Registered Members (so far) of the Advisory Committee with editorial rights: Prof Giuseppe Benagiano (Rome); Prof Mark Joseph Calano (Manila); Dr Luca Badini Confalonieri (London); Prof Roger Burggraeve (Leuven); Prof Ricardo Chica (Cartagena, Bolivia); Ass. Prof Kathryn Lilla Cox (Collegeville); Prof Christine Gudorf (Miami); Prof Jan Jans (Tilburg); Prof Paulachan Kochappilly (Bangalore); Prof Michael Lawler (Creighton); Prof Gerard Loughlin (Durham, UK); Prof Dietmar Mieth (Tübingen); Dr Irina Pollard (Sydney); Dr Christina Richie (Boston); Prof Todd Salzmann (Creighton); Prof Joseph Selling (Louvain); Prof David Stronck (California State University, East Bay); Dr Agneta Sutton (London); Dr John Wijngaards (London). More members are welcome. Share your knowledge, insight and judgment.
The Ethics of Using Contraceptives: State of the Question
Why does sexuality matter so much? The Christian faith is based on love, and one of the commonest expressions of this is through sexuality. It is up to the people of God, single and married, to carry on pursuing the search for truth.”
Jack Dominian
Almost 50 years ago, the Pontifical Commission on Birth Control finally agreed on a report which the Pope had requested concerning whether artificial contraceptives can ever be an ethical choice. After three years of study and deliberations, the commission argued affirmatively. Our purpose is to produce a concise document that reports on whether the judgement of contemporary Christian scholarship has changed since that 1966 report. The Key Question we are trying to answer is:
Is there a consensus among contemporary Christian scholarship that married Christian couples may responsibly use contraceptives for family planning?
Introduction
The Natural Law Argument against Artificial Contraception
The Catholic Church’s official ban on artificial contraception is based on one single argument advanced by Pope Paul VI in his encyclical Humanae Vitae (henceforth HV). The argument starts from the biological fact that a causal link exists between (marital) vaginal sexual intercourse and conception. It then infers from this fact that “each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life” (HV §11). Not doing so would mean going against the biological “laws of conception” created by God: “an act of mutual love which impairs the capacity to transmit life which God the Creator, through specific laws, has built into it, frustrates His design which constitutes the norm of marriage, and contradicts the will of the Author of life” (HV §13). Therefore, the argument goes, the use of artificial contraceptives is always “intrinsically wrong” and cannot even be justified by appeals to the principle of the lesser evil (HV §14).
HV contends that such an argument, based as it is on an interpretation of the biological evidence of human reproduction, is grounded in the “natural law” and therefore, by definition, is accessible to and can be evaluated by all rational people: “We believe that our contemporaries are particularly capable of seeing that this teaching is in harmony with human reason” (HV §12).
Incidentally, this interpretation of the biological evidence which affirms that every act of sexual intercourse must remain open to the possibility of procreation is also the basis for the absolute rejection under any circumstances of the morality of masturbation, homosexual relationships, and in vitro fertilisation, among other things.
Should HV’s interpretation of the biological evidence turn out to be mistaken, the conclusions that have been drawn from it will need to be revised. Accordingly, the report will assess first and foremost the validity of such an interpretation.
The Argument from Authority
In addition, HV does also advance another argument of a different kind. Pope Paul VI stated that the reason he rejected the final report of the Pontifical Commission on Birth Control was because “certain approaches and criteria for a solution to this question had emerged which were at variance with the moral doctrine on marriage constantly taught by the magisterium of the Church” (HV §4). This is a distinctively “intra-Catholic” argument which can only be accepted as valid if the following can be demonstrated:
there has been an uninterrupted “magisterium” in the Catholic Church throughout its history;
whatever has been consistently taught by such a magisterium throughout the centuries is infallible;
the immorality of artificial contraception is an example of just such a teaching which has consistently been taught by an official magisterium throughout church history.
In essence, it is an argument from authority: contraception cannot be morally licit, because previous popes have said it is not. That belief is reiterated later in the encyclical, where Paul VI reminds all Catholic priests that “the pastors of the Church enjoy a special light of the Holy Spirit in teaching the truth. And this, rather than the arguments they put forward, is why you are bound to such obedience” (HV §28).
Such a statement effectively asks the faithful to commit to a moral judgement without the necessary previous stages/conditions of being attentive to the relevant information, being intelligent in understanding its meaning and being rational in evaluating this understanding’s correspondence to reality.
Furthermore, the appeal to a supposed tradition of consistent teaching by church authorities is in tension with the claim that the immorality of artificial contraception is based on the “natural law” of the biology of human reproduction and can therefore be grasped by any rational person, whether or not they are Catholics. The tension results from the potential contradiction between those two “authorities”: on the one hand what the “natural law” evidence from (evolutionary) biology suggests, as we will see, and on the other what a supposedly consistent tradition of Catholic teaching has been saying throughout church history about the meaning and purpose of sexual activity.
The danger here is to regard past teachings by church authorities as correct simply on the basis of whether they have been consistent throughout history, rather than whether the arguments supporting them are sound.
Methodology
In this connection, it is important to underline that, according to the methodology of mainstream Catholic theology which is adopted here, the authority of any tradition within the Catholic Church does not rest simply on the status of the teacher, but on the quality of the evidence (scriptural, historical, and current; and from the data of sense as well as the data of consciousness) adduced.
Ethical or value judgements too need to be based on the relevant evidence. For instance, with regard contraceptives, the moral discernment requires, at the general level, some understanding of the following:
– the (evolutionary) biology of human reproduction;
– the meanings and values that human beings attribute to sexuality, as can be discerned by observing both the past (e.g. evolutionary biology, anthropology, and history) as well as the present (e.g. via large scale sociological surveys);
– the consequences (advantages and disadvantages) of different contraceptive methods.
