In the wake of recent discussions surrounding Natural Family Planning, I sat down with Dr Emma Vieira to look at the Catholic Church’s position on birth control, in all forms.
Dr Vieira, thank you so much for agreeing to talk with me on this issue. It is certainly a contentious and controversial one. Let’s start with the Church’s position on contraception. What is contraception?
Very simply, contraception is any act which interferes with conception – that is, fertilisation – as a result of the conjugal act. This can occur before the act itself – for example, the oral contraceptive pill when it inhibits ovulation – or during the act, in the case of barrier methods or withdrawal.
Contraception is to be distinguished from any act or drug which causes the demise of a fertilised ovum or embryo – for example, the copper IUD, which may be inserted up to five days after intercourse and which will cause an early abortion in most cases by interfering with implantation of the fertilised ovum. This also applies to the other mechanisms by which hormonal contraception works – to be discussed later.
What does the Church teach about contraception?
The Church teaches that marriage has two ends:
- Fecundity, that is, procreation – couples have a moral obligation to be open to the transmission of human life in every conjugal act
“Fecundity is a gift, an end of marriage, for conjugal love naturally tends to be fruitful” (CCC 2366)
“Amongst the blessings of marriage, the child holds the first place.” (Pius XI, Casti Connubii)
- Fidelity – the mutual good of the spouses: husband and wife are intended to assist each other in their vocation to sanctity, and the marital act, in both its unitive and procreative aspects, is a reflection of the life-giving love of the Trinity (see The Theology of the Body, St John Paul II). “Man and wife help each other day by day in forming and perfecting themselves in the interior life, so that through their partnership in life they may advance ever more and more in virtue” (Casti Connubii, 23)
Thus, according to both the natural moral law and the Divine order, divorcing the conjugal act from its primary end is evil in and of itself.
“Every action which, whether 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 is intrinsically evil.” (CCC 2370)
This teaching extends to procedures which purposely, and as their primary intention, render either spouse infertile – i.e. vasectomy (male sterilisation) or tubal ligation (“tubes tied”) under any circumstances. This also includes hysterectomy, or removal of the uterus, where the primary purpose is to prevent pregnancy – this is to be distinguished from a hysterectomy for medical reasons, eg. severe bleeding, fibroids, cancer, etc.
The Church has reiterated her teaching on the moral evil of contraception throughout the centuries, most recently and comprehensively in Casti Connubii (Pope Pius XI), Humanae Vitae (Pope St Paul VI) and Theology of the Body (Pope St John Paul II).
Why can’t a Catholic doctor prescribe contraception or refer for sterilisation procedures?
Because it is an act of cooperation, by which the doctor becomes complicit in the sin of the person using them, even if that person does not fully understand the evil of the action itself.
How do commonly used contraceptive methods work?
- Barrier methods – for example, condoms.
- Withdrawal – where the male partner “withdraws” prior to ejaculation.
- Spermicides – which are applied to the genital area and act by destroying sperm.
- Hormonal contraceptives (HC)
- 1. oral
- a. Progestogen-only “mini-pill” (POP)
Inhibits ovulation <50% of the time
Other mechanisms- thickens cervical mucus, impeding sperm movement
- alters endometrium inhospitable to fertilised embryo and can’t implant
- b. Combined oestrogen-progestogen (COCP)
Inhibits ovulation more reliably but still unpredictable
- a. Progestogen-only “mini-pill” (POP)
- 2. other hormonal contraceptives
- 1. oral
- Intra-uterine device (IUD) – copper or progestogen-only
- Implant – progestogen-only
- Depot injections – progestogen-only
Properly speaking, any hormonal contraceptive is really a potential abortifacient, rather than a pure contraceptive, depending upon which mechanism of action predominates at any given time in a particular woman. As discussed, progestogen-only methods and any IUD act primarily in an abortifacient fashion, whereas the COCP more reliably inhibits ovulation.
