This paper argues that in certain circumstances, a Catholic institution that cares for disabled persons can ensure that some of them conform to a temporary sterilizing intervention. The argument proceeds by observing that the Church permits temporary sterilizing interventions for rape victims, because such interventions are not contraceptive acts, but rather, acts of defense. For similar reasons, some mentally disabled persons cannot consent to sexual intercourse and since rape is defined as unconsensual intercourse, some mentally disabled persons are proper candidates of temporary sterilizing interventions. These interventions do not count as contraceptive acts either. This is the case even if the disabled person in question desires the intercourse. This is so because consent is an intellectual act and desire is a passion. Desire does not entail consent. Although the conclusion reached may look “liberal” or “heretical” the argument shows that it is consistent with firm Church teaching.
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References
1.
“Sterilizing agent” refers to any temporary measure used to prevent conception. Surgical or permanent sterilizations are not covered by the term “sterilizing agent” in this article. A typical example of a sterilizing agent is an oral contraceptive. Also, the phrase “using/administering sterilizing agents” should not be interpreted as referring to the moral act of contraception. The phrase “contraceptive act” in this article should be understood to refer to the intrinsically evil act of contracepting defined in Humanae vitae thus: “Similarly excluded is every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible.” Paul VI, Humanae vitae (1968), n. 14.
I do not specify here “Catholic” institution since all institutions ought to conform their practices to the natural moral law.
4.
For those readers who are primarily interested in what the Catholic institution may do, I should note that if my argument fails, the Catholic institution could still have residents under its care receiving sterilizing agents if the parents/guardians ensure this. The institution is not involved in immoral cooperation with evil in this case since it would not be contributing to or assisting in an immoral act.
5.
See U.S. Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 4th ed. (Washington, D.C.: USCCB, 2001), dir. 36.
6.
See Dorothy Griffiths and Yona Lunsky, Socio-Sexual Knowledge and Attitudes Assessment Tool—Revised (Wood Dale, IL: Stoelting Company, 2003).
7.
Per conversation with the director of the institution initiating the consult, March 25, 2008.
8.
See USCCB, Ethical and Religious Directives, dir. 36.
BrownridgeDouglas A.“Partner Violence Against Women with Disabilities: Prevalence, Risk, and Explanations,”Violence Against Women9 (2006): 807.
11.
I do not suppose here that the notions “voluntary” and “consent” are interchangeable salve veritate. But I do accept the widespread understanding of consent as including voluntariness.
12.
AquinasSt. ThomasSumma theologiae I-II, q. 6, a. 2, (trans. Fathers of the English Dominican Province, 1920), http://www.newadvent.org/summa/. All quotations of the Summa are taken from this translation.
13.
Eleonore Stump, “Aquinas's Account of Freedom,”Monist80 (1997): 577.
14.
AquinasSumma theologiae I-II, q. 1, a. 3, ad 3.
15.
AquinasSumma theologiae, q. 18, a. 5, ad 3.
16.
I include mention here of the ability to do otherwise just in case the reader accepts what is called the principle of alternative possibilities. The author does not accept this principle, and therefore my argument should be understood as claiming that acting involuntarily impugns morally valid consent. For what the principle of alternative possibilities is and why I do not accept it, see StumpEleonore, “Alternative Possibilities and Moral Responsibility: The Flicker of Freedom,”Journal of Ethics: An International Philosophical Review3 (1999): 299–324.
17.
Numerous magisterial writings have been devoted to articulating the complexity of this dimension of human relationships. John Paul II, Familiaris consortio (1981); Pontifical Council for the Family, The Truth and Meaning of Human Sexuality (1995); Sacred Congregation for the Doctrine of the Faith, Persona humana (1975); Sacred Congregation for Catholic Education, Educational Guidance in Human Love (1983); Vatican II, Gaudium et spes (1965), nn. 48-50; and Paul VI, Humanae vitae (1968).
18.
MansonNeil C., and O'NeillOnoraRethinking Informed Consent in Bioethics (New York: Cambridge University Press, 2007), 72, original emphasis.
19.
See TalbotT.J., and LangdonP.E.“A Revised Sexual Knowledge Assessment Tool for People with Intellectual Disabilities: Is Sexual Knowledge Related to Sexual Offending Behaviour?”Journal of Intellectual Disability Research50 (2006): 523–531.
20.
AquinasDe malo, q. 2, a. 6, resp., trans. Jean Oesterle (Notre Dame, IN: University of Notre Dame Press, 1995). Latin texts are from the Leonine edition, available at http://www.corpusthomisticum.org/iopera.html#QD.
21.
I thank an anonymous reviewer for such a case.
22.
Canon Law Society of America, Code of Canon Law: Latin–English Edition (Washington, DC: Canon Law Society of America, 1999), canon 1096, § 1.
23.
I thank an anonymous reviewer for this case.
24.
Congregation for the Doctrine of the Faith, Donum vitae (1987), II.A.1.
25.
The line of bandy in this section indicates the case-specific nature of this issue. Making the correct decision for a disabled person requires knowing detailed empirical facts, primarily the person's ability to understand the moral dimension of sexuality and her psycho-social history.
26.
Per report from the director of the institution initiating the consult.
27.
See YeungPatrickJr., LaethamErica and Rev. Joseph Tham, “Argument Against the Use of Levonorgestrel in Cases of Sexual Assault,” in Catholic Health Care Ethics: A Manual for Practitioners, ed. FurtonEdward J., and MoraczewskiAlbert, O.P. (Philadelphia: National Catholic Bioethics Center, 2009), 143–153.
28.
SmithJanet E.Humanae Vitae: A Generation Later (Washington DC: Catholic University of America Press, 1991).
29.
Humanae Vitae: A Generation Later, 99.
30.
Aquinas remarks, “It is evident then that every emission of semen, in such a way that generation cannot follow, is contrary to the good of man. And it done deliberately, it must be a sin.”Summa contra gentiles, trans. Vernon J. Bourke (Notre Dame, IN: University of Notre Dame Press, 1975), bk. III, ch. 122, emphasis added. Aquinas defends this position by pointing out that each part of man has a proper end. The emitting of semen has the end of generation, “to emit it [semen] for the purpose of generation, to which purpose the sexual act is directed. Therefore every emission of semen is ordered to procreation.” Summa contra gentiles.
31.
The Congregation for the Doctrine of the Faith says, 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 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. Congregation for the Doctrine of the Faith, Quaecumque sterilizatio: Responses on Sterilization in Catholic Hospitals (March 13, 1975), n. 1, emphasis mine. Of course, a straightforward interpretation of this definition would be inconsistent with dir. 36. Consequently, caution needs to be exercised in interpreting Quaecumque.
32.
SmithHumanae Vitae, 87. The premises are numbered 1-3 in Smith's text. I have numbered them 4-6 to keep the references to the respective premises clear.
33.
Humanae Vitae, 101.
34.
See Humanae Vitae, 85, for Smith's endorsement of this distinction and the definition of “wrong.”
35.
See, 85–86.
36.
GrisezGermainThe Way of the Lord Jesus, vol. 3, Difficult Moral Questions (Quincy IL: Franciscan Press, 1997), 252.