At a more specific level, the evidence to be considered should ordinarily encompass all the consequences of engaging in unprotected intercourse: including but not limited to their financial, physical, and psychological capacity to raise and educate a child, and so on. Those issues are best determined by the couple in question, with whom the ultimate responsibility of choosing whether and which contraceptives to use resides, as we will see later.
The point of attention here is that because knowledge of both the general and the context-specific evidence is, in principle, open to anybody, so is the resulting moral insight. HV acknowledged as much by stating that the question of contraception pertains to the “natural law” – that is, it can be determined by observing the created order of nature – so that the key arguments in favour or against are accessible to all rational beings. For this reason,
Christians as such, and the people involved in the church’s magisterium as such, have no privileged competency with regard to such questions […]. If one wishes to give moral instructions and teachings concerning such human realities, inasmuch as they are human, one must acquire sufficient competence, receiving information from others who are more competent.
The same criteria of compatibility with the relevant evidence from the created order applies to the appeals to the authority of a supposed Christian tradition of consistent teaching on the topic. Past pronouncements by church authorities and theologians on contraception or on the meaning and purpose of sexuality have to be evaluated on the basis of whether their arguments are still valid. To the extent that – as HV acknowledged – the moral discernment with regard to contraception is a matter of the so-called “natural law,” it is accessible to any person in virtue of their rationality. Therefore, traditional as well as contemporary arguments on the subject must be assessed on the basis of their compatibility with the evidence from the natural sciences, and other relevant disciplines such as psychology and sociology.
SECTION 1
The Meanings and Purposes of Sexual Activity
“[T]he morality of sexual actions is […] to be judged by the true exigencies of the nature of human sexuality.”
The Evidence from Evolutionary Biology
HV argued for the importance of observing nature to understand the meanings and purposes of human sexuality. Since the time it was written, our knowledge of the subject has increased, not the least thanks to studies on evolution and human sexual behaviour.
The sexuality and sexual behaviour of the human species is unique in nature because it is they are controlled not simply by hormones, but by human intentionality, i.e. their reason. Therefore, human beings have endowed sexuality with meanings and indeed values.
Most of the available evidence concerning the meanings and values human beings attribute to sexuality is embedded in the past and present historical record. This is captured by historical as well as sociological and cultural studies focusing on people’s reported understanding and evaluation of their sexuality. Later parts of the report will highlight some key relevant findings from those disciplines.
However, the pre-historical evidence on the evolution of human reproductive biology does highlights biological features that have evolved as a response to uses of sexuality for purposes other than procreation.
The most relevant factor for present purposes has been the ground-breaking expansion among primates – including humans – of the female’s sexual receptivity beyond their fertile periods: “Most mammals are sexually receptive only when fertile, whereas the human female’s potential for sexual arousal and orgasm at all times in the menstrual cycle, is no secret”.
Non-Conceptive Sexual Activity – The Socialization of Sexuality
But sexual pleasure is only one of the purposes of non-conceptive sexual activity. Others have to do with human beings’ deeply relational nature, via an evolutionary process which has been termed the “socialization of sexuality”. The majority of evolutionary biologists agree that
the sexual behaviour of Homo sapiens […] clearly evolved from that of the great apes, and among them, in spite of its conceptive nature, sexuality has already acquired other meanings.
among which one could recognise two distinct types:
(i) exchange sex, in which a female obtains direct non-reproductive benefits, like food, in exchange for sex; and (ii) communication sex, sexual activity, not necessarily copulative, to develop social relationship or to diffuse tension and avoid aggression (Manson et al., 1997).”
Evolutionary biologists also agree that “Extended sexuality is a common mate retention tactic in monogamous primates”. Indeed,
Because we are a socialized species, copulation has a greater significance than just the transmission of the genotype and serves many other functions […]. On the positive side, sexual pleasure is particularly important, so much so that evolutionary pressures have engineered the human female’s escape from dependence on ovulation for sexual satisfaction. Continued sexual receptivity favours pair-bonding, essential for the maintenance of long-term relationships and the raising of offspring. Self-esteem reinforces the sufficiency and security of the human being and for that reasons helps in raising the offspring. On the negative side, sexual behaviour may be used to establish dominance in relationships, express hostility or be used for material gain (it is said that prostitution is the oldest profession in human society). The sociobiological functions of sexuality go far beyond reproduction and pair-bonding. They influence the shaping and linking of groups of individuals into communities and communities into societies, that is, in anthropological terms, the humanization of biological relationships. Procreational sex in becoming recreational sex also becomes the glue of society.
That evolution means that, from the strictly biological viewpoint, human sexuality has as an intrinsic purpose not just procreation, but also non-conception. For human beings, the recreational (and not necessarily procreative) purpose is intrinsic to sex and fulfils essential sociobiological functions. Indeed,
human sexuality began to lose its exclusive reproductive meaning very early in the evolution of the genus Homo and, with a concealed ovulation and a female accessible to the male during the entire menstrual cycle, the need became that of avoiding, rather than seeking conception during intercourse.
As it has been noted, “contraception is not a human invention; rather pregnancy-avoidance mimics our extraordinary evolutionary heritage”.
Nature, then, shows how Homo sapiens is among very few species in which sexual behaviour is engaged in for purposes beyond the merely reproductive one. Humans have attributed to such a distinctive sexual behaviour meanings and values beyond those pertaining to passing on their genotype: “Early human societies throughout the world understood this and developed many ways of thoughtfully preventing unwanted conceptions.”
