Emergency contraceptives, commonly known as “Morning After” pills, have caused tremendous controversy between pro-life and pro-choice interest groups. The ethical issue surrounding emergency contraceptives has many voices chiming in on the debate from religious groups, scholars, researchers, politicians, to medical professionals. Simplified, contraceptives exist to provide choice for a couple concerning pregnancy. The controversy surrounding the “Morning After” pill is due to the nature of the medication being a reactive form of birth control which is consumed following sexual intercourse, rather than a preventative-type of contraceptive utilized prior to sexual intercourse.

            The dividing element of this issue is the understanding of when conception occurs. The “Morning After” pill functions by preventing a fertilized zygote from implantation into the uterus wall.  For some, this is an act of abortion because the pill essentially “kills” the zygote.  For others, conception occurs when the fertilized zygote actually implants into the uterus wall where it will be able to survive. In this latter case, the pill is simply just a contraceptive which prevents pregnancy in the same way a condom or birth control pill functions.  It has received immense publicity due to its questionable ethics and deserves consideration by any future medical professional, parent, and counselor. To understand the implications of the “Morning After” pill, the viewpoints on this issue will be considered in light of scholarly resources, Biblical and ethical principles, personal beliefs, clinical details and medical examples.

            Contraceptive pills, in general, function in three different ways by elevating the progestin level in the female. The pill inhibits ovulation by delaying the actual ovulation, withholds the egg from the ovary, or causes the endometrial wall to slough-off premature fixation of the fertilized egg to the uterine wall.  In the first two methods, the average birth control pill alters the normal menstrual so as to prohibit fertilization occurring during intercourse by ensuring no viable egg is present. In the third cause, the method utilized by the “Morning After” pill, the contraceptive irritates the lining of the uterus (endometrium) so as to inhibit implantation of a fertilized egg. This is caused by the use of large amounts of synthetic progestin to cause endometriosis, the sloughing off of the uterine wall. If “fertilization” is defined as when the sperm comes into contact with the egg, then the idea of “conception” must be defined. Typical birth control pills prevent fertilization by ensuring an egg never ovulates for the sperm to fertilize. The “Morning After” pill prevents a fertilized egg from implanting into the uterus.

            The normal progesterone level in an adult female during the follicular stage is 0.2 to 1.4ng, 3.3 to 25.0ng Luteal stage, and 4.4 to 28.0ng Mid-luteal stage. Levonogestrel (a “Morning After” pill) contains two pills of 0.75mg of progestin, a synthetic form of the hormone.  The progestin found in Levonogestrel is five hundred times the level produced normally by an ovulating female. In a simplified manner, the pill works by changing the chemical and physical composition of the wall so the fertilized egg is not able to implant into the uterine wall successfully.  For some, this means the “Morning After” pill should be labeled an abortifacient because it causes the uterus to reject the fertilized egg.  For others, the fertilized egg is viewed as not being alive until it actually implants into the uterus wall. Prior to implantation, it is not sustainable on its own. In this case, the “Morning After” pill is functioning as any other type of contraceptive tool as it intercepts the egg and sperm prior to conception.

            One viewpoint on this issue is that life begins at the initial conception of the fertilized egg, regardless of its implantation into the uterus wall. The claim is made that life begins at the actual fertilization of a sperm and an egg because “once there is the union of a sperm and egg, the twenty-three chromosomes are brought together in one cell with forty-six chromosomes so that one cell has all of the DNA, the whole genetic code for a genetically distinct human life” (Gargaro, 2002, p. 35). It isn’t a “potential” human life, or some other type of life because something non-human does not magically become human by aging in time or growing in size. Whatever is human must be human from the beginning (Gargaro, 2002, p. 38). Support for this viewpoint is seen in political rulings such as the 1999 passage of North Dakota law ensuring the fertilized egg had the same rights as a fetus. Representative Dan Ruby of Minot said, “This is very simply defining when life begins, and giving that life some protections under our Constitution — the right to life, liberty and the pursuit of happiness.” Through this law, North Dakota legislated the beginning stages of life through their decision to define life occurring at the moment of fertilization.

