Can a Catholic married woman use the birth control pill for a medical purpose?

Some medical problems (e.g. painful periods) are said to be treatable by using the birth control pill (BCP) to regulate the woman’s hormones and periods. Perhaps this approach is overused in sinful secular society because contraception is so heavily promoted, as if it were good, not evil. Perhaps some other treatment might be effective. But let’s suppose, for the sake of argument, that the physician’s judgment is correct, that the use of a BCP will be effective at treating a medical disorder in a particular woman patient. Can she use the birth control pill, morally, for a medical purpose?

This question is often answered incorrectly in Catholic discussion groups and by Catholic commentators. The correct moral analysis depends upon the teaching of the Magisterium on intrinsically evil acts and the fonts of morality.

There are three fonts of morality: (1) intention, (2) moral object, (3) circumstances.

Catechism of the Catholic Church: “The morality of human acts depends on: the object chosen; the end in view or the intention; the circumstances of the action. The object, the intention, and the circumstances make up the ‘sources,’ or constitutive elements, of the morality of human acts.” (Catechism of the Catholic Church, n. 1750.)

Compendium of the Catechism: “The morality of human acts depends on three sources: the object chosen, either a true or apparent good; the intention of the subject who acts, that is, the purpose for which the subject performs the act; and the circumstances of the act, which include its consequences.” (Compendium of the Catechism of the Catholic Church, n. 367.)

USCCB Catechism: “Every moral act consists of three elements: the objective act (what we do), the subjective goal or intention (why we do the act), and the concrete situation or circumstances in which we perform the act…. All three aspects must be good — the objective act, the subjective intention, and the circumstances — in order to have a morally good act.” (United States Catholic Catechism for Adults, U.S. Conference of Catholic Bishops, July 2006, p. 311-312.)

The intention is “the end in view”, referring to the intended end of the act. In other words, it is “the intention of the subject who acts, that is, the purpose for which the subject performs the act.” So the first font is the intended end or purpose for which the act is chosen. This can also be described as “the subjective goal or intention (why we do the act).” The intention is in the subject (the person who acts); it is an end or purpose or goal chosen by the free will of the human person.

By comparison, the moral object is in the act; every knowingly chosen act is inherently directed, by its very nature, toward a good or evil object. The free will can choose one type of act or another, but it cannot choose which moral object is associated with the chosen act. The moral object is inherent to the act because that act is ordered, by its very nature, toward that object. By choosing a particular objective act, we are necessarily choosing its inherent moral meaning as determined by its moral object.

The use of contraception is intrinsically evil and always gravely immoral. The moral object of contraception is the deprivation of the procreative meaning from sexual acts. Abortion is also intrinsically evil and always gravely immoral, even more gravely immoral than contraception. The moral object of abortion is the deprivation of life from an innocent human person.

The Magisterium definitively teaches that intrinsically evil acts are never justified by any intention or purpose, nor by any circumstances. So the circumstance that a woman has a difficult medical problem, and the intention to use birth control pills for a medical purpose, cannot justify the intrinsically evil acts of contraception and abortion.

Pope John Paul II: “These are the acts which, in the Church’s moral tradition, have been termed ‘intrinsically evil’ (intrinsece malum): they are such always and per se, in other words, on account of their very object, and quite apart from the ulterior intentions of the one acting and the circumstances. Consequently, without in the least denying the influence on morality exercised by circumstances and especially by intentions, the Church teaches that ‘there exist acts which per se and in themselves, independently of circumstances, are always seriously wrong by reason of their object’.” (Veritatis Splendor, n. 80)

Pope John Paul II: “It is a matter of prohibitions which forbid a given action semper et pro semper [always and in each instance], without exception, because the choice of this kind of behavior is in no case compatible with the goodness of the will of the acting person, with his vocation to life with God and to communion with his neighbor.” (Veritatis Splendor, n. 52.)

Pope John Paul II: “Consequently, circumstances or intentions can never transform an act, intrinsically evil by virtue of its object, into an act ‘subjectively’ good or defensible as a choice.” (Veritatis Splendor, n. 81.)

Pope John Paul II: “No circumstance, no purpose, no law whatsoever can ever make licit an act which is intrinsically illicit, since it is contrary to the Law of God which is written in every human heart, knowable by reason itself, and proclaimed by the Church.” (Evangelium Vitae, n. 62.)

The Catechism of the Catholic Church: “It is therefore an error to judge the morality of human acts by considering only the intention that inspires them or the circumstances (environment, social pressure, duress or emergency, etc.) which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object; such as blasphemy and perjury, murder and adultery. One may not do evil so that good may result from it.” (CCC, n. 1756.)