Finally, developmental biology shows that “human sexuality begins to unfold early in [the biological] development [of children], well before reproduction is possible”.
The Relationship between Sex and Procreation
Humanae Vitae’s Interpretation of the Evidence from the Biology of Human Reproduction
The heart of the argument of HV is a particular interpretation of the biological evidence concerning the relationship between sex and procreation. HV observes that the biological relationship which exists between sex and procreation is statistical, direct and causal. It then goes on to interpret this fact as implying that “each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life”. Its key affirmations are as follows:
The fact is, as experience shows, that new life is not the result of each and every act of sexual intercourse. God has wisely ordered laws of nature and the incidence of fertility in such a way that successive births are already naturally spaced through the inherent operation of these laws. The Church, nevertheless, in urging men to the observance of the precepts of the natural law, which it interprets by its constant doctrine, teaches that each and every marital act must of necessity retain its intrinsic relationship to the procreation of human life.
[This] is based on the inseparable connection, established by God, which man on his own initiative may not break, between the unitive significance and the procreative significance which are both inherent to the marriage act.
The reason is that the fundamental nature of the marriage act, while uniting husband and wife in the closest intimacy, also renders them capable of generating new life—and this as a result of laws written into the actual nature of man and of woman.
The Evidence from the Biology of Human Reproduction
Women are infertile for around 22 days a month; before menstruation and after menopause; and while pregnant or lactating (see Appendix). Statistically, then, conception is the exception and not the rule for intercourse. Moreover, we now know that even after insemination/conception there is a relatively high percentage of embryo wastage prior to implantation:
human fecundity rate; that is, the probability of achieving a clinically recognized pregnancy within any given menstrual cycle, is about 25% and high levels of fertilization failure or early developmental death, are the norm. This high attrition rate is due to abnormalities in the gametes and faulty development, leading to embryo death prior to implantation.
[H]umans are unique in the very high frequency of chromosome abnormalities and consequent early embryo wastage. [T]he natural in utero selection process […] eliminates 95% of chromosomally unbalanced conceptions.
In total, “as few as 30% of all human conceptions survive to birth, with a large majority of these failures lost in the very early stages of pregnancy.” In other words, from the biological or “natural” point of view, the relationships between insemination, conception, implantation and successful pregnancy to term are statistical, and in such a way that the final outcome – live birth, as the successful outcome of “procreation” – is the exception, not the rule.
A final point is that the “rhythm” method of family planning recommended by HV appears to carry increased risks of serious congenital anomalies.
Interpreting the Biological Evidence on the Relationship between Sex and Procreation
Accordingly, HV’s affirmation that those biological processes somehow “signify” an “inseparable connection” between the “unitive” and “procreative” significance of conjugal intercourse is unwarranted on two levels: 1) with regard to its interpretation of the biological facts, and 2) with regard to its understanding of the role of humans in the created order.
[1] As noted in the previous section, the “natural law” as can be glanced from the (evolutionary) biology of human reproduction shows that sexual intercourse has only a statistical relation to conception and procreation:
While the Encyclical acknowledges the “unitive sense” of marital intercourse, it claims that inseparable from it there is a “procreative sense.” [O]n contemporary biology, if insemination may be said to be inseparable from normal intercourse, conception cannot be said to be inseparable from insemination. The discharge of two million spermatozoa into the vagina does not mean or intend two million babies. Most of the time it does not mean or intend any babies at all. The relationship of insemination to conception is not the relation of a per se cause to a per se effect. It is a statistical relationship relating a sufficiently long and random series of inseminations with some conceptions.
So there arises the question whether this statistical relationship of insemination to conception is sacrosanct and inviolable. Is it such that no matter what the circumstances, the motives, the needs, any deliberate modification of the statistical relationship must always be prohibited? If one answers affirmatively, he is condemning the rhythm method. If negatively, he permits contraceptives in some cases. Like the diaphragm and the pill, the menstrual chart and the thermometer directly intend to modify the statistical relationship nature places between insemination and conception. [M]arital intercourse of itself, per se, is an expression and sustainer of love with only a statistical relationship to conception.
If anything, “the natural law in this matter would call for a randomness of sexual acts, a principle which would be specifically violated by rhythm”.
[2] HV’s affirmation is further unwarranted because it assumes a mistaken understanding of the role and agency of human beings vis-à-vis the created order. It affirms that human beings are not allowed to do violence to the biological laws themselves by interfering with the intrinsic relationship of intercourse to procreation.
However, this assumes that “biological laws” have a mind and intentionality of their own, which humans’ intentionality must obey without possibility of interfering with them. This “non-intervention” argument, positing a sort of “let nature take its course” principle, is a fundamentally mistaken interpretation of both the created world and of humans’ role in it.
First, the order of creation and its natural laws seem, at their most fundamental level of quantum mechanics, to have an essentially probabilistic basis. At the physical, chemical, and biological levels, the created order is a complex system of cycles of recurrence, all of which – including the most apparently stable – are subject to conditions which all have their probabilities of occurring and perduring. This also applies to the biological laws of human reproduction.
Secondly “just as there are schedules of probability within natural cycles, which set the conditions for other natural occurrences, so natural cycles set conditions for human choices, and human actions, or lack thereof, set conditions for the emergence of natural phenomena.”
As a consequence, and thirdly, “the fact that humans are agents of reason, and therefore have an autonomy that other portions of the created order do not have, means that humans have a unique role in affecting probabilities.” In effect, “[E]ach set of causal relationships [in nature] is subject to a set of probabilities. Human choices and human norms involve choosing how to affect probabilities, not merely choosing not to intervene in natural processes.” For example, any medical intervention generally affects probabilities – of healing, survival, death, etc.
