The Congregation for the Doctrine of the Faith recently published a response to a question about the liceity of hysterectomy in a very specific case. In popular publications, some responses to the new document have been decidedly negative, while over at the Church Life Journal, thomistic theologian Taylor Patrick O’Neill offered his view that there is, in a way, no news, since “the principles governing this particular ruling are those which have governed previous rulings….” In a scholarly venue, the Linacre Quarterly, Joshua Schulz and William Hamant have argued at length that the CDF’s decision is based on new principles and reaches a false conclusion.
But on the whole, the new decision did not generate a lot of buzz, either in the broader public or (to my knowledge) among scholars. I tend to agree with Schulz and Hamant. I think the new CDF statement should be getting a lot more attention from moral theologians. Let me explain.
A novel conclusion
Here is the question put to the CDF:
“When the uterus is found to be irreversibly in such a state that it is no longer suitable for procreation and medical experts have reached the certainty that an eventual pregnancy will bring about a spontaneous abortion before the fetus is able to arrive at a viable state, is it licit to remove it (hysterectomy)?”
The response: “Yes, because it does not regard sterilization.”
Expanding on that response, the CDF goes on:
“The precise object of sterilization is to impede the functioning of the reproductive organs, and the malice of sterilization consists in the refusal of children: it is an act against the bonum prolis. On the contrary, in the case considered in the question, it is known that the reproductive organs are not capable of protecting a conceived child up to viability, namely, they are not capable of fulfilling their natural procreative function.”
Just as regards removing the uterus, that argument makes some sense, but we should be clear about the position taken. The CDF explains that it is not considering a case where the issue is a danger to the mother. Rather, it is considering the case where a hysterectomy is an alternative to other options, “for example, recourse to infertile periods or total abstinence.” So the purpose of the proposed hysterectomy is to stop pregnancy. The intent is to allow for sexual activity while preventing the woman from going through pregnancy and miscarriage.
Put baldly, their argument seems to be this: So long as the intention is not to avoid raising children, then it’s OK if the intention is to prevent pregnancy. Even more baldly/tendentiously: Contraception is OK, so long as it is not contra-having-extra-uterine-children.
Now, doesn’t that seem like headline material? The Magisterium has stated—not infallibly, but with true authority—that there is at least one circumstance in which a Catholic may licitly obtain a surgery to allow her to engage in sexual activity without risking pregnancy.
Me: “Give me an English word for a medical intervention intended to allow someone to have sex without getting pregnant.”
Man-on-the-street: “Um, contraception?”
Me [frowning]: “Are you sure?”
Man-on-the-street: “Is this a trick question?”
Only interesting to eggheads?
Really, it makes sense that the ruling has not garnered a lot of attention. The point seems so arcane: in some super-duper rare, strange situation that is not even spelled out in the text (O’Neill speculates that we’re talking about uterine fibrosis), Catholics are officially permitted to do what almost everyone was already doing. Sounds like something only interesting to eggheads.
So let me dramatize the ruling by pointing to seemingly parallel situations. Suppose there is a man whose genes are so messed up that any child begotten of him will die before it reaches birth. This is a man whose reproductive system is defective such that he can never have an extra-uterine child of his own. One could argue that the CDF response would justify procuring a vasectomy for this man.
Or take the case of a woman living under China’s restrictive reproductive laws. Suppose she knows that if she conceives, the government will force an abortion and the child will die without ever being born. It appears that the logic of the CDF’s response would justify this woman having uterus removed because it cannot possibly carry a child to term. She does not have an anti-child will; she is not against the bonum prolis. But she knows that the child conceived will die, so she takes measures to ensure that she can engage in sexual activity without conceiving a child doomed to die.
Some will dispute with me here. After all, the situation of a woman under restrictive reproductive laws does not involve any dysfunction in her body, whereas the CDF was considering a case in which part of the reproductive system no longer works. And in the case of the man with the messed-up genes, his vas deferens is not defective, and so tying up the vas deferens doesn’t seem like a solution parallel to removing the defective uterus.
In other words, some moral theologians will see the defective organ as key. For these moral theologians, the argument against contraceptive surgery would appear to be that it violates the body’s integrity and teleology, so where the body already lacks integrity then we don’t have a problem.
