Hilger, D. J., Raviele, K. M., & Hilgers, T. A. (2018). Hormonal Contraception and the Informed Consent. The Linacre Quarterly, 85(4), 375-384. https://doi.org/10.1177/0024363918813579
Hilger DJ, Raviele KM, Hilgers TA. Hormonal Contraception and the Informed Consent. Linacre Q. 2018;85(4):375-384. doi:10.1177/0024363918813579
Hilger, David J., et al. "Hormonal Contraception and the Informed Consent." The Linacre Quarterly, vol. 85, no. 4, 2018, pp. 375-384.
A 2018 narrative review argues that oral contraceptive risks justify informed consent. Three physicians writing from a Catholic perspective cite findings on blood clots in veins and breast cancer. They name fertility awareness-based methods for married couples and abstinence for unmarried people as alternatives.
Key Findings
The authors conclude that cardiovascular risks, cancer risks, and changes in immunity together are substantial enough to justify informed consent, possibly in the explicit form.
A cited Danish study of 1.8 million women found a 20 percent increased breast cancer risk with current and recent oral contraceptive use, reaching 38 percent after more than ten years.
The authors report that venous thrombosis risk among hormonal contraceptive users is between three and six times the risk seen in nonusers, depending on the type of contraceptive.
The article cites oral contraceptive failure rates of 0.3 percent with perfect use and up to 9 percent with typical use.
For the Creighton Model, the article cites a meta-analysis with effectiveness of over 99 percent with correct use and over 96 percent with typical use.
Interpretation
The article is a narrative review by three physicians. It combines cited studies, legal standards for disclosure, and Catholic moral teaching. The authors write that cancer risks are difficult to quantify and that the degree of risk remains under scientific debate. The paper names possible effects after fertilization as moral risks for people of faith and for others who value human life from its earliest stage. The authors call for continued research into these risks and for informed consent conversations that reflect it.
RRM Context
Restorative reproductive medicine works with the ovulatory cycle. Fertility awareness-based methods track that cycle. Oral contraceptives are suppressive medications that act mainly by inhibiting ovulation. A chart gives both partners and their clinician a shared record of ovulation. That record supports a search for the cause of a cycle problem.
Our editorial summary of this paper, not the article's abstract.
Abstract
Since the 1960s, hormonal contraceptives have become the most commonly used method of pregnancy prevention in the United States and the world. Oral contraceptives are used by a large percentage of women, including Christian women. There are known health risks to women demonstrated in research published since Pope Paul VI's prophetic encyclical Humanae vitae in 1968. These risks include venous thrombosis, cardiovascular risks, and an increased risk of cancer. These risks are medically recognized with continued scientific debate on the degree. The risks are significantly increased with preexisting conditions and in certain demographic groups. Discussing known and potential treatment risks is a standard that is both accepted by the medical community and is increasingly expected by patients. This discussion can be accomplished by the mechanism and principle of informed consent. Depending on the circumstances, abstinence or fertility awareness-based methods (FABMs) should be presented to patients. FABMs are licit, safe, and effective methods of pregnancy prevention. Informed consent is the most effective means of providing patients with pertinent information on the significant risks of contraception.
Summary
This article discusses the use of the informed consent to provide patients with information on the medical and ethical risks of oral contraceptives. FABMs and abstinence are presented as effective, safe, and licit preferences to oral contraceptives. Discussing known and potential treatment risks is accepted by the medical community and expected by patients (shared decision making). The authors discuss the historical context of Pope Paul VI's encyclical Humanae vitae in relationship to the development and rapid adoption of oral contraceptives.
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