            It is understood scientifically that development of a viable, normal fetus does not occur in the fallopian tubes. The Anglican Church’s viewpoint, built upon the catechism of the Catholic Church, states that “human life must be respected and protected from the moment of conception. From the first moment of his existence, a human being must be recognized as having the rights of a person” (Disney & Poston, 2010, p. 270). As such, this requires a certain protection must be given to the fertilized egg. At this status, then, the zygote must “…be treated from conception as a person and the embryo must be defended in its integrity, cared for, and healed, as far as possible, like any other human being” (Disney & Poston, 2010, p. 285).   The definition of conception results in an emergency contraceptive potentially being perceived as an abortifaciant because the fertilized egg is considered human, regardless of the lack of sustainability prior to uterus implantation.  Medical professionals of this perspective believe “the scientific answer is that the embryo always had human potential, and no other, from the time of fertilization because of its human chromosome constitution. Two things are definite: first, human development begins at fertilization and secondly, the zygote and early embryo are living organisms” (Moore, 1989). This point of view has implications through its medical and social application.

            On the opposite side of the perspective, though, is the belief that life does not begin at fertilization but rather an embryo becomes human at implantation in the uterus or upon the eight week of pregnancy when human characteristics are noticeably distinct (Moore, 1989).  The simplified reasoning for this is because prior to implantation of the uterus wall, the egg cannot sustain itself and survive, even though it has been fertilized. This line of sustainability in life can even be stretched further as scientific research has shown that brain waves do not even occur until the eight week of gestation (Steinbock, 1994, p. 90). From a theological perspective, the Bible describes the beginning of life as “breathe” in several significant passages. For example, life is considered as when “breath” occurs in the story of Adam’s creation when “God breathed into his nostrils the breath of life; and man became a living soul” (Genesis 2:7, King James Version).  Because of this passage, Jewish law traditionally considers personhood to begin at birth and not at fertilization (McKinley, 2002, p. 45). Defining conception as when the fertilized egg becomes viable for life enables a clear delineation for use of emergency contraceptives.  

            In a continuing Christian theological perspective, the moment of becoming a “human being” or ensoulment must be addressed to complete a definition of when life begins. This moment cannot occur prior to when the embryo is actually able to receive nourishment, mature, and ultimately survive and grow. The “successful zygote is recognizable once it has implanted. At that point, it has a reasonable hold of life and is no longer ‘external’ to its mother - it has become part of the human race both anatomically and physiologically” (Meyer, 2006). This understanding has application on the definition of life within the standard development of an embryo for implantation “is the logical point in human development to which ensoulment can be attributed” (Meyer, 2006).  Prior to the implantation of the fertilized egg in the uterine wall, there is no outside existing possibility for life. The egg will not survive because it lacks the ability to draw sustaining nourishment from the mother. Taken to the extreme, this means that “before the onset of brain life, the termination of pregnancy should be regarded as no more problematic, morally, than the use of contraception” (Holm, 2005). Although this pushes the far end of the spectrum, the basic idea remains the same as to defining the start of life as when the egg is in the position to be viable long-term. This moment, as mentioned before, is upon its implantation into the uterus wall.  

            Based on the consideration of each viewpoint above, the evaluation is made that the “Morning After” pill is not an abortifacient because the fertilized egg is not sustainable on its own prior to implantation in the uterus wall. The author feels this way because largely due to the fact that fertilized egg alone is not viable. Just as seed pollinated and planted in the ground is not considered a tree until it takes form, so also an egg does not become a fetus prior to taking a sustainable position and form. After an egg is implanted into the uterine wall and receives nourishment life from its mother, it becomes a part of a living vessel and therefore, alive itself.  The fertilized egg is simply an external entity. The terminology “abortifacient” is misleading when applied to “Morning After” pills because it is not affecting the life of a growing embryo. The action held as controversial, the sloughing off of the endometrial wall caused by the “Morning After” pill, prevents the fertilized egg to attach itself to the uterine wall of the mother which is the critical piece in the giving and receiving of life.   