Each and every intrinsically evil act is always immoral, by its very nature, regardless of intention or circumstances. This teaching is clear and definitive; it is not a theological opinion, but a doctrine. The Magisterium teaches this truth about intrinsically evil acts universally; the Church has always condemned certain types of acts as always immoral, due to the nature of the act itself, regardless of intention and circumstances. This teaching falls under the ordinary and universal Magisterium and is therefore infallible. Whoever rejects this teaching commits the grave sin of heresy. Whoever teaches other to reject this teaching commits the graver sin of teaching heresy.

What is the moral object of the use of the birth control pill to treat a medical disorder?

The various chemical forms of birth control (typically a pill) are abortifacient contraception. They do not merely prevent conception. At times they work by killing the conceived prenatal (by preventing implantation).

“The close connection which exists, in mentality, between the practice of contraception and that of abortion is becoming increasingly obvious. It is being demonstrated in an alarming way by the development of chemical products, intrauterine devices and vaccines which, distributed with the same ease as contraceptives, really act as abortifacients in the very early stages of the development of the life of the new human being.” (Evangelium Vitae, n. 13).

The use of abortifacient contraception by a woman who is sexually active constitutes the grave sin of contraception and the graver sin of direct abortion. The chosen act, to use abortifacient contraception while sexually active, or (we could phrase it as) the choice to have sexual relations while using abortifacient contraception, is inherently ordered toward the evil moral objects of contraception and abortion.

The moral species of the act (the type of act in terms of morality), as determined by its moral object, is not changed by the fact that the pill also has the effect of treating a medical disorder. The act remains contraceptive and abortive, and so it remains intrinsically evil for those reasons.

If a woman is not sexually active at all, and she uses the birth control pill for a medical purpose, as prescribed by a physician specifically to treat that disorder, then she does not commit the sins of contraception and abortion. The pill in this case does not deprive the sexual act of its procreative meaning, because there are no sexual acts to suffer such a deprivation. And no prenatal human person is deprived of life, since conception will not occur without sexual acts. The use of the BCP in this case has the good moral object of treating a medical disorder.

Therefore, an unmarried woman who is not sexually active, or a married woman who refrains from all sexual acts during the time that she is using the birth control pill, may morally use the BCP for a medical purpose. In terms of the three fonts of morality, the intention (the purpose for which the act is chosen) is good, to treat a medical disorder. The moral object is good, since the chosen act is ordered only toward the treatment of a disorder, not toward the deprivation of life or the deprivation of procreation. The circumstances must be weighed on the basis of the good and bad effects of the medication, alongside other possible medical options (which is outside of my expertise).

However, if a married woman uses the birth control pill to treat a medical disorder,
AND she continues to have sexual relations with her husband, the chosen act is inherently ordered toward two evil moral objects: the deprivation of life (abortion) and the deprivation of the procreative meaning (contraception). Even though the good moral object of the treatment of the medical disorder remains, so that the act has three moral objects, the act is still intrinsically evil. One evil moral object is sufficient to make any act intrinsically evil and always immoral. The use of abortifacient contraception has two evil moral object, that of contraception and that of abortion. The additional good moral object of treating a medical disorder remains, but does not remedy the deprivations of the other two evil moral objects.

Saint Thomas: “in order for an action to be good it must be right in every respect: because good results from a complete cause, while evil results from any single defect, as Dionysius asserts (Div. Nom. iv).” (Summa Theologica, II-II, Q. 110, A. 3).

The woman who chooses to take a medication to treat a medical disorder has chosen an act with a good moral object. But if she also chooses to engage in sexual acts, knowing that the use of BCPs by a sexually active woman is contraceptive and abortifacient, her choice now has two additional moral objects: those of contraception and abortion. The choice to have contracepted sexual relations is a grave sin. The choice to use a medication which is abortive as well as contraceptive is an even graver sin. These sins are intrinsically evil, and so no purpose or circumstance can make the act moral.

Are the contraceptive and abortive effects of this choice (to have sexual relations while using birth control pills for a medical purpose) unintended consequences found only in the circumstances, not in the moral object? The purpose and the effects of an act are the first and third fonts of morality. But knowing these two fonts does not inform us as to the contents of the remaining font, the moral object. Many Catholics are confused on this point because they do not know how to determine what the moral object is.

The moral object is the end, in terms of morality, toward which the intentionally-chosen act is inherently ordered, by its very nature. The chosen act of the human person is called ‘concrete’ by Veritatis Splendor and the CCC. It is also called the ‘objective act’, and is said to have a ‘nature’. In other words, every knowingly chosen act is an objective moral reality, existing apart from the subject who chooses the objective act. And that act has its own nature, in terms of morality (called the moral ‘species’ of the act), which does not change with a change in intention or circumstances.

