Ethical Treatment after Rape

The Catechism offers a clear moral teaching:

"Rape is the forcible violation of the sexual intimacy of another person. It does injury to justice and charity. Rape deeply wounds the respect, freedom, and physical and moral integrity to which every person has a right. It causes grave damage that can mark the victim for life. It is always an intrinsically evil act. Graver still is the rape of children committed by parents (incest) or those responsible for the education of the children entrusted to them." (no. 2356) Note that rape is "an intrinsically evil act," meaning that it is evil at its very root, nothing justifies it, and it is objectively a mortal sin.

If a woman is raped, even though she may fear exposing herself to shame and notoriety, she should seek proper medical care as soon as possible. Such care must be extremely sensitive and compassionate.

In accord with the Ethical and Religious Directives for Catholic Health Care Services (no. 36), the care for the rape victim has four aspects: First, she must receive spiritual and psychological support and counseling to help her deal with the trauma of the attack. Such support and counseling will probably continue for some time after the immediate period.

Second, health care providers need to cooperate with law enforcement officials, gathering evidence that can be used in the prosecution of the rapist.

Third, the victim needs treatment for bruises, cuts, or other injuries.

Finally, health care providers must provide treatment to prevent the possible contraction of venereal disease and pregnancy. The Directives state, "A woman who has been raped may defend herself against a conception resulting from sexual assault. If, after appropriate testing, there is no evidence that conception has occurred already, she may be treated with medication that would prevent ovulation, sperm capacitation, or fertilization. It is not permissible, however, to initiate or to recommend treatments that have as their purpose or direct effect the removal, destruction, or interference with the implantation of a fertilized ovum."(no. 36)

The woman who is a victim of rape has the moral right to prevent the pregnancy for the following reasons: First, the rapist (including his sperm) is an unjust aggressor who has violated the woman's dignity. Second, rape is an act of force and violence, unlike the conjugal love in marriage whereby both spouses give freely of themselves in an act of unitive and procreative love. Third, the woman is not responsible for the action, and thereby has the right to prevent the pregnancy. (Please note that for these three reasons, this guidance does not violate the Church' s teaching regarding contraception as expressed in Humanae Vitae, which, because of the free-giving between spouses, stated, "Each and every marriage act must remain open to the transmission of life (no. 11).)

In preventing pregnancy, most rape treatment protocols recommend anti-fertility drugs to be administered within 72 hours and over a period of several days. These drugs, such as Ovral, inhibit ovulation. However, some contraceptives may also affect the endometrium of the uterus, causing the expulsion of a conceived ovum. This latter effect is problematical.

The real difficulty in rape treatment protocols is having moral certainty (not absolute but the best possible, good faith, certainty one can have) that conception has not occurred, for once conception has occurred, the new life has a right to life and must be protected. The Second Vatican Council asserted, "Life must be protected with the utmost care from the moment of conception: abortion and infanticide are abominable crimes."(Gaudium et Spes, no. 51) Subsequently, the Declaration on Procured Abortion (1974) affirmed that life is sacred from conception and that directly intended abortion is an intrinsically evil act: "From the time the ovum is fertilized, a life is begun which is neither that of the father nor of the mother; it is rather the life of a new human being with his own growth. It would never be made human if it were not human already"(no. 12). Not only does this new life have physical integrity, it also has a soul, created and infused by Almighty God. This unique human being, with both body and soul, has a right to life no matter who he is or how he was conceived.

For this reason, The Ethical and Religious Directives for Catholic Health Facilities state, "Abortion, that is the directly intended termination of pregnancy before viability, is never permitted nor is the directly intended destruction of a viable fetus. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo" (no. 12). Therefore, abortifacients —

those drugs which would cause the expulsion of a conceived ovum — are morally wrong.

Therefore, before administering contraceptives to a rape victim, health care providers must ascertain first her medical history (including menstrual history, recent sexual activity, and contraceptive usage). A pregnancy test should be performed. If she is not pregnant but her medical history suggests the possibility that ovulation may have occurred, then health care providers ought to administer a Luteinizing Hormone urine dip test or a progesterone blood level test. These tests would indicate if ovulation has indeed occurred and thereby a child was possibly conceived. If these tests are not available in a timely way or at all, treatment should proceed as long as there is a reasonable doubt that ovulation has occurred.

Here again is a key point. If there is a reasonable certainty that ovulation has not taken place, and there is reasonable certainty that it is not just about to occur, (as would be indicated by a test showing that the Leutinizing Hormone [LH] surge had not occurred) then one may proceed with treatment. If, on other hand, the LH surge has been detected, the "morning after" pill ought not be given, as ovulation is about to occur, is occurring, or has already just occurred. If there is certainty that ovulation has occurred and conception may have taken place, then the child has the right to life and the mother must not risk an abortion from the antifertility drugs. (See here for more on this)

On this latter point, some may have difficulty with the situation of a woman carrying to birth a child conceived through rape. Even though studies indicate a 0-2.2 percent occurrence of pregnancy due to rape (Abortion: The Hard Cases), the fact remains pregnancies do occur. We must never forget that the child is an innocent human being, made in the image and likeness of God, who did not ask to be conceived.

Also, as Christians, we bear the cross and suffer for the love of God. Consequently, a mother in such a case must love as Christ would truly love, and give life to the innocent child. For a mother who is the victim of the violence of an unjust aggressor to take the life of an innocent unborn child would make her now the unjust aggressor. As our Holy Father Pope John Paul II taught, whatever the reason for abortion, "however serious or tragic, can never justify the deliberate killing of an innocent human being."(Evangelium Vitae, no. 58) Instead, the faithful must support the woman who is the tragic victim and, if she has conceived, her child.