ScientificScientific data and data and Ethical Ethical questions questions

on on

““PROCURED PROCURED ABORTION”ABORTION”

A SERIOUS “ETHICAL A SERIOUS “ETHICAL QUESTION” OF OUR TIMEQUESTION” OF OUR TIME

October, 17October, 17thth 2014 2014A.GiuliA.Giuli

The Elaboration of an Ethical Judgment :The Elaboration of an Ethical Judgment : ““THE TRIANGULAR METHOD”THE TRIANGULAR METHOD”

(1) (1) BIOMEDICAL BIOMEDICAL DATADATA: : SCIENTIFIC SCIENTIFIC IDENTITY OF THE IDENTITY OF THE HUMAN EMBRYOHUMAN EMBRYO

(2) (2) ANTHROPOLOGIC FRAMEANTHROPOLOGIC FRAME: : INNER INNER VALUEVALUE OF THE HUMAN OF THE HUMAN

EMBRYOEMBRYO

(3) (3) ETHICAL EVALUATIONETHICAL EVALUATION::A A RATIONAL EVALUATIONRATIONAL EVALUATION WHICH IMPLIES WHICH IMPLIES ACKNOWLEDGMENTS FROM ACKNOWLEDGMENTS FROM POINTS POINTS 1 AND 21 AND 2

““PROCURED ABORTION”:PROCURED ABORTION”:HISTORICAL AND CULTURAL HISTORICAL AND CULTURAL

ISSUESISSUES From the second half of the 20From the second half of the 20thth century century : LEGALIZATION : LEGALIZATION

and DEVELOPMENT of procured abortion;and DEVELOPMENT of procured abortion; In1990 it is published the book: “In1990 it is published the book: “L’avortement: enjeu L’avortement: enjeu

politiquepolitique” (Abortion as a “political aim”)” (Abortion as a “political aim”): the procured : the procured abortion it is not an event due to poverty or serious familiar abortion it is not an event due to poverty or serious familiar problems but problems but a proper AIM OF INTERNATIONAL a proper AIM OF INTERNATIONAL POLITICSPOLITICS, in which many International Organizations are , in which many International Organizations are involved (e.g. The United Nation Agency: UNFPA).involved (e.g. The United Nation Agency: UNFPA).

The aim is not a social prevention of procured abortion The aim is not a social prevention of procured abortion but its planning and wide legalizationbut its planning and wide legalization. .

““THE BIRTH-CONTROL” THE BIRTH-CONTROL” POLITICS POLITICS (1)(1)

THE BIRTH-CONTROL POLITICS THE BIRTH-CONTROL POLITICS has its ideological roots has its ideological roots on on neomalthusianneomalthusian idea that after the second World War there idea that after the second World War there would be a would be a “demographic boom” “demographic boom” especially in Developing especially in Developing Countries. Countries.

These previsions do not take into account many factors linked These previsions do not take into account many factors linked with with industrialization and urbanization industrialization and urbanization that already create a that already create a decrease in birth rate decrease in birth rate (e.g. to postpone the age of marriage (e.g. to postpone the age of marriage implies a restriction of “fertility window”).implies a restriction of “fertility window”).

From 1950-60: International strategies of birth control are From 1950-60: International strategies of birth control are planned by planned by CONTRACEPTION, STERILIZATION AND CONTRACEPTION, STERILIZATION AND

ABORTIONABORTION..

““THE BIRTH-CONTROL” THE BIRTH-CONTROL” POLITICS POLITICS (2)(2)

USA, JAPAN and EUROPE together with UN AGENCIES on USA, JAPAN and EUROPE together with UN AGENCIES on population, World Health Organization (WHO), World Bank population, World Health Organization (WHO), World Bank (WB) with the financing of big Foundations (e.g. Rockfeller, (WB) with the financing of big Foundations (e.g. Rockfeller, Ford, IPPF) → Ford, IPPF) → legalization of abortion, sterilization and legalization of abortion, sterilization and contraception contraception all over the World, especially in Developing all over the World, especially in Developing Countries; Countries; imposition by law of a limited number of childrenimposition by law of a limited number of children. .

In Developing Countries economical aid is given if In Developing Countries economical aid is given if Centers for Centers for “Family Planning” “Family Planning” are created: in are created: in IndiaIndia, for a certain time , for a certain time sterilization was imposed; in sterilization was imposed; in ChinaChina, there is the due of a “single , there is the due of a “single child” (since 1970, 400 million abortions were practiced; a child” (since 1970, 400 million abortions were practiced; a number of deaths 8 time higher than the last World War). number of deaths 8 time higher than the last World War).

““THE BIRTH-CONTROL” THE BIRTH-CONTROL” POLITICS POLITICS (3)(3)

INTERNATIONAL CONFERENCE ON POPULATION INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT (Budapest 1974, Mexico City AND DEVELOPMENT (Budapest 1974, Mexico City 1984, Cairo 1994 and Pekin 1995, on woman): the aim is 1984, Cairo 1994 and Pekin 1995, on woman): the aim is the organization of the organization of “political programs” on “reproductive “political programs” on “reproductive health” health” imposed by International Authorities on different imposed by International Authorities on different Countries. Countries.

These politics are treating Latin America (once protected by These politics are treating Latin America (once protected by “Costa Rica Convention”, which declared the “right of life” “Costa Rica Convention”, which declared the “right of life” from conceptionfrom conception), are spread in Africa, Asia and Europe ), are spread in Africa, Asia and Europe (were the economical crisis should require a different (were the economical crisis should require a different attitude).attitude).

PROCURED ABORTION: PROCURED ABORTION: FROM A CRIME → TO A RIGHTFROM A CRIME → TO A RIGHT ““THE LEGALIZATION BOOM”THE LEGALIZATION BOOM”:: 55 million procured 55 million procured

abortion/year in the World (1 billion and 650 millions in the past 30 abortion/year in the World (1 billion and 650 millions in the past 30 years); years); in Europe,in Europe, 1 abort. every 11 sec. 1 abort. every 11 sec.

HUGE SPREAD OF ABORTION PILLS.HUGE SPREAD OF ABORTION PILLS. Legalization of Euthanasia (especially Legalization of Euthanasia (especially in Europe).in Europe). THE WESTERN “THE WESTERN “CULTURE OF DEATHCULTURE OF DEATH” BASED ON ” BASED ON

““PHILOSOPHY OF WELLBEINGPHILOSOPHY OF WELLBEING””: hedonistic and selective : hedonistic and selective culture; individualism; subjectivism; absolute freedom and culture; individualism; subjectivism; absolute freedom and relativism.relativism.