The moral object is a proximate end; it is the morally-direct result of the concrete act. Neither the moral object nor the moral nature of the concrete act can be changed. An intrinsically evil act is inherently immoral, and so it is always immoral. If a woman has sexual relations and uses abortifacient contraception, she commits the intrinsically evil acts of contraception and abortion, because her chosen acts are ordered toward those evil ends. The addition of another good moral object, treating a medical disorder, or a change in intention, so that there is no longer a contraceptive intent, does not change the concrete act from evil to good because it does not remedy the evil moral objects. And the moral objects determine the moral nature of the act. The concrete act remains morally the same.

Pope John Paul II: “A doctrine which dissociates the moral act from the bodily dimensions of its exercise is contrary to the teaching of Scripture and Tradition.” (Veritatis Splendor, n. 49).

Now certain clever commentators have been making various attempts to claim that abortifacient contraception can be used, morally, if the woman has a medical disorder that is treated by the birth control pill. But the essential moral nature of the concrete act has not changed, and the two evil moral objects — the deprivation of the procreative meaning and the deprivation of the life of innocent prenatals — remain. These commentators attempt to separate the bodily dimensions of the intentionally chosen act from its inherent moral meaning. But the concrete act and its inherent moral meaning (essential moral nature) are joined like body and soul.

Pope John Paul II: “In fact, body and soul are inseparable: in the person, in the willing agent and in the deliberate act, they stand or fall together.” (VS, n. 49).

If the concrete act has not changed in its bodily dimensions, then neither has its moral nature and moral object changed. The same concrete act cannot have a good moral object with one intention, and an evil moral object with another intention. The same concrete act cannot have a good moral object in one circumstance and an evil moral object in another circumstance.

It is common for misguided commentators to use the example of killing versus murder. They say that the concrete act of killing is not by itself moral or immoral. And they then assign a good or evil moral object to the act of killing based the intention or the circumstances. This type of moral analysis “dissociates the moral act from the bodily dimensions of its exercise” and has been condemned by the Magisterium in Veritatis Splendor. In this example, the intentionally chosen act is not ‘killing’; rather there is not enough information in the term ‘killing’ to determine the moral object or the nature of the act. Killing is not morally neutral. Every act of killing is either moral or immoral. The fact that not enough information is presented to determine the moral object and the moral nature of any act does not imply that the act is without a moral object or without a moral nature.

To determine the moral nature of an act which includes killing (or attempted killing), one must determine the moral object. If the act was intentionally chosen, and if the act is by its nature directly ordered toward the killing of an innocent human person, then the act is the intrinsically evil act of murder. Once enough information is presented about an act, the concrete act is moral or immoral, and the morality of the act cannot be separated from its bodily exercise.

In the case of abortifacient contraception, this moral fact is made all the more clear by the medical fact that some innocent prenatals are killed by the continued use of abortifacient contraception. Some married Catholic women use abortifacient contraception for many years for a medical purpose. But their purpose does not save the lives of the prenatals who die as a result. No clever theory can prevent the deaths of those innocents, nor give them back their lives. This is no mere theoretical discussion. Some Catholic woman are using abortifacient contraception, while sexually active, on the basis of the claim made by various commentators that this behavior is justified by a medical purpose. Some prenatals are being killed as a result of the spread of this erroneous claim.

It is important to note that the woman is able to take the BCP and yet refrain from sex, thereby avoiding the evil acts of contraception and abortion. Even when taking the pill has the good moral object of treating an illness, if she chooses to have sexual relations while using abortifacient contraception, the sexual acts are not ordered toward the treatment of a medical disorder. Her choice to remain sexually active while taking abortifacient contraception is inherently ordered toward two evil moral objects: the deprivation of life (abortion) and the deprivation of the procreative meaning (contraception). The use of abortifacient contraception is intrinsically evil. No additional moral object, and no intention or circumstances, can change these evil moral objects from evil to good.

Therefore, a married woman may not morally use abortifacient contraception while continuing to have sexual relations with her husband. To do so is the grave sin of contraception and the grave sin of abortion.

Why do some Catholic women choose to use abortifacient contraception while sexually active? It is because sex has become such a high value for them, in accord with the teaching and example of sinful secular society, that they are willing to violate the law of God on procreation and even willing to abort their own children, rather than refrain from sexual relations. A prostitute commits a grave sin by exchanging money for sex. These women are exchanging the lives of their own prenatal children for sex.

And some Catholic priests, theologians, apologists, and online commentators are committing grave sins of formal cooperation with these intrinsically evil mortal sins by encouraging and approving of this behavior.

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