Father John A. Hardon, S.J. Archives

Abortion & Euthanasia

Contraception and Sterilization

by Fr. John A. Hardon, S.J.

In his famous encyclical of 1968, Humanae Vitae, Pope Paul VI reaffirmed the historic Catholic teaching that each and every act of sexual intercourse must remain open to the transmission of life. Birth control by means of the “rhythm method,” i.e., abstinence from sexual intercourse during the fertile period, is morally permissible. But every other form of contraception and sterilization is always forbidden.

Pope Paul said: “These acts, by which husband and wife are united in chaste intimacy, and by means of which human life is transmitted, are, as the council recalled, ‘noble and worthy,’ and they do not cease to be lawful if, for causes independent of the will of husband and wife, they are foreseen to be infecund, since they always remain ordained toward expressing and consolidating their union. In fact, as experience bears witness, not every conjugal act is followed by a new life. God has wisely disposed natural laws and rhythms of fecundity which, of themselves, cause a separation in the succession of births. Nonetheless the church, calling men back to the observance of the norms of the natural law, as interpreted by their constant doctrine, teaches that each and every marriage act must remain open to the transmissions of life.” [1]

Therefore the pope condemns as absolutely illicit “direct sterilization, whether perpetual or temporary, whether of the man or of the woman” and every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible.” [2]

For a long time Catholic moral theologians have tried earnestly to defend these conclusions, but in recent years they have found them increasingly difficult to sustain. Contemporary moral analysis is still divided. But today, I think it is fair to say, a clear and decisive majority of Catholic moralists no longer support the traditional doctrine.

The new consensus does not deny that there is an essential connection between the procreative and love-union aspects of sexual intercourse. If affirms that these two aspects must be maintained in principle. Sexual intercourse is not only lovemaking; it is also life-giving. God’s creative love is mirrored in human procreative loving. As God’s love is creative—He created nothing apart from His love—so we create new beings like ourselves in the midst of our love for one another. Sexual love is a special kind of love, the kind that is creative of new human life. To separate in principle the lovemaking and life-giving aspects of sexual intercourse is to refuse the image of God’s creative love in human procreative loving.

What this means is that sexual intercourse has an essential relationship to parenthood. But it does not mean that each individual act must be open to the transmission of life. The link between sex and parenthood is to be maintained. But is not to be maintained blindly, with the decision of whether or not to procreate new life left entirely in the hands of chance or divine providence. Human parents must make responsible rational decisions about the number and spacing of their children. There may have been a time in human history when quantitative reproduction of the species was the paramount value, but that is no longer the case. Today quantitative reproduction is seen as a disvalue in our overpopulated world. The quality of life is not he most important consideration.

In the early sixties Catholic moralists began to question the Church’s condemnation of oral contraceptives. Their analysis of the morality of the use of the pill forced them to enlarge their inquiry to include every form or method of contraception. The majority conclusion at the end of the sixties was that the method used for contraception was morally irrelevant. In ethical terms it does not matter what method or technique is used for birth control. All that matters is that the link between human sexual love and parenthood not be broken in principle and that the practical decision about the number and spacing of children be made unselfishly and with responsible concern for the quality of engendered human life.

Linked with this new ethical analysis of contraception, and in some measure a result of it, was new theology of dissent which was developed by Catholic ecclesiologists. Post-Vatican I ecclesiology held that no one might licitly disagree with an authoritative decision of the ordinary papal magisterium except an expert in the field who had uncovered some new evidence in his research- and even the expert was only to suspend his judgment while he secretly brought the new evidence to the attention of the Holy See. Contemporary ecclesiology affirms the right of any person to dissent from noninfallible decisions of the Church when he has sufficient reason for doing so.

There can be many good reasons why people should practice birth control. Respect for human life means respect for the quality of human life and not just its quantitative reproduction. Responsible parenthood means more than generous procreation. It also means the feeding, clothing, housing, and education of children. In our society at least a high school education is necessary if a person is to live with any dignity, and it is quite reasonable for parents to want to provide a college education for their sons and daughters. To fulfill the duties consequent upon procreation, parents must spend a large amount of money.

