Catholic View on Contraceptive Methods

CONTRACEPTIVE METHODS
1. A Setting for Contraceptive Methods
The practice of avoiding conception through various techniques has been manifest in most part of the world from the time immemorial. The oldest recorded medical recipes to prevent conception are seen in the ancient Egyptian papyri of c. 1850 BC which describe many means of averting pregnancy. Other reasons to use contraceptive methods were to avoid shame, preserve beauty, and other individual motives.
There existed in ancient times various techniques of birth control that were in use, as evidenced in the Egyptian, Greek, Roman, Islamic, Indian and Chinese writings. These techniques could be classified as magical and ritual methods, herbal medicines, and potions to be taken by mouth, suppositories, vaginal fumigation, coitus interrupts, removal of semen from the vagina and the anointing or smearing of sexual organs with oil or with other liquids. Abstinence from sexual intercourse, prolongation of lactation, abortion, and infanticide were also practiced as means of limiting the size of the family. Some crude interference with the sexual organs such as circumcision, sub-incision, castration, ovariotomy etc., seems to have been in practice among preliterate people.
2. Different Contraceptive Methods:[i]
(i) Behavioral methods such as periodical abstinence (NFP in the Catholic Church) and withdrawal; (ii) Barrier and spermicide methods such as condom, diaphragm, cervical cap, sponge, spermicides, douching and condom for women; (iii) Mechanical and mechanical-hormonal methods like IUD; (iv) Hormonal methods such as oral contraceptives, diethylstilbestrol, RU-486 and a pill for man; (v) Implants like Norplant; (vi) Injectables like Medroxypogesterone acetate and norethindrone enanthate; and finally (vii) the surgical methods such as tubal sterilization or ligation and vasectomy, besides the old ones like hysterectomy, ovariotomy and castration.
3. Sterilization – What does it mean?
The dictionary meaning of the word “sterilize” is “make free from living germs,” or the killing of all means of potential for life in or on it, which is achieved through chemicals, heat, cold and radiation. It refers to any removal or suppression of some part of the procreative system by means of which an individual is rendered incapable of reproduction. Sterilization is the surgery that severs the tubes through which the sperm or ovum passes to attain fertilization. Sterility is the incapacity to transmit life. Sterilization is the course of action that removes one’s capacity to procreate that leads to sterility.
Sterilization can be either temporary or permanent. The latter is a true suppression of the generative faculty without any limit of time nor any prospect or hope of regaining it. Temporary sterilization is only the suspension of the faculty, which can be re-acquired. The pill technically constitutes a temporary sterilization and so they are better classified as sterilizing drugs.
Surgical sterilization is described as “the procedure by means of which a human being or an animal is rendered permanently incapable of reproduction.” Surgical sterilization differs from other forms of contraception only in its radical nature, because there is both a mutilating effect and a contraceptive effect. In this sense, sterilization is different from other contraceptive methods, which intervenes only in the individual sexual act and not with the sexual capacity or faculty, even though sterilization is generally understood as one of the contraceptive methods.
Male surgical sterilization is reported to have been first performed in the year 1894 in England. The possibility for women sterilization was first suggested in 1823, however until 1919-1920 tubal ligation was considered risky. The increase in the use of surgical sterilization is seen from the 1960s.
4. Sterilization Method
For vasectomy, an incision is made on both sides of the scrotum above the testicles, or a single middle line cut, through which a small segment of each vas deferens – the tubes that carry sperm from the testes to the prostrate. The removal of a portion of the vas and the tying of the ends, the other most prevalent techniques of vasectomy are: (i) the fulguration of the ends by electrocautery, (ii) the applying of two or more clips or staples on the vas, and (iii) the inserting of valves or other obstructive devices in the vas.
The surgical techniques for sterilization of the female are based on the interruption of the continuity with in fallopian tubes, the passage through which the egg passes from the ovaries to the uterus, thereby preventing the union of the egg with the sperm. Ovariotomy or Oophorectomy is the surgical excision of both the ovaries. Hysterectomy is an extreme irreversible means of female sterilization which consists in the surgical removal of the uterus. Vasectomy takes place under local anaesthesia, however the majority of female operations are performed under general anaesthesia.
5. Problems: Certain facts about Sterilization
Surgical nature, problematic reversibility and suspected connection with prostrate cancer render the method far from ideal. Medical risks of vasectomy involve minor discomfort or pain during or immediately after the operation, blood-clot formation, congestion or inflammation of the epididymis, spontaneous recanalization of the vas and the atrophy of the testes that occasionally results from the ligation of excessive vasculature – blood supply. Chronic testicular discomfort is relatively common after vasectomy, but rarely severe enough to make the person seek further treatment or regret having had the operation. There is the development of sperm antibodies because the sperm production is the same as before the operation. However, spermatozoa are not ejaculated, so they enter the blood stream where antibodies are produced to remove the sperm from the bodily system. This can lead to thyroid and joint disorders, heart and circulatory diseases and diabetes.
For women, nausea and vomiting are common. Full recovery takes at least a week. There are side effects like severe bleeding, post-operative infection, pelvic pain and a heavy alteration in hormone production thus causing menstrual irregularity. There are also increased cases of hysterectomy and hospitalization for menstrual disorders I women who have been sterilized. The sterilized women face contraceptive side-effects and failures more often than men.
Psychological problems including anxiety and a feeling of low self-worth can take place. Experience shows that the entire person with his or her sentiments is affected by sterilization. It affects the persons in their relationship with their partners. Professor Pasini speaks of a frequent tendency towards depressive syndrome after sterilization that amazes also the partner. Sense of the “effect of mutilation” can create repercussions at the psychological level. According to an author sterilizations are “giving rise to regret” in 25% of the sterilized persons. Reasons for regret after sterilization are enumerated by some authors: Young age at the time of operation, someone else making the decision for the sterilization, the presence of psychosexual disorder, i.e., not feeling like a man/woman, the abrupt decision to perform sterilization immediately before or after delivery, the wish for more children due to a change of partner, a change in financial circumstances or the death of a child.
In sum, physical, social and psychological consequences, sexual dissatisfaction, and later regret regarding the procedure and the loss of child - bearing potential remain as concerns of this surgical intervention. For all these reasons, the decision to be sterilized cannot be taken easily.
More over, promiscuous life and over indulgence in sex are taking place in our community due to the fact of sterilization and contraceptives. Thus moral aberrations with in marriage and outside the wedlock are prime reasons why the Catholic Church is against the idea of contraceptive methods.
6. The Diverse Motivations: “Responsible Parenthood”
Bernard Häring states: sterilization can have a variety of meanings and objectives according to different situations and purposes.[ii] As we go through history, we see Origen, the ecclesiastical writer of Alexandria, who was castrated for spiritual motives.[iii] To take revenge upon Peter Abelard, who fell in love with Héloïse, the niece of Fulbert, Abelard was ordered by Fulbert to be violently castrated.[iv] The Roman music chapels practised castration to maintain the voice of the young boys for choir singing.[v] While these motivations and cases of infrequent castration were on individuals or small groups, later in history, sterilization took place in the name of population growth, for eugenic reasons, and finally, as a consequence of a contraceptive mentality.
1. Eugenic indication takes place where the spouses’ sincere conscience makes an absolutely free decision to seek sterilization and forbids the transmission of life because of genetic heritage. 2. Medical indication arises from a serious danger to life or well-being of the mother because of a pathological condition in her. Weakened organs like heart, lungs, kidney, and diabetics, severe hypertension etc. are some of them. Here the death of the mother would endanger the life of the family. 3. Some argue that a grave risk to the life or well-being of the mother or fetus resulting from obstetrical indications could justify sterilization. Severe Rh sensitization, a weakened uterine wall from repeated Caesarian sections are some of them. Here the future of the family is in peril. 4. Psychiatric indications are cases of clinical evidence where women become emotionally regressive and suffer irreversible personality damage after pregnancy. It is now-a-days called post-partum psychosis. 5. In social indication, social situations like population growth may induce one to get sterilized. 6. In the economic indication, the condition of the family and a husband who is a drunkard, are now-a-days getting prominence in the decision making of the couples.
According to some authors of Catholic moral theology, all these factors need consideration as part of the total set of values that serves as a basis for decisions regarding responsible parenthood, because
“Sterilization in the situations described must be viewed as both a life-saving and life-serving decision and as an action that is clearly the lesser evil, given the life-threatening or life-damaging danger a future pregnancy would pose to either the woman or the fetus or to both.”[vi]
However, in none of these scenarios is recourse to sterilization a moral option according to the Church’s magisterium. Yet, a reason of proportionate seriousness – physical, sociological, psychological, economic or other – may influence the parents to opt for sterilization or have recourse to other contraceptive methods – thus creating another form of duress.
