Three Questions About The Principle of Double Effect

Three Questions About The Principle of Double Effect October 4, 2009

The principle of double effect has, through the years, become more prevalent in Catholic discussion because of its application with abortion. The principle is one of morality, where it says one can do a specific action which will have a bad effect, if that bad effect is not intended, if the effect and reason for the action is good (or at least neutral), and if the good intended is proportionately greater than the unintended evil. The actor must not consider the bad effect as a part of the means of the act, but rather, entirely unintended, if not undesirable.

The reason for this principle should be obvious: real moral activity in the world is tricky and often of mixed moral value. While we should always strive to do no evil, indirect, material cooperation of evil is near impossible to overcome. Even if we go into the wilderness and aim to become an ascetic cut off from the world, that very action means we give up our responsibility to the world, and what we fail to do that leads to the increase of evil in the world will be a part of the evil which has come about from our action.

The principle of double effect relates to abortion when dealing with questions such as ectopic pregnancies, where the baby is lodged in a place which would lead to the death of the woman if not removed , or in the case of cancer treatments, where a pregnant woman dying with treatable cancer can take the treatment to save her life, even if the baby will end up killed in the process. In both situations, doctors are allowed to heal the pregnant woman, despite the fact that the child will die. The intention of healing the mother is a good which is seen as proportionate to the bad effect of the death of the child, because if there were no treatment, both the baby and the mother would likely die.

This answer, which has become routine, is understood by most Catholics. It seems natural. And yet, it is of rather recent development.

During the reign of Pope Leo XIII, questions relating to such procedures were given to the Holy Office, and the official reply was that such medical procedures could not be licitly done. As an example, we read in Denzinger 1890c:

[From the reply of the Holy Office to the Dean of the faculty of theology of the University of Marienburg, the 5th of March, 1902]:

To the question: “Whether it is at any time permitted to extract from the womb of the mother ectopic fetuses still immature, where the sixth month after conception has not passed?”

The reply is:

“In the negative, according to the decree of Wednesday, the 4th of May, 1898, by the force of which care must be taken seriously and fittingly, insofar as it can be done, for the life of the fetus and that of the mother; moreover, with respect to time, according to the same decree, the orator is reminded that no acceleration of birth is licit, unless it be performed at the time and according to the methods by which in the ordinary course of events the life of the mother and that of the fetus are considered.”[1]

Any action which would have killed the child in the womb to deal with an ectopic pregnancy was seen, at that time, as a direct action against the child and for this reason, an abortion. While we would now say that the direct action is upon the mother, and the child is indirectly affected, it is easy to see how this could be reasoned out in either direction, and why the question is one of prudence in relation to a very difficulty, indeed, sorrowful situation. The ideal is and should always be to have no death involved. If there is a way to save such embryos in the future, they must be saved. But we do not live in an ideal world, and often the prudential decision might not be apparent to all – some will think only in the ideal (do not kill the fetus) while others will look to the practical situation (heal the woman). Both are right in their desires. Indeed, both are, in their way, the responsibility of the doctors to ensure as best they can. But when they cannot, it has been determined that double effect now allows for a good that would also include an undesired evil; it does not say the evil is not an evil, but dispenses one from the guilt, as long as that evil is not intended.

This leads to three questions which I think we should all consider. Where else could the principle of double effect be seen as applicable in the future? Can it lead into developing further our understanding of practical action in relation to moral theology? Or will it be a dead end, and a principle which must itself be put to question? I have my opinions on these questions, but I would like to hear with others have to say, and see how I can form a better opinion through others.


[1] Henry Denzinger, The Sources of Catholic Dogma. Trans. Roy J. Deferrari (St Louis, MO: B. Herder Book Co., 1957), 475.


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  • Paul

    The Catholic teaching on dealing with ectopic pregnancies was carefully dealt with by Bouscaren, in his 1933 book “Ethics of Ectopic Pregnancies” (written with an Imprimatur). The whole issue needs treating at length, and with great care. When that is all taken into account, the force of the (e.g.) 1898 and 1902 teachings has in fact not changed in the slightest. And current Catholic teaching on dealing with ectopic pregnancies is entirely consistent with previous teachings.

    • Paul,

      Perhaps you could flesh out how the teachings have “not changed.” And while one could try to weasel around in saying “back in the 19th century it was about getting an abortion, but in 20th century it was about medical procedure, so the intent is different” that is not exactly the case.

  • doug

    “Where else could the principle of double effect be seen as applicable in the future? Can it lead into developing further our understanding of practical action in relation to moral theology? Or will it be a dead end, and a principle which must itself be put to question?”

    Two typical examples are palliative care for the dying which might hasten death, and self defense using potentially lethal force. A less direct application is the use of anesthesia in surgery which on occasion results in death.

    I think that there is a broad spectrum of situations where the Principle of Double Effect applies which differ in their moral clarity.

    No one would argue that a joint replacement surgery to restore function is a bad thing. Healing the sick and injured is a good action. But it is known ahead of time that there are risks associated with it. It is entirely foreseeable that a certain percentage of the population will end up with an infected prosthesis and osteomyelitis which can lead to a lifetime of pain, suffering, and disability and can ruin lives. Here the intent is clearly on healing, and the unintended effect is foreseeable when one looks at a large sample, but not necessarily in an individual case.

    As the risk increases, however, the moral picture begins to change. If a hundred percent of patients ended up with an infection, it would be impossible to argue that the Principle of Double Effect remained in force. This is because the intended effect, healing, disappears as the risk increases. As long as there is a substantial benefit to be gained, however, the principle does apply.

    This is different from the case of an ectopic pregnancy, however. The benefit to be gained does not diminish as the risk of a bad outcome increases when treating an ectopic pregnancy, rather the bad effect and the good effect are intimately connected. In this particular case, however, there is no possible way of eliminating the bad effect, the death of the child. This death will occur regardless. It is inevitable. Another way of looking at it is that the procedure hastens the inevitable death. So is it okay to go shoot a terminally ill patient then, and argue that one has merely hastened the inevitable? This brings intentions into the picture.

