The Congregation for the Doctrine of the Faith published Thursday a response clarifying that a hysterectomy is a licit act when a woman's womb is not suited for procreation and medical experts are certain an eventual pregnancy will bring about a spontaneous abortion before viability.

The CDF's Response to a question on the liceity of a hysterectomy in certain cases was published Jan. 3. It was signed Dec. 10, 2018, by Cardinal Luis F. Ladaria Ferrer, S.J., prefect, and Archbishop Giacomo Morandi, secretary of the congregation.

The CDF said its response regards "situations in which procreation is no longer possible," and it completes responses, "which retain all of their validity," given in 1993 to questions proposed concerning "uterine isolation" and related matters.

The 1993 responses stated that hysterectomy is licit when there is a grave and present danger to the life or health of the mother (because it is chosen for therapeutic reasons; its aim is to curtail a serious present danger such as hemorrhage which cannot be stopped by other means), but that hysterectomy and tubal ligation are illicit when they are intended to make impossible an eventual pregnancy which can pose some risk for the mother (because they are direct sterilization).

In an illustrative note accompanying its response, the CDF said the question at hand is different from the cases of direct sterilization discussed in the 1993 responses because of "the certainty reached by medical experts that in the case of a pregnancy, it would be spontaneously interrupted before the fetus arrives at a state of viability."

"Here it is not a question of difficulty, or of risks of greater or lesser importance, but of a couple for which it is not possible to procreate," the CDF wrote.

The congregation wrote that the "object of sterilization is to impede the functioning of the reproductive organs, and the malice of sterilization consists in the refusal of children: it is an act against the bonum prolis."

By contrast, in this case "it is known that the reproductive organs are not capable of protecting a conceived child up to viability," or that the reproductive organs "are not capable of fulfilling their natural procreative function."

"The objective of the procreative process," the CDF said, "is to bring a baby into the world, but here the birth of a living fetus is not biologically possible."

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"Therefore, we are not dealing with a defective, or risky, functioning of the reproductive organs, but we are faced here with a situation in which the natural end of bringing a living child into the world is not attainable."

In such a case a hysterectomy "should not be judged as being against procreation, because we find ourselves within an objective context in which neither procreation, nor as a consequence, an anti-procreative action, are possible. Removing a reproductive organ incapable of bringing a pregnancy to term should not therefore be qualified as direct sterilization, which is and remains intrinsically illicit as an end and as a means."

The CDF noted that whether a pregnancy could continue to viability is a medical question, and that morally, "one must ask if the highest degree of certainty that medicine can reach has been reached."

The congregation added that its response "does not state that the decision to undergo a hysterectomy is always the best one, but that only in the above-mentioned conditions is such a decision morally licit, without, therefore, excluding other options (for example, recourse to infertile periods or total abstinence)."

"It is the decision of the spouses, in dialogue with doctors and their spiritual guide, to choose the path to follow, applying the general criteria of the gradualness of medical intervention to their case and to their circumstances."

The response also noted that it had been approved by Pope Francis, who ordered its publication.