7. The Magisterium of the Church
The contraceptive methods (The most radical form of contraception currently in use, short of abortion, is permanent sterilization.) not only involve merely the peripheral aspects of the person, i.e., his physical psychological and social levels, but it affects also the very core of his being, an area which defines the dignity and sanctity of the person. Having made reference to Pius XI, Pius XII, and Paul VI, the council fathers told:
“In questions of birth regulation, the sons of the Church, faithful to these principles, are forbidden to use methods disapproved of by the teaching authority of the Church in its interpretation of the divine law.” GS, 51
The Catholic Church has produced a large number of documents on contraceptive methods especially from the time of Casti connubii.[vii] From Casti Connubii (Pius XI, 31 Dec. 1930), Gaudium et Spes (7 Dec. 1965), Humanae Vitae (Paul VI, 25 July 1968), Familiaris Consortio (John Paul II, 2 Nov. 1981), Veritatis Splendor (John Paul II, 6 Aug. 1993), Evangelium Vitae (John Paul II, 25 March 1995), to CCC (1994), speak of contraceptive character of contraceptive methods and their immoral character on the basis; however sterilization is viewed both as mutilation and contraception.[viii] It is a distinctive as well as a unique type of mutilation.[ix]
Sterilization is not merely a mutilation of a faculty or a removal of an organ of its function. Further, it is not the deprivation of the whole or a part of the generative system; rather, it is an act that renders one incapable of the reproductive capacity.[x]
As regards our study, we make a primary distinction in sterilization, namely, direct or indirect and voluntary or compulsory for a clear ethical judgement. It is actually in the intentional effects of sterilization, namely, sterilization of the procreative power and protection of the health of the individual, that the whole distinction between direct and indirect sterilization lies.[xi]
Direct Sterilization: Sterilization may be willed as a means to a contraceptive effect. In this case the sterilization and the contraceptive effect are said to be directly willed, or simply, “direct.” Pius XII: “Any sterilization which of itself, that is, of its nature and condition, has as the sole immediate effect of rendering the generative faculty incapable of procreation, is to be considered direct sterilization.”[xii]
Indirect Sterilization: Sterilization with its contraceptive effect, may be the non-intended effect of an intervention which is aimed at therapy - i.e., the healing of a diseased organ, or a treatment of pathology,. In this case the sterilization and its effect are said to be indirectly willed, or simply “indirect.”
Voluntary sterilization is that one where the will of the agent is present. Compulsory or involuntary sterilization, besides its contraceptive nature, is that which is demanded by the state in the name of population control, eugenic purposes or punishment. However, sterilization in the name of population and eugenics can be either voluntary or involuntary according to the will involved in the act of sterilization.
As it is clear from the Church documents, the practice of contraceptive sterilization reasonably follows the same moral judgements as other contraceptive methods, because sterilization whether permanent or temporary prevents conception or fertilization. However, the permanent character of surgical sterilization is the one significant difference for which many moralists press for a greater and significant reason to defend it; because if we objectively consider the seriousness of the evil, the “sterilization of the faculty itself” is a greater moral evil than the “sterilization of individual acts.”[xiii]
Contraceptive Methods: Intrinsece Malum
One of the major teachings of Veritatis splendor is the existence of “intrinsically evil acts.”[xiv] Although the Catechism of the Catholic Church does not use the word “intrinsic evil,” it seems to explain what it means: “There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object.”[xv] It reiterates what Reconciliatio et paenitentia had already stated in 1984.[xvi] It was in 1930 that for the first time the papal documents began labelling contraception as “intrinsic evil,” a phrase that has come to stay in the ambience of moral theology. In Casti connubii Pius XI without missing words called artificial contraceptives an “intrinsic evil.”[xvii] As early as 19 April 1853, contraception’s intrinsically evil nature had been pinpointed and declared by the Holy Office. In a reply to the question on the practice of onanism the Holy Office answered: “Negatively; for it is intrinsically wicked.”[xviii] This position was confirmed in a response of the Sacred Penitentiary of 13 November 1901.[xix] The Catechism of the Council of Trent had already taken this stance openly.[xx] But the credit for modifying the expression “intrinsically evil” to “intrinsically dishonest” goes to Paul VI.[xxi]
The notion “intrinsically evil” means that there are actions that are never morally justifiable despite the subjective circumstances of the act, the intentionality of the agent and the totality of the situation within which a particular act is of necessity performed. Consequently, circumstances or intentions can never transform an act intrinsically evil by virtue of its object into an act ‘subjectively’ good or defensible as a choice.[xxii]
The reasons for the intrinsically immoral character of the contraceptive act is clearly mentioned in Veritatis Splendor. The encyclical, first of all, states: the “contraceptive practices whereby the conjugal act is intentionally rendered infertile” “are by their nature ‘incapable of being ordered’ to God.”[xxiii] So, sterilization, surgical or not, per se is not potentially able of being ordained to God. An act is good when it has as its aim man’s ultimate end. Through contraceptives man deliberately changes his course and goes against the will of God, the Ultimate End, thus separating himself from God. In the rhetoric of Reconciliatio et paenitentia it is “aversio a Dio”[xxiv]
Secondly, contraceptives are intrinsically evil because they “radically contradict the good of the person made in his image.”[xxv] In the arguments of Veritatis splendor, an act that aims at the good of the person is true only when it is consonant with his ultimate end.
Therefore, if someone has recourse to contraceptives, it is a grave sin. As Casti connubii solemnly states:
Any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life is an offense against the law of God and of nature, and those who indulge in such acts are branded with the guilt of grave sin.[xxvi]
In Humanae vitae, around forty years after Casti connubii, Paul VI reasserted contraceptives as always illicit even when the intention is something good.[xxvii] Hence he clearly asked the faithful to refrain from such practices in their life: “Equally to be excluded, as the teaching authority of the Church has frequently declared, is direct sterilization, whether perpetual or temporary, whether of the man or of the woman.”[xxviii] Therefore, the Catechism of the Catholic Church reminds us not to choose contraceptives, which involve a moral evil.
Now, why is sterilization to be ruled out? How does it make us unable to be ordered to God? How does it distort the moral good of the person? How does it become a grave sin, and more an intrinsically gave sin?
7.1. Contraceptive practices separates the Two Significations: Contra-life
Human sexuality is pervasive, constitutive and integral factor in the structure of one’s being.[xxix] Sexual union should essentially possess two important significances, as Paul VI envisages in Humanae vitae: the unitative meaning and the procreative meaning.[xxx]
This dual meaning of the marital act is imprinted in the being of man and woman by the plan of God the Creator. Partners in marriage are at the service of this design.[xxxi] Neither of the two significances should be stressed at the expense of the other. These two aspects really form a single organic whole. Therefore, these two inseparable factors of the conjugal act should not arbitrarily be separated by man on his own initiative.[xxxii]
As we interpret it, suppression of the procreative significance of the marital act is the target of every contraceptive sterilization. The seriousness of such sterilization consists in the total and radical separation of the procreative dimension from the unitive dimension of human sexuality by using “artificial” means; it consists in the elimination of the procreative dimension from sexual activity. So, to choose sterilization is to choose the unitive without the procreative, for sterilization “implies the deliberate blocking of the procreative dynamism of conjugal love.”[xxxiii] In sterilization, In conjugal act, procreation then becomes the “enemy” to be avoided in sexual activity.[xxxiv]
Marriage demands reciprocal self-giving between the partners, but a contraceptively sterilized person does not give his ‘fertility’, does not offer himself or herself as a person who can transmit life. Thus more than the separation of the two meanings, as Familiaris consortio states[xxxv] the “language of the body” is falsified in contraceptive sexual union.[xxxvi]
7.2. Contraceptive practices goes against Man’s Stewardship
Since God has fashioned our human body, every organ functions in accordance with his plan. The organs are directed towards a common finality which is inscribed in them. Man’s bodily life with all its faculties is entrusted to man.[xxxvii] His responsible use of freedom towards his body does not allow him to be merely an onlooker but a good steward.[xxxviii]
Stewardship means one’s duty to respect the body and a responsibility to attend to it, and do everything that is within one’s power to defend its physical and functional integrity. The principle of stewardship “has become even more important in modern times as a guide to the use of modern technology.”[xxxix] This stewardship is not merely limited to a protective function, on the contrary, it stretches out to the positive use of his faculties according to their nature.