    Intentions matter as much as effects. Does one intend the death of the child? The procedure brings it about. Does one intend the death in order to save the mother? I think that a physician does not in fact intend that death, but looks upon it as a truly lamentable situation and the procedure hastens one bad effect, the death of the child, but eliminates another bad effect, the death of the mother. There is truly a good action which is intended. This is different from killing the terminally ill, in which there is no good, or only at best a relief from pain which is morally dwarfed by the magnitude of the evil which is brought about.

    So we must weigh effects, both good and bad, and intentions, which must never be bad. This brings us to the question of self defense using lethal force. In this case, intentions and effects are not always clear to bystanders, and possibly mixed within the individual. It is impossible to issue a blanket statement, only to state that it is possible for the principle to apply, and equally possible for it to be abused in that situation. There are no easy answers. Unless it’s a completely clear situation such as a home invasion by multiple intruders on an innocent family with intent to kill and an impossibility of escape, there is room for doubt one way or the other, and so the matter must be approached with substantial caution in each individual situation.

    Some might argue that this in fact invalidates the Principle of Double Effect. I think that it is here that the principle shines the most, because it is entirely one’s state of mind and one’s intentions that end up determining the culpability for an action. It ends up between God and the individual what their culpability is. It therefore is quite instructive in guiding action. If one’s intent is to blow away the other guy, that is grave sin. If the intent is to defend the family in a horrible, lamentable situation and have no other practical course of action, one might perhaps avoid sin.

  • The principle of double effect (or, as I have been calling it, the principle of the lesser of two evils) was developed in the later Scholastic period, primarily by Suarez. To one degree or another, it has application wherever moral doctrine applies.

    I am surprised to learn that its use has become increasingly prevalent in recent years. Going back to the late 1950s, it occupied a central place in consideration of ethical challenges at Jesuit universities. In a real sense, it occupied center stage. One of the things I noticed when I began to participate on the Catholic blog was that its use was almost never present. This made moral considerations to be abstract and, for the most part, irrelevant to what is happening in people’s lives. I detect a strong strain of Indifference.

    The principle of double effect says that it is morally allowable to perform an act that has a a bad effect. For it to be applied, four conditions must be met:

    1) The act to be done must be a good in itself, or at least indifferent. One cannot directly choose to commit an evil act.

    2) The good that is intended must not be obtained by means of the evil effect. The evil effect must be incidental and not the actual factor that brings about the good.

    3) The evil effect must not be intended for itself but only permitted.

    4) There must be a proportionately grave reason for permitting the evil effect. If the good is slight and the evil great, the evil can hardly be called incidental.

    Regarding your query about where else — aside from abortion — the principle can be applied, let me underscore one, namely, the use of condoms in helping to control the spread of the AIDS virus. I recognize that condoms do not constitute a magic bullet that will stop AIDS in its tracks. Cultural factors make this to be impossible, as recent studies have shown. But in many cases, the use of condoms can be of assistance, and when used, they are morally acceptable in accordance with the principle of the lesser of two evils (double effect).

    This is more clearly seen in the case of spouses where one is infected with AIDS and the other is not. The infected party is obligated to protect the other partner, who in turn should be able to take protective measures. Condoms can serve that end and do so within the conditions laid down by double effect.

    Ironically, the use of condoms for preventive purposes raises a related question about whether religious authorities should be the ones that promote the lesser of two evils in this case. The Church needs to be careful that it does not put itself in a position of promoting irresponsible behavior. That would lead to scandal. So it becomes a matter of prudence that the State, not the Church, should take the lead on this issue.

  • “Even if we go into the wilderness and aim to become an ascetic cut off from the world, that very action means we give up our responsibility to the world, and what we fail to do that leads to the increase of evil in the world will be a part of the evil which has come about from our action.”

    This is not true.

    Someone who lives the life of a hermit can contribute very much to the world through prayer.

    Your argument seems to implicitly deny the efficacy of prayer; it is important to remember the spiritual element of human life.

    • Zach

      “What I have done or what I have failed to do.” Many people try to flee the world in order to avoid responsibility. What I have said is in fact very true; look up quietism. It’s exactly the problem of quietism. What I have said does not deny the efficacy of prayer.

      If someone were standing before me choking, I would do the Heimlich. This is not a denial of prayer, either.

  • doug

    The principle of double effect does not apply in the case of AIDS and condoms. The infected person has a grave obligation to abstain from sexual relations.

  • Liam

    Henry

    I would add a clarification about acts vs omissions. Both can be sinful, both can be gravely sinful. But. The consequences of acts are often easier to discern than the consequences of omissions. Thus, consent required for grave sin may be clearer to establish subjectively for acts than many types of omissions. This is something that is often neglected in abstract discussions of this sort.

    • Liam

      I agree it is harder to see acts of omission, but they are there.

  • Yeah, I don’t agree. I don’t think you see my point.

    • Zach,

      Your point is I didn’t believe in prayer, which is not the case.

  • doug
    Actually John Paul II and the then Ratzinger did not bring any charges of erroneous teaching vis a vis an ecclesiastical court against Fr. Karl Rahner, and Fr. Bernard Haring for dissenting publically against the papal position on birth control. That is not to say that they agreed with Rahner and Haring but they knew what both those theologians were thinking..ie that Catholic moral theology manuals (see Grisez/Way of the Lord Jesus/vol,1/page 854) allow for struggled not rash dissent on the not yet clearly infallible. While there were present some theologians during those years that said the position was infallible in the ordinary magisterium so as to be universal ordinary magisterium; there were many others who said it was not yet provably infallible as universal ordinary magisterium. This was debated by some of the principals in “Theological Studies” (Grisez and Ford for infallibility in the universal ordinary and people like Haring against in those pages which are well known). The Popes took no position on the debate but allowing it meant that they know it is unsettled at best. Publically they must say what they think but none of them has ever stated the simple phrase: it is infallibly settled.
    In addition the Washington DC dissenters on this topic were at first punished strictly by their Bishop whose sentence was overturned by Rome itself and the theologians had only to sign a statement that the papal position was “authentic Catholic teaching” which they did because that is not an admission of infallibility. George Weigel lamented the whole incident but it seems he did not know the dogmatic principls at work. I wish he had been so zealous about mentioning the sex abuse period which is invisible in his biography of John Paul II.

