The morning-after pill and the new meaning of "conception".
_{(Medical ethics and the morning-after pill, III)}

Gonzalo Herranz.
department of Humanities Biomedicas, University of Navarra.
article published in Diario Médico, 14-V-2001.

Finally, the author wonders about the silence of a large part of the medical profession in the face of topic , which has a strong impact on public opinion, and explains the new meaning of the term conception, which embryology books and dictionaries resist. He concludes that the information given to women is paternalistic because it considers them incapable of assuming their responsibilities.

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A little more than a month ago, I sent DM a couple of "Tribunes" on the morning-after pill (dpd), convinced that they would provoke a necessary and, I hoped, clarifying discussion . But this discussion has not happened: the days have gone by and no one in the professional field has said this is my mouth on the pages of DM.

The curious thing is that it is a selective, intra-professional silence. On the street, the media speech, with the partnership of many doctors, have not stopped talking about pdd on the occasion of the different steps on its way to pharmacies. And DM itself has echoed a brief and clear grade from the Spanish Episcopal lecture .

What could this silence mean within the profession? It could, in principle, be the expression of various attitudes: the boredom of some with a subject that has been dealt with a thousand times and about which it seems impossible to say anything new; the disinterest of others in a moral problem that they consider to have been overcome; the disdain of many in the face of the insoluble nature of yet another ethical conflict; the fatigue of those who are beginning to tire of fighting for values that are no longer shared. But the issue cannot stop there. It is necessary to bring it up again: it is not good for us doctors to respond with silence or indifference to an issue that is of so much interest to people and which involves us fully.

Playing with words

I want to deal here with a point that lies at the heart of the problem and which I only sketched out in a Tribune at the beginning of April: I am referring to the lexical change that allows the promoters of pdd to claim that it is not abortifacient. Because it is not just a lexical change: it is the imposition of an ideology.

I referred, in one of the April Tribunes, to the use of changing the meaning of some words to make the case that dpd is not abortifacient more convincing. I think it is illuminating to know the history and intent of these changes.

The transition to a society dominated by the contraceptive ethos required a change in thinking and attitudes about what was meant by conception: only by changing the meaning of the word could social mores change. This turned out to be quite simple: it consisted in dissociating conception from fertilisation, and identifying conception with completed implantation.

Let us look at it in some detail. Conception, in its original, genuine, general, unmanipulated meaning, is and has always been equivalent to fertilisation: conception is the union of the sperm and the egg, it is the beginning of the new being, it marks the beginning of pregnancy. This is what the general dictionaries of the different languages say in a massive majority and what medical dictionaries repeat in a massive majority.

But in the new order of things, things are different. In the new language, conception no longer means neither fertilisation nor the beginning of the new being, but, as before, the beginning of pregnancy, but marked by the culmination of the implantation of the blastocyst in the endometrium. The change is not merely an exercise in academic precision: it is an ideological revolution.

But the genuine meaning of the words, as in Galicia they say d'os amoriños primeiros, remains unchanged. Embryology books and dictionaries have resisted change. It is an exercise, both absorbing and amusing, to examine what they say about conception and fertilisation, about embryo and pre-embryo, about zygote and morula, about blastocyst and gastrula, about pregnancy and abortion, about contraceptive and abortifacient. The incorporation of the new ideology has been partial and erratic: some concepts are adapted, but others are left unamended. Everything seems artificial and fabricated. Just one example: sample: the authoritative Dorland's. At entrance "conception", it follows the modern redefinition: "conception, the beginning of pregnancy, marked by the implantation of the blastocyst in the endometrium". But, curiously, the revisers forgot to modify the entrance "pregnancy", which is still anchored in the old tradition: "pregnancy, the condition of having an embryo or foetus in the body at development, after the union of an oocyte and a spermatozoon". Sometimes the beginning of pregnancy is implantation, sometimes fertilisation. Fascinating.

Things do not and cannot fit together when language is tortured and goes mad. Geneticists who collaborate with clinical embryologists have developed preconception and preimplantation genetic diagnosis techniques, which turn their backs on the new nomenclature. And the gynaecologists themselves turn their backs on the new nomenclature at internship : in a 1998 study in the United States, when asked about the information they give to women in the process of obtaining informed consent, 73% responded that conception is synonymous with fertilisation and only 24% indicated that conception was synonymous with implantation.

Abortions that are not

With the new definition of conception, one thing is assured: contraception is not only preventing conception, it does not only cover the classical set of procedures, devices, or substances that prevent the meeting of the spermatozoon and the oocyte and their fertilisation. It now includes, and tries to cover under the ethical grade of contraception, procedures, devices, or substances that prevent the development of the embryo in the time between fertilisation and the end of implantation. What used to be early abortifacients, according to the new language, are no longer early abortifacients. Only those procedures or substances that prevent the implantation of the embryo from taking place deserve to be called abortifacients or abortifacients. development . Before implantation is completed, one cannot speak of abortion, it is incorrect to refer to a termination of pregnancy, because, by the magic of the new word, pregnancy can only be terminated once it has begun, and now it does not begin on day 1, but a couple of weeks later. In the new language, talking about abortions of embryos less than 14 days old is an oxymoron. That is what some representatives of the pharmaceutical industry, certain social partners and government, and a section of doctors are telling us about pdd.

But we all know that this is not a play on words, but the infinitely more serious question of our relations with the smallest human beings. These, in their innocence, are destroyed by pdd. The lexical manipulation tells us not to talk about abortions, but it does not tell us what to talk about. The act of depriving embryos that are prevented from implanting in the uterus of life must be called something else. The technical neologisms of endometrial contraception, postcoital interception, antinidating effect only describe part of the reality. They conceal the fact that, in many cases, depending on the time of the cycle at which the woman has had sexual intercourse, the survival of a considerable number of human embryos is prevented issue .

That is what is relevant. Calling it abortion or not is, to a certain extent, indifferent to the underlying ethical reality, but the action of eliminating innocent human lives must be called by some word. To obfuscate women by telling them that nothing happens with pdd, biologically and ethically, is a reprehensible paternalism, it is to hold them incapable of taking responsibility for their actions, it is to deny them the opportunity to choose. They must know that because of pdd a human life can be cut short, a human destiny cancelled, the promise of a life staff annulled. And that is a tragedy that is not fair to trivialise with word games, however suggestive they may be, however clever they may seem, even if they have received the blessings of ACOG and FIGO, WHO or SEC.