The physical health of the mother is often a important consideration in deciding responsibility for or against another pregnancy. The nervous state and mental health of the contemporary housewife have become increasingly important. Add the strains of modern life to the strain of raising children today and you will understand why there are women on every block who are nervous wrecks and many who have already been hospitalized for nervous breakdowns.

There is also the larger problem of overpopulation. Many competent demographers and economists predict that within a few centuries the human race will be facing disaster. This prediction is challenged y other experts who think that the food problem can be solved by the use of fertilizers, by tripling the present area of arable land, by making food through photosynthesis of algae, and, most importantly, by solving the real problem, which is not production but distribution nof food. But even if the more optimistic experts are correct—and they may not be—even if technological man can prevent a demographic disaster for a number of centuries, the fact remains that large numbers of people in many areas of the world are already suffering from starvation and overcrowding and that without birth control now, human lives will continue to be dehumanized.

Methods of Controlling Birth

A simple and common method of avoiding pregnancy without any mechanical devices or chemicals in the technique of Onan, coitus interruptus or withdrawal. Before ejaculation the man withdraws his penis from the vagina. There are a number of problems with this method: intercourse before orgasm cannot be relaxed; it is frustrating for the man to withdraw at the very moment when his natural impulse is to drive his penis deeply into the vagina; the woman often does not reach orgasm; and, since timing is so important the method is not always effective. The first few drops of ejaculate contain most of the spermatozoa; the secretion of the Cowper’s glands sometimes contains sperm; and because some of the sperm is left in the urethra after ejaculation, reunion then would be dangerous. Withdrawal is considered to be between 92 percent and 60 percent effective in preventing conception, depending on the carefulness and timing of the man.

Another method is condomistic intercourse. A condom or “rubber” is a cone-shaped bag made of rubber or sheep’s intestine. It is about 1 ½ inches in diameter and about 7 ½ inches long. If it does not have a small pocket at the end to catch and hold the semen, the user should leave about a half-inch loose at the end to prevent breakage. The user should also check if for holes before use either by blowing in it or, preferably, by filling it with water. About seven hundred and fifty million condoms are produced each year in the United States. They are used more frequently in nonmaterial intercourse and are very effective in the prevention of venereal disease. The condom does not dull pleasure appreciably unless it is coated with too much lubrication. There is always some danger of its breaking in use or slipping off, or of semen trickling out after the penis has become soft. In general, the condom is considered to be about 89 percent effective in preventing conception.

There are two main types of contraceptive pessaries, the cervical cap and the diaphragm. The cervical cap is a metal, rubber, or plastic cap that fits over the cervix and blocks the entrance of sperm into the uterus. It must be fitted by a physician and is kept in place partly by suction. It is generally used together with spermicidal creams and jellies. Since rubber caps can be worn for only twenty-four hours, most cervical caps are made of plastic; these can remain in place throughout the time between menstrual periods. They are used more commonly in Europe than in the United States. They are difficult for the woman to insert and remove, and when they are left in place, they sometimes have a tendency to migrate. They are about 96 percent to 90 percent effective.

The diaphragm is one of the most popular contraceptive devices in use today. Many women are returning to its use because of the scare about the pill or because of their own bad experience with the pill. The diaphragm is a piece of rubber stretched over a collapsible metal ring. It is inserted in the vagina so as to occlude the mouth of the uterus. It should be used together with spermicidal creams or jellies. It must be fitted the first time by a physician; after that the woman can learn to insert and remove it herself. It is inserted immediately or several hours before intercourse and may not be removed until about six hours afterward. It may be left in place for as long as twenty-four hours. When used with spermicidal chemicals it is about 96 percent to 90 percent effective.

