Category: Birth Control

Is it ethical for private citizens to pay drug-addicted men and women not to have children? That’s the issue raised by Barbara Harris, whose group pays women $200 if they agree to either be sterilized or use a form of long-term birth control such as Depo Provera. Since Harris started Children Requiring A Caring Kommunity (CRACK), the organization’s Project Prevention has found 560 addicts willing to accept her deal.

Harris will speak at the 28th annual conference of the Association for Behavior Analysis in Ontario, Toronto, in May 2002, and her scheduled talk isn’t going over well with folks who consider what she does analogous to eugenics efforts (according to The National Post, parts of Canada were covered by a law granting the state the right to sterilize some people until 1972).

Harris defended her tactics to the National Post saying, “There’s really no reason a drug addict or an alcoholic should get pregnant. And if we can prevent that from happening by offering them $200, then it’s the best $200 that could be spent.”

Critics, however, raise two major objections — that the practice is racially biased and that addicts cannot consent to sterilization.

The Canadian Foundation for Drug Policy’s Eugene Oscapella told the Post, “If she’s going after crack addicted babies, then she’s going after minorities, plain and simple.” In fact, though, so far the group has had 267 white clients take the $200 compared to 190 black clients.

The claim that drug addicts can’t consent to this is a bit odd. Dr. Peter SElby tells the Post that, “The real issue for people with a medical disability was whether they could appreciate what they were consenting to. It’s the same here, because the drug addiction entices them [crack addicts] to get it done.”

But if a person is so addicted to drugs that he or she cannot consent to long term birth control or sterilization, how can such a person possibly consent to potentially becoming a parent? The consent issue seems to raise a lot more problems than it solves (if a drug addict cannot consent to Depo Provera for money, could the same addict consent to drug treatment for money?)

Michel Perron adds a note of caution, noting that targeting crack addicts may be necessary since the jury is still out on the effect of crack addiction on fetal development. That is certainly true, but even if crack proves not to be all that harmful to the fetus, a crack addict is unlikely to prove to be an ideal parent. As Professor Arthur Schafer of the Centre for Professional and Applied Ethics at the University of Manitoba told the Post, “I think it’s legitimate to say to drug addicts, if you have babies they are going to pay a terrible price when they’re born and when they grow up and have you as a parent.”

Source:

Advocate of sterilizing addicts coming to Toronto. Odile Nelson, National Post, November 15, 2001.

The controversy over allowing women to obtain the morning-after contraceptive pill without seeing a doctor first is heating up as California recently became the second state (after Washington) to allow pharmacists to prescribe the pill and some are urging the U.S. Food and Drug Administration to approve the pill for over the counter sales, eliminating the requirement for a prescription.

The proposal is controversial both for potential health risks to women as well as because of opposition from pro-life groups who maintain that since the morning-after pill could potentially prevent a fertilized egg from implanting itself on the uterine wall, those women taking it are essentially receiving an abortion.

So-called emergency contraception works by flooding the body with a large dose of female hormones which can delay ovulation and apparently prevent implantation of a fertilized egg if sex occurs on the day of ovulation (though this latter point is inferred from the drug’s effect).

Morning-after contraception consists of two pills, with one take 12 and the other taken 72 hours after intercourse. The treatment is almost 100 percent effective in preventing pregnancy if the first does is taken within 12 hours, though the efficacy does begin to decline if women wait longer than 12 hours.

There are two drugs already approved by the FDA for morning-after contraception, but the problem in effectively using the drugs is obvious — arranging for a consultation with a doctor within 12 hours of intercourse is difficult to say the least. The proposed solution to this problem is to either allow pharmacists to prescribe the drug without requiring women to first see a doctor or to approve the drug for over-the-counter use so women could buy it off the shelf much like they can by pain killers and other drugs without a prescription.

Washington state started allowing pharmacists to prescribe the drug three years ago and over 25,000 women have received the drug from pharmacists. The druggists are required to screen and counsel women requesting the pill, as with all drugs there are side effects — though for the most part they are relatively minor such as nausea (though all drugs have the potential to cause serious side effects in people with serious health problems).

Pro-life activists oppose the move to loosen restrictions on the drug for the same reason they opposed the FDA’s approval of the drug in the first place — they believe it constitutes abortion. But what has killed efforts in general are concerns over whether or not pharmacists can prescribe the drug to minors without their parents permission and whether or not insurance companies should be required to pay for emergency contraception.

Mandating insurance coverage is a bad idea that will only act as yet another lever forcing health insurance costs up while forcing companies and institutions that find abortion morally objectionable to fund it. If a Catholic hospital, for example, doesn’t want to carry emergency contraception nor provide insurance coverage for its employees to obtain emergency contraception, it should not be forced to do so by the state.

The moral qualms surrounding minors receiving such prescriptions is compounded by the speed with which a decision must be made on emergency contraception, and frankly I don’t see a clean way to resolve that debate.

But leaving aside those two thorny issues, there is no reason that the FDA shouldn’t simply sidestep this whole issue and approve the drug for over-the-counter sale. As Bonnie Scott Jones of the Center for Reproductive Law and Policy told The Village Voice,, “Because emergency contraception poses no known health risks, has minor side effects, and can be taken in two simple, identical doses without medical supervision, it meets all the criteria necessary for over-the-counter status.”

The opposite view was expressed to Village Voice reporter Dave Gilden by an unidentified pro-choice Congressional staffer who Gliden report said, “There is a legitimate debate among people who care about women’s health. Would people stop going to gynecologists if they could get the drugs over the counter? An opportunity to educate and examine women would be lost, some people think.”

Give me a break. If that logic makes any sense at all (and it does not), why not require a prescription to obtain a condom in order to force men to more regularly visit their doctors? This sort of paternalism is extremely offensive, but to be expected even from pro-choice folks who often have as much of a paternalistic streak as the pro-life crowd. Lets OTC emergency contraception so we can get the decision out of the hands of these clowns and where it belongs — with the women and men who have to live with these reproductive choices.

Sources:

No Rx Required. Dave Gilden, The Village Voice, April 4-10, 2001.

Calif. Testing Morning-After Pill Acess. Denise Gellene, The Los Angeles Times, April 11, 2001.