            The implantation viewpoint of life and conception has a three-fold impact on healthcare. First, it changes the negative stigma towards the use of emergency contraceptives from it being termed an abortive procedure to it being recognized as a viable secondary preventative measure of birth control. Following, this change of the underlying stigma would empower parents to utilize the “Morning After” pill as an ethical form of non-abortive birth control in family planning. Potentially, this has a cascading effect of preventing the amount of actual abortions. This would accordingly reduce the amount of post-abortion complications, trauma counseling, and suicide rates in women. Finally, by settling on the implantation viewpoint of life, the controversy shifts from a perceived “grey area” of contraceptives to allowing pro-life interest groups to focus on actual abortive procedures, such as partial-birth, late-term, and alternative abortions. This allows related organizations and political groups to streamline resources, communications, and activities to affect procedures which terminate the life of a living human.

            In conclusion, emergency contraceptives and “Morning After” pills have continuously caused controversy. Conflict on the issue will continue until the true origin of life is proved, a scientific mystery which might never be proved.  Within the context presented of this paper and the specific intention of understanding the beginning moment of feasible life, the conclusion is reached that the pill itself does not terminate a sustainable, viable fertilized egg. As such, it does not terminate a developing fetus and therefore, it does not terminate a life. Due to the presented information, emergency contraceptives are not an abortifacient but rather a second option for a contraceptive to be used in conjunction with regular birth control. The final decision relies upon each person’s belief as to when the miracle of life through conception and fertilization occurs.

Joshua Napieralski

A note from the author: My personal beliefs disagree with any form of contraception. Also, this is NOT the RU486 pill which is often known as the “abortion pill.”

References

 Disney, L., & Poston, L. (2010). The breath of life: Christian perspectives on conception and ensoulment. Anglican Theological Review, 92(2), 271-295. Retrieved from Ebscohost Database.

Gargaro, C. C. (2002). Abortion violates human rights. In M. E. Williams (Ed.), Abortion: Opposing Viewpoints (36-44). San Diego, CA: Greenhaven Press, Inc.

Holm, S. (2005). Embryonic stem cell research and the moral status of human embryos. Reproductive BioMedicine Online, 1063-67. Retrieved from Ebscohost Database.

McKinley, B.E. (2002). Abortion does not violate human rights. In M. E. Williams (Ed.), Abortion: Opposing Viewpoints (45-53). San Diego, CA: Greenhaven Press, Inc.

Meyer, J. R. (2006). Embryonic personhood, human nature, and rational ensoulment. Heythrop Journal, 47(2), 206-225. doi:10.1111/j.1468-2265.2006.00285. 

Moore, K. L. (1989). Before we were born: Basic embryology and birth defects. Philadelphia: Saunders.

 Steinbock, B. (1994). The moral status of extracorporeal embryo. In D.A. Harris (Ed.), Ethics and Biotechnology (79-92). London: Routledge.

 Unhealthy lifestyles coincide with unhealthy choices. The normal American lifestyle is inundated with roadblocks that propel far outside the suggested BMI boundaries of “normal.” Tobacco, alcohol, lack of exercise, poor diets with limited nutritional value have increased our need for health care. The increasing trend of obesity has resulted in $117 billion dollars spent in U.S. health care costs each year, with tobacco costing Americans $180 billion annually (Blue Cross, 2009). Poor food choices lead to an unhealthy lifestyle path which often results in obesity, diabetes, and other secondary diseases related to cardiovascular, metabolic, respiratory, gastrointestinal, renal, genitourinary, and gynecological problems. Because of the current societal trends, consideration should be giving to regulating the American healthcare cost system to determine pricing and guidelines. If this doesn’t happen, the average American will feel the pain of high premiums, expensive medications, and difficulty in receiving the medical care they genuinely might need