More to the point, for human beings to choose not to intervene in natural processes also affects the latter probabilities, just as choosing to intervene does.
Human beings always “interfere” with natural processes, whether by deciding to “tamper” with them or by “letting nature take its course.”
Given the above, then, “the moral questions are not whether to interrupt nature’s course or not, but which actions are in accord with the meaning of human life and dignity and which contravene these….” For a religious believer,
Doing the right thing involves discerning, with an acceptance of the limitations of one’s foresight, how God might want me/us to affect the future conditions of the world. God’s will, rather than being a matter of conforming to an already established pattern in the world, involves creating patterns as part of a web of conditioning probabilities. The moral task involves not conforming to nature but transforming it.
Therefore,
To the degree that natural law demands that one be attentive to the created order, the moral theologian must take stock of the manifolds of non-intelligent schemes of recurrence that condition human being. Thus knowledge of the natural world—reproductive processes, ecological systems, medical diagnoses—is an imperative for responsible ethics.
Responsible moral discernment, then, will often require
attend[ing] to chemical, biological, and zoological schemes of recurrence as conditioning factors in human existence, both within the human subject and between that subject and her environment, without seeking to derive moral norms directly from these natural processes. It will take as an important task, not defining ways in which persons should conform to nature, but clarifying the values implicit in interventions in nature, and stipulating which transformations are ultimately conducive to human flourishing and which are not.
In conclusion, not only is it impossible to infer simply from the (statistical) relationship between sexual intercourse and conception an absolute judgment of value about the morality of contraception. It is also impossible to argue that, with regard to the specific case of the biological laws of human reproduction, the natural capacity human beings have to influence the essentially statistical basis of the laws of nature should not be exercised.
The Evidence from Psychology and Sociology
The “Global Study of Sexual Attitudes and Behaviors” provides a large amount of empirical evidence about the meaning that people give to sexual activity. One finding among many others:
Sex in companionate relationships [“companionate” marriage is the marriage which “emphasizes equality between intimate partners”, p. 146] tends to value positively sexual competencies, interests, and performance between intimate sex partners. In other words, sex in companionate relationships serves not only reproductive purposes, but also expresses the quality of the relationship.[5]
[What else emerges from recent sociological studies concerning the meanings and values that people (and couple) give to sexuality?]
[Theology section?]
Theologians reflecting on the purposes of sex have also included pleasure, strengthening mutual commitment, etc [unfinished].
The Ethics of Sexual Activity and of Contraceptive Use
It has been noted that sexual activity has a plurality of meanings and outcomes beyond biological reproduction and the transmission of the genotype (3.1). These can be affirmed and celebrated within marriage. Contraception can facilitate the other meanings of sexual activity, such as love, play, comfort, celebration and companionship.
The non-conceptive meanings of sexuality are so important that Paul the apostle advised couples in Corinth thus: “Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer. Then come together again so that Satan will not tempt you because of your lack of self-control” (1 Cor 7:5). In the same vein, Vatican II made the following observation: “where the intimacy of married life is broken off, it is not rare for the faithfulness to be imperiled and its quality of fruitfulness ruined” (GS, §51).
It has also been noted that human beings can and indeed regularly intervene into natural processes (4.3). The latter include the biological processes of human sexuality.
The discernment of when and how to intervene is to be done on a case by case basis by the people involved. However, some general guidelines can be provided. The 1966 Majority Report stated:
It is proper to man (sic), created to the image of God, to use what is given in physical nature in a way that he may develop it to its full significance with a view to the good of the whole person […].
This intervention of man (sic) into physiological processes, an intervention ordained to the essential values of marriage and first of all to the good of children is to be judged according to the fundamental principles and objective criteria of morality.
In a similar vein, but more recently, it has been suggested that the same criteria be used to evaluate the morality of sexual activity as they are used to evaluate the morality of any other human endeavour. Specifically, several conditions or norms have been highlighted for the correctness of sexual activity and relationship: “do no unjust harm, free consent, mutuality, equality, commitment, fruitfulness, and social justice”.
The same can be said with regard to the responsible use of contraceptives. Here the relevant criteria are those for a responsible parenthood:
Let them [husband and wife] thoughtfully take into account both their own welfare and that of their children, those already born and those which the future may bring. For this accounting they need to reckon with both the material and the spiritual conditions of the times as well as of their state in life. Finally, they should consult the interests of the family group, of temporal society, and of the Church herself.
The 1966 Majority Report also stated that “the morality of sexual actions is […] to be judged by the true requirements of the nature of human sexuality”. Given what we know about the non-conceptive purposes of sexuality, this report reiterates the conclusion that “the morality of sexual acts between married people […] does not […] depend upon the direct fecundity of each and every particular act,” but in the context of the “fecundity”, fruitfulness, or generativity of the marital relationship overall. The authors proposed that “the regulation of conception by using means, human and decent, favoring fecundity in the totality of married life and toward the realization of the authentic values of a fruitful matrimonial community” could be beneficial for both the couple and society. When couples choose for themselves if family planning could enhance their relationship as committed Christians, then they would be liberated to serve the world and the Church in other ways. The option for contraception would give “married life its unitive value, and do so in service of its procreative function”.
Procreation is not the only form of “fertility”, “fruitfulness” or “generativity”. Some couples may decide not to have children in order to devote themselves to other worthy endeavours at the service of society and the common good. They do not thereby intend to forfeit the possibility of maintaining sexual intimacy. As Bernard Häring put it:
Love’s fecundity is a reality totally different from biological fertility […]. Conjugal love has a value in itself: Its proper fecundity is in love and for love itself. It enriches not only the spouses but all whom they meet who become sharers of the overflow of their love. Persons who are truly in love become beautiful, intuitive, insightful, attentive, caring, generous and gracious.