    Catholic laity must obey Rome on birth control unless their objections are the result of prayer, counsel, study etc…and in short a struggle that they feel will hold up at their particular judgement right after death. They do not have that option on abortion which is infallibly condemned in section 62 of Evangelium Vitae in a shortened form of the ex cathedra formula but based on a polling of all bishops with the Pope. Abortion is clearly settled infallibly; contraception is not though Grisez, Lio and others give their opinion that it is.

    Theologians had a big part in this dilemna at all because if you read the entire history of the matter, theologians like Augustine and Aquinas and later writers were more involved in this than Popes were as to actual thinking out of the problem. There are 265 Popes and only about 8 who seemed to have written on it at all (check footnote 4 of Humane Vitae and all its references almost are from the last 200 years even though he had used the word “constant”…the death penalty was constant from the canon to 1952 and all that tradition went out the window with no traditionalists mentioning the defenestration whatsoever…why so?)….and most of those 8 Pope were modern and two of those pre modern Popes… Sixtus V and Gregory the Great having said things about the sexual area that were extreme. Strangely Sixtus V who wanted to excommunicate couples who used contraception was the Pope who started the 29 Popes in succession involvement with the sterilization of boys for the papal choirs which was stopped by the 30th Pope in that line…Leo XIII. Sixty years later sterilization was called “mutilation” by Pius XI without his having mentioned that 29 Popes had cooperated in the castrati system without noticing that. Can you see how Rahner and well read theologians might question how universal this magisterium was on the matter?

    I’d like to see Benedict working on the issue with a think tank. I don’t see it. I see him writing another book about the Christ of the gospels which he feels will reform the Church even though only 2 million out of 1 billion people are slated to buy it….2%.
    In short, I wish Rome were as exercised on the matter as you and other sincere and perhaps young people are. Rome should have a think tank working on birth control 24/7 so as to explain it better to the 64% who are not following Rome on it according to the US Bishops’ figures.

  • that should be 94% not 64% at the end of that too long post.

  • doug

    Bill, I think you should go back and re-read paragraphs 4-7 of Humanae Vitae, which addresses the authority of the Church to expound on the issue of contraception. It is an exercise of the ordinary teaching authority of the Church. Paragraphs 53 through 56 of Casti Connubii would also be helpful. Origen, Augustine, and Aquinas all opposed birth control. This link cites the Church Fathers on contraception. http://www.scripturecatholic.com/contraception.html

  • Doug
    Do I sound like I don’t know the tradition? I’ve read nearly all of Augustine and the entire Summa T of Aquinas. Augustine said that men were a better companion to men than women were/ excepting women’s ability to have children and Aquinas literally copied the idea and repeated it twice in the Summa Theologica. I’m just glad that the Boston Globe did not know of the passages in both men during the sex abuse reporting. It would have ended any respect for the Fathers and Aquinas throughout the readership. Hence we had a virgin, Aquinas, giving undo defference to Augustine perhaps based on Augustine’s experience with fornication for over ten years. Jerome also was not a virgin and stated that he got many of his ideas on marriage from Seneca whom he referred to as “our Seneca”. You remember Seneca…a stoic who believed in infanticide. The point is that in the sexual area, the West…not just the Fathers…are suspect as to the general health of thinking on sexuality. Love is not connected to the actual act of sex by the Magisterium until Dietrich von Hildebrand in the 1920’s and then a Pope puts it in Casti Cannubii in 1930. See any problem with that? We see this also in secular figures in the High Renaissance with Leonardo Da Vinci calling sex the “beast with two backs”. Within the Church, sex was concupiscence not an act that was integrally expressive of love….til 1930.

    Let’s go back and read Ludwig Ott on how the ordinary magisterium is not always infallible from his Intro the Fundamentals of Catholic Dogma just prior to section 9:

    ” With regard to the doctrinal teaching of the Church it must be well noted that not all the assertions of the Teaching Authority of the Church on questions of Faith and morals are infallible and consequently irrevocable. Only those are infallible which emanate from General Councils representing the whole episcopate, and the Papal Decisions Ex Cathedra (cf. D 1839). The ordinary and usual form of the Papal teaching activity is not infallible. Further, the decisions of the Roman Congregations (Holy Office, Bible Commission) are not infallible. Nevertheless normally they are to be accepted with an inner assent which is based on the high supernatural authority of the Holy See (assensus internus supernaturalis, assensus religiosus).”

  • David Nickol

    The principle of double effect does not apply in the case of AIDS and condoms. The infected person has a grave obligation to abstain from sexual relations.

    doug,

    You are speaking for yourself here, and not for the Church. The question of whether condoms may be used within marriage to prevent the transmission of AIDS from an infected partner to an uninfected partner is an open question. It seems pretty clear to me that the principle of double effect does indeed apply to condom use, since if the concern is that condoms act as a contraceptive, that is the effect that is foreseen but unintended. The intention would be to prevent disease transmission, not to prevent conception.

    About three years ago, a report was submitted to Pope Benedict XVI by the Pontifical Council for Health Care Ministry. A study had been done involving married couples who used condoms to prevent AIDS transmission. This fairly recent account from Whispers in the Loggia give an idea of where things stand at the moment. It seems obvious to me that the study would not have been done in the first place if the answer to the question were already known.

    The question of whether condom use in some circumstances may be morally acceptable is a separate and more difficult question, Father Faggioni told Catholic News Service.

    Some bishops and cardinals have argued, for example, that a married couple in which one spouse has AIDS may reasonably be expected to use condoms to prevent transmission of the deadly disease. Others have said the church’s teaching against contraception regards married couples and that, because sexual relations outside marriage are already considered immoral, discussion of condom use outside marriage is irrelevant.

    In 2006, Cardinal Javier Lozano Barragan, head of the Pontifical Council for Health Care Ministry, announced that his council had handed in a 200-page study on condoms in AIDS prevention, for further development by the Vatican’s doctrinal congregation.

