A yes to prophylactic hysterectomy - congregation for the doctrine of faith in response to a question


#1

I feel that it cannot be justified by the principle of double effect because ether good effect is achieved as result of bad effect. A uterus which cannot bear a pregnancy is not a threat to mother unless she becomes pregnant. Here pregnancy is prevented removing the uterus, which is the bad effect, to save mother from the consequences of pregnancy, which is the good effect. Again, the principle of totality cannot justify their answer. So this act seems to be a mutilation. Can anyone explain this answer to me?

Congregation for the Doctrine of the Faith

A questionnaire
on the liceity of a hysterectomy in certain cases

Question : When is it possible to become irreversibly in such a state that it is not longer suitable for procreation and medical experts have reached the possibility of becoming pregnant , is it licit to remove it ( hysterectomy )?

Response : Yes, because it does not regard sterilization.

Illustrative Notes

The question comes from the first case, recently submitted to the Congregation for the Doctrine of the Faith, which constitutes a negative issue on July 31, 1993. it would be spontaneously interrupted before the fetus arrives at a state of viability. This is not a question of difficulty, or of risks of greater or lesser importance, but of a couple for which it is not possible to procreate.

The precise object of sterilization is to impede the functioning of the reproductive organs, and the malice of sterilization Consists in the refusal of children: it is an act against the bonum prolis . They are not known to be able to fulfill their natural procreative function. The birth of a fetus is not biologically possible. Therefore, we are not dealing with a defective, or risky, functioning of the reproductive organs, but we are dealing with a situation in which the natural

As a procreation, as we find ourselves within an objective context in which neither procreation, nor as a consequence, an anti-procreative action, are possible. It can be used as direct sterilization, which is and remains intrinsically illicit as an end and as a means.

The problem of the disease could be, or could not, continue on the state of viability is a medical question. From the moral point of view, one must ask if the highest degree of certainty that can be reached, and in this sense the response is valid for the question, as it has been proposed in good faith.

Furthermore, the decision to undergo a hysterectomy is always the best one, but that only in the above-mentioned conditions is such as a decision morally licit, without, therefore, excluding other options (for example, recourse to infertile periods or total abstinence). It is the decision of the spouses, with the path to follow, and the general criterion of the medical intervention.

The Sovereign Pontiff Francis, in the Audience granted to the undersigned, has approved the above response and ordered its publication.

Rome, from the Offices of the Congregation for the Doctrine of the Faith, December 10, 2018.

Luis F. Card. Ladaria, SI


Is the Church a Patriarchy?
#2

@edward_george1, bioethics is a specialty of yours, right?


#3

I think the answer is right in the illustrative notes

This is not a question of difficulty, or of risks of greater or lesser importance, but of a couple for which it is not possible to procreate.

The precise object of sterilization is to impede the functioning of the reproductive organs, and the malice of sterilization Consists in the refusal of children: it is an act against the bonum prolis . They are not known to be able to fulfill their natural procreative function. The birth of a fetus is not biologically possible. Therefore, we are not dealing with a defective, or risky, functioning of the reproductive organs

Emphasis mine.


#4

To add to this, the couple is already sterile once they’re reached this point, so to remove the uterus isn’t to have an elective sterilization procedure.


#5

There are situations like thinned out uterus where pregnancy is still possible but with substantial risks of uterine rupture and death of mother. I was particularly thinking about this situation. Here, hysterectomy cannot be an option according to the traditional moral theology.


#6

According to the justification’s own wording, it’s permissible because it’s not possible to even have a successful pregnancy. We’re not talking simple conception, I think, but carrying to viability or to term.

I can’t speak for every case. The NCBC may be able to advise, but I’d only reach out to them if I had a real situation with real specifics, not a hypothetical.


#7

I think here, it is because the uterus could cause death of the child before the embryo implants, so a natural abortion is practically a foregone conclusion if conception occurs…

This is an actual problem, some women have conditions which make them unable to sustain a pregnancy after conception.


#8

But God controls whether we conceive, right? Why cause a conception that is impossible to survive early pregnancy?


#9

I can’t answer that. There are women who can conceive but for some reason, their womb is unable to sustain the pregnancy. Even in women with the capability of carrying a child to term, the embryo doesn’t make it through implantation in many cases. Often these miscarriages happen before the woman has any idea that a child has been conceived.


#10

Whether a pregnancy is viable or not, how is it going to define direct sterilization?