But there are three problems with this objection. First, the CDF identifies the “malice of sterilization” as “the refusal of children”. The fact that the body itself fails to function only enters into the CDF’s argument as a reason why it is not possible to bring a child to birth. Nothing in the text indicates that one reason for this impossibility would be morally different from another. So unless we add a premise not contained in the text, both of the scenarios outlined above seem to fit the scaffolding of the CDF’s argument.
Second, the reproductive organs in this situation do work, at least enough to achieve pregnancy. The purpose of the surgery in question is not to remove a uterus that doesn’t work at all but to remove what function the uterus has left.
Third, that understanding of the argument against contraception misunderstands the role of the body in morality. I don’t want to turn this humble blog post into a whopping moral treatise, but let me just set this opinion down: If you think the key to this whole situation is that the organ is defective, then you have not followed what JPII meant when he said that the moral object must be seen from the perspective of the acting person (see VS 48 and 78).
Examining the premises
When the CDF reaches a newsworthy conclusion, one might expect they got there by using newsworthy premises. And that seems to me what happened.
Often in tricky medical situations one finds an appeal to the “principle of double effect,” but I have to admit that I can’t see where the CDF text employs that principle. The text doesn’t spell out two different effects of the action, one of which is good and the other bad. It does not say, for example, that one effect of the surgery is good while the other is sterilization.
Rather, the argument hinges around a claim that surgery undertaken is simply not sterilization. I see a novelty here, inasmuch as the CDF redefines the word “sterilization”: while the text says that “the precise object of sterilization is to impede the functioning of the reproductive organs,” it goes on to say that “the malice of sterilization consists in the refusal of children” or in an “act against the bonum prolis”. Now, “the malice” of a given sin should be the malice that defines it, that sets it apart from other sins. But “the refusal of children” does not set sterilization off from other sins: periodic abstinence can be also motivated by a refusal of children, and that is a sin of some kind but not an act of sterilization. Or going the other way, a couple could fully plan on having more kids next week, but this week they decide to temporarily sterilize themselves so as engage in sex without interrupting their vacation with the kids they have. This can hardly be described as “the refusal of children,” even though it is sterilization.
No, the defining malice of sterilization seems to lie in a refusal to modify one’s behavior so as to integrate sexuality into one’s character. Or to put that in different terms, the defining malice of sterilization is a refusal to consider fertility as an aspect of one’s personhood. It substitutes technology for behavior change. So it appears to me that the CDF’s argument only works by missing the definition of sterilization.
But the CDF’s text muddies the point about sterilization by redefining fertility. It defines “to procreate” as “to bring a baby into the world,” i.e., to full term and birth. For example, the question at hand is described as regarding “situations in which procreation is no longer possible” because a baby cannot be brought to term. And again, it states that “the medical procedure should not be judged as being against procreation, because we find ourselves within an objective context in which neither procreation, nor as a consequence, an anti-procreative action, are possible.” So the opposite of “sterility” is not the ability to get pregnant—the usual meaning of “fertility”—but the ability to bring a child to birth.
The word “procreation” stand at the center of the Church’s teaching on contraception: Humanae Vitae condemned “any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation—whether as an end or as a means” (par. 14). Is the morally relevant point that these condemned actions attempt to prevent bringing a baby to term? In Humanae Vitae, does “prevent procreation” mean “avoid labor and birth”—is that a sound reading of that text? When addressing artificial insemination, the Church defined procreation as “the act which brings the child into existence,” because she saw that as the morally relevant point (CCC 2377; cf. the CDF’s Instruction on Respect for Human Life in its Origen and on the Dignity of Procreation). Is that not the case with sterilization?
Let me illustrate some potential problems with the new definition of “procreation” in the context of sterilization. The CDF says that it is OK to remove an organ in order to prevent conception because conception itself is not the final goal of the marital act: the final goal is the bring a baby into the world. But that premise is not true! The final goal of the marital act is not to bring a baby into the world, but to produce a new adult human being. So the argument would seem to show that it is OK to remove an organ in order to prevent conception if we have moral certainty that the child will not survive to adulthood.
If you don’t think my extension of the argument works, grant me this at least: this is a high-stakes conversation. We have a new principle on the table, and no one has tested where the principle goes.
At the end of the day, the Magisterium’s authority has been engaged to some degree on this issue, and Catholics must respect that fact. But it would be good for Catholics to notice what is at stake, and for those with relevant expertise to have a constructive conversation about it.