Another very effective instrument is the intrauterine contraceptive device (IUCD). This is a small loop. Spiral, bow, or ring made out of plastic (or sometimes metal). It is inserted into the uterus and left there. A thin string attached to it hands down through the vagina so that the woman can occasionally check to see if it is still in place. How, precisely, it prevents pregnancy is not entirely clear. Some few medical authorities think it causes peristalsis of the Fallopian tubes, so that the released ovum travels through the tubes and uterus too quickly to be fertilized. What appears to be the case is that it interferes with nidation. In some way it renders the complex process of implantation impossible; hence its effect is contraimplantation rather than contraception. Although it sometimes causes bleeding and pain and sometimes is rejected by the uterus, it is so simple, cheap, and effective that Dr. Alan Guttmacher predicts that it will be the most important contraceptive for the immediate, foreseeable future. It is rated between 99 percent and 97 percent effective.

Spermicidal chemicals are also used. They generally come in the form of cream, jellies, and foams. Vaginal suppositories that melt after about fifteen minutes or vaginal tablets that dissolve in moisture may also be used. These chemicals must be inserted into the vagina from five to fifteen minutes before ejaculation occurs. They are considered to be between 95 percent and 73 percent effective. The new foams in aerosol spray cans can easily be spread all around the vagina and are between 97 percent and 90 percent effective.

Vaginal douches are relatively ineffectual and are rated only about 64 percent effective. The vagina is flushed out after intercourse with plain water or with a solution such as vinegar, soapsuds, or alum. Other devices sometimes used—such as sponges, tampons, or balls of cotton treated with spermicides—are also relatively ineffective. Their rating is about 73 percent to 68 percent.

The most effective means of contraception is sterilization. The male can be sterilized by a simple surgical operation performed under local anesthesia in the physician’s office. The operation is called a vasectomy. An incision is made on both sides of the scrotum above the testicles, an inch of the vas deferens is excised, and the two ends are tied. Since no more sperm can be carried to the seminal vesicles and those already present will die after a short time, fertility will come to an end after several days. After the operation the patient is not incapacitated, but should avoid strenuous work or exercise for about two days. If the operation is done skillfully, spontaneous recanalization rarely takes place. The man normally suffers no impotency or decrease of sexual desire. Two hundred thousand vasectomies are performed each year in the United States, and the procedure should become more widespread as some of the myths that surround it are laid to rest. If for some reason a man regrets his decision, it is sometimes possible to repair the vasectomy. Today there is about 50 percent chance of success in an attempt to restore fertility through surgical recanalization of the tubes.

Castration, the surgical removal of the testicles, is a more drastic method of sterilization. It often results in changes in secondary sex characteristics, which, however, can be controlled by hormone therapy. It does not necessarily result in impotence if it is performed on an adult. But if one’s only purpose is sterilization, a vasectomy is the preferred technique.

Surgical sterilization of the female is a more complicated procedure. There are a number of techniques currently in use. An oophorectomy is the surgical excision of both ovaries. After the ovaries have been removed, no more ova will be produced, and hormone therapy is sometimes needed to prevent changes in secondary sex characteristics. A salpingectomy is a surgical operation in which the Fallopian tubes are cut, tied, and resectioned. It is easily done and is often recommended by doctors during a Caesarean section. The operation is considered about 99 percent effective or better in preventing pregnancy. It is possible to attempt to rejoin the tubes so as to restore fertility, but the operation is risky and the chance of success is small. Work is presently in progress on a simpler technique in which metal or plastic clamps are attached to the tubes by way of a small incision in the vagina.

A technique which is used frequently in Japan and which probably will receive more attention in the United States is intrauterine coagulation of the uterine tube outlet. The openings of the tubes into the uterus are electrically cauterized, and the resulting scar tissue permanently blocks the tubular orifices.

A hysterectomy, i.e., the surgical removal of the uterus, is generally performed through the vagina. It is seldom performed solely for the purpose of sterilization.

Birth control pills are probably best classified as sterilizing drugs, since sterilization is their primary effect, although they also seem to work as contraceptives and abortifacients. The pills are a combination of synthetic hormones (progesterone and estrogen) which has three effects: (1) it inhibits the production of pituitary gonadotropin and so inhibits the growth and development of the ovarian follicles (sterilization); (2) it affects the mucous lining of the uterus so as to make implantation more difficult and early spontaneous abortion more likely if contraception does take place (abortion); and (3) it causes the mucous plug of the cervix to thicken so as to keep sperm from entering the uterus (contraception).