    The pontifical council’s study, the cardinal said at that time, included “an enormous rainbow” of theological and moral positions, from theologians who expressed “very rigorous” opinions against condom use even when used as a disease-preventing measure to those who held a “very understanding” perspective.

    The hope was that, after additional study, the doctrinal congregation or even Pope Benedict might make a pronouncement on the complex questions.

    But sources told CNS in mid-March that the doctrinal congregation’s action on the report has been quietly put on hold, at least for the moment.

    “You could say officially that it remains under study,” one source said.

  • David,

    Thanks for the comment. I had just noticed Doug’s comment and was about to reply when i saw your response.

  • David Nickol

    Someone who lives the life of a hermit can contribute very much to the world through prayer.

    Your argument seems to implicitly deny the efficacy of prayer; it is important to remember the spiritual element of human life.

    Zach,

    To the best of my knowledge, very little has been written or explained about the efficacy of prayer. How does prayer work? It is not immediately obvious that those who withdraw completely and live as hermits can have a beneficial effect on society by means of their prayers. To say that they can implies to me that they pray to God to intervene, and by their prayers convince God to do something to benefit society that he would not otherwise have done. If God intervenes at all, does he really need to be prompted to do so by the prayer of hermits?

    • David,

      There were many problems with Zach’s response. The first is assuming that one who goes off on one’s own to live the life of a hermit, they are going to engage a life of prayer. The second seems to mistake that those who go off to have a life of prayer will be cut off from the world and inactive save for prayer. The monastic movement, which is what I assume he was thinking of, was quite socially active, and indeed, worked for the creation of a “city” in the desert. The third, of course, is his view is that prayer is necessarily greater work. While it can and is indeed important (I am quite the fan of monasticism proper) it is another to take the route he did; it reminds me of Christian Scientists who explain that they don’t go to doctors because the need for medical help is a lack of faith. Fourth, that is why I do not see prayer and action as unconnected — one prays and acts; the denial of activity and attempt to become inactive save in prayer is indeed the problem of quietism (especially when one sees that the kind of prayer tended to be of mystical union).

  • David Nickol

    It does seem to be the case that until Bouscaren made his arguments regarding ectopic pregnancy in 1933, Catholic medical ethicists argued against medical intervention until the tube ruptured, at which point the pregnant woman’s life was in grave danger, and of course many women died. So if earlier teachings did not change, they were interpreted in a new way that allowed early intervention (removal of the tube which contained the fetus, but not removal of the fetus from the tube) when it had not been permitted before.

    One can say that for all practical purposes, the teachings of the Church changed. Whether the intellectual exercise of reconciling Bouscaren’s interpretations with earlier Vatican statements is a worthwhile endeavor is open to debate.

  • Gerald A. Naus

    Let me quote Vox Nova http://www.patheos.com/blogs/voxnova/2007/05/27/the-moral-dilemma-with-ectopic-pregnancies/
    “The problem is that the only permissible “treatment” for ectopic pregnancies causes further damage to the fallopian tubes, thereby greatly increasing the chances that the woman’s life will be endangered again and future children will be killed due to more ectopic pregnancies. According to the American Academy of Family Physicians
    Previous ectopic pregnancy becomes a more significant risk factor with each successive occurrence. With one previous ectopic pregnancy treated by linear salpingostomy, the recurrence rate ranges from 15 to 20 percent, depending on the integrity of the contralateral tube.1,9 Two previous ectopic pregnancies increase the risk of recurrence to 32 percent, although an intervening intrauterine pregnancy lowers this rate.”

    Simplified, taking the house down with the inhabitant is more destructive than taking the inhabitant out and leaving the house intact. The egg/embryo/fetus is doomed, there is no need to cause further damage by removing the tube/part of it when not necessary.

    The “hierarchy” of treatments seems to be (depending on factors like how far the pregnancy is along)

    – ending the pregnancy via methotrexate (when not too far along)
    – surgery on the fallopian tube (salpingostomy)
    – extraction of the fallopian tube (salpingectomy)

    Any good doctor would go by a least-damage-caused approach. Let me try to look at this from a Christian perspective. There is no need to make a bad situation worse to uphold an “absolute,” that’s just l’art pour l’art. In particular when it impedes/prohibits future “openness to life,” a Catholic mandate. Imo, Jesus employed a purpose (telos) oriented interpretation of laws, rather than a literal one (he wouldn’t be a “strict constructionist”). Heck, healing on the Sabbath could be called “situational ethics.” Strict adherence can pervert the original purpose.

    It certainly seems advisable to stay away from “faithful” American Catholic hospitals in this medical situation, as they may perform the far more dangerous procedure needlessly. How that wouldn’t be malpractice beats me.

  • I’ve been thinking about double-effect for a few months now. I used to hate it, because I didn’t understand it and couldn’t apply it. My mistakes were two-fold:

    1) Confusing motive with intention
    2) Not allowing for side-effects

    With regard to condoms and aids, on point 1 – one’s use of a condom to prevent HIV transmission doesn’t have any relevance on one’s intention to sterilize the sexual act. The intention is displayed by the deliberate choice to put on a condom. One might as well say that an abortionist does not intend to kill a baby because his motive is to protect a woman.

    On point 2 – side-effects have no causal relationship to the good effect. In an ectopic pregnancy, the health of the mother is not caused by the death of the fetus. If the fetus were to be saved by a miraculous transplant into another womb, the mother would still live. In the case of HIV transmission, the ‘prevention’ is caused directly by the sterilization of sex. No sterilization of sex, no prevention. One cannot imagine a scenario where the sex could be made fruitful by using a condom, yet still prevent HIV transmission.

    The root cause of the misapplication of double effect is, I believe, found in the absolute division of mind and body, spirit and flesh, that we see in our technological society. Intent becomes motive, and side-effects are made subjective – it’s all in our heads. If we use a condom, or abort a baby, or shoot a man in the chest, all that matters is that our “heart” is in the right place. It is very hard to realize that this is utterly false to not only truth, but to Jesus Christ.

