Should the 'Morning After' Pill Be Available to All Ages?

Although man is a political animal, most doctors like to believe that they are not primarily motivated by politics. But the difficulty, or impossibility, of avoiding politics altogether was illustrated by a recent editorial in the New England Journal of Medicine about the decision of Health and Human Services Secretary Kathleen Sebelius not to allow the over-the-counter sale of the morning-after contraceptive pill to women and girls of all ages, only to those over 17 years. Girls under that age will need a prescription.

This was against the recommendation of the FDA's committee that the contraceptive should be available over-the-counter to everyone of whatever age, with no questions asked. The editorial accused the secretary of playing politics and of disregarding science.

That the secretary was making a political decision is certain; what is not certain is that she or anyone else could make a non-political decision, for facts do not compel policies as if, once enunciated, there was no choice to be made -- though, of course, facts (one may hope) do affect policy decisions.

"First, the facts," says the editorial magisterially, if a little condescendingly, as if bringing enlightenment to the benighted. But, as the on-line commentary that the editorial provoked demonstrated, facts do not always speak for themselves, nor is there universal agreement about which facts are relevant, conclusive, or even best-described.

"The best available evidence," we are told, "indicates that it [the morning-after pill] prevents pregnancy largely by delaying or preventing ovulation, but prevention of implantation cannot be ruled out. [It] does not cause abortion..." But, according to a doctor from Fredericksburg, Virginia, "since life begins at conception, abortion involves the termination of the embryo from the moment of conception"; and therefore, if he is right, the morning-after-pill acts, sometimes at least, as an abortiofacient. And this would be so irrespective of one's attitude to abortion.