A woman starts taking the pills on the fifth day after the first day of menstruation. She takes one each day, preferably at the same hour, for twenty days. Menstruation will usually occur two to five days after the last pill is taken. Five days after the menstruation begins, she starts the cycle of pills again, and so on until she no longer wished to be infertile. If menstruation does not occur after she has taken the twenty pills, she simply begins taking them again after seven days. When taken according to instructions, oral contraceptives are practically 100 percent effective in preventing pregnancy.

The pill, of course, is often prescribed for therapeutic purposes other than the suppression of fertility—for instance, as a remedy for premenstrual tension, excessive bleeding, an irregular menstrual cycle, and certain skin disorders.

Another method of controlling birth is to abstain from sexual intercourse during the female’s fertile days of the month. This is known as the safe period or rhythm method. A woman generally ovulates about once a month. The ovum lives for about twenty-four hours after ovulation, and the sperm can live in the uterus for about forty-eight hours. Therefore conception is possible only during three days of the month.

Ovulation is generally believed to take place fourteen to sixteen days before menstruation. Therefore to determine the time of ovulation, a woman must count back from the first day of her next anticipated menstruation. By counting back sixteen days she arrives at the earliest time of ovulation, and by counting back fourteen days she arrives at the latest time of ovulation. If she has a twenty-eight day menstrual cycle, she will ovulate between the thirteenth menstrual cycle, she will ovulate between the thirteenth and fifteenth day after the first day of her period. Allowing for the life span of the ovum and the sperm, she should abstain from coitus from the eleventh to the seventeenth days after the first day of her last menstruation.

If a woman has an irregular menstrual cycle, she should keep written records of the time of menstruation for one year in order to determine the earliest and the latest time of menstruation. For instance, if her cycle varies between twenty-four and twenty-eight days, by counting back sixteen from the earliest time of the next menstruation and fourteen from the latest time of the next menstruation, she can determine the earliest time of ovulation (eight days after the first day of the last period) and the latest time of ovulation (fifteen days after the first day of the last period.). Adding time for the viability of the sperm and egg, she can determine that conception will be possible between the sixth and seventeenth days after the beginning of her menstrual period.

Aside from the emotional or psychological difficulties that sometimes result from abstinence during the fertile or unsafe period, there are also some technical problems with this method. Certain emotions, such as fear or joy, can postpone or hasten ovulation. After childbirth the first few months are frequently too irregular for any safe period to be calculated, and during menopause the menstrual cycle is generally too irregular to permit reliable calculations of fertile periods. About 15 percent of all women have cycles too irregular for the use of this method.

Another method of determining the time of ovulation is by measurement of basal temperature, or lowest normal body temperature of the day. At the time of ovulation or one or two days after there is a dip in temperature and then a sharp rise of1/2 to 7/10 of a degree; the temperature remains at this higher level until one or two days before the beginning of the next period. Since the ovum lives only for one or two days, after this rise in temperature no conception is possible for the rest of that cycle. A woman should keep a record of her temperature in the morning for about six months in order to determine any peculiarities. One of the problems with this method is that other factors, such as a cold, can also cause a rise in temperature and so confuse the pattern. Further, it is possible for more than one ovum to mature during a cycle.

Because of the polemics that have surrounded the question of rhythm or periodic continence as the “Catholic” method of birth control, it is difficult to ascertain how effective it really is. Some authorities rate it as 86 percent effective; others make higher claims. Contemporary research no doubt will increase its effectiveness. Recently Prof. Jacques Ferin of the Belgian University of Louvain announced that thanks to technical progress, doctors are very close to being able to predict with certainty the day on which a woman could conceive during her menstrual cycle. [3] Dr. Mary S. Calderone has said: “Stop apologizing for the rhythm method. We have a tendency to . . . list all of the medical methods, and then say, with a shrug, ‘and the rhythm method.’ Well, we should know the facts about it: it is very effective…. You’re going to have failures with practically any method, but you are certainly going to have failures with the rhythm method, not because it is not effective, but because the restrictions it places on people make it rate low in acceptability.” [4]

For the record we might note another method known as Carezza, or as it is called in most of the moral literature, amplexus reservatus. This is the prolongation of coitus, even for hours, without male ejaculation. It does not seem to have gained much popularity.

