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October 17, 2013 | Posted By Lisa Campo-Engelstein, PhD

Some physicians will write prescriptions in advance for young women so they can have immediate access to emergency contraception if the need arises. In order to be most effective, emergency contraception should be used within a few days of unprotected sex. Writing prescriptions for emergency contraception in advance makes it easier for women to take it right away and can reduce barriers they may face in trying to access it when they are under time pressure. My goal in this blog is to discuss some of the ethical issues raised by physicians writing preventive prescriptions for emergency contraception.

Some are concerned that the practice of physicians writing prescriptions in advance for emergency contraception will condone, and even encourage, young women’s sexual activity, especially premarital and "promiscuous" sexual activity. As with nonemergency forms of contraception and the HPV vaccine, some believe preventive measures against the risks involved with sexual activity are a tacit endorsement of sexual activity. On a related note, even if people did not oppose young women's sexual activity, they may still be concerned that writing prescriptions in advance for emergency contraception will discourage young women from using nonemergency contraception.  

Also there is the concern that young women may not understand how emergency contraception works and how it is different from nonemergency contraception. Part of what underlies this concern is that minors may not be able to give fully informed consent to use emergency contraception (or even nonemergency contraception). Some people believe that parental consent is necessary precisely for this reason – that minors may not be able to give informed consent for emergency contraception because they are not able to understand and assess the risks and benefits of emergency contraception. Furthermore, given the controversial nature of sexual and reproductive matters, some parents claim that they have the right to be informed about their child's sexual reproductive life so that they can help guide and even make decisions for their child. When weighing children's autonomy versus parental obligation to nonmaleficence and beneficence toward their children, some believe that parental paternalism is justified because parents are best situated to make decisions for their children since children, especially younger children, are often viewed as lacking full decision-making capacity.

In contrast, some argue that young women's reproductive autonomy should be upheld, even if they are under 18. Because sexuality and reproduction is such a personal matter (as well as a controversial political matter as mentioned above), some claim that reproductive decisions are best made by individuals themselves and not by their parents or others, such as healthcare providers or the government. Some may see the request for a preventive prescription for emergency contraception as an example of mature and responsible behavior that is further evidence that young woman are capable of making reproductive decisions for themselves. According to mature minor statutes, minors are able to obtain medical treatment for specific health-related conditions without parental consent, including sexual and reproductive health (an exception is abortion, as some states have parental consent laws for abortion). Under the mature minor statutes, women under 18 should be allowed to get preventive prescriptions for emergency contraception.

Some take a consequentialist approach and argue that banning preventive prescriptions for emergency contraception will lead to more negative outcomes not only for individual women, but also for their partners, families, and society. Given that half of all pregnancies in the US are unintended and that close to half of all unintended pregnancies end in abortion, allowing prescriptions for emergency contraception could reduce the prevalence of abortion. Discussions about emergency contraception with healthcare providers – which are a prerequisite for getting a preventive prescription for emergency contraception – could also lead to further use of nonemergency contraception and more overall responsible reproductive behavior (e.g. barrier methods to prevent STIs). On the broader social level, some believe that inhibiting or denying any type of reproductive health care unjustly treats reproductive healthcare differently than other types of healthcare. Furthermore, treating reproductive healthcare differently disproportionately affects women, which some see as a covert form of sexism.   

The Alden March Bioethics Institute offers a Master of Science in Bioethics, a Doctorate of Professional Studies in Bioethics, and Graduate Certificates in Clinical Ethics and Clinical Ethics Consultation. For more information on AMBI's online graduate programs, please visit our website.

1 comments | Topics: Reproductive Medicine, Women's Reproductive Rights

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Gynecologist mountain view, ca

Gynecologist mountain view, ca wrote on 12/23/13 4:58 AM

Superb kind of work by the team as on this particular topic people needs more precise information and special attention to it.Thanks a lot.

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BIOETHICS TODAY is the blog of the Alden March Bioethics Institute, presenting topical and timely commentary on issues, trends, and breaking news in the broad arena of bioethics. BIOETHICS TODAY presents interviews, opinion pieces, and ongoing articles on health care policy, end-of-life decision making, emerging issues in genetics and genomics, procreative liberty and reproductive health, ethics in clinical trials, medicine and the media, distributive justice and health care delivery in developing nations, and the intersection of environmental conservation and bioethics.
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