January 18, 2019 (LifeSiteNews) — The Congregation for the Doctrine of the Faith published earlier this month its Response to a number of dubia (“doubts”) concerning the removal of a woman's uterus. Its very controversial text deems hysterectomy to be morally acceptable when that organ is “no longer” capable of carrying an unborn child up to the point of viability because, according to the CDF, such an operation “does not regard sterilization.” A more apt translation of the Italian text would read “because it is not sterilization.”
The Response was signed December 10, 2018, by the prefect of the Congregation for the Doctrine of the Faith, Cardinal Luis Ladaria, and approved by Pope Francis, who ordered it to be published, thus making it part of the Magisterium to which Catholics “owe religious submission of will and intellect.” It is not, however, infallible.
The text is very problematic because it adopts a visibly different solution to a former Response of the CDF in 1993 in not unrelated cases, and even more so because it in fact rests on skewed definitions of the words “procreation” and “sterilization.” It recalls that in the 1993 Response – which it clearly reaffirms – hysterectomy was declared acceptable “when there is a grave and present danger to the life or health of the mother” but “illicit” when the objective is to “make impossible an eventual pregnancy which can pose some risk for the mother” – even death, in fact – because the first intention of the act is sterilization.
The 2018 Response presents itself as dealing with a very different situation. It reads as follows:
Question: 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)?
Response: Yes, because it does not regard sterilization.”
It is accompanied by an illustrative note mentioning “Some extreme cases.” “Here it is not a question of difficulty, or of risks of greater or lesser importance, but of a couple for which it is not possible to procreate.”
On those grounds, it proclaims:
“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. The objective of the procreative process is to bring a baby into the world, but here the birth of a living fetus is not biologically possible. Therefore, we are not dealing with a defective, or risky, functioning of the reproductive organs, but we are faced here with a situation in which the natural end of bringing a living child into the world is not attainable.”
This is strange reasoning indeed, insofar as the removal of the uterus is well and truly performed in order to “impede the functioning of the reproductive organs,” precisely because they are still capable of hosting conception (and of allowing the unborn child to live for a time at least). Deliberately preventing that from happening in itself constitutes sterilization.
The way the CDF gets around this obstacle is by a saying the “malice of sterilization consists in the refusal of children” – that is, children who are brought into the world by birth and then brought up by their parents. This is presented as “the objective of the procreative process.” In the absence of a perspective of giving birth to a “viable” child, capable of remaining alive outside the womb, this “procreative process” is considered not to exist.
The Illustrative Note accompanying the Response confirms this when it says:
“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. Removing a reproductive organ incapable of bringing a pregnancy to term should not therefore be qualified as direct sterilization, which is and remains intrinsically illicit as an end and as a means.”
The classic definition of procreation is here destroyed by a stroke of the pen. “Engendering” or “begetting” a new human being means allowing it to come into existence through the encounter of the male and the female reproductive cells that once united, become a unique and irreplaceable human being endowed with an immortal soul. Intentionally preventing conception through contraceptive means or by sterilization is contrary to divine law, it is this prevention that constitutes the evil of refusing life – of refusing procreation whose objective, from the Catholic point of view, is to increase the numbers of the elect: procreating human beings who are called to become saints in heaven.
The recent Response, if read logically, appears to consider a conceived child who is not viable as not being the fruit of the true procreation, as if it did not have intrinsic human dignity and as if it were not called to enjoy immortal life. It is especially disturbing in the new context created by the international theological commission saying infants who die without baptism can, through the effect of God’s mercy, enter into the kingdom of heaven.
At the same time, the Response suggests that there are other solutions:
“Furthermore, the response to the question does not state that the decision to undergo a hysterectomy is always the best one, but that only in the above-mentioned conditions is such a decision morally licit, without, therefore, excluding other options (for example, recourse to infertile periods or total abstinence). It is the decision of the spouses, in dialogue with doctors and their spiritual guide, to choose the path to follow, applying the general criteria of the gradualness of medical intervention to their case and to their circumstances.”
This is another case of presenting a correct solution – “recourse to infertile periods or total abstinence” – together with an unacceptable one, as if they were so many “options” open to couples with regard to their personal problems, principles giving way to situation ethics.
Whatever the reasons behind this Response, its implications give cause for concern. For instance, if it is correct, why should spouses who cannot hope to give birth to a viable child be expected not to contracept? Why should it not at some point be licit to eliminate a nonviable fetus?
According to Dr. Philip Schepens MD, member of the Pontifical Academy for Life from 1995 to 2017, member of its Board until 2004 and Secretary-General of the World Federation of Doctors who respect Human Life, and currently a member of the board of the John-Paul II Academy of Life and Family, the Response of the CDF on hysterectomy is “is unnecessary and at the same time unnecessarily creates confusion.”
Having approved our reasoning above, he added these comments:
“The doctrine of the Church is clear regarding sterilization: that which directly impedes fertilization during sexual intercourse or renders the reproductive organs, both male and female, improper for reproduction, violates the divine commandment: ‘Be fertile and multiply.’”
Hysterectomy can be licit in some cases though, Schepens explained: “On the other hand, a procedure, surgical or otherwise, that renders procreation impossible, but that is carried out with the primary objective of fighting an illness in that person, is permissible provided that it is not sterilization that sought after, but healing that illness. If the procedure has the effect of sterilizing, as a secondary, non-sought after effect, it is morally permissible, according to the ‘double effect’ doctrine.”
As a medical doctor, Schepens went on to clarify: “Miscarriage, just like sterility, is not an illness but can be the consequence of one or more illnesses. Among those most often affecting women, we can mention uterine cancer or cervical cancer, the presence of benign myoma of the uterus and endometriosis. Concerning the two last-mentioned illnesses, a complication that often requires hysterectomy is metrorrhagia, that is, heavy bleeding that can happen at any moment and that in the long run can have very adverse consequences for the health and even the life of the woman. Not a single gynecologist, Catholic or otherwise, would refuse hysterectomy in that case, if other less burdensome solutions are incapable of restoring health.”
Dr. Schepens also quoted incompetence of the cervix as a possible cause of repeated miscarriages: in this case, as the fetus grows, it weighs upon the cervix that cannot resist and lets the fetus leave the womb. He said many techniques exist to remedy this condition that “hardly ever requires hysterectomy or sterilization.”
“Sterilization by ligature of the Fallopian tubes in order preventively to avoid miscarriage is in my opinion as a doctor never permissible, because ‘always’ and ‘never’ do not exist in medicine, and a woman cannot be held responsible for an unwanted miscarriage. In the case of serious endometriosis – and I personally know of more than one case – certain women have ended up by giving birth to a normal child, having gone through miscarriages before and sometimes after that event. This risk can lead to couple to decide to resort to birth regulation by natural methods (NFP)”, he added.
Schepens also recalled that from the moment of conception, the human zygote exists as an individual organism, distinct from its two parents: “Its very early stage of development takes nothing away from its biologically demonstrable status of a human being, distinct from all others,” he explained.
Jeanne Smits is a member of the John Paul II Academy for Human Life and Family.