II. On Sterilization

I. Sterilization pertains to eugenic science.

Genetic science is the experimental science of hereditary transmission and variation among living things, namely, plants and animals, and of the laws which govern it; these laws have hitherto been uncertain.

Eugenics is the same science applied to human beings; this latter science is therefore less developed than the former.

The foundation of this science is investigation of the cell.

Eugenism etymologically means good birth. Eugenics intends a good race, a strong and robust people. It proposes to itself the end of rendering the human stock and species better and more robust, since at present there are several causes infecting it, especially certain diseases which continually increase to the great detriment of the family and civil society, such as tuberculosis, syphilis, mental diseases including dementia, alcoholism, morphinism, cocainism, and so forth, and many others. Several of these are transmitted by heredity, arise from a disturbed organic alteration, and are exceedingly frequent. Tuberculosis and syphilis bring the greater injuries upon society.

It is certainly licit to employ means for diminishing and extirpating them, provided that the means themselves are licit, not evil.

But several means which have been employed are illicit and evil. Some are indirect, which positive eugenics uses, such as the legal prohibition of every marriage with any such person, and the obligation of producing a medical certificate establishing health as an indispensable condition of marriage. Others are direct, which negative eugenics uses, such as sterilization, neo-Malthusianism, the procuring of abortion, and so forth.¹

¹ Hence Payen, Déontologie médicale, ch. XII, art. 4, §2, establishes the following concerning false eugenism: False eugenism prevents marriage by the obligatory prenuptial certificate, upon which legal authorization is made dependent; it prevents conception by neo-Malthusianism and sterilization; it prevents birth by abortion; it prevents life by infanticide, before which certain persons do not draw back after birth; it prevents survival in society by the rejection of laws protecting the weak, which, however, it regards as inhuman and cruel.

In what follows we shall speak of sterilization.

II. Sterilization (onvruchtbaarmaking) signifies an action or operation which renders something sterile, so that it produces no fruit, for example, the action of preventing fermentation. Thus they speak of sterilization of a liquid, such as milk.

In biology, it is an action by which a living being is rendered infertile or incapable of reproduction. In physiology, it is an action which deprives a human being, male or female, of the possibility of procreation, or renders that person incapable of generation.

Sterility is distinguished as twofold: one is mere sterility or solely the incapacity to generate; the other arises from incapacity to perform carnal intercourse apt for generation. The former is called by theologians and canonists simply sterility or impossibility of generating; the latter is not customarily called sterility, but impotence, because it includes impotence to have intercourse, which, if perpetual, is a diriment impediment to marriage.

Theologians understand this of intercourse considered physiologically, or of an action of itself apt for generation, whereby the seed of the man is deposited in the due vessel or in the vagina of the woman. But physicians often consider the matter merely physically, namely, the mere physical possibility of copulation, whether seed is deposited or not. Hence a man who can perform intercourse, although he does not emit seed and cannot emit it, is not impotent for physicians. For theologians, however, he is truly impotent, indeed by natural law, so that if this condition is perpetual, he cannot enter marriage.²

² Physicians do not thereby deny the doctrine of theologians, but use a different terminology.

III. There are various manners of effecting sterilization.

1. Biological means can produce temporary sterilization in the woman. Thus:

a. by injection of a certain element of semen, for example, hormones especially of a ram, which acts after the manner of a vaccination rendering her immune for a period of six to eight and one-half months; but perhaps the time could be increased by repeated injections;

b. likewise by injection of an extract from the ovaries, placenta, or fetus.

Similarly, by injection of an anaphrodisiac substance, sterility or impotence can perhaps be obtained in the man, but only for a time.

2. Physical means likewise. By the so-called X-rays or Roentgen rays, or by rays produced from radium and directed upon the testicles of the man or ovaries of the woman, temporary or perpetual sterility can arise according to the dose. Thus genital activity is destroyed or atrophy of the testicles and ovaries is procured. But the means is not always infallibly certain. With a weak dose, there is rather a stimulation to ovulation.

Other physical means are painful and uncertain.

3. Surgical means especially:³

³ Cf. Muret, De la stérilisation sexuelle.