  • standmickey

    Nate: Very good points, but I do have a question (a question, not an argument): many women use birth control medications to treat conditions unrelated to the actual procreative act, i.e. to regulate menstrual cycles. By the moral reasoning you presented here, would this be illicit?

  • Nate,
    Do you think the Pope erred then in even considering condoms and having his health department head look into it several years ago probably based on an African diocese precedent which allowed their married infected couples to use condoms on the days wherein NFP methods noted those days to be infertile so that the unitive could not be separated from the procreative?
    Did Benedict sin in even being uncertain and open at least then at that time period?

  • Nate
    Here was the sending of trial baloons by Rome in 2006 when Cardinal Barragan stated that his department had a mandate to look into it:
    http://www.foxnews.com/story/0,2933,194173,00.html

  • David Nickol

    Nate,

    To the extent I understand what you are saying, I think you are quite incorrect. It seems clear to me that in applying the principle of double effect, intentions are of paramount importance. The exact same act can be good or evil, based solely on the intentions of the person who performs it.

    What you say about ending an ectopic pregnancy applies also to elective abortion. The mother does not necessarily will the death of the fetus. She just wants to end the pregnancy. If there were a host mother or an artificial womb available, removing a first-trimester fetus from a woman’s womb would not necessitate the death of the fetus.

    The “sterilization of sex” is not necessarily immoral. In Catholic though, it is the intention that counts. Women and men may receive medical treatments that render them temporarily or permanently sterile. (Humanae Vitae: [T]he Church does not consider at all illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result there from—provided such impediment is not directly intended for any motive whatsoever.]

    In the case of a married couple, one of whom is infected with AIDS, they may want with all their hearts to have children. The “sterilization of sex” would not merely be unwilled. It may be contrary to their wishes.

    For some reason, I think many people find the very idea of a condom to be repellent, not for moral reasons, but because they find it disgusting. There is a “yuck factor” that gets in the way of rational moral argument. There is no disgust in the idea of a woman using the pill as a treatment for endometriosis, even though it renders her temporarily sterile, and she need not refrain from sex while she is sterile, but not by intention, from using the pill.

    It also seems to me that for some Catholics, there is an obsession with the form of sexual intercourse, as if intentions did not really count for anything at all.

  • doug

    I am not convinced that the principle of double effect does not apply in the case of condom and AIDS, because a non-problematic solution exists, being abstinence. As long as a viable non-problematic alternative exists, to look for recourse to the principle of double effect is to find poor excuses for sin. We need look no further than the idea of self defense to see that this is the case.

    If one has the means at one’s disposal to escape one’s attacker, yet chooses instead to fatally shoot that person rather than escape, one has committed murder. It is murder because a non-problematic alternative existed, escape. To appeal to the principle of double effect in this case would not be justified.

    Similarly, to argue that condoms are permissible to prevent AIDS rather than utilize sexual abstinence is to ignore the obvious solution while trying to justify a sinful act. The two situations have the same moral and logical structure. The appeal to the principle of double effect should only apply when it is the only means to achieving the morally good outcome. The only case that I can think of where this would apply with condoms and AIDS would be in the case of rape, marital or otherwise, where a woman may justifiably try to persuade the use of a condom as a means of self-defense, assuming she has not consented to the sexual act and is limited to trying to limit the harm it may cause. I’m not sure even that falls under the principle of double effect, as the lack of consent to sin means that the woman is not culpable in any case, and the act is not a marital act.

  • doug

    David:

    You are correct that I don’t speak for the Church; however I do wish to echo what the Church does say. Perhaps a read of what Cardinal Trujillo has to say on the topic can help.

    http://www.vatican.va/roman_curia/pontifical_councils/family/documents/rc_pc_family_doc_20031201_family-values-safe-sex-trujillo_en.html#ChurchCriticism

  • Paul

    It’s clear that Nate understands precisely where the difficulties come from, and how they are resolved.

    As Bouscaren points out in the book that I referred to, the teaching of 1902 has to be taken in the context of the prior teachings of (e.g.) 1889 and 1898. Once that is done, the teachings can be seen to be completely consistent, and unchanged from today.

    • Paul

      You have not made any answers; to say it is unchanged is simply not true. But the thing is, it doesn’t have to be unchanged.

  • Paul

    As to answers, I have provided a reference to a book that describes the Catholic teachings on the permitted ways of dealing with ectopic pregnanices very carefully. Having read it, it is then possible for anyone to decide whether you have represented the teaching accurately.

    • Paul

      That does not help. We can all give books and more books and more books. If you want to discuss the issue, discuss it. Explain your position. Show why YOU say there is no change. The practical change is quite obvious, when one studies the record. You say otherwise. If you want to converse on this, then the best thing is for you to do so. Explain your position as I have said. Don’t just go “read the book” and then think it does anything — among other reasons, people on here might not have easy access to the book, might think the book is out of date, might want more than one reference because one person’s interpretation is not itself validation, etc.

  • David Nickol

    As long as a viable non-problematic alternative exists, to look for recourse to the principle of double effect is to find poor excuses for sin.

    doug,

    To consider lifelong celibacy a “viable non-problematic alternative” in this case seems to me to place a very low value on the unitive aspect of marital sex and also to assume that no married couples would find total abstinence an extreme hardship.

  • doug

    You write: ” because a non-problematic solution exists, being abstinence. As long as a viable non-problematic alternative exists, to look for recourse to the principle of double effect is to find poor excuses for sin.”

    Not according to Saint Paul and the Holy Spirit. In chapter 7 of First Corinthians, Fr. Bernard Haring
    who talked like you and Cardinal Trujillo for decades and defended the papal position trenchantly as a moral theologian before encountering angry Catholic women who were fed up with the unreliable rythmn method and who sent a representative to the birth control commission in the mid 1960’s…Fr. Haring noticed that we were blythly giving the epistle of Paul little attention (who is the Holy Spirit anyway compared to the 8 Popes out of 265 who wrote on this area).