Man as a good and faithful steward has the freedom and intelligence to use his faculties in accordance with their natural teleologies, but he is not free to intervene with these natural finalities, much less to destroy them for his own consumeristic conveniences. Man’s power over his body is not absolute or unlimited. According to the anthropological vision expounded by Pius XII, man is not the sole master or owner of his body nor its absolute lord, but only its user, its steward.[xl] So, responsibility towards his body consists primarily in being open and faithful to the order that is inscribed in its nature by its Creator.[xli] Thus man’s stewardship over his body and its faculties does not mean in any way that he has the right of suppression or suspension over their natural functions and finalities or to destroy them for his convenience and intemperance.
Humanae vitae states that such sterilization oversteps the dominion that a person has over his or her generative faculties: “In fact, just as man does not have unlimited dominion over his body in general, so also, with particular reason, he has no such dominion over his generative faculties as such, because of their intrinsic ordination toward raising up life, of which God is the principle.”[xlii] Man is not the creator of his body; he is only a steward, a possessor. If man radically belongs to God the Creator, and if he is only the steward of his bodily members, every human being is responsible for his body before God,[xliii] for “stewards are stewards precisely because of their relationship with the Master.”[xliv]
7.3. Contraceptive practices goes against the Social Import of the Reproductive System
The human procreative system as a whole is a member of the human body, but man does not possess dominion over his generative system, because the human reproductive system has a finality of its own. However, the individual has dominion over the other parts of his body, because the other parts of the human body have no finality of their own, independent of the person. Therefore, the other organs of the body are immediately ordered to the good of the whole person, the totality of the organism. The generative aspect of the procreative faculty is neither for itself, nor is it only or even primarily for the good of the individual, but for the good of the species. It is an exception to the general law.
The procreative power, the cause of the renewal of the species, is a special gift of God to human society. The social orientation of the procreative system is manifest here. The reproductive faculty is primarily meant for the good of the society rather than that of the individual. So there is every reason to say that though the whole being and finality of the other parts of man are totally subject to the good of the individual, the procreative faculties cannot be totally subject to the good of the individual.[xlv] Nature and Creator impose upon the married couple who use that state by carrying out its specific act, the duty of providing for the conservation of the human race.[xlvi]
Another important point is that though the generative faculty is meant for the propagation and well-being of the society, it is not fully subordinated to the society. That is, the generative faculty has a relationship to society, not so as to subordinate its essence to society but, to some extent, its activity. However, it is fully subordinated to God, its Creator and the last End.[xlvii]
Maintenance of the human society is a designated significance of the reproductive faculty, and the partners in marriage contribute to the continued existence of the society and ensure the survival of mankind in the future.[xlviii] As the authors of Health Care Ethics sum up: “Sex is a social necessity for the procreation of children and their education in the family…..”[xlix] Thus the limits of the generative faculty, far from being a private matter, has a natural significance which is open to and at the service of the existence of human society.[l]
7.4. Contraceptive practice goes against the Notion of Human Body as An Integrated Totality
In the encyclical Veritatis splendor, John Paul II is categorical in saying: “Only in reference to the human person in his ‘unified totality’ the specifically human meaning of the body can be grasped.”[li] Hence man must be respected in the integrated totality of his spiritual and bodily being.
The human body is composed of various organs in harmonious order. While some of them are very essential for its existence, others are necessary for the perfection of its life, its wholeness and its integrity. Although God has fixed, assigned and limited each organ with its own role to play, all of them belong to one body and their functions are interrelated. They work together for the common good of the body. This bodily integrity is a natural good and it is essential for attaining human perfection. It is inherent to man by nature. Natural in the sense that it is not given by any human authority.[lii]
According to the Catechism of the Catholic Church, sterilization is considered as that which goes against the moral law of “respect for bodily integrity.”[liii] Sterilization violates the integrity of the person and becomes intrinsically evil in both ways: as a mutilation and as a contraceptive.
Contraceptive sterilization destructs the integrity of the person because, firstly, as a mutilation it “violates the integrity of the human person.”[liv] Thus, sterilization violates the principle of totality and integrity.
Sterilization, since it is a contraceptive practice, is involved in “acting against” the power to give life. This is more significant since our understanding of human sexuality is a personal one.[lv] Thus, sterilization violates the principle of personalised sexuality.[lvi]
7. 5. Contraceptive practice hoes against the Notion of the Dignity of the Human Person
Man’s dignity is derived from his having been created by God. Quoting Gaudium et spes, John Paul II speaks in the encyclical Veritatis splendor of the singular dignity of the human person: “The only creature that God has wanted for its own sake”[lvii] Man, the image of God, is created for God, although the material world is created for him. Since man’s destination is God, he cannot be used as a means to achieve earthly ends. Whenever such an attempt takes place, it does not tend to be “founded on the inviolable dignity of the human person.”[lviii]
In contraceptive methods man and his abilities are valued from the perspective of usefulness when they are proposed for the control of population and eugenics etc. Evangelium vitae sadly recognises the role played by contraceptive sterilization in the sharp decline of the birth rate. However, John Paul II warns of the temptation the faithful may have in using “the same methods and attacks against life . . . where there is a situation of ‘demographic explosion.’”[lix] Thus, according to him, instead of solving the problem of demographic growth through means that respect the sanctity and dignity of persons, the authorities concerned take recourse to contraceptive methods, such as sterilization etc.[lx]
In such situations, man is made a means for economic development and material prosperity. As Evangelium vitae states: here, “the values of being replaced by those of having. The only goal which counts is the pursuit of one’s own material well-being.”[lxi] However, the fundamental rights of man cannot be sacrificed for the sake of economic development, because man is the end of every material and economic development and not vice versa, i.e., he is not a means or an instrument for material development.[lxii]
8. A Debate among Theologians
There are a large number of Catholics and a significant number of theologians who think in a different way on the transmission of life. However, the statistics presented at the 1980 Roman Synod on the Family showed that 76.5% of American Catholic women used some form of contraception, and 94% of those women were using means condemned by Humanae vitae. Pericle Cardinal Felici declared: “statistics could never determine the Church’s moral teaching.”
Below we find two main arguments of the debate for the allowance of sterilization. Our intention here is not to enumerate the counter arguments of magisterium on sterilization, however, it is to indicate the views that cause the dilemmatic or confused situation of Catholic physicians.
8.1. A Recourse to Biological Process
Richard McCormick remarks that a number of moral theologians have found the arguments against sterilization insufficient to establish the absolute prohibition of direct sterilization. First of all, according to him, the fact that
direct sterilization is always a moral evil . . . absolutize[s] a biological aspect of the human person by equating the unequatable: human life and the sources of human life. Depriving a person of life is one thing; depriving oneself of the power to procreate is a remarkably different thing and ought not to be treated in an identical way ethically.[lxiii]
John C. Ford and Gerald Kelly second this view. In their Contemporary Moral Theology, they aver: “One cannot exaggerate the importance attached to the physical integrity of the act in the papal documents and in Catholic theology generally.”[lxiv]
Medicine respects the biological fact. But interference in the biological process is contrary to the accepted rule of medicine. However, the best standards of medicine demand the well-being of the patient too.
Walter Kasper says that “human fruitfulness never can be exclusively dependent on a biological or natural rhythm. It must above all be subordinated to man’s sense of moral responsibility.”[lxv] Therefore, he adds that the moral decision to have responsible parenthood based on the four criteria is in no way autocratic and arbitrary. They are: respect for the God given inner meaning of human nature; respect for the dignity of the other partner with the responsibility for mutual love; responsibility for the children; and the responsibility for society.