The Theological Argument

The argument made against contraception by Pope Paul VI in Humanae Vitae is the same as that made in the recent past by theologians like Josef Fuchs, of course, changed his opinion during the study and discussions of the papal birth control commission and he expressed his revised opinion in the majority report.

The principal ethical argument against contraception is based on an analysis of the act of sexual intercourse as an expression of a love relationship which is totally self-giving and procreative in character. Fuchs developed the argument in this way: “The Creator so arranged the sexual act that it is simultaneously both per se generative and per se expressive of intimate oblative love. He has so arranged it that procreation would take place from an act intimately expressive of conjugal love and that this act expressive of conjugal love would tend toward procreation. Therefore an act which of itself does not appear to be apt for procreation is by this very fact shown to be one which does not conform to the intentions of the Creator. The same thing should be said about an act which of itself is not apt for the expression of oblative love. Indeed, an act which is not apt for procreation is by this very fact shown to be one which is of itself not apt for the expression of conjugal love; for the sexual act is one.” [5]

This is the same argument that found its way into Humanae Vitae, in which Pope Paul wrote: “That teaching often set forth by the magisterium is founded upon the inseparable connection, established by God and unable to be broken by man on is own initiative, between the unitive and procreative meanings, both of which are present in the conjugal act. For by this intimate structure, the conjugal act, while most closely uniting husband and wife, also capacitates them for the generation of new life, according to laws inscribed in the very being of man and woman. By safeguarding both of these essential aspects, the unitive and the procreative, the use of marriage preserves in its fullness the sense of true mutual love and its ordination to man’s exalted calling to parenthood.” [6]

Both the strength and the weakness of this argument are pointed up in the approach of Paul Ramsey. Ramsey affirms that sexual intercourse is at the same time an act of love and a procreative act. By this he does not mean that it always in fact nourishes love and engenders a child, but that it tends of its own nature toward strengthening of love (the unitive good) and engendering of children (the procreative good). This affirmation is not based on natural law in the sense of the mere fact and function of biological life, but on the Christian story of creation which appears not in the book of Genesis but in the Prologue to the Gospel of John and in Ephesians 5. Here we see that God created the entire world of his creatures out of love: God’s love was creative and he created nothing apart from his love. Human love is made in the image of God’s love. Human love reflects God’s love because it is procreative. We procreate new beings like ourselves in the midst of our love for one another. In this there is a trace of the original mystery by which God created the world because of his love. Therefore, God’s love is normative for Christian love. Hence a couple may not “procreate from beyond their marriage, or exercise love’s one-flesh unity outside of it.” [7]

Note Ramsey’s conclusion. He argues that man may not radically put asunder what God has joined together. But God made human love procreative. Therefore, Ramsey concludes not that contraception is illicit (that is what the pope concludes), but that artificial insemination and fornication are illicit, since by artificial insemination one procreates beyond the sphere of mutual love, and by fornication one loves beyond the sphere of responsible procreation. But by contraception the spheres of love and procreation are not separated, even though the act as unitive and procreative is divided.

The Catholic thesis, however, wants to conclude more from the premises. It wants to conclude that each act is unitive and procreative by God’s design. Speaking of the separability of these two aspects of coitus as it has been defended by non-Catholics, Fuchs has argued: “They do not sufficiently grasp that the Creator united this double aspect. The sexual faculty has but one natural actuation in which the generative and oblative aspects specify each other.” Others have contended that contraceptive interference cannot be viewed as a merely biological intervention. Rather, they argued, contraception does not permit the act to be procreative and therefore it does not permit the act to be expressive of personal love, either because it expresses some restriction itself-donation or because the permanent sign of this love, the child, is excluded. In other words, the marital act is essentially an act of procreative love. This is the act as given to us by God. If the married couple are to use it properly, they must allow the act to retain both of these essential characteristics.