THE DIGNITY OF HUMAN BEING IS OBSCURED, THE DIGNITY OF HUMAN BEING IS OBSCURED, ESPECIALLY IN THE MOST VULNERABLE TIME OF LIFE. ESPECIALLY IN THE MOST VULNERABLE TIME OF LIFE.

THE GRADUAL COLLAPSE OF THE GRADUAL COLLAPSE OF THE VALUE OF LIFETHE VALUE OF LIFE

The average man has not a specific formationThe average man has not a specific formation on on problems related to contraception, abortion, IVF, problems related to contraception, abortion, IVF, euthanasia… euthanasia…

There is not adequate cultural and ethical formationThere is not adequate cultural and ethical formation on on this topics this topics even among cultivated or religious peopleeven among cultivated or religious people;;

From statistics we see that From statistics we see that “eugenic abortion”“eugenic abortion” (caused (caused because the foetus has problems, malformations…) is because the foetus has problems, malformations…) is practiced even in Christian families that practiced even in Christian families that are not able to are not able to made adequate ethical judgment on this grave made adequate ethical judgment on this grave problemsproblems. .

RESPECT FOR LIFE & RESPECT FOR LIFE & COUNTRIES’ DEVELOPMENTCOUNTRIES’ DEVELOPMENT

Many economists and demographists consider that the Many economists and demographists consider that the crisis of crisis of birth is one of the key cause of the actual economical crisisbirth is one of the key cause of the actual economical crisis , in , in Europe and all over the World. Europe and all over the World.

If If the population is agingthe population is aging the demand of services arises and the the demand of services arises and the request of goods/innovative products and the productivity request of goods/innovative products and the productivity decrease; no saving and lesser means for production and decrease; no saving and lesser means for production and investment. investment. The enterprises don’t risk for new investment if The enterprises don’t risk for new investment if there is not the perspective on new buyersthere is not the perspective on new buyers .. THE OPENNESS TO LIFE IS A FUNDAMENTAL THE OPENNESS TO LIFE IS A FUNDAMENTAL

FACTOR FOR THE FUTURE AND WELLBEING OF FACTOR FOR THE FUTURE AND WELLBEING OF EVERY COUNTRYEVERY COUNTRY

OPENNESS TO LIFE IS AT THE CENTRE OF TRUE OPENNESS TO LIFE IS AT THE CENTRE OF TRUE

DEVELOPMENTDEVELOPMENT. .

When a society moves towards the denial or suppression of When a society moves towards the denial or suppression of

life, it ends up no longer finding the necessary motivation life, it ends up no longer finding the necessary motivation

and energy to strive for man’s true good.and energy to strive for man’s true good.[Benedict XVI, [Benedict XVI, Encyclical letterEncyclical letter, , Caritas in VeritateCaritas in Veritate, 29-06-2009 (n.28)], 29-06-2009 (n.28)]

A A new societynew society and and developmentdevelopment arise from arise from moral change moral change

and renewaland renewal

DEFINITIONS DEFINITIONS (1)(1)

AbortionAbortion: : from the Latin word from the Latin word abortus abortus (past participle of the (past participle of the verb verb ab-orior) → ab-orior) → to perish, not to be born (the opposite verb is to perish, not to be born (the opposite verb is oriororior: to born): to born)

The termination of a human pregnancy before The termination of a human pregnancy before foetal viability foetal viability (the ability of a fetus to survive outside the uterus in case of (the ability of a fetus to survive outside the uterus in case of premature pregnancy).premature pregnancy).

– Spontaneous abortionSpontaneous abortion: : natural occurring events or natural occurring events or pathological causes independent of human will.pathological causes independent of human will.

– Procured abortionProcured abortion:: due to a due to a human direct intentionhuman direct intention..

→ → There is the There is the direct and intentional will direct and intentional will to terminate the life of to terminate the life of the newborn baby.the newborn baby.

DEFINITIONS DEFINITIONS (2)(2)

In Italian Books of Penal Law, procured abortion is In Italian Books of Penal Law, procured abortion is considered among the “crimes against life and personal considered among the “crimes against life and personal safeness”; it is defined as the “safeness”; it is defined as the “intentional interruption of a intentional interruption of a pregnancy with the consequent death of the conceived pregnancy with the consequent death of the conceived babybaby”. ”.

This definition underlines the This definition underlines the intentional killing of a human intentional killing of a human life life before birth even though the actual laws depenalize before birth even though the actual laws depenalize abortion. abortion.

[Cf. F.Antolisei, [Cf. F.Antolisei, Manuale di Diritto PenaleManuale di Diritto Penale, sp.I, Giuffrè, Milano 1986, p.87.], sp.I, Giuffrè, Milano 1986, p.87.]

Procured Abortion: Procured Abortion:

THE PROCEDURES THE PROCEDURES (1)(1)

The new individual human life begins at conceptionThe new individual human life begins at conception: all procedures that : all procedures that cause the death of the embryo, before and after implantation, are to be cause the death of the embryo, before and after implantation, are to be considered considered real abortionsreal abortions..

From the clinical point of viewFrom the clinical point of view, the choice of the specific abortive , the choice of the specific abortive technique depend on the gestational time.technique depend on the gestational time.

By 40By 40thth days from fertilization: chemical abortion days from fertilization: chemical abortion

– INTERCEPTIVESINTERCEPTIVES, , which impede embryo implantation which impede embryo implantation (Intra (Intra Uterine device - IUD), progesterone mini-pills, “the after-day pill”).Uterine device - IUD), progesterone mini-pills, “the after-day pill”).

– CONTRAGESTATIVESCONTRAGESTATIVES, which interfere with progesterone's action , which interfere with progesterone's action causing causing the detachment of the embryo already implanted in the the detachment of the embryo already implanted in the uterus uterus (e.g. RU 486).(e.g. RU 486).

