Yup, that's right. Sorry for any bad wording on my part.

[wired]

No, it's quite alright. I had always been under the impression that Plan B and other morning-after contraception pills were meant to prevent a fertilized egg from implanting. This significantly changes my opinion on them.

[UnluckyStuntman]

No, it's quite alright. I had always been under the impression that Plan B and other morning-after contraception pills were meant to prevent a fertilized egg from implanting. This significantly changes my opinion on them.

That was also my understanding of how EC's worked, though I've read a few different articles which claim they may also prevent a fertilized egg from implanting on the uterine wall (thought it seems that scientists aren't sure why it works that way and it's just sort of a lucky side effect).

[Marduk]

Wait a second, aren't there all sorts of times where a fertilized egg implants but pregnancy doesn't actually occur? And a woman may not even be aware that it happened?

[UnluckyStuntman]

Wait a second, aren't there all sorts of times where a fertilized egg implants but pregnancy doesn't actually occur? And a woman may not even be aware that it happened?

The only way that happens is if the woman miscarries. Fertilized egg + implantation = pregnancy (though some say it begins at ovulation or fertilization). It's not uncommon for a woman to miscarry without even realizing that she was pregnant to begin with, espeically if she wasn't trying to get pregnant (and therefore was not tracking her cycle or peeing on pregnancy/fertility tests regularly).

So, the woman will have her period - which may or may not be heavier or more painful than normal - and she will have never known that she was pregnant in the first place.

[Marduk]

So, the woman will have her period - which may or may not be heavier or more painful than normal - and she will have never known that she was pregnant in the first place.

Yeah, that's basically what I was thinking of. Sorry, I guess that's technically a "pregnancy." I just find it mystifying that we're so concerned about all of this, and yet it happens so much without even realization.

[Laser Jock]

Yeah, that's basically what I was thinking of. Sorry, I guess that's technically a "pregnancy." I just find it mystifying that we're so concerned about all of this, and yet it happens so much without even realization.

Yeah, especially if you include an egg getting fertilized but not implanting (which lots of people seem to be concerned about). That happens even more often. Eirene looked up some stats for me and although studies give different numbers, something like 30–70% of fertilized eggs ("conceptuses") are lost at or before the time of implantation, while 13–26% of unrecognized pregnancies result in a miscarriage. (This doesn't include the number of cases where a woman knows she's pregnant and miscarries, which would usually be anything after the first few weeks.)

Granted, I can see someone arguing the opposite, that just because miscarriages can happen doesn't mean an abortion is okay, which is true.

[Marduk]

Granted, I can see someone arguing the opposite, that just because miscarriages can happen doesn't mean an abortion is okay, which is true.

Sorry, apparently I'm misspeaking all over the place. I'm not trying to make any specific argument about abortion one way or the other. All I'm suggesting is that if one believes that any implantation equals human life, or even worse (worse for the sake of this point), if fertilization equals human life, then we've got something worse than cancer and heart disease combined on our hands.

What I mean is that the argument that either of those equals the beginning of human life then those who argue that would also have to realize that natural causes terminate way more pregnancies than abortion.

[Eirene]

This reminds me of something I read on this guy's blog:

The very idea of a “moment” of ensoulment is one of those theological contrivances rejected by every folk culture that has ever existed, including ours. Intuitively, we all understand that the moral value of the fetus (like everything else about it) develops gradually, beginning somewhere around zero at conception and becoming immeasurable by the time of birth. In actual practice everyone — even a conservative Christian who “believes” in ensoulment-at-conception — understands that late miscarriages are more tragic than early miscarriages, and that the death of an infant is more tragic yet.

Consider, for example, that the majority of fertilized ova fail to implant in the uterus and abort spontaneously without the woman even being aware of her pregnancy. Anyone who honestly believed these were full-fledged human souls would regard failure-to-implant as the greatest health problem and greatest human tragedy of all time. But where is the religious monument to these billions of souls? Where is the big research program to do something about this holocaust?

Nowhere, because deep down no one really believes that a fertilized ovum has the moral value of a baby. The whole idea has been trumped up to justify opposition to abortion. It does not deserve the respect it is typically granted.

[Laser Jock]

Yeah, sorry about that, Marduk. I didn't mean to imply that you were saying that. I think your point is a good one, and I've thought basically the same thing.

[Whistler]

In renaissance times they believed that ensoulment happened around the "quickening," or when the woman could start to feel the kicks of the baby in her body. I like that idea.

[Emiliana]

This reminds me of something I read on this guy's blog:

The very idea of a “moment” of ensoulment is one of those theological contrivances rejected by every folk culture that has ever existed, including ours. Intuitively, we all understand that the moral value of the fetus (like everything else about it) develops gradually, beginning somewhere around zero at conception and becoming immeasurable by the time of birth. In actual practice everyone — even a conservative Christian who “believes” in ensoulment-at-conception — understands that late miscarriages are more tragic than early miscarriages, and that the death of an infant is more tragic yet.

Consider, for example, that the majority of fertilized ova fail to implant in the uterus and abort spontaneously without the woman even being aware of her pregnancy. Anyone who honestly believed these were full-fledged human souls would regard failure-to-implant as the greatest health problem and greatest human tragedy of all time. But where is the religious monument to these billions of souls? Where is the big research program to do something about this holocaust?

Nowhere, because deep down no one really believes that a fertilized ovum has the moral value of a baby. The whole idea has been trumped up to justify opposition to abortion. It does not deserve the respect it is typically granted.