    Haring noticed that Paul talked about marriage to two different groups of unmarrieds: one group needed marriage to avoid fornication (verse 9) and who are not to stay away from sex within marriage lest the devil tempt them except for brief periods of prayer….and the second group did not need marriage to avoid fornication but Paul said the second group could marry and they did not sin thereby (verses 27-28) even though they did not need marriage to avoid fornication.

    It is the second group which is quite capable of abstinence and capable of the Josephite marriage. But how did group one suddenly become capable of it when Revelation from God in their case said they were not even capable of remaining single and avoiding fornication.

    The first group who were very sexualized (like Augustine who later was never alone with women (according to a contemporary) after he repented and became Bishop) the first group obey now the word of God and get married at say 22 years of age to avoid fornication inter alia; are then in a car accident in Paraguay where they get a tainted blood transfusion and HIV; and now suddenly whereas the Holy Spirit told them to marry lest they commit fornication, Cardinal Trujillo is telling them that suddenly they are like the second group and are miraculously no longer in danger of fornication but are indeed capable of the Josephite marriage just like group 2 always was capable of the Josephite marriage which by the way Mary never had since she had no concupiscence according to Aquinas after the Virgin birth. Joseph was old and disappears from the gospel somewhere between Christ being 12 and 30 years of age so he too did not really have a Josephite marriage but our group one person who is 22 year old who got a bad blood transfusion is now supposed to be capable of that marriage according to Cardinal Trujillo or simply have sex as the Cardinal noted and die.
    It is repeated constantly in books on the Vatican Council that Spanish and Italian Bishops were most often on the strict side of authority questions and northern Euro Bishops were not. For those of you who admire the strictness of those two groups, look at their cultures and the cultures one of them has left south of us and ask yourself if they really brought about strict cultures. And I like the singing of Shakira from South America; I just think she does not need the strip teases to augment her voice. From Inquistion to women singing in their underwear on Telemundo is a very natural progression because over strictness is a farce from beginning to end. Mel Gibson was stricter than the Pope on liturgy and now he is in fornication and adultery. Natural progression.

    So group one single people who were told to marry lest they commit fornication and who then obey and marry but get HIV in a bad hospital of the world are now to preserve continence as though they never did have a problem which the Holy Spirit said they had from the beginning. And you are wondering why MIT and Harvard are not teaching this wisdom.

    Were Rome even concerned enough about these people, it would give them a right to separate just as it gives the right to separate in cases of emotional abuse. But no. No word of that. Our very sexualized group one are to remain with their wife and live in close proximity to her and never have relations for the decades to come based on a model of marriage that neither Mary nor Joseph had in reality since the former had no concupiscence and the latter was up in years. And is the Pope working on this problem for these people? I don’t see it. I see each Pope doing what he liked in college. John Paul liked being on stage in college and he managed to do that 17% of his time. Benedict likes to write and likes the academic life in general and he does that and his last encyclical is gone as to the blogs talking of it because no one can summarize what it was about. I’m missing the servant of the servants part somehow.
    Aren’t the couples with HIV…the servants and the Pope is to be their servant which means there should at least be round the clock work on this by theologians with the Pope checking on their progress so as to serve these servants. We should be moving them toward perfectly careful condom use which does prevent transmission in the study that I read or the Pope should be moving them toward separation if they are Paul’s and the Holy Spirit’s group one who married to avoid fornication among other reasons and who were not to stay away from sex except for prayer and briefly….according to God…but who is He next to 8 Popes out of 265 who wrote on this area?

  • Liam

    There’s also a much simpler solution to the silly idea of lifelong abstinence for the married: that is, instead of tackling the big question of whether wearing a condom during conjugal intercourse in such a context was sinful, merely addressing the issue of the gravity of its sinfulness. In pastoral practice, that is what the Church does and has long done (well before the Council, btw, though unevenly). It’s time we were just more transparent about it, rather than getting tripped up in these discussions. I recall a remark by Cardinal Felice in the late 1970s or early 1970s in the context of a joint press conference or interview with Abp Quinn of Boston where Felice underscored this very point (though not limited to the situation of AIDS).

  • Liam

    sorry

    that was Abp Quinn of San Francisco. Confusing my cities by the bay…

  • David, you make a good point in reminding us that intention is important, and that in the case of therapeutic hormone therapy (as standmickey mentioned) an unintended effect is the sterilization of the sexual act. Yet intention is different than motive, for the Pope writes that sterilization may not be “intended for any motive.”

    This is the first and most important point for understanding double-effect, I think – the difference between intention and motive. Intention refers to the interior act of the will – the deliberate choice to act in a certain way. Motive refers to the reasons one has for making that choice.

    You will often see the Church use those words – the deliberate choice, or the deliberate action, in place of “intention”, because so many people confuse intention with motive. Intention is a precise term related to the movement of the will, not to the ultimate goal of one’s behavior. Intention is the choice of means, not the goal of an end.

    So a woman who chooses an abortion with full knowledge and full freedom always intends to kill her baby. Her motive may be noble, but her intention is not. Her goal may be life, but her means is death.

    In hormone treatment, the means is appropriate (medicine) and the end is appropriate (healing), though there is a side-effect of sexual sterilization. We are not normally responsible for side-effects.

    In condoms, the means is not appropriate (sexual sterilization) though the end is appropriate (HIV prevention). One may never use a condom (assuming full knowledge and freedom) without the intention to sterilize sex.

    At least, that’s how I understand it. 🙂

  • Gerald A. Naus

    “I am not convinced that the principle of double effect does not apply in the case of condom and AIDS, because a non-problematic solution exists, being abstinence.”

    Must be nice to view life in such neat, simple manner. Abstinence is especially “non-problematic” in Africa and too many other places where women are property (something the West has ditched, but not all that long ago, just look at how recent a concept spousal rape is).

    Frequently they have their clitoris cut off, which “helps” with the “dry sex” so many African men crave (further aided by the unfortunate women who use concoctions to stay “ultra brut” for the ultra brutes). Close your eyes and think of Somalia – and be barefoot and pregnant until death or infertility. Open to life ! Then those men get to point to Scripture as to how women should obey their husbands. Easy when the Hebrew Scriptures list women, alongside donkeys, as things to be coveted by the neighbor. Not that it’s surprising that such men aren’t coveted.