What about using drugs with contraceptive actions for another purpose? For example, using hormonal contraceptives for medical indications such as endometriosis, acne etc.
A more helpful way of phrasing the question might be – “Is it acceptable to use a hormonal drug to treat a gynaecological condition?”
This is a complex issue.
To the best of my knowledge, the Church has not issued a detailed statement on this particular problem.
The first thing to be said is that none of this applies to women who are not sexually active, so any of these medications can morally be prescribed for such women.
The second thing to be said is that one is obliged to use any and all other means to address the medical problem – eg. surgery in case of endometriosis, antibiotics and topical lotions in case of acne etc. In most cases, these treatment are more beneficial than HCs, and without the numerous other side effects.
In order to explore the issue more fully, we need to understand the principle of double effect – this is probably known to most of you, but I will review it here for clarity…
The definition of the principle of double effect states that it may be morally permissible to perform an act which has at least two effects, one good and one bad. The good effect must be intended, the bad effect(s) must not be intended, but may be foreseen and allowed. There are four conditions which must be verified at the same time for the principle of double effect to be valid:
1. that the action in itself from its very object be good or at least indifferent;
- in this case, the action is the prescription of hormonal drugs – in itself a morally neutral act
2. that the good effect and not the evil effect be intended;
- in this case, the good effect of healing is intended, the evil effect of contraception or even an early abortion is not intended
3. that the good effect be not produced by means of the evil effect;
- in this case, the healing of disease is not due to either the contraceptive or abortifacient effect
4. that there be a proportionately grave reason for permitting the evil effect” (1949, p. 43).
- more about this later, this is the crux of the issue…
There are two main approaches adopted by various theologians, scholars, and medical practitioners on this issue:
1. To take the line of “intention” and apply the principle of double effect
- as we noted above, the prescription of these drugs for medical purposes does fulfil the first three conditions for the principle of double effect to be validly used
- I would argue that if these drugs were pure contraceptives, and one was prescribing them for a serious indication such as severe endometriosis, (AND one had tried every other means of treatment) this could be permissible, using the principle of double effect – one is attempting to fix a serious problem by using a medication which has foreseen and unwished-for but permitted side effects (that is, a contraceptive action)
- Some moral theologians I have spoken to seem to believe that the fourth condition of proportionality is also fulfilled, and take the view that the principle of double effect applies across the board for hormonal contraceptives, regardless of the potentially abortifacient effect
2. The position adopted by other moral theologians is that in the case of the prostogen-only pill, these drugs can never be licitly used due to the high likelihood of an abortifacient side effect, but that the combined oral contraceptive pill may be used in certain serious instances due to the smaller and less certain likelihood of an early abortion.
However, my belief is that the proportionality which is required for the principle of double effect to be validly used, does not exist in this case. In other words, the early abortion which may be caused by a hormonal drug is a grievous side effect which outweighs any potential good. Those who argue the immediately preceding position, I suspect are doing so with the understanding that the potential abortifacient effect of the COC is unknown but probably small. And realistically, this is almost unknowable because you would have to do daily blood tests in every cycle for a woman on the drug in order to know this for certain – even then, the drug may act via different mechanisms at different times in a particular woman, so one could not test for, say 6 months, and be certain that ovulation would remain reliably suppressed. I think this is an understandable position for a moral theologian who is not sitting in the consultation chair, but in my own practice I would rather be able to sleep at night, as I am the one directly responsible for the decision and its consequences.
Dr Emma Vieira is a General Practice registrar who works part-time in family medicine. She graduated from the University of Newcastle in 2007, and has worked in Tamworth, Sydney, and Wagga Wagga. She and her husband, a high-school teacher, have three beautiful little girls. They live and work in rural New South Wales.
This series of articles has also been approved by Rev Dr Peter Murphy – Ph.B., S.T.L., S.T.D. (Philosophy & Moral Theology), and is ‘true blue Catholic’
Originally posted 2015-08-26 12:00:00.