Procured Abortion: Procured Abortion:

THE PROCEDURES THE PROCEDURES (2)(2)

By the first trimesterBy the first trimester– Endo-uterine aspiration by vaginal way with flexible cann. Endo-uterine aspiration by vaginal way with flexible cann. (63%)(63%)

– Dilatation of cervical channel and rasch. Dilatation of cervical channel and rasch. (12%) (12%)

After the first trimesterAfter the first trimester– Cervical dilatation and empt. With rings’s p. (the foetus is destroyed)Cervical dilatation and empt. With rings’s p. (the foetus is destroyed)

– High trasvaginal dose of prostaglandin E2High trasvaginal dose of prostaglandin E2 After the 16After the 16thth week week

– the empt. is precede by somm. of pharm. which stimulate uterine the empt. is precede by somm. of pharm. which stimulate uterine contractions and cervical dilatation (e.g. Hypertonic saline solution / intra-contractions and cervical dilatation (e.g. Hypertonic saline solution / intra-amniotic)amniotic)

Partial Birth-abortionPartial Birth-abortion: :

human fetus is killed during deliveryhuman fetus is killed during delivery

THE SIDE EFFECTS OF ABORTION THE SIDE EFFECTS OF ABORTION Retention of placental tissueRetention of placental tissue Uterus's perforationsUterus's perforations Uterine cervix lac.Uterine cervix lac. Metrorrhages (bleeding of uterine origin)Metrorrhages (bleeding of uterine origin) Highest incidence of ectopic pregnancyHighest incidence of ectopic pregnancy Highest frequency of spontaneous abortions and premature deliveries in Highest frequency of spontaneous abortions and premature deliveries in

case of subsequent pregnanciescase of subsequent pregnancies Infections, hemorrhages, death due to tossique choc (chemical abortion)Infections, hemorrhages, death due to tossique choc (chemical abortion) Grave and durative psychics consequencesGrave and durative psychics consequences: the experience of abortion : the experience of abortion

left an indelible and sorrowful sign in the woman’s psyche; the woman left an indelible and sorrowful sign in the woman’s psyche; the woman perceive that she has killed an innocent life – “perceive that she has killed an innocent life – “The Post Abortion The Post Abortion Syndrome”Syndrome”..

The sepulture of aborted babies The sepulture of aborted babies

Many associations have proposed the sepulture of aborted Many associations have proposed the sepulture of aborted babies babies to give dignity to the little death bodies to give dignity to the little death bodies helping families helping families to maintain an affective link with the baby. to maintain an affective link with the baby.

In some Countries, like Italy, with the agreement of the local In some Countries, like Italy, with the agreement of the local authorities, authorities, specific areas are set in public cemeteriesspecific areas are set in public cemeteries and and Requiem Celebration are prepared. Requiem Celebration are prepared.

In the past, the little bodies, often destroyed, were collected in In the past, the little bodies, often destroyed, were collected in the “special discharges”, and used as biological materials to the “special discharges”, and used as biological materials to obtain cosmetics or other pharmaceutical products. obtain cosmetics or other pharmaceutical products. The sepulture would permit to avoid abuses and to sens. The sepulture would permit to avoid abuses and to sens.

society on these subjectssociety on these subjects. .

THE CHEMICAL ABORTIONTHE CHEMICAL ABORTION

The chemical way of procured abortion is also called The chemical way of procured abortion is also called “medical abortion”; it is the alternative to chirurgical “medical abortion”; it is the alternative to chirurgical abortion (the “cripto-abortion”, or “hidden” abortion)abortion (the “cripto-abortion”, or “hidden” abortion)

Chemical product which are able to interrupt a Chemical product which are able to interrupt a pregnancy: pregnancy:

1)1) INTERCEPTIVESINTERCEPTIVES

2)2) CONTRAGESTATIVSCONTRAGESTATIVS

3)3) CONTRACEPTIVESCONTRACEPTIVES

CONTRACEPTION → CONTRACEPTION → ABORTIONABORTION The hormonal contraceptives The hormonal contraceptives (e.g. estro-progestinic pill) impede ovulation (e.g. estro-progestinic pill) impede ovulation

(the liberation of the oocyte from the ovary, by the alteration of the (the liberation of the oocyte from the ovary, by the alteration of the hypothalamic-hypophysis-ovary axes) and alters hypothalamic-hypophysis-ovary axes) and alters the cervical mucusthe cervical mucus product product by the uterine cervix so that the spermatozoa cannot go along the cervical by the uterine cervix so that the spermatozoa cannot go along the cervical channel and join the tube for fertilization (this second effect is less important channel and join the tube for fertilization (this second effect is less important than the block of ovulation). → than the block of ovulation). → these mechanisms impede fertilizationthese mechanisms impede fertilization..

The last generation contraceptives, indeed, have also an The last generation contraceptives, indeed, have also an abortive effectabortive effect: if : if the conception occurs they alter endometrium mucosa impeding embryo the conception occurs they alter endometrium mucosa impeding embryo implantation, and alter Fallopian tube motility impeding the way of the implantation, and alter Fallopian tube motility impeding the way of the embryo through the uterus → embryo through the uterus → these mechanisms are abortive because these mechanisms are abortive because determine the death and the elimination of the uterusdetermine the death and the elimination of the uterus. .

From a cultural point of view it is frequent that the recourse to abortion From a cultural point of view it is frequent that the recourse to abortion is a consequence of a failed contraceptionis a consequence of a failed contraception. .

KL. Moore, TVN. Persaud, 2003

Posterior uterine wall Blasotcyst

Morula 8-cell stage embryo

4-cell-stage embryo

2-cell stage embryo

zygote

Fertilization

Oocyte in the Fallopian tube

Released oocyte

Developing corpus luteum

Follicle rupture

Conjunctive tissue

Atresic folliculeClotted blood

Endometrium

Corpus albicans Mature corpus

luteum → P

Epithelium

Blood vessels

Early primary follicle

Growing follicle

Secondary follicle

Maturing follicle

Mature follicle

Oocyte

THE INTERCEPTIVESTHE INTERCEPTIVES

THEY THEY IMPEDE EMBRYO IMPLANTATIONIMPEDE EMBRYO IMPLANTATION

1)1) Hormonal interceptives:Hormonal interceptives: synthetic estrogens and/or synthetic estrogens and/or progestinics which progestinics which alterate endometrial uterine alterate endometrial uterine structure structure prepared for implantation.prepared for implantation.