Bernard Häring, who highly endorses the natural methods which safeguard the biological process better than most methods of birth control, is not satisfied in giving higher priority to biological processes than to the psychological and psychosomatic in individual cases..[lxvi]
8.2. An All-inclusive Vision of “Totality”
In Pius XII’s discourse to the urologists, the principle of totality is used to justify surgical interventions in the situations of bodily pathology.[lxvii] Here the principle is limited only to the somatic aspect of life, i.e., any treatment including mutilation is licit, if it is necessary for the health or the well-being of the whole individual organism.[lxviii] However, many theologians have tried to extend this principle to other aspects of a person’s existence, including his relationship to his family, community, and the society at large. They recommended that a good not directly related to the person’s body, may justify the removal or impairment of an organ or bodily function.[lxix] Basing on such a reasoning Bernard Häring wrote:
In the past, medical ethics used the principle of totality to a great extent but only in view of the somatic concept of health and somatic medicine. . . . The traditional use of the principle of totality justified intervention in view of physical health and functioning. Medical ethics for the future must rest on an all-embracing concept of ‘totality’: the dignity and well being of man as a person in all his essential relationships to God, to his fellow men, and to the world around him.[lxx]
Häring argues that “totality” comprises not only physical but spiritual health, including those “essential relationships” that constitute the context of well-being. Thus, he justifies sterilization as a positive therapeutic or healing intervention to save the “totality” of marriage based on the holistic vision of the human person and of health and healing.[lxxi] Though, in such situations, Häring leaves the decision to the individual’s conscience, he demands serious reasons to commensurate with the seriousness of a permanent intervention in a fundamental faculty.
Some moral theologians in the past judged some “medically indicated” sterilizations to be therapeutic and therefore justifiable. For example, John C. Ford and Gerald Kelly have argued that a scarred and weakened uterus may be regarded as a pathological organ in view of a future pathological condition resulting from pregnancy and it may be removed under the principle of totality.[lxxii] They appear to widen the definition of “therapeutic” sterilization to embrace not only instances of clear and present danger but also clear and future danger. Moreover, many others try to extend this reasoning to either women or men confronting serious economic and emotional reasons since such factors affect the well-being of the person.
Another approach invoking the principle of totality to justify sterilization argues that the marriage or the family itself constitutes a totality and a part may be sacrificed for the good of the marriage or the totality of the family. In Medical Ethics, Bernard Häring gives as follows:
Whenever the direct preoccupation is . . . saving a marriage (which also affects the total health of all the persons involved), sterilization can then receive its justification from valid medical reasons. If, therefore, a competent physician can determine, in full agreement with this patient, that in this particular situation a new pregnancy must be excluded now and forever because it would be thoroughly irresponsible, and if from a medical point of view sterilization is the best possible solution, it cannot be against the principle of medical ethics, nor is it against the ‘natural law’ (recta ratio).[lxxiii]
Accordingly, as we have seen, there are situations in family life where a pregnancy would be, as Häring notes, “thoroughly irresponsible.” At times, discovering whether natural family planning “works” means also running an irresponsible risk. Besides, to demand a spouse to forego sexual relations altogether is very often to threaten the marriage, because “where the intimacy of married life is broken, it often happens that faithfulness is imperiled.”[lxxiv] Thus, the supporters of this argument like to extend the principle of totality to the total well being either of the person or of the family.[lxxv] Here “the main criterion is the principle of totality - not a totality of mere organic functions but a perspective of wholeness that considers the total vocation of the human person.”[lxxvi]
9. B. Towards a Positive Pastoral Practice against Contraceptive Methods
The obligation to avoid evil is based on the revealed moral law and the natural moral law. The practice of Christian faith invariably prohibits the deliberate performance of evil acts. The Veritatis splendor forbids authoritatively the performance of evil action even if good can come from it (Rom 3:8).[lxxvii]
However, far from teaching the mere avoidance of evil action, Christ taught that one must be perfect as our heavenly Father is perfect (Mt 5:48), and his challenge to Christians is seen in the story of young man (Mt 19: 16-21) as portrayed in the Veritatis splendor.[lxxviii] Even conscientious objection is “often ineffective as a means of inviting and leading . . . [the] patients to the good alternative, and to the truth.”[lxxix] The content of conviction which Dr. Moloney shares and all Catholic priests should possess is clear from the pastoral letter of Glennon P. Flavin - that alerts Catholic physicians of the “contraceptive culture”: “To preach the word, to stay with this task whether convenient or inconvenient - correcting, reproving, appealing - constantly teaching and never losing patience” (2Tim 4: 2).[lxxx] Accordingly, “let them (the priests) . . . consider as their proper … duty . . . to be able to give to those married persons who consult them wise counsel and healthy direction, such as they have a right to expect.”[lxxxi]
As part of the “patient preaching of the word,” firstly, a Catholic priest may present the following positive practice to those who stand in a queue requesting sterilization, because “the problems of births . . . cannot be resolved save within an integral vision of man, that is, in conformity with the moral law and the principles of morality.”[lxxxii]
Having this vision, secondly, priests can also endorse this creative practice for the Catholic physicians, because we understand the esteem the physicians hold in the society, as a non-Christian attests:
Physicians play an important role in the overall acceptance of . . . voluntary sterilization. . . . There are two simple reasons why physicians can have such influence. They are the delivers of the service, and their advice, justifiable or unjustifiable, carries much weight in health matters with the individual patient and with the community at large.[lxxxiii]
Realising the significant sway of physicians in the society, and on the other hand, the unique responsibility of the doctors to be “guardians and servants of human life,” and as the intrinsic and undeniable moral dimension of their health care profession, they can furnish this dynamic as well as convinced praxis.[lxxxiv] Only through such a positive practice, according to Humanae vitae, priests and doctors can promote a climate of respect for morality and for right reason.[lxxxv]
B.1. The “Didache” on the Meaning of Suffering
The Christian responsibility of the Catholic health care professionals ask them to value the significance of suffering and to share it with those who seek sterilization or other contraceptive methods for various indications or “sufferings” converting those moments as means of “total personal growth.”[lxxxvi] They could be asked to unite their suffering and inconvenience resulting from non-sterilization or not using contraceptive methods to the suffering of Christ and thus to find significance in it. As Carl Rogers maintains, if one involves in actual caring, he has to suffer with the patient.[lxxxvii] There is a moral meaning to sufferings resulting from not using contraceptive methods, not merely because these sufferings cannot be evaded, “but because the demands of morality cannot be satisfied without asking the self to submit to limits imposed by morality itself.”[lxxxviii]
In the Christian conception of reality, pain and suffering are not sought for their own sake. So also, in the “medical indications” of a woman, suffering is not sought after; nor is it the after-effect of an evil doing. Therefore, it is significant to distinguish the types of suffering that spring up fidelity to the cross and those that do not. “The suffering that is a consequence of our living a faithful life has a different valence than that which is not.”[lxxxix] The difference in the suffering resides in the fact that they are the consequences of “choosing a way of life.”[xc] Consequently, for a Catholic woman a “no” to sterilization or other contraceptive methods is a “yes” to via crucis, choosing a way of moral life that imparts suffering, but a “different” suffering, brimming with meaning.
