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Reprinted with permission from: "Archives of Family Medicine", February 2000, Volume 9 Number 2, page 133, Copyright: March 18, 1999, American Medical Association.
Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent
Walter L. Larimore, MD
I have prescribed "the
Pill" since 1978. My wife and I used the Pill for years, having no moral
concerns about it. Then, in 1995 my friend and practice partner John Hartman,
MD, showed me a patient information brochure --- given
to him by a friend --- that
claimed the Pill had a postfertilization effect causing " . . . the
unrecognized loss of preborn children." John asked me if I had ever heard
of such a thing. I had not. I did read the brochure and its claims seemed to be
outlandish, excessive, and inaccurate. So, I decided to begin a literature
search to disprove these claims to my partner, myself, and any patients who
might ask about it. The more research I did, the more concerned I became about
my findings. I called researchers around the country and interviewed them.
During this process I met Joe Stanford, MD. Joe volunteered to assist in the
research that ultimately became this systematic review. We were concerned
enough about our findings and about the fact that so many of our colleagues and
patients seemed to share our ignorance about this potential effect that we
presented the preliminary results of our research at a number of research
forums, just to see if we were off base. Most of the reviewers suggested that,
although this evidence was new to them (as it was to us), it seemed accurate
and not off target. Furthermore, several said that they thought it would change
the way family physicians informed their patients about the Pill and its
potential effects.
The most difficult part of
this research was deciding how to apply it to my practice. I discussed it with
my partners, my patients, ethicists I know and respect, and pastors in my
community. I studied the ethical principle of double effect and discussed the
issue with religious physicians of several faiths. Finally, after many months
of debate and prayer, I decided in 1998 to no longer prescribe the Pill. As a
family physician, my career has been committed to family care from conception
to death. Since the evidence indicated to me that the Pill could have a
postfertilization effect, I felt I could no longer, in good conscience,
prescribe it --- especially
since viable alternatives are available. The support and encouragement that my
partners, staff, and patients have given me has been unexpectedly affirming. It
seems that my patients have appreciated the information I have given them. Many
have been surprised or even shocked (as I was) to learn about this potential
effect. Many of my patients have chosen to continue taking the Pill, and we
have physicians in our practice and community who will prescribe it for them.
Patients who take the Pill tell me that they are much more careful with their
compliance. Others have chosen other birth control options --- especially
one of the modern methods of natural family planning. So, this is research that
has changed my soul and my practice. It has been an extraordinarily difficult
issue with which I have had to wrestle. I suspect it will be so for many who
thoughtfully read and consider the evidence contained in this review.
Author/Article
Information
Walter L. Larimore, MD
Kissimmee, Fla