The same criteria used for evaluating whether to have a child apply in evaluating whether to use contraceptives. If a couple determines that in their particular circumstances they should not have a baby, then contraception can be a morally licit choice.
Who Decides on the Morality of Contraceptive Use?
If moral insights, especially on matters considered to be of “natural law”, are in principle open to anybody, then the process for reaching a moral judgment on those matters should be open to anybody. It is not the exclusive prerogative of the clergy or the episcopal hierarchy to propose moral insights. The laity, and particularly experts in the relevant disciplines, have an equal right of participation in the deliberative and decision-making processes to reach a formal statement on those matters.
Furthermore, the principle of subsidiarity discourages higher-level authorities making decisions if a lower-level is efficacious. Subsidiarity demands, on the one hand, that
each decisional level (from the individual upward) has an inalienable responsibility to decide and act within its own operational range and, on the other hand, that only those actions which cannot be achieved by the individual or the smaller group alone, can be appropriately achieved through recourse to the higher level of a structured community. It is essential to observe that the divide between what can be decided autonomously and what should be decided by delegation must be determined by the delegating individual or group and not by the higher levels.
For it is only the former who has the responsibility to decide on the appropriateness and extent of the delegation.
The most foundational level of decision-making in contraceptive use are the two parties engaged in intercourse. Only they should decide if, when, and how to use contraception. This applies to any couple, whether or not they are Catholic. With regard to Catholic couples specifically, we can expect the Spirit to guide them in this, and other, matter of life by virtue of their baptismal vows: “The parents themselves and no one else should ultimately make this judgment in the sight of God.”
Again, the choice of contraceptive methods too is the exclusive responsibility of the couple concerned, using the generally accepted criteria for making responsible decision (e.g. no harm to others, potential consequences, etc).
The choice of contraceptive methods should be a matter of conscience for the couple involved. New methods are being researched: for instance, concerning both hormonal and non-hormonal contraceptives for men. In that choice, the usual ethical criteria should be used.
The moral discretion of each couple should determine the use of contraception. Many Catholic theologians concur that contraception is often acceptable, and in some cases it borders on an imperative: e.g. to prevent HIV transmission from one spouse to another, to prevent vertical transmission of HIV from mother to child, or to prevent serious medical, financial or other hardships that a pregnancy would entail for the woman, couple, or family.
SECTION 2
Circumstances Where the Use of Contraceptives Can be Morally Required
It is common knowledge that if one spouse is HIV positive, this virus can easily be transmitted to the other spouse through an act of sexual intercourse. The use of a condom would in this case severely lessen that possibility and could provide protection for the spouse who is not infected. Accordingly, in the case of a couple who has decided to have marital intercourse despite one spouse being HIV positive, the use of condoms is morally better than having unprotected sex.
The Principle of the “Double Effect”
James Keenan, S.J., summarizes the principle of the double effect as having four components:
1. The object of the action must be right or indifferent in itself; it cannot be intrinsically wrong.
2. The wrong effect, though foreseen, cannot be intended.
3. The wrong effect cannot be the means to the right effect.
4. There must be proportionate reason for allowing the wrong effect to occur.[23]
The principle of the double effect can be applied to the use of barrier forms of contraception (condoms, both male and female) to prevent transmission of human immunodeficiency virus [HIV]. We need not assume that condoms would be used by non-married couples, thus simplifying the morally salient features to a matter of life or death for lawfully, sacramentally wedded couples.
James Keenan, S.J., is the most recognizable Catholic writer on the subject of condom use to contain HIV. Along with Jon Fuller, he points out that in the case of HIV serodiscordant couples (i.e. where one partner is infected and the other is not) “the use of a condom can be seen… as a means to prevent the ‘transmission of death’ or ‘potential death to another.’” Using the double effect, condoms lend support to the use of barrier contraception, which also has second and simultaneous effect of preventing conception.
The double effect may also be applied to other cases of deadly sexually transmitted disease like human papillomavirus (HPV), which causes cervical cancer and Ebola, which has an extremely high fatality rate.
The Principle of the “Lesser Evil” (Minus Malum)
The use of barrier forms of contraception can also be accepted under the “lesser evil” (minus malum) principle, in the case of an unmarried HIV serodiscordant couple. While it may be considered wrong that the couple is engaged in conjugal activity, it would be even worse to have pre-marital intercourse and not protect the uninfected partner from HIV transmission. Therefore, the “lesser evil” is to use a condom in unmarried sex, rather than have unmarried sex without a condom and risk HIV infection. The same applies to couples where one of the partners has any other sexually transmittable disease.
The Precedent of Anovulant Drugs and Women Missionaries
Women are at risk for rape in all countries and societies. Statistics show 17.6% of US women have been raped at some time in their lifetime. If a woman were to conceive as a result of the rape, the child would not be born within a stable marriage with two parents who are committed to each other.
Conception from rape is even more complicated when the woman is religiously dedicated and will not marry while continuing her vows. While Catholic teaching emphasizes the need to keep the unitive and procreative aspects of sexual intercourse together, there have also been cases where this is subordinate to the need to protect women from pregnancy.
Aline H. Kalbian recorded that during the 1960’s, in the face of an unwanted and unjust pregnancy, Catholic nuns in the Belgian Congo “were given anovulant drugs by doctors on the missions in order to ward off pregnancy which might otherwise result from rape, which was a constant threat in that chaotic episode.” In this case, Catholics accepted—and provided—contraception as a necessary medical step to prevent possible pregnancy. The dual suppositions that pregnancy can be harmful and that contraception is a necessary preventive measure are highlighted in this case. We might use casuistry to extend the voluntary use of contraception for any woman at risk for pregnancy due to rape, which is, unfortunately, all women.
