Denver, Colo., Feb 26, 2019 / 15:01 pm
The National Catholic Bioethics Center issued a commentary this month in response to a December Vatican document on the moral liceity of hysterectomies in certain medical situations.
The commentary affirmed what other theologians have observed in recent weeks: that it is difficult to understand what situations the Congregation for the Doctrine of the Faith's hysterectomy guidance intended to address, and that in the often-complex world of speculative bioethics, considering the concrete applications of theoretical reasoning is essential to giving clear and helpful moral guidance.
When the Congregation for the Doctrine of the Faith issued in December a 'responsum' saying that 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, many moral theologians expressed among themselves the need for clarity about the document's purpose.
Considered narrowly and on its face, of course, the CDF response is true: a hysterectomy is not, of itself, illicit.
However, to say that the response's implications are difficult to reconcile with the preceding Magisterium and with moral theology would be an understatement.
The CDF was asked if, "when the uterus is found to be irreversibly in such a state that it is no longer suitable for procreation and medical experts have reached the certainty that an eventual pregnancy will bring about a spontaneous abortion before the fetus is able to arrive at a viable state, is it licit to remove it"?
In its Dec. 10, 2018 response, published Jan. 3, the congregation responded "yes, because it does not regard sterilization." The response bears the signatures of Cardinal Luis F. Ladaria Ferrer, S.J., prefect, and Archbishop Giacomo Morandi, secretary of the congregation.
The National Catholic Bioethics Center wrote that "while the response affirms that removing a uterus that is incapable of carrying a child to viability is not per se a direct sterilization, it does not offer a comprehensive rationale and explanation – including a full and specific medical scenario – under which performing such a hysterectomy would, in practice, be morally legitimate."
The CDF said its response regards "situations in which procreation is no longer possible," and that 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 posed by the womb – e.g., it is chosen for a therapeutic reason, to curtail a serious present danger such as hemorrhage which cannot be stopped by other means.
However, the responses also said that hysterectomy and tubal ligation are illicit when they are intended "to prevent a future possible danger deriving from conception" or to avert "the risks of a possible pregnancy" when the womb is "foreseeably incapable of carrying a future pregnancy to term without danger to the mother," because these are direct sterilization. The NCBC's commentary summarized the 1993 responses as stating that hysterectomy "is not legitimate for the purpose of avoiding potential risks or dangers that would arise only if the woman were to conceive a child."
In an illustrative note accompanying its 2018 response, the CDF said the question it sought to answer 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."
The congregation added 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."
The CDF argued that hysterectomy in the case under recent consideration is different because in the recently considered scenario "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."
Further, the CDF asserted that "The medical procedure 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."
The CDF's response would seem to say in effect that "procreation" has not occurred at the moment of fertilization, nor at any point prior to the possibility of the live birth of a child, and says directly that "the objective of the procreative process is to bring a baby into the world."
By defining procreation as the live birth of a child, the CDF seems to have allowed for a creative appropriation of its own 1975 document Quaecumque sterilizatio, which said that "any sterilization which of itself, that is, of its own nature and condition, has the sole immediate effect of rendering the generative faculty incapable of procreation, is to be considered direct sterilization … Therefore, notwithstanding any subjectively right intention of those whose actions are prompted by the care or prevention of physical or mental illness which is foreseen or feared as a result of pregnancy, such sterilization remains absolutely forbidden according to the doctrine of the Church."
It is unclear that Cardinal Franjo Šeper, who was prefect of the CDF in 1975, intended to say that "any sterilization which of itself, that is, of its own nature and condition, has the sole immediate effect of rendering the generative faculty incapable of protecting a conceived child up to viability, is to be considered direct sterilization."
Yet, as it defines procreation in this way, that is how Cardinal Ladaria's CDF seems to have retroactively read Quaecumque sterilizatio.