2)2) Mechanical interceptives: Mechanical interceptives: induction of an induction of an immunological reaction which determines an immunological reaction which determines an inflammation of the endometrial mucosa impeding inflammation of the endometrial mucosa impeding implantation (e.g. Intra Uterine Device)implantation (e.g. Intra Uterine Device)

THE HORMONAL THE HORMONAL INTERCEPTIVES INTERCEPTIVES (1)(1)

Estrogens and/or progestinicsEstrogens and/or progestinics The aimThe aim: to impede implantation of the embryo (anti-: to impede implantation of the embryo (anti-

nidatory activity)nidatory activity) Action sitesAction sites::

1) Alteration of the endometrial structure of the uterus 1) Alteration of the endometrial structure of the uterus prepared to receive the human embryo.prepared to receive the human embryo.

2) Alteration of the tube’s motility2) Alteration of the tube’s motility

3) 3) LuteolysesLuteolyses → early regression of the → early regression of the Corpus LuteumCorpus Luteum, lack , lack of progesterone which do not permit a normal prosecution of progesterone which do not permit a normal prosecution of the pregnancy. of the pregnancy.

ABORTIVE EFFECTABORTIVE EFFECT

KL. Moore, TVN. Persaud, 2003

Posterior uterine wall Blasotcyst

Morula 8-cell stage embryo

4-cell-stage embryo

2-cell stage embryo

zygote

Fertilization

Oocyte in the Fallopian tube

Released oocyte

Developing corpus luteum

Follicle rupture

Conjunctive tissue

Atresic folliculeClotted blood

Endometrium

Corpus albicans Mature corpus

luteum → P

Epithelium

Blood vessels

Early primary follicle

Growing follicle

Secondary follicle

Maturing follicle

Mature follicle

Oocyte

THE HORMONAL THE HORMONAL INTERCEPTIVES INTERCEPTIVES (2)(2) The hormones are taken in high dosed by 12 -72 hours (3 days) after The hormones are taken in high dosed by 12 -72 hours (3 days) after

intercourseintercourse. . HIGH DOSE ESTROGENS: HIGH DOSE ESTROGENS: etinilestradiol (etinilestradiol (0,5-2,0mg/day) for 5 days (0,5-2,0mg/day) for 5 days (five five

by five by five protocol); the first dose is taken 72 hours after the sexual intercourse. protocol); the first dose is taken 72 hours after the sexual intercourse. Collateral effectsCollateral effects: nausea (54-70%), vomito (24-33%), cefalea, metrorragie : nausea (54-70%), vomito (24-33%), cefalea, metrorragie ed episodi di edema polmonare. Higher percentage of ectopic pregnancies. ed episodi di edema polmonare. Higher percentage of ectopic pregnancies.

Combined Combined estroprogestinics: estroprogestinics: 100µg 100µg etinilestradioletinilestradiol+0,5mg +0,5mg levonorgestrellevonorgestrel by 72 hours to a sexual intercourse, for two times every 12 h. (the modified by 72 hours to a sexual intercourse, for two times every 12 h. (the modified “Yuzpe protocol”). “Yuzpe protocol”). Collateral effectsCollateral effects: the same of estrogens pills, + trombo-: the same of estrogens pills, + trombo-embolic risk. embolic risk.

High dose progestinics: High dose progestinics: levonorgestrellevonorgestrel - two doses of 0,75mg evry 12 - two doses of 0,75mg evry 12 hours (or a single dose of 1,5 mg). It is the so called “day-after pill”. hours (or a single dose of 1,5 mg). It is the so called “day-after pill”. Collateral effectCollateral effect: nausea (21,3%), vomito (5,6%) e cefalea risk for woman : nausea (21,3%), vomito (5,6%) e cefalea risk for woman with tromboembolic disease.with tromboembolic disease.

HORMONAL INTERCEPTIVES HORMONAL INTERCEPTIVES (3)(3)

If the pill is taken during pre-ovulation phase, before If the pill is taken during pre-ovulation phase, before the LH peak, some interceptives are able to the LH peak, some interceptives are able to impede impede ovulationovulation (21-33%, depending on the method used). (21-33%, depending on the method used).

This is a This is a contracpetive effectcontracpetive effect which is secondary which is secondary compared to the compared to the abortive mechanism abortive mechanism (which has an (which has an efficacy of 70-100%). efficacy of 70-100%). The abortive effect is the The abortive effect is the principal aim of the hormonal interceptionprincipal aim of the hormonal interception. .

It is important to give a clear and objective It is important to give a clear and objective information on this behalf so that the woman would information on this behalf so that the woman would be aware on her choice (she is performing a be aware on her choice (she is performing a real real abortionabortion). ).

RA-Pharma has developedEmergency Contraceptive Pills.

NorLevo®, also known as Vikela®, Unofem®, Vika®, is an Emergency Contraceptive Pill.

It is sold as a package with one blister containing 1.5 mg of levonorgestrel, a progestin.This new product does not contain estrogens and its side-effect profile is therefore better.

Incorrect informationIncorrect information

““

6. How does Emergency Contraception work? Our current understanding is that several Our current understanding is that several

mechanisms could be involved such as impairment of mechanisms could be involved such as impairment of ovulation, or modification of the uterine lining. In any ovulation, or modification of the uterine lining. In any

case, emergency contraception case, emergency contraception takes effect before the takes effect before the implantation of the egg in the uterusimplantation of the egg in the uterus..

If you are already pregnant before using emergency If you are already pregnant before using emergency contraception, the pregnancy will continue normallycontraception, the pregnancy will continue normally..

INTERCEPTIVES’ PILLS: THE INTERCEPTIVES’ PILLS: THE STORY STORY (1)(1)

19401940: the first use of estrogens for abortive aim;: the first use of estrogens for abortive aim; 19701970: estro-progestinic and progestinic (first exp.); : estro-progestinic and progestinic (first exp.); 19801980: danazol and mifepriston;: danazol and mifepriston; In In 19941994 the the Center for Reproductive Law and PolicyCenter for Reproductive Law and Policy (USA), along (USA), along

with other groups like the Planned Parenthood of New York City with other groups like the Planned Parenthood of New York City ask to the Food and Drug Administration (FDA) a chemical product ask to the Food and Drug Administration (FDA) a chemical product with specific indication for use “with specific indication for use “emergency contraceptionemergency contraception”;”;

In In 1997 1997 the FDA declares the the FDA declares the efficacy and safety efficacy and safety of hormonal of hormonal abortivs and affirm not necessary further expensive experimental abortivs and affirm not necessary further expensive experimental trials. trials.

The authorization and diffusion of this chemical product will The authorization and diffusion of this chemical product will startstart. .