The Precedent of Contraception for the Mentally Disabled
In 1986, Lisa Cahill examined several articles on sterilization and mental disability in the journal Theological Studies. She points out that Edward Bayer and Marcellino Zalba
advance the argument that the natural (‘intrinsic’) relation of sexual activity to procreation and to the welfare of the species can be deliberately severed when certain circumstances are present in combination: violence and injury (including danger of pregnancy) to the total personal welfare of a woman.
Bayer also focused on sterilization for mentally incompetent women, where a pregnancy and childbirth (or abortion) would constitute an emotionally and physically distressing event for the woman, and where she would be unable to care for the child if born.
While involuntary sterilization for mentally disabled persons is hotly debated in bioethics, there are less drastic forms of very effective, less-invasive, temporary contraception, such as intra-uterine devices (IUDs), which would protect a woman from gestating a child that she could not care for.
Maternal Mortality
Contraception is a basic form of preventive medicine that can save women’s lives. According to the World Health Organization (WHO), approximately 800 women die from preventable causes related to pregnancy and childbirth each day and an estimated 80% of all maternal deaths are traced to severe bleeding, infections, high blood pressure during pregnancy and unsafe abortion. Young women aged 15-19 are at risk for maternal mortality at an average of 52 deaths per 100,000 births. In parts of Sub-Sahara Africa the numbers reach into the hundreds. Furthermore, the United Nations reported that in 2010 there was an average of 210 material deaths per 100,000 live births, with parts of Africa experiencing 500 deaths per 100,000 live births. A woman’s lifetime risk of maternal death is 1 in 3800 in developed countries, compared to 1 in 150 in developing countries (WHO).
Socio-Economic Consequences of the Lack of Access to Artificial Contraceptives
In addition to the increased maternal mortality and morbidity that accompanies lack of access to contraception for spacing purposes in many nations, parental aspirations for children in the contemporary world economy increasingly require longer years of education which is in many nations the responsibility of parents. Larger families divide parental resources into smaller portions, limiting children’s access to education. In addition, since the 1970s worker salaries in most of the world have stagnated or lessened in terms of buying power, requiring more and more married women to work outside the home to support the family, reducing the time and energy that mothers have to expend on children.
SECTION 3 [move to an Appendix?]
The Arguments from Authority: The Appeals to the Bible, to Tradition, and to the Sensus fidelium
As noted earlier, HV contended that its argument was valid on the strength of natural law alone. However, it did also add an argument from authority, asking Catholics to accept the conclusions on the basis of the respect they must show towards of the authority of the pope and the magisterium.
As explained in the methodology section, a decision has been made in this report to focus not on the arguments from authority – which posit that the conclusions must be correct because a so-called Catholic “magisterium”, a constant tradition of teaching, and/or the bible have said so – but rather on the arguments behind those conclusions advanced by any of those sources.
The Evidence from the Bible
It is significant, however, that HV differed notably from the previous papal encyclical on contraception (Casti Connubii) in that it did not adduce any scriptural passage condemning contraception as always and intrinsically evil as another obvious argument from authority in addition to the appeal to the authority of the magisterium.
The reason is that, in the opinion of the majority of exegetes, the bible does not explicitly condemn contraception. Nor does the bible affirm that (conjugal) sex should be for procreation only or – a fortiori – that each sex act should be open to procreation. On the contrary, as we will see, the bible records approvingly several other non-conceptive uses of sexual intercourse.
Traditionally, the main passage that was adduced as condemning contraception is the story of Onan, in Genesis 38:8-10. As it has been noted,
Those who advocate this position usually base their conclusion on two major arguments, one exegetical and one theological.
Exegetically, opponents of the practice of contraception point to the statement that “what he did” (אֲשֶׁר עָשָׂה), not what he possibly intended, was wicked in the Lord’s eyes. Their point is that the only thing the text describes Onan doing is ruining his semen and avoiding conception. To separate motive and relevant circumstances from “what he did,” however, is not exegetically tenable. The general phrase אֲשֶׁר עָשָׂה occurs 191 times in the Old Testament and sometimes assumes a link between the action itself and the motive or circumstance related to it. The same words are used to denote what Ham did in seeing and announcing his father’s nakedness (Gn 9:24), what David did in marrying Bathsheba (2 Sam 11:27), and what Eliashib did in providing lodging for Tobiah (Neh 13:7). The actions themselves, seeing and talking about a naked parent, taking a wife, or showing hospitality to someone, are not morally deficient in themselves, but motives and attendant circumstances in these examples made the actions displeasing to the Lord. And since the motive behind Onan’s actions as well as the deceptive manner of practicing contraception are revealed in the immediate context (verse 9), it is not inappropriate to take this into consideration in defining “what Onan did.”
Moreover,
If scripture condemns contraceptives, we would expect a prohibition in passages that speak about sex and sex relations. For example, Lev 20:10-21 presents a list of specific sexual crimes punishable by death under the Mosaic Code. If coitus interruptus is a sexual abuse, one would expect to see it in this list, but neither it nor any other form of birth control appears.
Theologically, those who equate the sin of Onan with contraception in general see the procreation of children as the primary if not the only legitimate purpose of marital intercourse. While motives might vary, therefore, the activity itself would remain unacceptable.