In the past few years many theologians have found this analysis difficult to sustain. It is not easy to see why it is not sufficient to conclude, as Ramsey does, that the unitive and procreative goods may not be separated in principle but that separation is possible in an individual act. There are many acts of coitus that are in fact sterile and yet are expressive of personal love.

The central affirmation of Humanae Vitae is that because each marriage act must remain open to the transmission of life, every act of contraceptive intercourse is morally evil. It is fair to say that on the level of ethical analysis this affirmation remains unproven.

Papal teaching on this matter is not infallible doctrine. It is authentic noninfallible doctrine. It demands serious consideration and respect. But it does not exclude the possibility of error or rule out legitimate dissent.

Honesty in one’s effort to come to a conscientious conclusion about contraception requires that one place under careful scrutiny one’s own attitude toward ecclesiastical and magisterial authority. It is certainly bad theological methodology to go from the conclusion that the immorality of contraception is not infallibly taught to the presumption that it is therefore erroneous. One does not start with this presumption about authentic noninfallible teaching, but rather with the opposite.

Nonetheless, it is not easy to understand how the Holy Father could get the necessary certitude and clarity for the argument from reason. It is true that we must be wary, especially in moral matters, of the kind of rationalism that expects too much certitude from human reason, but neither can we assume that the pope receives his knowledge in some magical way.

A model of respectful dissent has been given by Richard McCormick. In his “Notes on Moral Theology” he concludes: “In the light of these reflections it is the opinion of the compositor of these Notes that the intrinsic immorality of every contraceptive act remains a teaching subject to solid and positive doubt. This is not to say that this teaching of Humanae Vitae is certainly erroneous. It is only to say that there are very strong objections that can be urged against it and very little evidence that will sustain it. One draws this conclusion reluctantly and with no small measure of personal anguish. With proper allowance made for one’s own shortcomings, pride, and resistance, what more can a theologian say? He can say, of course, that the teaching is clear and certain simply because the papal magisterium had said so. But ultimately such an assertion must rest on the supposition that the clarity and certainty of a conclusion of natural-law morality are independent of objective evidence.” [8]

Sterilization

A great many priests and lay people no longer have any problems of conscience about artificial birth control. They have decided that papal teaching on contraception is either erroneous or at least solidly doubtful, and they are supported in their judgment by the common dissent of contemporary Catholic theologians. But frequently they do not have the same security or clarity of conscience on the question of sterilization.

Perhaps the reason for their hesitation here is that this specific question has not undergone the same kind of public debate and widespread airing in the media. Or perhaps the reason is that many priests are not so clear themselves on this issue. In seminary textbooks sterilization is not treated together with contraception. It is treated as a separate question in a separate section of the manuals. Contraception is treated under the sixth commandment as a sexual sin, whereas sterilization is treated under the fifth commandment as a sin of bodily mutilation.

The evil of sterilization, according to this argument, is that it is an unlawful mutilation of our bodies, since it involves the suppression of the function of a very important bodily faculty, the faculty by which we procreate new life. In all cases other than sterilization, mutilation is permitted if it is in accord with the principle of totality. That is to say, mutilation is permissible if done for the good of the whole body. For instance, an amputation is moral only if it is done for the total health of the individual. Since an arm or a leg is given by God for the good of the whole body, it may be sacrificed only for the good of the whole body.

The same reasoning, however, could not e applied to sterilization, the moralists argued, because unlike all other faculties and members of the human body, the sexual faculty is not given to us by God merely for the good of the whole body or individual person. The sexual faculty is given for the good of the species and so is not subordinated to the total good of the species and so is not subordinated to the total good of any individual. The sexual faculty has a wider finality: it is ordered to the good of the human race.

When this traditional argument against sterilization was pressed, however, the real reason for opposition to the act was disclosed. The question was raised: If the sexual faculty is for the good of the species, may it be surgically excised or may its function be suppressed when necessary for the good of the species, for instance, in a population crisis? The response was negative. The reasoning: The sexual faculty is not for the good of the species in the sense that it is in any way subordinated to the common good or the good of society; rather, it is directly subordinated to God himself, the author of life.