The Catholic Church does not deny that it would be comforting to a woman suffering such conditions to know that she would not become pregnant again. However, according to the Christian perspective, it is the belief in the loving providence of God that helps those who suffer from such situations to integrate the reality of these sufferings into a faith-vision of life, and thus to “give a voice to their pain.”[xci] Acceptance of this faith-vision of suffering does not imply that the suffering that prompted one to request sterilization or have recourse to contraceptive methods, is eliminated or even alleviated. It still remains, but the frustration and anguish that generally come with suffering is transcended by reason of faith in Christ, because “the suffering of Christ becomes for the Christian the way to deal with their own suffering.”[xcii] Accordingly, a Catholic health care worker may ask those who request sterilization or have recourse to contraceptive methods in the name of “sufferings” to try to acquire a Christian view of pain and suffering which would dispose them for personal transformation.[xciii]
B.2. A Pedagogy on the Facts: The Negative Effects of Sterilization
Both secular as well as Catholic doctors who are in family practice insistently ask to make known to their patients the overwhelming bad effects in prescribing sterilization or contraceptive methods on physical, psychological and moral grounds.[xciv] For, “they have the biological and medical information necessary to understand such issues, and they have the professional prestige and influence to be heard.”[xcv] There are many males and females who have recourse to different contraceptive methods without knowing the empirical evidence of the medical deficiencies of these methods.[xcvi] Thus, it has been scientifically established that the contraceptives damage the patient’s health and well-being. Medical practice, however, is an opening to Catholic health care workers who genuinely wish to help the patient by indicating some good reasons to reject different contraceptive methods thus leading them to truth.[xcvii]
So, first of all, the people have to be informed of the nature and significance of all the contraceptive methods especially sterilization: its irreversibility, the difference between voluntary and therapeutic or direct and indirect sterilization. The physicians are also to explain the common physical side-effects, short-term and long-term risks of sterilization, describing the psychological and psychosexual disorders, that is, not feeling like man/woman etc., and regret after sterilization.[xcviii]
In the moral realm, the failure to integrate sexuality into one’s whole being hinders the integration of the fundamental values of life and love into one’s person, and retards one’s moral formation and fulfilment.[xcix] In Humanae vitae, Paul VI speaks of the consequences of artificial birth control as “conjugal infidelity and the general lowering of morality.”[c] As the expression of Evangelium vitae shows, it is evidenced in the “culture of death”-style of the contemporary world.[ci]
It is therefore imperative that couples and the young people are fully aware of the bad effects brought about by sterilization and other contraceptives and be given right information about them, because otherwise they will eventually be influenced by the mentality artificially created by today’s mass media. This constrains Catholics, especially doctors, to carry out a comprehensive education at the grass roots.[cii] Therefore,
Catholic doctors must take leadership in their communities in making known to its constituency the official, authentic and authoritative moral teaching of the Church on medical . . . questions and must not be content to follow the thinking and the practices of large numbers of people in its midst.[ciii]
B.3. An Alternative to Sterilization
According to the Ethics Religious Directives (here afterERD) of 1971, the healing ministry of Catholic professionals aim at “the total good of the patient, which includes his higher spiritual as well his bodily welfare.”[civ] Pope John XXIII Medical-Moral Research and Education Center, in order to respond to the ethical queries received from health care personnel, analysed the ERD and commented: “The ‘total good’ of the actual or potential patient who is considering . . . sterilization (or other contraceptives) includes an alternative for that patient, since . . . sterilization or other contraceptives . . . [are] contrary to the patient’s total good.”[cv] The commitment to the “total good” or “wholeness”-norm finds an alternative in the medically reliable and health-value-oriented method of natural family planning.[cvi]
The references in the Official teachings like Gaudium et spes, Humanae vitae, Evangelium vitae, Familiaris consortio and the Charter for Health Care Workers not to mention the many others, suffice to show the great importance that the Catholic Church attaches to this method.[cvii] Why the Church endorses to this method such a prominence is clear from the words of Hans Urs von Balthasar:
There remains a world of difference between the knowledge and utilization of the periods of the bodily infertility by the married couple and the arbitrary, interfering fertility curtailment by contraceptive means. To many the difference appears small. And small it may be where the human being understands himself as the creature manipulating and discovering himself, as homo technicus. Where should limits generally be set for such a person in the loveless planning of himself? But for the person who thinks as a Christian the difference remains great.[cviii]
Therefore, Catholic health care professionals are obliged to “provide for married couples . . . instruction . . . in methods of natural family planning.”[cix] Ashley and O’Rourke echo the same: physicians have a serious obligation to promote natural family planning as a method indubitably in keeping with Christian values.[cx]
At the beginning of the second half of this century, Pius XII pointed out that “it is the role of the doctor and not of the priest” to teach natural family planning.[cxi] Quoting the Familiaris consortio, the Charter for Health Care Workers appeals in the name of the Church to the “responsibility” of physicians in “effectively helping couples to live their love” in this way.[cxii] Bearing in mind the teachings of the Church, doctors have a professional responsibility to present to married partners detailed scientific information about the natural methods,[cxiii] because as John Paul II speaks, the promotion of alternatives to sterilization demonstrates a physician’s ecclesial commitment.[cxiv]
B.3.1. Advantages of Natural Family Planning
No methods of birth regulation are without some serious disadvantages and natural methods have been criticized on several grounds.
First, although they are highly effective under ideal conditions, natural methods have not been as widely tested in ordinary conditions as have progesterones (pills) and intrauterine devices. It has been shown, however, that the Billings method can be used with excellent success even by uneducated women (World Health Organization, l98l).
Second, some (Guerrero, l973) have theorized that natural family planning may produce genetic defects, since if a pregnancy does occur, it is more likely to be at a time when the ovum or sperm are somewhat aged. Hilgers (l977) has shown that not only is there little evidence for such a theory, but strong reason to regard it as false, and a recent study (Brown et al., l987; Gray l984) again disproves this theory.
Third, and much more important, natural methods require a period of abstinence, which if they are to equal progesterones and intrauterine devices in effectiveness, may be as long as half the cycle (WHO l984). Moreover, there is evidence that such abstinence makes following the system more difficult (WHO, l987).
In answer to this last and most serious difficulty, proponents of natural family planning first point out that because of improved methods, abstinence can often be reduced with safety to five or six days in a cycle. Second, they emphasize that contraceptive methods also have strong psychological drawn backs. Thirdly the same studies from WHO that set forth the difficulties of NFP also reported overall satisfaction with the method, even though it required greater self discipline to follow.
Positively proponents of natural methods (Kippley, l974; Zimmerman, l98l) argue that:
l. Such methods place responsibility on both partners, not merely on the woman, as do most methods, or on the man, as does vasectomy.
2. Many women who use such methods have reported an enhanced sense of personal dignity resulting from an awareness of their own body and its rhythms (Klaus, l979).
3. Abstinence from intercourse can help a couple learn to have confidence in the strength of their love for each other and to express it in a variety of ways, without that preoccupation with “total orgasm”, which is proving to be a source of tension for many men and women today.
4. Periodic abstinence removes something of the sexual routine and enhances the experience when it is actually decided on. Although spontaneity is an element of love making, a truly mature notion of spontaneity is not just being able to have intercourse at any time. Rather, it is knowing how to give oneself to another at the appropriate time, a time necessarily determined by the rhythm of some lifestyle.
Besides these possible subjective psychological advantages, natural family planning has several definite objective merits.
l. When properly practiced, it can be as effective as any method except sterilization and does not have the obvious disadvantages of a sterilizing procedure.
2. Unlike other comparably effective methods, that is, progesterones and intrauterine devices, it has no medical risks.
3. It is never abortifacient, as progesterones and intrauterine devices almost certainly are.
4. It is inexpensive, does not require regular medical check ups to avoid side effects, and can be effectively taught by simple practical instruction. Finally, the mechanistic tendencies of our society are evidenced in reaction to natural family planning. The tendency is to evaluate methods of family limitation only from statistical efficiency, instead of questioning which methods result in greater marital love between man and wife.
Health care professionals need to be well informed on natural family planning and have a serious professional obligation to promote it as a method indubitably in keeping with Christian values, as well as having important medical advantages for couples who use it consistently and satisfactorily. Catholic health care facilities and physicians should provide instruction in this method honestly and objectively. Also, they should give correct information about other methods so that couples will not think they are being treated as guinea pigs but have free and informed consent in trying to use natural methods for responsible parenthood. It is especially essential that catholic scientists advance research on natural methods so as to overcome the crisis of conscience among Catholics. They also must provide others with a method of responsible parenthood and population control that does not tend to separate sexuality from family life, as has the spread of contraceptive practices.

[i] Robert A. Hatcher et al., Contraceptive Technology, 16th rev. ed. (New York: Irvington, 1994).
[ii]Häring, Free and Faithful in Christ, 3: 17-22; See also Louis M. Hellman, Karen Lebacqz and Jane M. Friedman, “Sterilization,” in Encyclopedia of Bioethics (New York: Macmillan, 1978), 1606-1618.
[iii]He took the words of Jesus literally: “There are eunuchs who have themselves eunuchs for the sake of the kingdom of heaven” (Mt 19: 12). See Tettamanzi, Sterilizzazione anticoncezionale, 12.
[iv]Abelard was a French medieval philosopher and theologian and Fulbert was the Canon of Notre Dame cathedral. Eileen Kearney, “Abelard, Peter,” in Encyclopedia of Catholicism, ed. Richard, P. McBrien (New York: Harper Collins Publishers, 1995).
[v]Tettamanzi, Sterilizzazione anticoncezionale, 12. The practice was condemned by Sixtus V in the constitution Dum frequentur (1587).
[vi]Genovesi, In Pursuit of Love, 396.
[vii]Till the beginning of the 20th century, the Christian Churches were unanimous in saying that contraception is a threat to the dignity of marriage. It is the revised teaching of the Anglican Church in 1930 regarding contraception that gave rise to the encyclical of Pope Pius XI, Casti conubii (Encyclical Letter on Christian Marriage, Dec. 31, 1930), AAS 22 (1930). Here he forcefully maintained the Catholicism’s traditional teaching on contraception. For a documentation of the various important interventions of the Magisterium on sterilization, see Dionigi Tettamanzi, Sterilizzazione anticoncezionale (Brezzo di Bedero: Edizioni Sacom, 1981), 123-136. He includes the interventions of popes, councils, synods of bishops, Roman congregations and episcopal conferences.