    Of course, condoms aren’t the solution, and brutes aren’t likely to use them, it’s the culture that must change. In the meantime, they provide some remedy. In an area where even Anglican bishops are ultra-conservative, I wouldn’t put too much hope in religion.

    When a nine year old girl is raped and impregnated (Brazil), and would likely die without an abortion and it’s the doctors and mother who get excommunicated, priorities are indeed peculiar. Of course, thanks to the great pro-life president George W. Bush, she could legally be denied the morning-after-pill even in this charming country, which shares many a feature with African countries (and would be ineligible to join the EU for countless reasons…)

    The heritage remains in the USA (although here it’s largely a Puritan “gift”, that and everyday Catholics have always been more relaxed about sex than many other Christians groups, except for the Protestantized American Catholics), where sex terms are used as curse words (German is more feces-oriented when it comes to cussing), one speaks of “dirty”, “nasty”, “naughty”, “filthy”, “mind in the gutter”, “nightly pollution” and the words for the “naughty bits” are either clinical or crude. One can show heads cut off but not breasts caressed – even the rotting corpses on CSI have said “naughty bits” discretely blown out. An exposed nipple enraged many people more than the Iraq war. It’s always immorality that causes God’s wrath, and by immorality sexual immorality is meant.

    Granted, we have moved on from torture devices for masturbation-prevention (although male genital mutilation is still dominant in the USA – once used as a punishment/preventative measure) and, unlike Augustine’s take, it’s not viewed as worse than incest (the latter, sans condom/pill being “open to life”) but on “your books” it might still issue a one-way-ticket to hell.

  • David Nickol

    Does God grant the “charism of celibacy” not only to priests, but to homosexuals, those who are divorced or separated, and those in marriages where one spouse is HIV+?

  • doug

    What I mean by non-problematic is that it is morally non-problematic. You don’t commit a sin by abstaining. That doesn’t mean it’s not difficult. I fully appreciate the difficulties. I fully understand the unitive function of the marital act. Catholic teaching is that the unitive function and the procreative function are not to be separated. Condoms do just that, no matter why they might be used.

    If we allow condoms utilizing the principle of double effect, then the very same reasoning would allow the use of in vitro fertilization to avoid the bad outcome of a health condition and promote the good of children.

    I had a feeling that eventually someone would get around to wanting to reject the ban on contraception outright. I think that Bill concludes too much from Cardinal Trujillo’s position. I think in the case of a young couple who through no fault of their own were infected with HIV in one partner, he would appreciate that they are subject to strong temptations. A strong temptation may mitigate culpability, but it does not change the nature of an act. In addition, for every person who may find themselves in that situation, you will find a score or more of others who compare their individual situation to it, decide that their desires constitute a sufficiently grave situation, and use the reasoning you have presented as permission to engage in objectively sinful behavior.

    I should know. I was one of them. And we still had three children before I abandoned trying to apply secular reasoning to my religious beliefs. Had I been infected with the AIDS virus, my wife would be dead along with me by now because condoms don’t work. We now have eight children, praise be to God! You see, I am a convert away from the line of thinking that tries to modernize the faith. It is theologically and scientifically unsound to try to do so. Scientifically, because one has to fiddle with the numbers to either deny God or try to change the way he wants us to live. I’ve known many single mothers abandoned by their boyfriends who thought that a condom would allow them to avoid pregnancy. Thank goodness they weren’t counting on those things to save their lives.

  • Doug
    Show me…don’t imagine for me… show me where Cardinal Trujillo is aware of the two distinct groups in I Corinthians….one group who are to get married because they “cannot control their sexual urges” in the translation of the Catholic Jerusalem Bible and the second group who are marrying without that need. Show me anywhere in any of his writing. Your imagination of Trujillo is irrelevant.
    Since Rio’s streets are filled with street children for whom there is no more room nor food in their home of origin, having 8 children is fine if one has the income and not fine if one does not. Hence it is not a point in debates about what third world couples or first world poor couples should do. Tomas Sanchez, a Catholic theologian in the Baroque period affirmed for his Catholic audience that they could indeed sell one or more of their own children into servitude in order to feed the other children.
    That was never mentioned in my 16 years of Catholic school.
    But show me where Caridnal Trujillo in his writings is aware of two distinct groups of St.Paul and of the Holy Spirit in I Corinthians 7 or anywhere else.

  • David Nickol

    I fully understand the unitive function of the marital act. Catholic teaching is that the unitive function and the procreative function are not to be separated. Condoms do just that, no matter why they might be used.

    Doug,

    Then you will have to explain to me why it is licit for a Catholic wife to take the pill for noncontraceptive reasons (for example, acne, premenstrual dysphoric disorder, endometriosis, hirsutism). Is it a sin when a man artificially withholds his sperm for a good reason, but not when a woman artificially withholds her eggs?

    I had a feeling that eventually someone would get around to wanting to reject the ban on contraception outright.

    I believe if any of us lives long enough, someone will come up with a rationale that allows Catholics to use some “artificial” method of fertility control while allegedly remaining “fully consistent” with past Catholic teachings. See the discussion above regarding Bouscaren coming up with an argument that allowed doctors to stop waiting for women to be in immanent danger of death before treating them for ectopic pregnancy.

    Had I been infected with the AIDS virus, my wife would be dead along with me by now because condoms don’t work.

    If condoms don’t work, then NFP doesn’t work, penicillin doesn’t work, and basically nothing works — what you mean is that condoms don’t work 100 percent of the time. What does? The odds of contracting AIDS from one unprotected act of sexual intercourse are 1 in 500. Taking current drugs, an HIV+ person can have an extremely low viral load, which means that even without condoms, the risk of HIV transmission drops far below the 1 in 500 figure. So the risk of transmission of AIDS between partners under treatment who use condoms consistently and correctly is very low. (This is, by the way, one of the issues dealt with in the Vatican study that is collecting dust somewhere.)