Thus it became clear that the real objection to sterilization was the same as the objection to contraception in general. It interferes with the procreative purpose of sexual intercourse. Its fundamental evil is not that it is mutilation—if it were, it could be justified by the principle of totality. Its fundamental evil is that it is contraceptive mutilation. Hence, even if it is necessary for the total good or health of the individual, it is still intrinsically evil and therefore may not be willed, intended, or directly performed for any reason.

According to these principles only indirect sterilization is allowable. It would be morally permissible, for instance, to remove a cancerous uterus, even though sterilization would be a necessary but unintended consequence. But it is always forbidden to perform any surgical operation for the purpose of sterilization for any reason, even to protect the life or health of an individual or to safeguard any other important value. A good end never justifies an evil means. This is the theology contained in Humanae Vitae, in previous papal statements, and even in the American bishops’ recent Ethical and Religious Directives for Catholic Health Facilities.

Contemporary moral analysis has found this thinking too narrow. [9] Sterilization that represents a rejection in principle of the relationship between human sexuality and parenthood is judged immoral. So is any form of contraception which would do the same thing. But sterilization done to protect some important value, for instance, one’s health, marriage, or the quality of human life, is morally evaluated in the same way as contraception in general.

This means that in contemporary ethical thinking there is no essential moral difference between sterilization and other methods of birth control. Sterilization is contraceptive mutilation. Insofar as it is contraceptive, it is governed by the same principles of contraception. So long as it does not negate in principle the connection between sex and parenthood, it is permissible for a proportionate reason.

There are, however, some very important practical differences between sterilization and other contraceptive practices. One is the relative permanence of sterilization. In our swiftly changing world permanent decisions are risky. A young couple ought to be rather cautious when thinking about sterilization. Because of the current publicity vasectomies are fashionable now. But being fashionable now could prove later to be a grave and often irreparable mistake for a young married couple.

Many couples do not realize that there are other means of contraception which are generally as effective as sterilization and do not entail any irreversible decision. For instance, the use of a diaphragm, together with spermicidal foam sprayed over the vagina from an aerosol can, is about 96 percent effective. Also, the birth-control pill, properly used, is just as effective a means of preventing conception as a vasectomy.

As older couple, however, might reasonably make a different decision. Should they choose to terminate altogether and finally their reproductive capacity, their decision could more easily be considered prudent. This aspect of the issue should be carefully weighed in any individual decision.

There are two other practical considerations that might be mentioned. One is that because of its permanence a vasectomy or tubal ligation undergone before a marriage with the purpose of excluding all children would attack the bonum prolis in such a way as to affect the canonical validity of the marriage. The other practical consideration is the reported psychological effect that a vasectomy may have on a man. It is not easy to get accurate information about this, but it seems that at least in some cases a vasectomized man experiences a loss of his sense of male identity or masculinity. As far as I can tell this is not a usual result, but since it might occur, it should be at least a minor consideration in an individual’s effort to come to a practical decision.

Voluntary sterilization, of course, is an issue quite separate from involuntary sterilization. A more difficult question arises concerning the mentally retarded.

A young girl in a mental institution may be so mentally deficient as to be completely unable to understand or cope with pregnancy. Yet unless she is kept in isolation and under constant surveillance, there is a great likelihood that she will become pregnant.

Sterilization in this case would be justified by the principle of totality. It would be for the total good of the person that her reproductive capacity be ended. Since she could not give informed consent to sterilization, her parents or guardians would have to give it for her.

Some important cautions are needed here. Some retarded children are not so mentally deficient that they could not be loving parents capable of providing for and educating their children. Their life style might never attain the standards of middle-class suburbia. But that does not mean that the state or anyone else may deprive them of their right and ability to have children of their own.

No one should be sterilized involuntarily for the good of society, the taxpayers, or the hospital staff. An individual should be sterilized only if it is in his own interest and for his own good. Someone else will have to make this judgement for a child, and he or she will have to be extremely cautious in order to insure that it is being made honestly.

Copyright © 1999 Inter Mirifica