[viii]For example, in Casti connubii, no. 71, AAS 22 (1930): 565, speaking on sterilization, Pius XI said: “They are not free to destroy or mutilate their members.” In another place, no. 56 (AAS 22, page 560) we read “Any use whatsoever of matrimony exercised in such a way that the act is deliberately frustrated in its natural power to generate life is an offence against the law of God and of nature.”
[ix]For example, Marcellinus Zalba, Theologiae moralis summa, vol. 2, Theologiae moralis specialis (Madrid: Biblioteca de Autores Christianos, 1953), 263-270.
[x]Pius XII, “To the Seventh International Haematological Congress” (Allocution on Blood Transfusion, Sept. 12, 1958), AAS 50 (1958): 734-737.
[xi]Charles E. Curran, “Fertility Control: Ethical Issues,” in Encyclopedia of Bioethics (New York: Macmillan, 1995), 837.
[xii]CDF, “Sterilization in Catholic Hospitals,” 420.
[xiii]CDF, “Reply on: Sterilization in Catholic Hospitals” (Mar. 13, 1975), in Catholic Identity in Health Care: Principles and Practice, Orville N. Griese (Braintree, Massachusetts: The Pope John Center, 1987), 420.
[xiv]John Paul II, Veritatis splendor (Encyclical Letter Regarding Certain Fundamental Questions of the Church’s Moral Teaching, Aug. 6, 1993), nos. 80-83, 115, AAS 85 (1993): 1197-1200, 1223-1224. “To deny intrinsic malum is equivalent to denying the proper and natural structure of a certain action, or to affirming that man can always and in all cases, insert in a certain act one “signification” rather than another, or even two different and contradictory significations.” Dionigi Tettamanzi, “Il ‘compromesso’ come scelta morale,” in Verità e libertà: Temi e prospettive di morale cristiana (Cassale Monferrato: Piemme, 1993), 535. However, J. Fuchs holds that the intrinsic malum is falsifying abstraction, because it seems to determine the morality of an action apart from the intention of the subject and from the concrete circumstances. See “The Absoluteness of Moral Terms,” Gregorianum 52 (1971): 415-457. These two quotes are to show the on-going debate on the category of intrinsic evil. The challenge of the intrinsically evil act is based on the Thomistic teaching where the morality of the act is estimated on the simultaneous consideration of the object, the intention and the circumstances (see also CCC, nos. 1749-1761). However, referring to Thomas Aquinas CCC, no. 1759 also states that “an evil action cannot be justified by reference to a good intention.” See also CCC, no. 1760.
[xv]CCC, no. 1756. See also John Paul II, Veritatis splendor, no. 80, AAS 85 (1993): 1197-1198.
[xvi]John Paul II, Reconciliatio et paenitentia (Post-Synodal Apostolic Exhortation on Reconciliation and Penance, Dec. 2, 1984), no. 17, AAS 77 (1985): 221.
[xvii]Pius XI, Casti connubii, no. 54, AAS 22 (1930): 559.
[xviii]Heinrich Joseph Denzinger and Adolf Schönmetzer, Enchridion symbolorum definitionum et declarationum de rebus fidei et morum, 32nd ed. (Barcelona: Herder, 1963): no. 2795.
[xix]Ramón García de Haro, Marriage and Family in the Documents of the Magisterium, trans. William E. May (San Francisco: Ignatius Press, 1989), 131.
[xx]Catechism of the Council of Trent, part II, can. 7, no. 13: “It happens that the crime of those who, joined in marriage, either impede conception by medicines or expel the life conceived, is most grave; for this must be considered the impious conspiracy of murderers.”
[xxi]Paul VI, Humanae vitae, no. 14, AAS 60 (1968): 491. However, CCC does not give any contraceptive practices in the list of the evil acts that are gravely illicit by reason of their object. See CCC, no. 1755-1761. For a list of magisterial documents on the intrinsic evil character of sterilization, see De Haro, Marriage and Family in the Documents of the Magisterium, 202-203.
[xxii]John Paul II, Veritatis splendor, no. 81, AAS 85 (1993): 1198.
[xxiii]John Paul II, Veritatis splendor, no. 80, AAS 85 (1993): 1197-1198.
[xxiv]John Paul II, Reconciliatio et paenitentia, no. 17, AAS 77 (1985): 222.
[xxv]John Paul II, Veritatis splendor, no. 80, AAS 85 (1993): 1197-1198.
[xxvi]Pius XI, Casti connubii, no. 56, AAS 22 (1930): 560.
[xxvii]Paul VI, Humanae vitae, no. 14, AAS 60 (1968): 491.
[xxviii]Ibid.
[xxix]CDF, “Declaration on Certain Problems of Sexual Ethics” (Dec. 29, 1975), in Vatican Council II, vol. 2, More Post Conciliar Documents, ed. Austin Flannery (Bombay: St. Paul Publications, 1988), 486-496. Moreover, every aspect of one’s living, namely, the physical appearance, the development of personality, even one’s prayer and personal relations with God, is deeply and characteristically affected by and linked to one’s sexuality. Thus human sexuality suffuses the whole human being; it is rooted in the very kernel of one’s existence
[xxx]Paul VI, Humanae vitae, no. 12, AAS 60 (1968): 488. For a theological response to this, see Vincent J. Genovesi, “Are the Two Meanings of Conjugal Sex Inseparable?” in In Pursuit of Love: Catholic Morality and Human Sexuality, 2nd ed. (Collegevelle, Minnesota: The Liturgical Press, 1996), 193-196.
[xxxi]John Paul II, Familiaris consortio (Apostolic Exhortation Regarding the Role of the Christian Family in the Modern World, Nov. 22, 1981), no. 32, AAS 74 (1982): 118-120. See also Melchior Pitchai, The State and Contraceptive Sterilization: With a Special Reference to India (Coimbatore: Kalaimani Printing Industries, 1989), 162.
[xxxii]Paul VI, Humanae vitae, no. 12, AAS 60 (1968): 488.
[xxxiii]CBCI, “Sterilization in India” (Apr., 1976), Origins 6 (1976): 36.
[xxxiv]John Paul II, Evangelium vitae (Encyclical Letter on the Value and Inviolability of Human Life, Mar. 25, 1995), no. 23, AAS 87 (1995): 427.
[xxxv]John Paul II, Familiaris consortio, 32, AAS 74 (1982): 119.
[xxxvi]Peter J. Elliott, What God Has Joined ...: The Sacramentality of Marriage (New York: Alba House, 1990), 215.
[xxxvii]Bernard Häring , Medical Ethics (Middlegreen: St. Paul Publications, 1987), 64.
[xxxviii]Benedict M. Ashley and Kevin D. O'Rourke, Health Care Ethics: A Theological Analysis, 3rd ed. (St. Louis, MO: CHA, United States, 1989), 51-53, 201-203
[xxxix]Ibid, 202.
[xl]Pius XII, “To the Italian Medical-biological Union of ‘St. Luke’” (Allocution on Christian Principles of Medical Profession, Nov. 12, 1944), in Pio XII: Discorsi ai medici, A cura di Fiorenzo Angelini (Roma: Edizioni Orizzonte Medico, 1959), 46.
[xli]Paul VI, Humanae vitae, no. 13, AAS 60 (1968): 489
[xlii]Ibid.
[xliii]Carlo Caffarra, “Il problema morale della sterilizzazione,” Medicina e morale 19 (1979): 204.
[xliv]Germain Kopaczynski, “Stewardship, Dominion, and Autonomy,” Ethics & Medics 20 (1995): 2.
[xlv]Charles E. Curran, “Sterilization: Roman Catholic Theory and Practice,” Linacre Quarterly 40 (1973): 98.
[xlvi]Pius XII, “To the Congress of the Italian Catholic Midwives Union” (Allocution on the Apostolate of Midwives, Oct. 29, 1951), AAS 43 (1951): 845. As translated in Odile M. Liebard, Love & Sexuality: Official Catholic Teachings (Wilmington, North Carolina: Consortium Book, 1978), 112.
[xlvii]John F. Dedek, Contemporary Medical Ethics (New York: Sheed and Ward, 1975), 73.
[xlviii]Walter Kasper, Theology of Christian Marriage, trans. David Smith (London: Burns & Oates Ltd., 1980), 19; Ashley and O'Rourke, Health Care Ethics, 253.
[xlix]Ashley and O'Rourke, Health Care Ethics, 200.