The theological argument too, however, clashes with many other passages in the bible which suggest meanings and purposes of sexuality other than procreation:
On the basis on passages like Gn 1:28, 9:1, Ps 127 and 128, […] propagation is very much a part of God’s normal purposes for marriage and that children are distinct blessings from God. We would also maintain, however, that passages like Gn 2:18, 24, Ec 9:9, Sol 4:1-7, 5:10-16, 1 Co 7:1-6, and 1 Pe 3:7 also speak to this issue. Companionship, sexual satisfaction, and mutual helpfulness are also purposes in marriage and are legitimate ends in themselves aside from the production of children.
Paul advised the Corinthians thus:
The husband should fulfill his marital duty to his wife, and likewise the wife to her husband. The wife does not have authority over her own body but yields it to her husband. In the same way, the husband does not have authority over his own body but yields it to his wife. Do not deprive each other except perhaps by mutual consent and for a time, so that you may devote yourselves to prayer. Then come together again so that Satan will not tempt you because of your lack of self-control.
The other passage which has sometimes been interpreted as referring to the use of chemical contraceptives is Galatians 5:19. In that list of the “works of the flesh”, Paul mentions the word “pharmakeia”. However, that interpretation is not ordinarily regarded as correct by the majority of scholars.
It is also important to note that the Bible does not contain a single consistent sexual ethic: some books of the Bible uphold polygamy while others reject it. Some biblical authors condemn premarital or extramarital affairs and others show it as being a part of God’s will.
The Argument from Tradition and Authority
One of the arguments advanced by HV was that
The conclusions at which the [Pontifical Commission on Birth Control] arrived could not, nevertheless, be considered by us as definitive… above all because certain criteria of solutions had emerged which departed from the moral teaching on marriage proposed with constant firmness by the teaching authority of the Church.[9]
This affirms that the evaluation of the morality of contraception needs also to take into account the past moral teaching of “the teaching authority of the Church” when such teaching has remained consistent. It is, in effect, saying that the morality of contraception is to be determined (ultimately? primarily?) via an appeal to (past) authority.
This contrasts with the methodology assumed here, which is that the correctness of a moral teaching – whether contained in the bible or in the church’s tradition – should be evaluated exclusively on the basis of a correct understanding of the relevant facts: here, those to do with the purposes of human sexuality and the biology of human reproduction (see §X.Y). This is the more so – and the point is crucial – on something which HV rightly regarded as a matter of “natural law”: namely, as something the determination of whose morality is dependent on a correct grasp of the created evidence. A grasp which, by definition, is accessible to all people – Christians and non-Christians alike – in virtue of their being endowed with reason.
This is not to imply that, for a Christian, scriptural evidence (correctly interpreted) and/or a consistent agreement among Christians in the past cannot provide moral guidance. Rather, it is to say that the moral worth of even scriptural and traditional statements need to be evaluated against whether they were based on a correct understanding of the relevant facts.
But even on its own merits, HV’s argument from authority does not provide sufficient evidence to support its distinctively Roman Catholic ecclesiological assumptions. While it is not the purpose of this report to address them comprehensively, it is useful to spell them out:
1. the antiquity of a tradition or teaching is a guarantee (or at least a strong indication) for its correctness;
2. there has been an uninterrupted “magisterium” in the Catholic Church throughout its history;
3. whatever has been consistently taught by such a magisterium throughout the centuries is infallible;
4. the immorality of artificial contraception is an example of just such a teaching which has consistently been taught by an official magisterium throughout church history.
HV provided no proof to support those tacit assumptions. Several pieces of evidence strongly suggest that they are mistaken.
[1] The length of time a given teaching has been upheld by church authorities (or Christians more generally) is only an indication, not a warranty, of whether or not it is correct.[11] One might well point to historical examples of both magisterium and faithful agreeing on some issues that one side later repudiated. The issues of usury, slavery and freedom of conscience come to mind: the history of the change in their moral evaluation can be found in John Thomas Noonan, Jr., A Church that Can and Cannot Change: The Development of Catholic Moral Teaching (Notre Dame IN: University of Notre Dame, 2005).
The arguments supporting any teaching – whether recent or traditional – also need to be examined. In the specific case of contraception, we see that historically the positions forbidding it as morally illicit were based on a mistaken understanding of the biology of human reproduction, or on an evaluation of sexual activity in general as always sinful unless engaged into for the purposes of procreation.[12]
[2] The understanding of a hierarchical magisterium comprised of bishops and pope is relatively new in the history of Christianity. The NT knows of no such institution; what it does witness to are offices such as those of apostles, teachers, prophets, elders, who taught in the community, as well as institutions such as decision-making assemblies (Acts 15), where among other things doctrinal decisions where taken. Without going into details, suffice to say that some Catholic theologians have observed that
The notion of magisterium is rooted in the promise of the Spirit of truth to the company of believers. The basic proposition of the theology of the magisterium is, in Rahner’s words, that “the Church as a whole cannot fall from eschatological grace—hence from truth as grace either—because she is the concrete presence of the definitive self-assertion of God which has occurred in the God-Man.” The promise of truth, then, primarily concerns “the church as a whole.” The Spirit was not promised only to the hierarchical ministry of the Church. “The body of the faithful as a whole, anointed as they are by the holy One, cannot err in matters of belief.” Neither the magisterium nor the Church is simply hierarchical. Neither theologians nor Church officers may claim with any historical accuracy to be, in an exclusive sense, the magisterium.
[3] The time since the publication of HV has proved wrong the claim that the “teaching authority of the church” (which the encyclical understood – in a rather reductionist way – as consisting of its episcopal hierarchy) has been consistent throughout history in its condemnation of artificial contraception.
There is no need to delve here into the historical evidence concerning Christians understanding and evaluation of contraception. Most of the historical statements by bishops and theologians have been gathered, and they point to a generally negative view contraceptive practices, based on an erroneous understanding of biology as well as, at times, an Augustinian view of sexuality as something degrading and only to be engaged into in the context of marriage and for the purposes of procreation.