INTERCEPTIVES’ PILLS: THE INTERCEPTIVES’ PILLS: THE STORY STORY (2)(2)

From 1980From 1980, commercialization in Europe: Great Britain, , commercialization in Europe: Great Britain, Holland, Finland → Holland, Finland → all European Countriesall European Countries. .

In ItalyIn Italy, comm. of , comm. of NorlevoNorlevo (from 2000) and (from 2000) and LevonelleLevonelle (from 2001), based on the synthetic steroid (from 2001), based on the synthetic steroid levonorgestrellevonorgestrel; ; they can be bought in pharmacy by medical prescription. they can be bought in pharmacy by medical prescription.

This abortive products are spread by This abortive products are spread by family planning family planning organization organization especially in developing Countriesespecially in developing Countries; ;

The first target of this abortive pills are the women victim The first target of this abortive pills are the women victim of grape, then the so called “of grape, then the so called “woman at risk of woman at risk of pregnancypregnancy”, e.g. women in refugee camps.”, e.g. women in refugee camps.

INTERCEPTIVES’ PILLS: THE INTERCEPTIVES’ PILLS: THE STORY STORY (2)(2)

The concept of “risk” The concept of “risk” → to all that women that could → to all that women that could have an “have an “unwanted pregnancyunwanted pregnancy” (e.g. teenagers), making ” (e.g. teenagers), making up internet sites, special telephone lines and distribution of up internet sites, special telephone lines and distribution of abortion-kits in schools along with “sexual education”, for abortion-kits in schools along with “sexual education”, for the diffusion of the so called “the diffusion of the so called “emergency contraceptionemergency contraception”. ”.

These pharmaceutical products are publicized as the “These pharmaceutical products are publicized as the “day day after pillafter pill” or “” or “emergency contraceptionemergency contraception” to induce the ” to induce the wrong idea they are contraceptives which impede the wrong idea they are contraceptives which impede the constitution of a new human being;constitution of a new human being; instead, instead, their primary their primary effect is abortiveeffect is abortive and they have been used with poor and they have been used with poor consciousness. consciousness.

““ELLAONE”: THE 5ELLAONE”: THE 5THTH DAY PILL DAY PILL Pharmacological namePharmacological name: : ULIPRISTAL ACETATE ULIPRISTAL ACETATE (CDB-2914), “anti-(CDB-2914), “anti-

hormone” with antiprogestinic action. 30µg of ulipristal acetate are taken hormone” with antiprogestinic action. 30µg of ulipristal acetate are taken since 120 hours (5 days) from a sexual intercourse. since 120 hours (5 days) from a sexual intercourse.

Way of actionWay of action: The active principle links to uterine progesterone receptors : The active principle links to uterine progesterone receptors impeding the action of this hormone. impeding the action of this hormone.

The endometrium is altered impeding embryo implantation: The endometrium is altered impeding embryo implantation: abortive action.abortive action.

If ovulation is not yet occurred ulipistral may inhibit or postpone it by If ovulation is not yet occurred ulipistral may inhibit or postpone it by different mechanism (to postpone the LH peak; to inhibit the follicular ovary different mechanism (to postpone the LH peak; to inhibit the follicular ovary break (break (Human Reproduction 2010Human Reproduction 2010): ): contraceptive mechanismcontraceptive mechanism

We still don’t have enough studies on ripetitivety of the use, on foetus and We still don’t have enough studies on ripetitivety of the use, on foetus and newborn health exposed to this pharm.; on teenagers girls who use this newborn health exposed to this pharm.; on teenagers girls who use this phpharm. arm.

MECHANICAL INTERCEPTIVES MECHANICAL INTERCEPTIVES (1)(1)

IUD: IUD: Intra-Uterine DeviceIntra-Uterine Device

Mechanical disposal of different shape and material inserted Mechanical disposal of different shape and material inserted into the uterusinto the uterus

The actionThe action: to impede human embryo implantation : to impede human embryo implantation ABORTIVE MECHANISMABORTIVE MECHANISM

The implantation is impede by 3 mechanism:The implantation is impede by 3 mechanism:

1) Mechanical effect1) Mechanical effect

2) Biological effect of rame2) Biological effect of rame

3) Hormonal effect of progesteron3) Hormonal effect of progesteron

MECHANICAL INTERCEPTIVES MECHANICAL INTERCEPTIVES (2)(2)

1.1. Mechanical effectMechanical effect: induction of a chronic inflammatory : induction of a chronic inflammatory reaction due to the insertion of the device → reaction due to the insertion of the device → the uterine the uterine mucosa is altered impeding embryo implantationmucosa is altered impeding embryo implantation; ; prostaglandin liberation prostaglandin liberation increase of contractile activity of increase of contractile activity of the uterine muscles and vasoconstriction.the uterine muscles and vasoconstriction.

2.2. Biological effect of rameBiological effect of rame: rame ions inhibitory effect to some : rame ions inhibitory effect to some endometrial enzymes, consequent alteration of endometrium; endometrial enzymes, consequent alteration of endometrium; fluidification of endometrial mucus. fluidification of endometrial mucus.

3.3. Hormonal effect of progesteroneHormonal effect of progesterone: atrophy of superficial layer : atrophy of superficial layer of endometrium.of endometrium.

The 2. and 3. effects improve the The 2. and 3. effects improve the abortive action due to abortive action due to the mechanical effectthe mechanical effect. .

MECHANICAL INTERCEPTIVES MECHANICAL INTERCEPTIVES (3)(3)

COLLATERAL EFFECTSCOLLATERAL EFFECTS

Painful menstruations, crampsPainful menstruations, cramps

Risk of grave pelvic and uterine infectionsRisk of grave pelvic and uterine infections

Increased risk (3-5%) of Increased risk (3-5%) of ectopic pregnanciesectopic pregnancies

Anemia due to grave hematic lossAnemia due to grave hematic loss

Risk of uterus perforationsRisk of uterus perforations

→ → The risk of infertility increaseThe risk of infertility increase

Often teenager and young woman Often teenager and young woman are not aware of are not aware of the abortive actionthe abortive action and the and the related risksrelated risks of this pills. of this pills.

