The confusion about contraceptives

May 1, 2014

The Hobby Lobby case has brought to the fore the current state of confusion regarding how contraceptives work. One of the problems is lack of clarity on the question of whether some—or any—contraceptives can cause an abortion.

Why is there so much uncertainty? Doesn’t the name contra (against) conception say it all?

A Change in Definition

Well, actually, the answer is no. And to understand why, we need to go back about fifty years, when Albert Rosenfeld realized that the newly available oral contraceptive pill (OCP) might not only prevent the sperm from fertilizing the egg (the classic definition of ‘conception’) but might also terminate embryonic human life by inhibiting implantation in the womb (which occurs about a week later). Since such interference would occur after conception, he realized that some people would say this represented an abortion (or was abortifacient). He recommended a ‘solution’ to this problem: “Equate conception with the time of implantation rather than the time of fertilization—a difference of only a few days.” That is, he got around the fact that these drugs might cause the termination of a pregnancy by changing the definition of when a pregnancy started—because if there were no pregnancy, you couldn’t say you were causing an abortion. (Whether this abortive mechanism does actually operate for the pill is still not clear, as we see below.)

Following Rosenfeld’s logic, the subsequent printing of the American College of Obstetricians and Gynecologist’s terminology text in 1972 saw a deliberate change of the definition of ‘conception.’ The accepted scientific view that conception was the result of the process of fertilization was altered to define ‘conception’ as implantation. As a result, the link between fertilization and conception was broken. Pregnancy was still defined as “the state of a female after conception and until termination of the gestation,” but the text now dated a pregnancy (and by implication a human life) from the time of the implantation of the embryo into the wall of the mother’s uterus. Under the new definition, any device that prevented the embryo from implanting in the uterus could be marketed as a contraceptive. 

Note that those who made this definitional change had no authority to do so—they weren’t embryologists. Despite medical textbooks adopting the new definition, respected embryology textbooks still mark conception (and the beginning of human life) at fertilization.

Two Classes of Contraceptives

This change of definition means there are two classes of contraceptives: those that work before fertilization, the classic definition, and prevent the sperm from joining with the egg; and those that cause an early abortion by acting after fertilization. We can work out which category any given contraceptive method falls into by considering how it works. This isn’t as easy as you might think—but some guidelines are available for those whose conscience prevents them from putting an early human embryo at risk.

If you want to avoid fertilization from occurring, you need to stop the egg and sperm from meeting. The methods in this group will include barrier contraceptives, such as condoms or diaphragms, where a physical obstruction is placed between the sperm and the egg. You could achieve the same effect by limiting the availability of one or the other. Preventing the production of eggs would make fertilization impossible (this is usually done with hormones). Similarly, the withdrawal method and natural family planning (also called fertility awareness methods) will work by keeping the sperm out of the way. Natural family planning works by avoiding intercourse during the woman’s fertile period, so that no sperm is around when there’s an egg present. The withdrawal method aims to keep sperm out, period.

We also have information to put some methods in the other camp—those that work after fertilization and so run the risk of causing an early abortion. We know that some hormonal implants, ormeloxifene, IUDs, and ‘abortion’ pills such as RU486 can definitely work after fertilization, and so would be ethically unacceptable for those who value life from fertilization.

However, we are left with a grey area—those methods whose mechanism is not fully understood. Because they are so widely used, the most important ones in this category are the oral contraceptive pill and some other hormonal contraceptives. Debate about whether the pill is an abortifacient has raged for years, with some dodgy research muddying the waters for the non-scientifically-minded. 

Here’s a brief explanation. There are three known actions by which the pill prevents pregnancy: 

1.    The pill suppresses ovulation (egg production); 
2.    the pill makes it difficult for the sperm to move through the cervix; and 
3.    the pill makes the lining of the womb thinner and hostile to the embryo implanting. 

The first two actions are not controversial, as they obviously just stop egg and sperm from getting together and so are acting before fertilization. The concern is the third effect. Some Christians have argued that if the first and second mechanisms fail, so that an egg is produced and sperm do get through the cervix, then an embryo could form. If this was the case and the womb was not prepared for the embryo to implant and develop, it would put the pill into the second contraceptive category of abortifacients. 

However, I think there is better evidence that if the first and second mechanisms fail and an embryo is formed, then we would also expect the third mechanism to fail (as they come as a package—all or none) and you would not have an abortion, but an unplanned pregnancy. There are disagreements about the reliability of the evidence both sides claim to support their arguments. The definitive research needed to decide the issue once and for all has not, and probably will never be, done. 

To make it all a little more confusing, some contraceptives, such as the pill, can be prescribed for non-contraceptive purposes, such as hormonal disturbances in the woman. If the required action of the method for the effect you want does not involve prevention of pregnancy, you can argue this is a permissible use even for those who oppose abortion. 

Obviously this is a complex area, and putting aside the legal implications of the decision, it doesn’t help to just lump all contraceptives into one basket when we are debating the morality involved. 

We need to remember, then, that the Hobby Lobby case is not about all contraceptives, but only those that challenge the ethical values of those that value human life from the time of fertilization. It’s good to debate these issues in our community, but let’s make sure we base our arguments on the facts.

(Editor’s Note: Megan Best, MD, is a medical ethicist and author of Fearfully and Wonderfully Made: Christian Ethics and the Beginning of Human Life. In the book she discusses these issues in depth. Further information about contraceptives can be found in Chapter 6. Appendix 1 explains in detail the debate about whether the pill causes abortions.)

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24