A. In the man there are:

a. castration, or removal or extirpation of the two testicles; but its effect is injurious to the organism, namely, it injures health and the virile character because of the absence of the internal secretion of hormones;

b. vasectomy, or the ligation or resection of the two vasa deferentia, that is, the canals which carry sperm or seed from the testicles into the penis, so that the seed cannot be ejaculated. The operation is very simple, not painful, dangerous, or injurious; it lasts five to ten minutes, so that the man can return to ordinary work almost immediately or already on the following day. Nor does it modify the virile character or sexual appetite, for the man retains perfect seed, but cannot ejaculate it.

It is disputed whether a remedy can be applied to the cutting or resection and communication through the vasa deferentia restored, at least in certain circumstances. Nevertheless, no example is known in which the possibility of generation has been restored to a man.

B. In the woman:

a. ovariotomy or hysterectomy, that is, removal of the two ovaries or the uterus, which is performed by the natural way through the vagina (colpotomy), or through the abdomen (laparotomy), in which latter case it brings some danger. Its effects are injurious and it changes the character of the woman; but it injures less than castration does in the man;

b. fallectomy or salpingectomy, that is, ligation or resection of the oviducts, or the two tubes which provide communication between the ovaries and the uterus; by this the ovum is prevented from descending into the uterus and the male seed from reaching and fertilizing it. It includes some danger and can be performed in eight different ways. Nevertheless, it is not always an infallibly certain means; the more efficacious manner is cutting between two ligatures;

c. inclusion of the uterus or its isolation; but this does not provide an always certain means.

Can sterilization be removed and the power of generating restored to the woman, in a case in which the ovaries have not been removed? Response. Communication between the ovaries and the uterus can sometimes be restored if there was a simple resection of the tubes or inclusion of the uterus; four cases, namely, are reported.

In modern times castration has come little into use; but ovariotomy for women was often in use toward the end of the nineteenth century. In our days only vasectomy and fallectomy are customarily performed.

Sterilization, therefore, is an action by which a genital organ is removed or substantially injured, or by which the passage of an essential element, namely, the seed or the ovum, into the due place in which conception is possible is impeded.

IV. The importance of the question is evident from the fact that not only do certain individuals employ sterilization by private counsel, but in certain States the civil power has introduced it by law or even rendered it obligatory.⁴

⁴ The following can be consulted: Davis, State Sterilisation of the Unfit; Landmann, Human Sterilisation; Nisot, La question eugénique dans les divers pays.

This did not originate in Germany; it has already existed for forty years. In the year 1897, a law was proposed in the American State of Michigan, but was not admitted. In 1905, Pennsylvania adopted a law, but it was not sanctioned by the authority of the State. In 1907, a law was enacted in Indiana, and thereafter in many federated States of America. Today, of forty-eight, twenty-seven have a law concerning sterilization.⁵ In the Dominion of Canada also, two provinces, namely, Alberta (1928) and British Columbia (1933), have a law.

⁵ They are: Indiana, Washington, California, Connecticut, Nevada, Iowa, New Jersey, New York, North Dakota, Kansas, Michigan, Wisconsin, Nebraska, Oregon, South Dakota, New Hampshire, North Carolina, Alabama, Montana, Delaware, Virginia, Idaho, Utah, Minnesota, Maine, Mississippi, West Virginia, Arizona, Vermont, and Oklahoma. Namely, thirty States; but in two, namely, Nevada and New Jersey, the law is not applied, and in New York it was abrogated in 1920.

In Europe, besides Germany, the Swiss canton of Vaud (Waadt) and Denmark introduced a law in 1929; recently Sweden and Norway also did so in 1934, and finally Finland in 1936. A law was proposed in Great Britain; and a certain tendency toward proposing one can be observed in Czechoslovakia and Spain.

Not all the laws are alike, for they are more or less rigorous and extend to some or several categories; some require many more conditions; some permit sterilization only with the consent of the person, if the person is capable of consenting, or with the consent of relatives; others also impose an obligation.

In the federated States of America, according to a statistical computation of 1 January 1933, the persons sterilized in application of the law were 16,066, namely, 6,999 men and 9,067 women, of whom one-half are from California, namely, 8,504 persons. Recently the number has increased to 8,644 men and 11,419 women.⁶ Therefore it is not true, as many assert, that the law is not applied in America. Sterilization is almost always procured by vasectomy and fallectomy, namely, in nineteen out of twenty cases.