Research on 3265 girls between 14-21 Research on 3265 girls between 14-21 years oldyears old

((AIED, Associazione italiana per l’educazione demograficaAIED, Associazione italiana per l’educazione demografica))

84%84%: no information on abortive action and : no information on abortive action and collateral effects of “emergency contraception”collateral effects of “emergency contraception”

60%60%: information given by friends of the same : information given by friends of the same age, or boyfriendsage, or boyfriends

48%48%: pills used as contraceptives: pills used as contraceptives

No awareness or correct informationNo awareness or correct information

CONTRAGESTATIVESCONTRAGESTATIVES

They arrest the pregnancy inducing the They arrest the pregnancy inducing the DETACHMENT OF THE EMBRYO ALREADY DETACHMENT OF THE EMBRYO ALREADY IMPLANTED INTO THE UTERUSIMPLANTED INTO THE UTERUS

RU 486, prostaglandins, anti-hCG (RU 486, prostaglandins, anti-hCG (Human Chorionic Human Chorionic GonadotropinGonadotropin) vaccine) vaccine

General actionGeneral action: : they decrease progesterone level they decrease progesterone level the the endometrium is distrupted, endometrium is distrupted, the embryo is detached from the embryo is detached from the uterus and expulsedthe uterus and expulsed..

RU 486:RU 486:The story of a discussed pill The story of a discussed pill (1)(1)

19601960: first experimentations on contragestative pills, : first experimentations on contragestative pills, technical and scientific problems.technical and scientific problems.

19801980: the French researcher Etienne-Emile Baulieu : the French researcher Etienne-Emile Baulieu experiments on an “abortive pill” which is effective by experiments on an “abortive pill” which is effective by 7 weeks from conception. 7 weeks from conception.

→ → The pill is bought by the pharmaceutical industry The pill is bought by the pharmaceutical industry Roussel-Uclaf and named Roussel-Uclaf and named RRoussel-oussel-UUclaf 38486 (→ claf 38486 (→ RU-486RU-486), the first clinical trials begins.), the first clinical trials begins.

RU 486:RU 486:The story of a discussed pill The story of a discussed pill (2)(2)

From experimentation the first problems arises in 50% of From experimentation the first problems arises in 50% of analyzed cases up to 40 days after the somministration. analyzed cases up to 40 days after the somministration.

→ → In 1988In 1988: Roussel-Uclaf Pharm. decided not to proceed with : Roussel-Uclaf Pharm. decided not to proceed with commercialization but the Ministry of Health force to commercialization but the Ministry of Health force to commercialize this pill.commercialize this pill.

Many feminist organizations are against the RU-486.Many feminist organizations are against the RU-486. 19901990: RU-486 is commercialized in USA but made in China : RU-486 is commercialized in USA but made in China

because no USA industry wants produce this pill. because no USA industry wants produce this pill. 20042004: the FDA (: the FDA (Food and Drug AdministrationFood and Drug Administration) introduce ) introduce

among the collateral effect “grave battery infection, among the collateral effect “grave battery infection, hemorrhages, death”.hemorrhages, death”.

The RU-486 is used in the big Campaign of Birth Control in The RU-486 is used in the big Campaign of Birth Control in Developing Countries. Developing Countries.

Economical and social pressure may induce to sell products Economical and social pressure may induce to sell products which are abortive and not safe for women’s healthwhich are abortive and not safe for women’s health

RU 486: action mechanism RU 486: action mechanism (1)(1)

The medical procedure implies different phases and it is based on The medical procedure implies different phases and it is based on the assumption of at least 2 different active principles: the the assumption of at least 2 different active principles: the mifepristonmifepriston and a and a prostaglandinprostaglandin, at 48h one from the other., at 48h one from the other.

Pharmacological namePharmacological name: : MIFEPRISTON MIFEPRISTON (“anti-hormone”).(“anti-hormone”).

Way of actionWay of action: it react with endometrial progesterone receptors, : it react with endometrial progesterone receptors, blocking and impeding progesterone actionblocking and impeding progesterone action

Endometrium is disrupted and the trophoblast detachedEndometrium is disrupted and the trophoblast detached

From endometrial cells From endometrial cells prostaglandins are releaseprostaglandins are release which which stimulate uterin contraction of the miometrius and cause the stimulate uterin contraction of the miometrius and cause the dilatation and release of the uterus cervix with the expulsion of the dilatation and release of the uterus cervix with the expulsion of the embryo. embryo.

RU 486: action mechanism RU 486: action mechanism (2)(2)

The Ru486 do not cause abortion in 100% of cases, the The Ru486 do not cause abortion in 100% of cases, the abortive effect is possible by 49 days after conception, abortive effect is possible by 49 days after conception, when progesterone levels are very law.when progesterone levels are very law.

With the pregnancy progress levels of progesterone With the pregnancy progress levels of progesterone arise and the abortive pill is not able to antagonize the arise and the abortive pill is not able to antagonize the progesterone present in the blood. progesterone present in the blood.

RU 486: SIDE EFFECTSRU 486: SIDE EFFECTS

Nausea, hemorrhages, death due to toss. choc – among Nausea, hemorrhages, death due to toss. choc – among young women in good health -(young women in good health -(New England Journal of New England Journal of Medicine, 1/12/2005Medicine, 1/12/2005).).

in 5-10% of cases the rasch. is required.in 5-10% of cases the rasch. is required.

4 cases of septic death in the USA from September 2003 to 4 cases of septic death in the USA from September 2003 to June 2005; 1 death in Canada in 2001; 1 death in France in. June 2005; 1 death in Canada in 2001; 1 death in France in.

2 death due to 2 death due to Clostridium Sordellii infection were Clostridium Sordellii infection were signaled signaled by the by the New England Journal of Medicine: inNew England Journal of Medicine: in 2008 (29 years 2008 (29 years old lady) and in 2009 (21 years old girl) old lady) and in 2009 (21 years old girl)

((NEJM, , Fatal Fatal Clostridium sordelliiClostridium sordellii Infections after Medical Abortions Infections after Medical Abortions, September 30, 2010  Vol. 363 No. 14,

http://www.nejm.orghttp://www.nejm.org)

““RU 486, RU 486, KILLER SIDE EFFECTS” KILLER SIDE EFFECTS”(1)(1)

A USA study on 637 cases of side effects (2000- 2004):A USA study on 637 cases of side effects (2000- 2004):

237 cases of hemorrhages (1 death, 42 cases danger for 237 cases of hemorrhages (1 death, 42 cases danger for life, 168 grave situation);life, 168 grave situation);

66 cases of infections (7 cases of septic choc of which 3 66 cases of infections (7 cases of septic choc of which 3 death and 4 woman saved in extremis);death and 4 woman saved in extremis);

513 times the chirurgical intervention was due (in 513 times the chirurgical intervention was due (in emergency in 235 cases);emergency in 235 cases);

Allergies (8 case of grave hort.);Allergies (8 case of grave hort.);

Urgent intervention of ectopic pregnancies not Urgent intervention of ectopic pregnancies not diagnosed (1 death).diagnosed (1 death).

