The newly published preparatory document for the rapidly approaching synod on “Pastoral Challenges of the Family in the Context of Evangelization” observes that “knowledge of conciliar and post-conciliar documents on … the family … seems to be rather wanting.” Church teachings regarding marriage, sexuality, and family “do not seem to have taken a foothold in the faithful’s mentality,” and generally, “many Christians … are found to be unaware of the very existence of” Church teaching on the family.
The documents from the magisterium of Pius XII, Paul VI, and Saint John Paul II that address the gift of human sexuality within marriage seem to have little impact on the majority of the lay faithful. Even less is the awareness of the Church’s clear teaching regarding sterilization for therapeutic purposes—when such procedures are sought in order to secure the health of a woman. The vast majority of Catholics are unaware that the Church has succinctly addressed whether procedures such as a hysterectomy or tubal ligation can be done to secure health.
In 1975 and again in 1993 the Congregation for the Doctrine of the Faith (CDF) responded directly to questions about such medical interventions in two brief documents that were ordered and approved by Pius XII and John Paul II, respectively. The former was a response to questions posed by the Bishops of North America concerning use of such procedures in Catholic hospitals.
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Both documents emphasize the difference between direct sterilization and indirect sterilization as articulated by Pius XII and Paul VI. Direct sterilization is a sterilization that “of itself” and “of its own nature and condition, has the sole immediate effect of rendering the generative faculty incapable of procreation.” With direct sterilization, sterility is chosen either as an end (sterility is the goal) or as a means (sterility is sought to bring about another goal, i.e. the health of a woman). Direct sterilization is “absolutely forbidden” in Catholic institutions, because it is not “oriented to the integral good of the person.” Catholics should never choose a sterilization procedure that is “direct.” To do so freely and knowingly is a mortal sin.
Indirect sterilization, on the other hand, is licit because it “has a directly therapeutic character.” Indirect sterilization addresses a present pathological condition in which part of the reproductive system is “seriously injured” and poses an “immediate serious threat to the life or health of the mother.” A typical case, addressed by the CDF, is when the uterus itself is seriously injured. In such a case, a hysterectomy may be chosen even though permanent sterility is a foreseen but undesired consequence. Sterility is tolerated as resulting from a healing act that is directly therapeutic. It is important to note that the woman’s life is not saved as a result of becoming sterile. Sterility is not the aim or solution; rather, it is an indirect and unfortunate consequence of the medical procedure that directly preserves health.
But what if part of the reproductive system does not itself present a risk but rather a future pregnancy poses a significant risk to the health of the mother? Often in such a situation medical practitioners recommend a hysterectomy or tubal ligation. Can a woman follow this recommendation to prevent a future pregnancy and in order to secure her health? The CDF answers plainly, “Negative,” explaining that in this case these procedures would not be “properly therapeutic.” Sterility would be the immediate goal of the procedure itself. Risk to her health is reduced because she is made sterile; therefore, a morally problematic means is chosen to secure a good end. This is a direct sterilization, and therefore, it is immoral. In 1975 the CDF described contrary opinions as “dissent” and in 1993 it said such contrary opinions “cannot be regarded as valid and may not be followed.”
An ethical means of securing the health of the woman must be chosen. For example, the careful practice of periodic abstinence (NFP) may be embraced as an act of love for one’s spouse. This will undoubtedly be experienced as a true test of faith, require great trust in God, and demand sacrificial love for one’s spouse.
It is essential that these teachings be communicated to patients accurately and sensitively in order to ensure a couples’ authentic good. This should happen within what Pope Francis has described as a “culture of encounter” and while always remembering “the ethical good of the person … is the highest good.” A woman should not be arbitrarily deprived of a healing procedure that will also induce sterility if there is an immediate serious threat to her. Conversely, she should not be misled: if the potential threat to her health is posed by a future pregnancy, sterilization may not be chosen. To the extent possible, this challenging, yet essential teaching, ought to be proclaimed within the context of the “Gospel of the Family.”