What about Christians at large – i.e. the vast majority of the church? After all, both bishops and theologians were ordinarily expected to remain celibate for most of the period under consideration, while it is the laity – and indeed especially laywomen – whose historical discernment and practices on the subject of contraception it would be interesting to recover. This is difficult, given the relative scarcity of the material allowing us to reconstruct the beliefs and practices of common people.
Be that as it may, the question of whether there has been consistency and continuity in belief and teaching on the subject of contraception can be determined without need for delving into the history of clerical statements on the matter.
The Argument from the Sensus Fidelium: Christians Worldwide Are Using Contraceptives
Many Catholic bishops have since the publication of HV spoken out publicly against an absolute ban on contraceptives. The same can be said of many Catholic theologians. This is despite the fact that – with regard to both bishops and especially theologians – the papacy and the Roman Curia have actively discouraged discussion on the topic, and have often acted punitively against theologians and bishops who challenged HV. During the papacies of John Paul II and Benedict XVI candidates to the episcopacy in the RCC were screened for their adherence to HV. Dissenting theologians, on the other hand, risked being formally condemned by the Congregation for the Doctrine of the Faith, losing their jobs, or being silenced.
Most significantly, however, it is the understanding and evaluation on the subject of contraception by Christians at large that demonstrates the lack of continuity and consistency in the tradition. Because while it is difficult to reconstruct the beliefs and practices of past generations of Christians, we do have a much better picture of the period since HV thanks to numerous sociological surveys.
Several recent polls have suggested that the majority of the Catholic Church at large disagrees with the conclusions of that encyclical, both in theory and in practice, as Catholics in most Western countries at least – i.e. those for which we have reliable statistical data – make use of several methods of artificial contraception. This is particularly important from an intra-Catholic perspective, because of the belief that “The entire body of the faithful, anointed as they are by the Holy One, cannot err in matters of belief” (LG §12).
Finally, according to ecumenical dialogues, the other Christian churches are part of the sensus fidelium, and they have mostly rejected HV too.
In conclusion, regardless of the continuity of church teaching and belief of the history up to the first half of the twentieth century, sociological evidence shows that for several decades now the majority of Christians does not believe in (or practices) the old ban on contraceptives: “Forty years of non-acceptance that goes into very considerable detail should suffice to consider a revision” of HV’s ban on artificial contraception.
Conscientious Objection by Catholics to the HV
The currently accepted official position of the Catholic hierarchy enjoins Catholics to grant papal encyclicals a presumption of truth, a “religious submission of will and of mind.”
However, it is also generally accepted that the presumption of truth does not entail the impossibility of examining the teachings being proposed. Indeed, the traditional teaching concerning the primacy of conscience requires Catholics – just like everybody else – to follow their consciences. Therefore, if a woman or man were convinced that the morally right action would include limiting procreation by artificial means, they would be obligated to follow their well-formed and informed conscious to take preventative measures.
Conclusion: The Ethics of Using Contraceptives
The consensus of contemporary Catholic scholarship is that Christian couples may responsibly use contraceptives in certain circumstances.
The moral discretion of each couple should determine the use of contraception. Many Catholic theologians concur that in some cases contraception is acceptable, and in some cases it borders on an imperative [i.e. to prevent HIV transmission from one spouse to another, to prevent the birth of a severely disabled child, to prevent vertical transmission of HIV from mother to child, or to prevent medical or other hardships that a pregnancy would entail for the woman, couple, or family.
Appendix
Women’s Fertility – A Perspective over the Life-Span
Biologically, a woman’s fertile periods are limited. Women are fertile from first menarche to menopause. Most women begin menstruating between the ages of 11-15, with a mean of 13 years old [Tarhane, Sonal, and Arti Kasulkar, “Awareness of adolescent girls regarding menstruation and practices during menstrual cycle,” Panacea Journal of Medical Sciences 5, no. 1 (2015): 29-32.] Menopause has three gradual phases: premenopause, perimenopause, and postmenopause. Although it varies from woman to woman, one study placed women ages 30 and 48 in the premenopausal category, women ages 48 to 59 inclusive as perimenopausal, and woman 60 and older as postmenopausal. (Slemenda, Charles, Christopher Longcope, Munro Peacock, Siu Hui, and C. Conrad Johnston, “Sex steroids, bone mass, and bone loss. A prospective study of pre-, peri-, and postmenopausal women,” Journal of Clinical Investigation 97, no. 1 (1996): 14-21, at 14). Female fertility begins to decline in the 20’s, and sees drops until full menopause. Women rarely become pregnant after 50 and even women 35 and older are considered at lower risk for conception.
Between first menses and menopause women are physically fertile and can potentially become pregnant. However, “during the average woman’s menstrual cycle there are six days when intercourse can result in pregnancy; this ‘fertile window’ comprises the five days before ovulation and the day of ovulation itself.” The average menstrual cycle is 28 days long. (Wilcox, Allen J., David Dunson, and Donna Day Baird, “The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study,” BMJ 321, no. 7271 (2000): 1259-1262, at 1259.)
Women are also unable to conceive during pregnancy and lactation, although rare exceptions occur (World Health Organization, “Infertility Definitions and Terminology,” 2013).
Therefore we see that women have the potential to conceive for approximately 6 out of 28 days, over a period of less than 50 years [in reality, closer to 25 years], minus any time that they are pregnant or lactating.
Statistically, therefore conception is the exception and not the rule for intercourse, given that women are infertile for 22 days a month; before menstruation and after menopause; and while pregnant or lactating.