““RU 486, RU 486, KILLER SIDE EFFECTS” KILLER SIDE EFFECTS” (2)(2)

High failure tax of RU 486: pers. of pregnancies in 8% High failure tax of RU 486: pers. of pregnancies in 8% of cases (if the pill is taken by 49 days); in 23% of cases of cases (if the pill is taken by 49 days); in 23% of cases (if the pill is taken after 49 days);(if the pill is taken after 49 days);

The survival foetuses have 23% possibilities of The survival foetuses have 23% possibilities of malformations;malformations;

They are not jet good studies on teenager even though They are not jet good studies on teenager even though the pill is distributed to girls of 13-17 years old. the pill is distributed to girls of 13-17 years old.

The Annals of Pharmacotherapy, 2006The Annals of Pharmacotherapy, 2006

New questions arises for “conscience objection” (e.g. New questions arises for “conscience objection” (e.g. pharmacists)pharmacists)

ETHICAL ISSUESETHICAL ISSUES

ETHICAL VALUTATIONETHICAL VALUTATION

We apply theWe apply the bioethical methodology:bioethical methodology: We consider the We consider the objective valuesobjective values and the and the objective truth objective truth

concerning the procured abortion concerning the procured abortion (the ethical judgment of (the ethical judgment of subjective responsibilitiessubjective responsibilities may be different) may be different)

The elements to be consideredThe elements to be considered: :

- The The biological realitybiological reality of the new conceived baby; of the new conceived baby;

- The The objective valueobjective value of of human life from conceptionhuman life from conception ( (per se per se and in and in relation with contingent situations); relation with contingent situations);

- The The responsibilityresponsibility of persons/institutions involved in procured of persons/institutions involved in procured abortion (e.g. medical doctors; nursing staff –abortion (e.g. medical doctors; nursing staff –objection of objection of conscienceconscience); ); political and social responsibilities.political and social responsibilities.

““SUBJECTIVE” SUBJECTIVE” RESPONSIBILITIESRESPONSIBILITIES

The level of The level of objective values and truth objective values and truth may be different may be different from the from the subjective responsibilitiessubjective responsibilities: the single woman : the single woman may have may have some attenuations some attenuations (constriction, ignorance), (constriction, ignorance), and and she deserve respect and help she deserve respect and help even though she made even though she made an abortion. an abortion.

Nevertheless Nevertheless the objective reality of the action the objective reality of the action per se per se remainremain: the : the moral help moral help of people involved in abortion of people involved in abortion include to give a include to give a correct information correct information on the on the objective objective truth; truth; in this way the person may be helped to avoid-in this way the person may be helped to avoid-prevent the action of abortion.prevent the action of abortion.

...

ovocita

spermatozoo

ZIGOTE:ZIGOTE:embrione umano

allo stadio di una cellula

FECONDAZIONE: FECONDAZIONE:

INIZIO DELLA VITAINIZIO DELLA VITA

Bambino

MORTE

Embrione FetoNeonato Adulto AnzianoGiovane

ZIGOTE (fecondazione)

BLASTOCISTI EMBRIONE ADULTOMORULA

THE INTRINSIC VALUE THE INTRINSIC VALUE OF THE HUMAN EMBRYO OF THE HUMAN EMBRYO (1)(1)

Genetic and biological dataGenetic and biological data: : a new biological individualitya new biological individuality it is constituted it is constituted at the moment of conceptionat the moment of conception

Philosophical (rational) reflectionPhilosophical (rational) reflection: the biological : the biological individuality has the individuality has the dignity/value of the PERSON from dignity/value of the PERSON from conception conception

The zygote (one-cell embryo) it is a human being, with an The zygote (one-cell embryo) it is a human being, with an autonomous life and a specific identity conferred by the autonomous life and a specific identity conferred by the unique substantial principle.unique substantial principle.

The person is manifested by its abilities, behaviors… The person is manifested by its abilities, behaviors… but but it is not reduced to themit is not reduced to them!!

THE INTRINSIC VALUE THE INTRINSIC VALUE OF THE HUMAN EMBRYO OF THE HUMAN EMBRYO (2)(2)

If some characters or behaviors, specific of the human If some characters or behaviors, specific of the human being, are not jet present (as it happens in the human being, are not jet present (as it happens in the human embryo/foetus) embryo/foetus) it doesn’t imply that there is not a it doesn’t imply that there is not a personperson: : the person exist before and over the the person exist before and over the expression of capabilities, behaviorsexpression of capabilities, behaviors. .

It does not exist a It does not exist a human life without a subject human life without a subject and it and it could not be a continuous-gradual transition from could not be a continuous-gradual transition from “something” to “someone”.“something” to “someone”.

We cannot think of a human life without referring to a We cannot think of a human life without referring to a real human being, a human person.real human being, a human person.

THE “SACREDNESS” THE “SACREDNESS” OF EVERY HUMAN LIFEOF EVERY HUMAN LIFE

The intrinsic value of every human being, its Sacredness The intrinsic value of every human being, its Sacredness (in a Christian perspective the human being is (in a Christian perspective the human being is Imago Dei;Imago Dei; in Christ in Christ the man is called at communion with God – Trinitarian Life) the man is called at communion with God – Trinitarian Life)

→ → Every person has the same value Every person has the same value from conception to deathfrom conception to death; we can never affirm that life ; we can never affirm that life

without dignity existswithout dignity exists. . The human physical life is a fundamental value The human physical life is a fundamental value in which other in which other

values of person are founded and developed. values of person are founded and developed. The fundamental right to safeguard of the physical life The fundamental right to safeguard of the physical life has has

founded in the perspective that every intervention on physical life founded in the perspective that every intervention on physical life is an intervention on the whole man in its totality.is an intervention on the whole man in its totality.