As technology improves, the benefit for a patient must be balanced with the rising cost for the technology.  In 2006, it was estimated that over $2 trillion dollars was spent overall on medical care with an average cost of $6,830 dollars per person (Clemmitt, 2008). Although the costs are rising, patients often demand the newest testing methods which are viewed as more effective in diagnoses. This creates a potentially incorrect perception of the technology a medical facility should offer to its patients. Americans tend to associate new innovations with actual advancements in accuracy. Spending on new medical technology exceeds $200 billion annually (Beaver, Bums, Karbe, 2008) but is potentially not always necessary. A simple analogy explains this concept: when a hammer is given to a young boy, everything (from the coffee table to the sibling to the house pet) turns into a nail to be hammered. In the same way, when a new medical instrument is given to medical professionals and revealed to uninformed customers, it becomes the tool of choice and suddenly must be used for every case and every individual. This conundrum has led to excessive, even wrongful, use of various technology related to diagnoses at a substantial cost. The increased use of the newest technology is responsible for between 40% to 50% of yearly health care costs (Callahan, 2008). Evaluation needs to occur regards to whether or not the newest piece of medical equipment is absolutely necessary when viewed in light of cost and practicality.  Although we as Americans tend to gravitate towards to the newest innovation, that tool might not be the most appropriate instrument for medical use. Going one step further, consideration must be given to the cost of not only the instrument but also new protocols and new employees it will take to operate and perform these new system. Before integrating a new version, the question should be asked if established tests, imaging systems, and other medical instruments truly need to be recycled. Many Americans have the expectation that Medicare and Medicaid will pay for their medical testing with the cost directly impacting the medical institution. Unfortunately, health institutions do not often consider the overall cost correlated with medical equipment. 

Along with the cost of healthcare, the changing shape of the Baby Boomers, born between 1946 and 1964, and their parents in the Bob Hope/Silent Generation, born between 1925 and 1945. Baby Boomers are 76 million strong and represent a substantial impact upon the health care system as the largest generation cohort, just slightly behind the Millennials/Gen Y generation in size (Kotler, 2011). The Silent Generation is approximately 42 million in size. The US Census Bureau estimates that by 2030, those in one of these two older populations will be one in five Americans. If there is not a reasonable solution for the rise in healthcare costs, Medicaid and Medicare will be stretched beyond the point of tension.

In addition to the aging population shifts, there is a basic problem for the average or low-income American to access insurance. Forty-seven million people in America currently lack basic insurance to cover simple to complex medical procedures (Johnson, 2007). This forces the cost coverage onto other citizens and medical institutions, spreading resources thin. The cost of premiums is increasing due to the growth of physician services, as well (Pricewaterhouse, 2008).  These services constitute thirty-three percent of health spending and have been correlated to cause a thirty percent increase in premiums.

Doctors themselves are being impacted by the current trends as they are experiencing a rise in lawsuits. In order to protect themselves from scrutiny and malpractice cases, doctors are forced to utilize more tests and diagnostic tools, regardless of whether or not the test may be necessary. As a result of the excessive tests and procedures, the cost of each visit increases, causing a rise in insurance payout and placing strains on premiums. The cost does not stop at the office, though, but continues to the area of pharmaceuticals.  Although the semantic difference between the capitalization of a brand name drug and the non-capitalization of the generic drug is minor, it represents a large gap in the cost comparison of the two. Consideration of the use of generic and brand name drugs could be integrated into this conversation to help mitigate costs

Healthcare costs need to be regulated in light of the societal, technological, generational, and professional challenges discussed.  No system is currently in place which can effectively structure this process with the multi-faceted dimensions. Until America has a dynamic, flexible but fair system to determine proper pricing and guidelines, Americans will continue to experience increased premiums, pharmaceuticals, and unnecessary diagnostic processes. At the basic level, though, these trends will continue to impact those without the means for insurance by pushing even basic insurance to a cost position which is even further out of their reach. §

Joshua Napieralski

 References

Blue Cross. (2009). Why does my health insurance cost so much. www.ibx.com.

Clemmitt, M. (2008). Rising health costs. Issues for Debate in American Public Policy. Washington, D.C. CQ Press.