⁶ Before 1921, there were 3,238 persons sterilized, namely, 1,858 men and 1,380 women: 403 because of mental deficiency, 2,700 psychopathic persons, and 135 criminals. By 1 January 1925: 6,244, namely, 3,307 men and 2,937 women.

The American law was enacted principally for eugenic reasons and secondarily for pecuniary reasons, so that the State would have to pay less for the care of the infirm and insane.⁷

⁷ Thus Ada Jukes (d. 1740) is adduced, of whom, before the year 1877, 709 descendants were known: 312 were beggars, 76 criminals, among whom were 12 murderers, 174 prostitutes, and 196 illegitimate. But after new investigations made after the year 1877, 2,094 persons of the Jukes family are now known, of whom 1,258 were still living in 1915. Among these, more than half suffered from mental deficiency or epilepsy; 41 had been condemned for a crime; only 65 were normal. For their support in public institutions, the State of New York paid two million dollars. Similarly, Dr. Malley relates that two prostitutes in New York had, through five generations, 709 delinquent descendants, of whom 152 women were prostitutes; for them the State paid 5,500,000 dollars. Likewise a certain man known by the name Zero had 303 descendants, of whom 81 were abnormal, 74 died at a young age, 62 were illegitimate, 36 morally ruined, 84 vagrants, 24 criminals, and 22 doubtful; only 39 were upright. A certain vagrant woman (d. 1740), according to Plate, had as descendants 106 illegitimate persons, 142 beggars, 181 prostitutes, and 76 criminals. The annual expenses for asylums alone in the federated States are 85,000 dollars, and increase each year.

The German law was enacted for eugenic reasons, for the improvement of the stock. The State must especially watch over the preservation and perfection of the stock, and indeed the biological and physical perfection of the race, which is a condition of intellectual perfection. Therefore the hereditary transmission of defects is to be prevented. Article 1 of the law reads: "Every person afflicted with a hereditary condition can be rendered infertile by surgical intervention if, from medical experience, it is likely foreseen that his posterity will contract by heredity grave physical and moral abnormalities." The following are regarded as grave: congenital mental deficiency, schizophrenia, manic-depressive insanity, hereditary choreomania (Erbsveitstanz, danse de St Guy héréditaire), hereditary epilepsy, hereditary blindness, hereditary deafness, grave hereditary physical deformity, and also grave alcoholism.

Pecuniary reasons were also invoked. The daily expenses for a criminal are 3.50 marks, and for a deaf-mute five to six marks, while workers have a wage of 2.51 marks. In one year, the expenses made for criminals and persons infirm from heredity are estimated at 350 million marks; others say that they reach one billion marks. Since the German Reich today is among the poorest, it intends to diminish those expenses.

That law does not please many, both in Germany and in international newspapers, which consider rendering such a law obligatory to be contrary to the dignity of the human person.

On 15 January 1935, the Völkische Beobachter wrote that 410,600 persons were to be sterilized in Germany, namely, 200,000 because of mental deficiency, 80,000 because of schizophrenia, 20,000 because of manic-depressive insanity, 600 because of choreomania, 60,000 because of hereditary epilepsy, 4,000 because of hereditary blindness, 16,000 because of hereditary deafness, 20,000 because of grave physical defects, and 10,000 because of grave alcoholism.

Many were disturbed by these numbers. Hence the ministerial counselor Gutt declared that he would take every precaution lest there be abuses in the application, and said that the aforesaid computations were exaggerated.

Certain concessions were also made to Catholics: persons sentenced to sterilization need not undergo it if they are willing to remain confined in an institution where every sexual relation is carefully prevented. And Catholic physicians are not obliged to designate the infirm who ought to be sterilized under the law.

But these declarations and concessions regard certain circumstances in the execution of the law, not the principles upon which it rests.

V. The questions to be treated concern the morality of sterilization:

1. the morality of private sterilization;

2. the morality of sterilization to be imposed by public authority;

3. cooperation in sterilization.

To these is to be joined an appendix concerning the marriage of sterilized persons.

We shall speak briefly concerning these matters.