It just came to my attention this evening that the CDF has issued a response to a dubium about special cases of hysterectomy. It will likely be a controversial document. Unfortunately, the current milieu in the curia has led to a general distrust of “official theology.” But despite the seeming laxity of the response, to me it seems correct.
Here is my first go at a written breakdown of the issue of the removal of a gravid uterus rendered permanently incapable of sustaining pregnancy to the point of fetal viability. If it seems a little rushed, it’s because it is a little rushed. Apologies in advance. And if you see that I’m missing something major, let me know in the comments. (But despite the current climate in moral theology, we should still gently err on the side of going along with the CDF, lest we fall into sinful temerity.)
First point: gestation is not part of the procreative faculty. The document does seem to use this language at one point (“no longer suitable for procreation”), but it is easy to explain this as an indirect or qualified use of the expression. There is no magisterial document teaching about this precise point about which I am aware, but it seems quite plain that procreation is the act of bringing a human being into existence through the reproductive organs. The object of gestation is a human being so conceived. Therefore, procreation occurs prior to gestation in the womb. (This also has ramifications for the licit treatment of frozen embryos, but we will not get into that debate here.) The procedure is aimed at the womb precisely insofar as it is an organ of gestation.
Second point: the subjective psychology of the act of hysterectomy has a definitive moral significance in this case. What one really desires to achieve by the action matters, and so provided that the principle of totality is respected (meaning a sum good is done to the human being), doing material damage, even directly causing the corruption of an organ that is part of a faculty one foresees using in some capacity later, is admissible, so long as the corruption of the faculty itself is not intended as such and no greater evil is occasioned outside of that substance (viz. the person being operated on).
Third and most important point: the procedure does sterilize the woman, but it is actually a choice in favor of preventing vain gestation rather than in favor of sterilization. If the sterility of this same woman is presumed upon in any future conjugal act, accidental material sterility becomes contraceptive sterility. (In other words, permanently sterile people must still retain a willful openness to the possibility of life in each sexual act, regardless of its actual possibility through natural means, and so too must procedures which happen to cause sterility be done only for non-sterilizing reasons if one is presuming to use his or her sexual faculty in the future.) If we presume that sterility is not a motivating factor in choosing to do the procedure, but is rather just a side-effect, we are left facing the question of implantation… To make this clearer, suppose a woman somehow discovers immediately that she has conceived. The embryo begins to travel toward her severely compromised uterus, where it may implant but will certainly not come anywhere close to term, dying after just 3 or 4 weeks. In the few hours she has, it is possible for her to have the procedure. (Perhaps this is the scenario which we can consider as paradigmatic, or else we are liable fall into the trap of turning the procedure into an act of contraceptive sterilization.) The hysterectomy will indeed prevent implantation, saving the woman some pain and suffering, but it will also cause the child’s life to be shortened by several weeks. The child himself is not positively or actively attacked, as in a salpingostomy or craniotomy, but rather he is prevented from reaching the temporary safety of the uterine wall by that organ’s removal; an action is done to the woman which causes an indirect abortion, such as might occur in a salpingectomy done in response to an ectopic pregnancy. It is then merely a case of weighing the goods, provided sufficient certitude has been reached about the condition of the womb and there is no possibility of saving the child by some other means (like an artificial womb). So, which is worth more – the possible few weeks of preborn life of the child, or the possible inconvenience of the mother, who will be mentally tortured the whole time about the impending doom of her child, in addition to other pains and expenses? It seems usually that the hysterectomy has the stronger case.
A final point for further consideration of this case… The foreseeable possibility of baptizing the preborn child could potentially change the moral decision. But because of the lack of a clear timeline for the child’s preborn death, among other possible medical complications, it does not seem evident that it should be high on the list of considerations. This issue also brings up other soteriological problems which are too much to explore here, so this will be it from me on this question for now.
Keep your eyes open for discussion on this text… Many are likely to see it as something that it is not. You heard it here first.
St. Gianna Molla, pray for us.