ETHICAL ISSUES ETHICAL ISSUES (1)(1)

PROCURED ABORTION IS THE PROCURED ABORTION IS THE DELIBERATE AND DELIBERATE AND DIRECT KILLINGDIRECT KILLING OF A INNOCENT HUMAN BEING OF A INNOCENT HUMAN BEING (IN SPITE OF THE TECHNICAL USED) IN THE (IN SPITE OF THE TECHNICAL USED) IN THE BEGINNING OF HIS LIFE - FROM CONCEPTION TO BEGINNING OF HIS LIFE - FROM CONCEPTION TO BIRTHBIRTH. .

In the procured abortion a human life in development is In the procured abortion a human life in development is suppressed, so it is neglected suppressed, so it is neglected the fundamental value of a the fundamental value of a human individual, what constitute his lifehuman individual, what constitute his life. .

In the In the objective truth objective truth the procured abortion is the the procured abortion is the killing of a killing of a human beinghuman being: it is suppressed the life of an : it is suppressed the life of an innocent babyinnocent baby, , who is vulnerable an who is vulnerable an totally confided to his mother’s care. totally confided to his mother’s care.

ETHICAL ISSUES ETHICAL ISSUES (2)(2)

No reasons, even if grave and dramatic, may justify the No reasons, even if grave and dramatic, may justify the suppression of an innocent human beingsuppression of an innocent human being..

This moral valuation concerns This moral valuation concerns every intervention on human every intervention on human embryosembryos which implies its suppression, even if for which implies its suppression, even if for good aims good aims (e.g. experimentations on human embryos); (e.g. experimentations on human embryos);

Finally, because of the gravity of the issue, it is sufficient to be Finally, because of the gravity of the issue, it is sufficient to be in doubtin doubt about the personal identity to be morally obliged to about the personal identity to be morally obliged to assume the more secure behavior, to avoid any danger or risk assume the more secure behavior, to avoid any danger or risk on human persona.on human persona. It is in fact objectively grave to assume the risk of a It is in fact objectively grave to assume the risk of a

murdermurder..

THE PROCURED ABORTION

IS THE DELIBERATE AND DIRECT

KILLING

OH A HUMAN BEING

AT THE BEGINNING OF HIS LIFE

BEFORE BIRTH

ABORTION AND HUMAN ABORTION AND HUMAN RIGHTSRIGHTS

From the juridical point of view to recognize the From the juridical point of view to recognize the universal value of human being, should require to universal value of human being, should require to fully fully recognize human rights to the human embryo from recognize human rights to the human embryo from conceptionconception..

The right to life is the first of fundamental rights, The right to life is the first of fundamental rights, because without this foundation no other rights could be because without this foundation no other rights could be recognizedrecognized. .

Even the Even the right of freedomright of freedom, so important in our culture, , so important in our culture, cannot be exercised if we don’t recognize the right to cannot be exercised if we don’t recognize the right to life. life.

PERSONAL AND COLLECTIVE PERSONAL AND COLLECTIVE RESPONSIBILITIESRESPONSIBILITIES (1)(1)

The prenatal human life is completely confided to the cares and The prenatal human life is completely confided to the cares and protection of protection of the motherthe mother, but dramatic circumstances or egoistic , but dramatic circumstances or egoistic reasons may led the mother to suppress the life which is growing reasons may led the mother to suppress the life which is growing in her womb. in her womb.

Indeed, it is unfair to give all the responsibility of an abortion to Indeed, it is unfair to give all the responsibility of an abortion to the mother. Besides the mother there are the mother. Besides the mother there are other persons other persons whose whose responsibility may be pare or higher then the mother’s one. responsibility may be pare or higher then the mother’s one.

It ma be guilty the It ma be guilty the father of the baby father of the baby who directly induce the who directly induce the mother to abort, or indirectly let her alone facing the problems of mother to abort, or indirectly let her alone facing the problems of a pregnancy. a pregnancy.

PERSONAL AND COLLECTIVE PERSONAL AND COLLECTIVE RESPONSIBILITIESRESPONSIBILITIES (2)(2)

We cannot forget the complicities of We cannot forget the complicities of relatives, friends and relatives, friends and counselors of public counselingcounselors of public counseling..

A A grave responsibilitygrave responsibility is of is of medical doctors and nursing medical doctors and nursing staffstaff which directly procure abortion, or directly cooperate which directly procure abortion, or directly cooperate on this act.on this act.

Nowadays we may think to the Nowadays we may think to the direct responsibility of direct responsibility of pharmacistspharmacists who sell the who sell the abortive pillsabortive pills. In the Italian . In the Italian Parliament we are now discussing the possibility of Parliament we are now discussing the possibility of objection of conscience for pharmacistsobjection of conscience for pharmacists. .

PERSONAL AND COLLECTIVE PERSONAL AND COLLECTIVE RESPONSIBILITIESRESPONSIBILITIES (3)(3)

Moreover there are grave Moreover there are grave collective responsibilitiescollective responsibilities at at legislative levellegislative level, and for , and for mass-media and culture mass-media and culture which contribute to create which contribute to create a mentality against the a mentality against the unborn human lifeunborn human life. .

The attitude of all men of good will, not only of The attitude of all men of good will, not only of Christians, should be to complete dissociate from Christians, should be to complete dissociate from

abortive laws, because man could never obey to an abortive laws, because man could never obey to an intrinsically immoral positive law.intrinsically immoral positive law.

These considerations do not involve only people These considerations do not involve only people who are believers or Christians, but they concern who are believers or Christians, but they concern

the responsibility of every human beingthe responsibility of every human being, , independently of his creeds.independently of his creeds.

This is, in fact, a fundamental theme for our society.This is, in fact, a fundamental theme for our society.

The world of today needs to look with new eyes, The world of today needs to look with new eyes, with hope to the futurewith hope to the future; ;

BUT TO HAVE HOPE IT IS NECESSARY TO BUT TO HAVE HOPE IT IS NECESSARY TO RESPECT THE LIFE OF EVERYBODYRESPECT THE LIFE OF EVERYBODY. .

WE SHOULD WE SHOULD

«HAVE COURAGE TO FACE THE TRUTH «HAVE COURAGE TO FACE THE TRUTH

AND TO ADRRESS TO QUESTIONS AND TO ADRRESS TO QUESTIONS

WITHOUT COMPROMISSIONS»WITHOUT COMPROMISSIONS»

(Giovanni Paolo II, E.V. n.58)(Giovanni Paolo II, E.V. n.58)