[l] Benedict M. Ashley and Kevin D. O'Rourke speak of the social significance of the procreative faculty based on the principle of the common good and of the ecological imbalance that takes place due to contraceptive practices. See Ethics of Health Care: An Introductory Textbook, 2nd ed. (Washington, D.C.: Georgetown University Press, 1994), 50, 137.
[li]John Paul II, Veritatis splendor, no. 50, AAS 85 (1993): 1173.
[lii]Pitchai, The State and Contraceptive Sterilization, 128-129; Ashley and O'Rourke, Health Care Ethics, 36-37.
[liii]CCC, no. 2297.
[liv]John Paul II, Veritatis splendor, no. 80, AAS 85 (1993): 1197-1198.
[lv]CDF, “Declaration on Certain Problems of Sexual Ethics” 486-496; Ashley and O'Rourke, Health Care Ethics, 199-201.
[lvi]John Paul II, Veritatis splendor, no. 80, AAS 85 (1993): 1197-1198.
[lvii]Ibid, no. 13, AAS 85 (1993): 1143.
[lviii]John Paul II, Evangelium vitae, no. 20, AAS 87 (1995): 423.
[lix]Ibid, no. 16, AAS 87 (1995): 418.
[lx]Ibid. “Consequently, rather than wishing to face and solve these serious problems with respect for the dignity of individuals and families and for every person’s inviolable right to life, they prefer to promote and impose by whatever means a massive programme of birth control.” Population problem is a social problem which demands the collaboration of not only the state, but the society as a whole, i.e., the government, private organisations and families. Moreover, the Church is for national development which is not based on a population policy preoccupied only “about numbers” and the curtailing of numbers by any means including abortion, contraception and sterilization. Thus according to the Church’s mind, population policy must always be seen as part of a more comprehensive development policy. For example, development strategies require equity in the distribution of resources and technology within the international community and access to international markets. Renato Martino, “Population and Development: The Issues, the Context,” Origins 24 (1994): 260-263. In the scope of our study, the population problem is not our concern.
[lxi]John Paul II, Evangelium vitae, no. 23, AAS 87 (1995): 426.
[lxii]CBCI, “Sterilization in India,” 36. So, the Catholic bishops of India wrote during the sterilization campaign in India: “What causes us grave consternation are some of the other means being contemplated and, in particular, . . . sterilization, which militate against the very dignity of the human person.” So, only the family planning programmes that enhance the human dignity and freedom are accepted. It may be a slow process in bringing about a change in the demographic trend, yet it is the proper means appropriate to human rationality.
[lxiii]McCormick, “Sterilization: The Dilemma of Catholic Hospitals,” 277. However, McCormick says: “Sterilization, it can and should be argued, is not a neutral intervention, much less a desirable one. As drastic and often irreversible it has the character of a last resort, much as in its own domain violent self-defense, whether personal or national, is to be viewed as a last resort.” Ibid, 278.
[lxiv]John C. Ford and Gerald Kelly, Contemporary Moral Theology, vol. 2, Marriage Questions (Cork: The Mercier Press, 1963), 288.
[lxv]Walter Kasper, Theology of Christian Marriage, trans. David Smith (London: Burns & Oates Ltd., 1980), 20.
[lxvi]Bernard Häring, Medical Ethics (Middlegreen: St. Paul Publications, 1987), 80-81.
[lxvii]Pius XII, “To the Delegates of the 26th Congress of Urology” (Allocution on the Removal of a Healthy Organ, Oct. 8, 1953), AAS 45 (1953): 673-679. In the next chapter we discuss on the principle of totality.
[lxviii]Gerald Kelly, Medico-Moral Problems (St. Louis: CHA, 1957), 246.
[lxix]Martin Nolan, “The Principle of Totality in Moral Theology,” in Absolutes in Moral Theology (Washington, D.C.: Corpus, 1968), 237.
[lxx]Häring, Medical Ethics, 58.
[lxxi]Häring, Free and Faithful in Christ, 3: 20-21.
[lxxii]Ford and Kelly, Contemporary Moral Theology, 2: 328-329.
[lxxiii]Häring, Medical Ethics, 84.
[lxxiv]Second Vatican Council, Gaudium et spes (Pastoral Constitution on the Church in the Modern World, Dec. 7, 1965), no. 51, AAS 58 (1966): 1072-1073.
[lxxv]“In evaluating such an approach, one must honestly recognize that such a proposal runs contrary to the explicit teaching of Pius XII.” Charles E. Curran, “Sterilization: Roman Catholic Theory and Practice,” Linacre Quarterly 40 (1973): 103. Ashley and O'Rourke in Health Care Ethics, 274, states: “According to its proper meaning, the Principle of Totality and Integrity applies to the physiological functions of the person and cannot licitly be extended to other levels of human function such as the social or spiritual.”
[lxxvi]Häring, Medical Ethics, 57. Although there may be merits and new insights in the above arguments based on the broader explanation of the principle of totality, but it cannot remain in accord with the official teaching of the Church. See also Pius XII, “To the Delegates of the 26th Congress of Urology,” 673-679.
[lxxvii]John Paul II, Veritatis splendor (Encyclical Letter Regarding Certain Fundamental Questions of the Church’s Moral Teaching, Aug. 6, 1993), nos. 79-80, AAS 85 (1993): 1197-1198.
[lxxviii]Ibid, nos. 6-22, AAS 85 (1993): 1138-1151.
[lxxix]Moloney and Rebard, “Theory and Practice of Proscribing Sterilization,” 21.
[lxxx]Flavin, “Artificial Contraception, Catholic Couples and Catholic Physicians,” 1-4. A pastoral letter which was very well received throughout his diocese of Lincoln, U.S.A. and has been published well beyond that diocese.
[lxxxi]Paul VI, Humanae vitae (Encyclical Letter on Human Life, July 25, 1968), no. 27, AAS 60 (1968): 500-501.
[lxxxii]Ramón García de Haro, Marriage and Family in the Documents of the Magisterium, trans. William E. May (San Francisco: Ignatius Press, 1989), 293.
[lxxxiii]Mahmoud F. Fathalla, “Professional Attitudes,” in Voluntary Sterilization: A Decade of Achievement, ed. Marilyn E. Schima and Ira Lubell (New York: The Association for Voluntary Sterilization, 1980), 48.
[lxxxiv]John Paul II, Evangelium vitae, no. 89, AAS 87 (1995): 502.
[lxxxv]Paul VI, Humanae vitae, no. 27, AAS 60 (1968): 500-501.
[lxxxvi]Ashley and O'Rourke, Health Care Ethics, 199.
[lxxxvii]Carl Rogers, On Becoming a Person (Boston: Houghton Mifflin, 1961), 39-44.
[lxxxviii]Stanley Hauerwas, Suffering Presence, (Notre Dame: University of Notre Dame Press, 1986), 25.
[lxxxix]Stanley Hauerwas, Naming the Silences: God, Medicine and the Problem of Suffering (Grand Rapids: William Eerdmans Publishing Co., 1990), 85.
[xc]Lucien Richard, “Ethics and Suffering: Stanley Hauerwas,” in What Are They Saying About the Theology of Suffering (New York: Paulist Press, 1992), 118 (italics, emphasis is added).
[xci]Hauerwas, Naming the Silences: God, Medicine and the Problem of Suffering, xi. See also Brian V. Johnstone, “Learning through Suffering: The Moral Meaning of Negative Experience,” in History and Conscience: Studies in Honour of Sean O’Riordan CSsR., ed. Raphael Gallagher and Brendan McConvery (Goldenbridge, Dublin: Gill and Macmillan, 1989), 144-160.
[xcii]Richard, “Ethics and Suffering,” 117.
[xciii]Pius XII, “To the Italian Medical-biological Union of ‘St. Luke’,” 48-49. See also Kevin D. O’Rourke, “Is Your Health Facility Catholic,” Hospital Progress 55 (April 19740): 40-44; Ashley and O'Rourke, Health Care Ethics, 199.
[xciv]Moloney and Rebard, “Theory and Practice of Proscribing Sterilization,” 21, 24. Careful counselling is recommended by scientific medical journals also. For example, Emma Gorton, “Male and Female Sterilization,” The Practitioner 238 (1994): 576-578; S. A. H. Rizvi, S. A. A. Naqvi and Z. Hussain, “Ethical Issues in Male Sterilization in Developing Countries,” British Journal of Urology 76 (1995): 103-105.
[xcv]Ashley and O'Rourke, Health Care Ethics, 230.