    You see, I am a convert away from the line of thinking that tries to modernize the faith. It is theologically and scientifically unsound to try to do so.

    I am assuming you don’t mind that the concept of “quickening” was abandoned because of advances in scientific knowledge.

    It is, of course, ironic that we are arguing about whether a Catholic married couple may use condoms to prevent the transmission of HIV when the vast majority of Catholics (95 percent?) use some forbidden means of contraception. (And of course Catholic women procure abortions slightly out of proportion to their numbers in the population.) One would think the Church would be more concerned with the almost total disregard of the teachings regarding birth control than with a rather small number of couples using condoms to prevent the transmission of the AIDS virus!

  • David
    Amen times 1000.

  • Paul

    It is plainly more reasonable to discuss a read book than an unread one.

    Bouscaren shows that, after the various teachings had been given, the majority of Catholic theologians were of the opinion that the teachings allowed ectopic pregnancies to be dealt with in the way they still are today. But some theologians did not agree. In such an important area, this needed resolving. The value of Bouscaren’s work is that it made quite clear that the majority were correct, and that the practical application was without moral problem.

  • David, you wrote, Then you will have to explain to me why it is licit for a Catholic wife to take the pill for noncontraceptive reasons (for example, acne, premenstrual dysphoric disorder, endometriosis, hirsutism).

    Let me give it a shot! 🙂 In using the pill as a contraceptive, the woman deliberately chooses to become sterilized as a means to some end. In using the same pill to combat acne, a woman deliberately accepts the risk of sterilization (~97%?) as a side-effect that is neither a means nor an end.

    There is the ‘miracle test’ that I like to use to figure out hard double-effect cases. Because the evil must not be the cause of the good, any case that fits the double-effect can ask: “if the evil is prevented by a miracle, would the good effect be endangered?”. If the answer is ‘yes’, then the evil is not a side-effect, but the direct cause – and is therefore illicit.

    So in the case of treating acne with the pill, we may ask – what is the sterilization were prevented? Would that endanger the treatment of acne? Not at all. In fact, women who use the pill sometimes get pregnant. Therefore, in the case of a woman who takes the pill for acne, the sterilization is clearly a side-effect.

    Let’s apply the ‘magic test’ to the contraceptor. If the sterilization is prevented, does the contraceptor’s ‘good effect’ still occur? Not at all. The sterilization, then, is not a side-effect, and is directly and deliberately chosen as a means to an end. Evil is directly pursued – and that is a very different case.

  • David Nickol

    Nate,

    The spouses in my hypothetical married couple are a young doctor, the wife, and a nurse, the husband. The husband becomes HIV+ as the result of a needle stick. When they married, they had planned on having as many children as God gave them. They mutually agree that sexual intercourse is important enough to them to take limited risks. They use condoms to block the virus from entering the wife’s body, but contrary to what they would earnestly wish, it also blocks the husband’s sperm. By a miracle, the condoms they use inexplicably succeed in blocking the virus but let the sperm through, and the couple is overjoyed to have many children. Sterilization, which was never intended in the first place, is prevented, but the desired outcome of preventing the virus from being transmitted is achieved.

  • David Nickol

    Equally to be condemned, as the magisterium of the Church has affirmed on many occasions, is direct sterilization, whether of the man or of the woman, whether permanent or temporary.

    Similarly excluded is any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation—whether as an end or as a means.
    Humanae Vitae

    It seems to me that within Catholic thought, for temporary or permanent sterilization to be morally wrong, it must be specifically intended. Temporary or permanent sterility may be utterly predictable and absolutely certain, and yet if it not intended and unwanted, it is not morally wrong.

    Also, in cases of indirect abortion, it is the intention that is all important. The removal of a pregnant woman’s cancerous uterus, or the removal of the tube in the case of an ectopic pregnancy, is absolutely certain to kill the embryo. The exact same act performed with different intentions could be considered the equivalent of murder.

  • “Equally to be condemned, as the magisterium of the Church has affirmed on many occasions, is direct sterilization, whether of the man or of the woman, whether permanent or temporary.”

    What are the many occasions? The modern operation was not known til about 1904 and the pre modern operation was used on 9 to 12 year old boys for the castrati singers in the papal choirs so that women would not sing in Church from the 1580’s per Pope Sixtus V til Leo XIII 1878 (300 years and 29 Popes involved formally by not stopping it)…til Leo XIII who stopped the Church involvement with the castrati which opera had stopped 70 prior to Leo stopping it. His stopping it meant retrospectively that 29 Popes could have stopped it and did not.
    The problem with our encyclicals is that they contain an ideal historical world that never has to be substantiated with actual history. It marketing…it’s similar to “the best sofa ever made” is at our store, “the best drain cleaner etc etc. All this gets in the way of Vatican II trying to show that the Church herself is not perfect until the end of time while our encyclicals continue to market a history that never existed but would have been pure.

  • David, that’s a good example, but the miracle you propose would change the condom from a barrier to a filter. It would change the condom into an entirely different object. The condom, by definition a barrier to fluids, would cease to exist. The miracle test fails because there is a logical contradiction in having a condom act as a non-condom.

    If you can find a condom-like material that acts as a filter to disease without also filtering out sexual fluids, then you have something the world very much needs. One might suggest that society has a duty to help fund such research.

    David, did you ever read my article about the Pope’s new encyclical and technology? I feel like it is really pertinent here.

    http://www.catholicpeacemaking.com/CaritasAndTechnology

  • David Nickol

    David, that’s a good example, but the miracle you propose would change the condom from a barrier to a filter.

    Nate,

    More later, when I am not at work, but I think my only mistake was to specify the nature or mechanism of “the miracle of the condoms.” In your example about the woman taking birth control pills for acne, you do not explain how a miracle could allow the pill to work against acne without having it also prevent ovulation.

    Also I do not agree that temporary sterilization is a bad outcome in the same way the death of a fetus is a bad outcome in the case of removal of a cancerous uterus.

  • I’d have to know more about how the pill works to answer that question. Did you read the article about technology?