I've read this quote somewhere before (did you maybe quote it on the Board at some point?) and it has really stuck with me as a good opposition to people who say that birth control/emergency contraception causes abortion.

TMI:
Fun fact: I once took Plan B.
Fun fact #2: I puked it right back up.
/TMI

[wired]

Alright, so let me make some clarifying remarks and try to point out why it matters to me personally.

First, I agree that, as a matter of Mormon religious doctrine, we do not know when the soul enters the body. I've heard all sorts of great (put irony tags around that) explanations for when the soul does or does not enter a body. (One prominent one I remember argues that its not until after birth. Otherwise, how would Christ told Nephi that he would come into the world tomorrow. This sort of logical deduction does not do it for me, at all. There's so many assumptions that you have to make to get to the "otherwise" conclusion that it's a virtually useless thought exercise.) I doubt we'll ever know. I personally would not be surprised (but am not of the opinion) if there's no uniform answer. I also think that our understanding of "souls" and "spirits" is probably dramatically trivial compared to what there actually is that I'm not sure taking about the concept of "ensoulment" or the "soul entering the body" is really a relevant question to be asking.

So that first bit is to make clear: my opposition to abortion generally does not stem from a belief about when the soul enters the body.

Second, if I understand LJ and Marduk correctly, both leave open the possibility for arguing about the propriety of abortion even if it isn't connected to an underlying theory of "ensoulment." And I think you both are also saying that the amount of miscarriages early on should not actually influence abortion policy. (Admittedly, I might be making too big of a jump there - if so, please correct me.) If I understand that correctly, I agree with you both on both points.

My personal view is that any discussion about abortion (or contraception) is going to be a line-drawing exercise. We could prohibit interfering with the life of an unborn child at birth (which are what radical pro-choice advocates want), "viability" (which is what the law presently does), at trimester intervals (which is what Roe v. Wade did), at implantation, fertilization, or even earlier than that at the moment of sex (this would be a theory that supports outlawing any contraception like a condom or hormone treatment). On a personal view, I think that we ought to err on the side of protecting potential life rather than killing it (that might seem incendiary, but I think it accurately describes what happens in most abortions), but that that ought to be balanced against unanticipated harms that stem from protecting life. I draw it fertilization rather than earlier than that because, for me, there's something different about a combined sperm and egg than there is about either separately. I am sure that subject to logical attack, but I think part of it has to do with the independent viability of a sperm and an egg. Alone, neither one of them can become human. Together they can become human.

Third, if I further understand you, you are both saying that if someone does subscribe to a theory of ensoulment at fertilization (or implantation) that has troubling inconsistencies. The primary inconsistency being that people who oppose abortion on a theory of ensoulment overlook a far more detrimental loss of life in the form of early miscarriages, rather than abortion. As I said, I don't really base my opinion on a theory of ensoulment, but I think there's reasonable arguments to be made if I did. Since ensoulment is a purely religious idea, I think it can be modified in purely religious ways that maintain internal coherence. For example, one could easily think that early miscarriages are the result of God's will, maybe even a physical body that did not receive a spirit from God. On that belief, one could be untroubled by early miscarriages, but gravely opposed to abortion because it is essentially playing fetal Russian roulette. (Sure, there might not be a soul in that fetus, but there might also be.)

Fourth, I don't really agree with the quote that Eirene put up. It starts with a false premise ("a 'moment' of ensoulment is one of those theological contrivances rejected by every folk culture that has ever existed.") It's inaccuracy stems from its sweeping language; there are indeed folk cultures (and social cultures more broadly) that have accepted the idea of ensoulment. The concept of "quickening" referred to earlier in this thread is one of those theories that has had wide acceptance. Has it ever had universal acceptance? Probably not, but I can't think of anything that's ever had universal acceptance.

He also talks about relative value of miscarriages and infants. I can agree with the observation, but I don't know that it actually ought to impact policy or point to any societal trend. I think the impact people feel by it is more reflective of expectations about the loss, rather than the value on individual life. In other words, we expect many early miscarriages, fewer late miscarriages, and fewer still deaths of infants. But I don't think that necessarily translates to valuing them less or appraising their "moral value" differently.

And his summary dismissal that "no one really things an ovum has the moral value of a baby" rests on the proposition that people only argue that because they are trying to trump up opposition against abortion. But I doubt that many devout people are trumping up that opposition for opposition's sake; it is because they really do believe that an ovum has similar moral value (if not equivalent) to a baby.

[Marduk]

If you assume that all early miscarriages are God's will and therefore ought not to be averted, yet assume many if not all of those could have equivalent value to a born infant, then you must disavow the medical profession entirely; else, how is curing heart disease not averting God's will?

[thatonemom]

This reminds me of something I read on this guy's blog:

In actual practice everyone — even a conservative Christian who “believes” in ensoulment-at-conception — understands that late miscarriages are more tragic than early miscarriages . . ..

Wow, people shouldn't say stuff like that. Because it is offensive to anyone who's had a miscarriage. I've had friends who were just as heartbroken having a miscarriage at 6,7,8 weeks as I was having one at 15. It sure isn't any less tragic to the person going through it. And comments like that are really dismissive to their experience.

But, even losing a pregnancy at 15 weeks, I didn't look at it the same as losing a child. It was more the loss of the potential or possibility. I don't think there's any less potential at 6 weeks than at 20 (neither baby could live on its own at that point) But I'm not sure where I'd put the starting point. Maybe when the implanted egg starts to divide and grow?