#11

No. Biology controls that.

God might act in extraordinary circumstances, but in normal circumstances it is our actions and our biology that result in pregnancy.


#12

It’s really not that difficult:

remove a healthy uterus in order to sterilize yourself: not allowed

remove a diseased organ (uterus) that is no longer properly functioning: allowed


#14

I have thoughts on this, as a student of Bioethics myself, but I’m withholding comment until I see what the National Catholic Bioethics Center makes of it. They’re due to produce a commentary soon.

-Fr ACEGC


#15

I objected because there are situations like thinned out uterus where pregnancy is still possible but with substantial risks of uterine rupture and death of mother. I was particularly thinking about this situation. Here, hysterectomy cannot be an option according to the traditional moral theology and the magisterial teachings as it amount to a direct sterilization. The principle explaining this would be the double effect. The good effect of saving the life of mother from a anticipated pregnancy which could be threat to mother’s life is achieved through hysterectomy which is the bad effect. The good effect is explicitly achieved through the bad effect. Here, the sole purpose of hysterectomy is to prevent conception. Further, effect such as reducing threat to mother’s life comes only as a secondary good effect. Hence hysterectomy seems illegitimate here.

The question addressed here unfortunately considers only a subset of uterine diseases where pregnancy is totally impossible, as rightly described in the illustrated notes as “but of a couple for which it is not possible to procreate”. (Though procreation is not synonymous with conception) In such cases, as there is no possibility of conception at all a hysterectomy cannot be a direct sterilization there, and can be legitimately sought.

Chances are there that many will misinterpret their answer.


#16

(post withdrawn by author, will be automatically deleted in 24 hours unless flagged)


#18

The issue is better explained in this article:


#19

This seems like a really bad decision to me.

I don’t really understand how this is not direct sterilization, unless they are claiming life does not being at conception–which it looks like they are. The CDF seems to be saying the good of procreation has not been achieved merely by conception–the creation of a new life–but only when a baby is brought to viability. Therefore, if conception is possible, but bringing the baby to viability is not, there is no sterlization since no good is being prevented.

That seems very dehumanizing to persons who have not reached viability! A person has worth and is a good from the moment of conception!

In the cases at hand the utuerus poses no threat to the mother, but rather it is being removed to prevent the premature deaths of children that may be concieved–by preventing their conception in the first place! The very intended effect is to prevent conception! This is the definition of contraception and the Church has said over and over (including in the CDF document cited by this one, which dealt with the same issue, except the potential harm addressed was to the mother, not the child) that we can’t directly intend sterilization or contraception even for a good end.

And by what logic is this limited to a hysterectomy to prevent conception? Using the logic of this response, using other forms of contraception (condoms, spermicide, etc.) would also be acceptable since they are not really preventing the good of procreation but only conception, where development to viability is not possible.

Humanae Vitae specifically says the Church considers “always unlawful the use of means which directly prevent conception, even when the reasons given for the latter practice may appear to be upright and serious.”

The CDF specifically is saying it is ok to directly impede conception when the pregnancy will certainly result in a spontaneous abortion. That is doing evil for good.


#20

But the problem with this is that a thinned out uterus per se is not an indication for hysterectomy. It becomes life threatening only when she become pregnant. So the purpose of hysterectomy is to prevent pregnancy which in turn avoids a life threatening situation. That is why it becomes unacceptable.


#21

Here is the prior answer from the CDF which says that the uterus can be removed if it is an immediate threat to the mother. It then says it cannot be removed simply because pregnancy would be a threat to the mother. Moral means of avoiding pregnancy must be used.

http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_31071994_uterine-isolation_en.html

In this new answer, there is no threat to the mother contemplated–the only negative effect they are trying to avoid is an inevitable spontaneous abortion.

The two answers seem contradictory to me, despite the assertion to the contrary in the latter.


#22

One would need to take into consideration the extent of the thinned uterus. Is it just at the fascia level? Is it a full thinning? Was there a dehiscence with the last pregnancy? Was it a full dehiscence or just a window? If it is so very damaged to the point a rupture is imminent past the first trimester (or early second trimester), the organ itself is of danger to the mother. A strong uterine cramp, especially during the menstruation phase of her cycle) could cause significant problems on a non-pregnant women…hence, it’s a damaged organ. One must look at the full extent of the damage or disease before assuming that only a pregnancy will cause increased complications.


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