[xcvi]We have already cited the scientific and medical deficiencies of sterilization, especially the physical and psychological ones.
[xcvii]Moloney and Rebard, “Theory and Practice of Proscribing Sterilization,” 21; Ashley and O'Rourke, Health Care Ethics, 230, 271.
[xcviii]Robert T. Michael, “Why Did the U.S. Divorce Rate Double within a Decade?” Research in Population 6 (Greenwich, Conn.: JAI Press, 1988), 361-369, cited in Janet E. Smith, Humanae Vitae: A Generation Later Washington, D.C.: Catholic University of America Press, 1991), 127; Nona Aguilar, The New No-Pill, No Risk Birth Control (New York: Rawson Associates, 1986), 186-191; Jeff Brand, Marital Duration and Natural Family Planning (Cincinnati, Ohio: Couple to Couple League, 1995). Ashley and O'Rourke in Health Care Ethics, 273, speak of an ecological crisis due to the sterilization-culture.
[xcix]Moloney, and Rebard, “Theory and Practice of Proscribing Sterilization,” 21-25. A doctor tells how she accepted the Church’s stand regarding contraception, and how she recognised the bad effects of contraceptives. This is evidently given by the Dutch psychiatrist, Anna A. Terruwe, M.D., from her own personal experience, in her book entitled The Abode of Love, trans. Robert C. Ware (St. Meinrad, ID: Abbey Press, 1970), 81-82.
[c]Paul VI, Humanae vitae, no. 17, AAS 60 (1968): 493-494.
[ci]John Paul II, Evangelium vitae, no. 13, AAS 87 (1995): 414-415. Besides, in recalling the moral principles of the Catholic Church, the physicians should be able to deliver the message that this is not the problem of the Catholics alone, but is a global need. Also, they should inspire people about the violence against life and human body. This creates a formation in the values of life, thus enabling people to make choices in view of the building up of a “culture of life.” Charles G. Vella, “Breve panoramica storico-sociale sul fenomeno della sterilizzazione,” in Il problema della sterilizzazione volontaria, A cura del Centro Internazionale Studi Famiglia (Milano: Franco Angeli, 1983), 41.
[cii]Vella, “Breve panoramica storico-sociale sul fenomeno della sterilizzazione,” 41; Ashley and O'Rourke, Health Care Ethics, 271.
[ciii]Harrington, “The Catholic Doctor, the Catholic Hospital and Contraception,” 26.
[civ]NCCB, “ERD for Catholic Health Facilities” 93.
[cv]Pope John XXIII Medical-Moral Research and Education Center, “Why Should Catholic Hospitals Promote Abortion, Sterilization Alternatives?” Hospital Progress 65 (1984): 67 (italics, emphasis is added).
[cvi]Natural Family Planning stands very favourably against the contraceptive pill/sterilization in all categories of comparison. For example, lower cost, greater safety, ease of compliance, much lower discontinuation rates, and more positive personal relational effects. Moreover, it carries a success-rate of 97% use effectiveness and 98% method effectiveness. WHO, “A Prospective Multicenter Trial of the Ovulation Method of Natural Family Planning, IV: The Outcome of Pregnancy,” Fertility and Sterility 41 (1984): 573. See also Griese, Catholic Identity in Health Care, 89, 397. It is true that NFP has some apparent drawbacks in that it requires periodic abstinence and the fostering of self-control. In all other areas of life, everyone must practice restraint. However, NFP is ethically and morally acceptable to all religions and in all cultures. See Moloney, and Rebard, “Theory and Practice of Proscribing Sterilization,” 19-25. Even in secular circles it is well accepted. For example, in the December 1991 issue of the American Journal of Obstetrics and Gynecology, John T. Queenan, M.D. et. al., state that “NFP [Natural Family Planning] is an important topic. . . . It is generally accepted that new hormonal or surgical methods of contraception will not be available in the next decade and that the need for the nonhormonal, noninvasive methods is well documented.” It is not my intention to write about the advantages of NFP. Yet, I would like to note that besides medical and social advantages, psychologically and spiritually it brings peace of mind and peace of conscience.
[cvii]Second Vatican Council, Gaudium et spes (Pastoral Constitution on the Church in the Modern World, Dec. 7, 1965), no. 51, AAS 58 (1966): 1072-1073; Paul VI, Humanae vitae, no. 24, AAS 60 (1968): 498; John Paul II, Evangelium vitae, nos. 88, 97, AAS 87 (1995): 500-501, 511-512; John Paul II, Familiaris consortio (Apostolic Exhortation Regarding the Role of the Christian Family in the Modern World, Nov. 22, 1981), no. 32, AAS 74 (1982): 118-120; PCPA, Charter for Health Care Workers, nos. 17-20. The Second Vatican Council Fathers also recalled the pastoral advice of St. Paul (ICor 7: 5) to abstain from sexual relations for a time.
[cviii]In the original it is scattered in three different paragraphs. “Es bleibt ein himmelweiter Unterschied zwischen der Kenntnis und Benutzung der Periode leiblicher Unfruchtbarkeit durch die Gatten, und der eigenmächtig eingreifenden Fruchtbarkeitsbeschränkung durch empfängnisverhütende Mittel.
Vielen erscheint der Unterschied klein. Und klein mag er dort sein, wo der Mensch sich als das sich selbst erfindende und manipulierende Wesen, als homo technicus versteht. Wo sollten diesem denn überhaupt Grenzen gesetzt sein in der liebelosen Verplannung seiner selbst?
Aber wer christlich denkt, für den bleibt der Unterschied groß.” Hans Urs von Balthasar, “Ein Wort zu “Humanae Vitae,” in Neue klarstellungen (Johannes Verlag, Einsiedeln, 1979), 127.
[cix]NCCB, “ERD for Catholic Health Care Services,” 458.
[cx]Ashley and O'Rourke, Health Care Ethics, 271.
[cxi]Brennan, “Quick Sands of Compromise,” 14. Pope Pius XII already in the forties foresaw that the young people, engaged as well as married couples will use every possible argument - medical, eugenic, social, moral, - “to induce and pressure the doctor to give a decision or to lend his aid in favour of following the instincts of nature while at the same time depriving the life-generating force of the possibility of attaining its goal” and that a doctor can only resist this pressure if he is firmly convinced “that the Creator Himself, for the good of the human race, has indissolubly bound up the voluntary use of those natural energies with their intrinsic purpose . . . a bond which can never lawfully be loosed or broken.” “To the Italian Medical-biological Union of ‘St. Luke’,” 52-53.
[cxii]PCPA, Charter for Health Care Workers, no. 20. The words of Bp. Glennon P. Flavian in his pastoral letter on “Artificial Contraception, Catholic Couples and Catholic Physicians,” 3, shows the responsibility of the physician. “Dear Catholic physicians, . . . you are called by God to witness to the Catholic Faith which you profess. As members of a noble profession, you are in a position to be God’s instruments in manifesting His truth and His love. This you can do by dissuading your patients from the practice of sinful contraception and by introducing to them the moral methods of Natural Family Planning. Then you will be the objects of God’s promise: ‘The person who brings a sinner back from his way will save his soul from death and cancel a multitude of sins’ (Jas. 5, 20). Thus, you will contribute to the spiritual welfare of your patients; and, like the Divine Physician, you will care for the whole person - body and soul.”
[cxiii]“Let them also consider as their proper professional duty the task of acquiring all the knowledge needed in this delicate sector, so as to be able to give to those married persons who consult them wise counsel and health direction, such as they have a right to expect.” Paul VI, Humanae vitae, no. 27, AAS 60 (1968): 500-501. Two modern and well-tested methods in NFP are the ovulation or Billings method and the sympto-thermal method. Dr. Kevin Hume says that these methods open up “new vista for physicians whose professional minds have been occupied over the last three decades with the suppression of fertility by drugs and devices and the ‘quick fix’ of sterilization.” Kevin Hume, “Book-review: The Scientific Foundations of

the Ovulation Method by Thomas W. Hilgers,” Linacre Quarterly 64 (1997): 50. See also Thomas W. Hilgers, “The Ovulation Method: Ten Years of Research,” Linacre Quarterly 45 (1978): 383-387.
[cxiv]“The ecclesial community [doctors, experts, etc.] at the present time must take on the task of instilling conviction and offering practical help to those who wish to live out their parenthood in a truly responsible way.” John Paul II, Familiaris consortio, no. 35, AAS 74 (1982): 125.