Beever, C., Heather, B., & Karbe, M. (2008). U.S. health care’s technology cost crisis, strategy, and business. Booz and Company E-News. 

Callahan, D. (2008). Health care costs and medical technology. Princeton, NJ: Princeton Univeristy Press.

Kotler, P. (2010). Framework for marketing management. Upper Saddle River, New Jersey: Pearson Education, Inc.

Johnson, T. (2007). Americans and insurance. Nations Health, 37(8). American Public Health Association. 

Pricewaterhouse Coopers.  (2008). HealthCare Cost Study 2008. America’s Health Insurance Plan.

We here about it all the time, often associated with the mental picture of an obese person, very often times associated with age. I’ll try to make this as gruesome as possible so that you understand the drastic effects of diabetes. Take it from me, being 40 hours a week in a hospital, diabetes is one thing you do not want to have and if you do you need to manage it.

Type 1, IDDM, or, obsoletely, juvenile diabetes

In type 1 diabetes, your body does not produce enough insulin (from the pancreas) to convert the sugar (glucose) in your bloodstream into the energy that is needed on a day to day basis. According to diabetes.org 5% of people with DB have this form. Through insulin therapy, it can be managed, even in kids and young adults. Without insulin, glucose stays in your blood stream (hyperglycemia) which can lead to problems of circulation, kidneys, heart, eyes, wound healing, basically can destroy everything.

Here are some signs and symptoms (s/sx)

• Being very thirsty
• Urinating often
• Feeling very hungry or tired
• Losing weight without trying
• Having sores that heal slowly
• Having dry, itchy skin
• Losing the feeling in your feet or having tingling in your feet
• Having blurry eyesight

http://www.nlm.nih.gov/medlineplus/diabetestype1.html

International sign for diabetes for whatever reason- maybe because it looks like a doughnut? A blueberry one I suppose.

Wikipedia states that “There is a growing body of evidence that diet may play a role in the development of type 1 diabetes.” Thank you, Captain Obvious.

The best we can come up with right now is that the strongest lead that we have now is an autoimmune response to the beta cells that secrete insulin. There are multiple tests that lead to the definitive diagnosis of diabetes, such as HA1C.

Diabetes type 2 coming shortly, followed by insipidus, and then we’ll tie them all together with some videos made by myself, some YouTube videos, charts, diagrams, and pictures. User submitted content is welcomed!!!

Many patients and even fellow students have asked me what MAP stands for in regards to a person’s set of vital signs. I’m going to break it down and provide you with sources that will further explain what MAP (mean arterial pressure) is in simple terms.

Let’s begin with the formula for finding the numerical value of the patient’s MAP. Through the formula we’ll break it down.

MAP=(COxSVR)+CVP

So we have cardiac output x systemic vascular resistance + central venous pressure

According to Wikipedia (yes, not the best place for sources however great for information) the CVP is usually insignificant enough to exclude from this equation.

Cardiac Output is the amount of blood pumped by the heart in one minute. So, CO=HRxSV or heart rate x stroke volume.

Stroke Volume is the amount of blood shot through the left ventricle in each beat of the heart. Unless you have some iodine based IVP dye and a place to do a heart catheterization, we’re not going to discuss how to measure the SV…right now.

How can we practically estimate the MAP of a patient? I’m glad you asked.

MAP is approximately equal to Diastolic Pulse+1/3(Systolic Pulse- Diastolic Pulse). If you know anything about algebra you can concoct about 10 different ways to manipulate this formula. I’m not going to get into that now.

What is the clinical significance of a patient’s MAP? (The question everyone was waiting for.) MAP’s normal ranges are between 70 and 110mmHg. I know this because it is in ICU guidelines. If the MAP drops below 60mmHg, there is not enough perfusion pressure to sustain life giving organs. That is when you make the patient get up off the bed and run around (not really). If this number drops below 60 for an extended period of time, the organ will become ischemic. Basically, it’s variable galore as each organ obviously requires a different load of oxygen so times of onset of ischemia are different based on variable perfusion.

I hope this helps.

Joshua Napieralski, SN