Question One: On the Morality of Private Sterilization

I. Sterilization belongs to the genus of mutilation. For it is an action which renders a person sterile or infertile. Hence it is mutilation under both the moral aspect and the medical and surgical aspect: an operation by which a bodily member or organ is removed or rendered unfit for its natural function, or which suppresses a member or organ, or its use or organic function,¹ in the case, the function of generating.

¹ Etymologically, mutilation is the amputation or removal of a member; but theologically, a grave injury is also called mutilation, as when an organ remains but is deprived of its natural function.

Direct mutilation, which is intended in itself as an end or means, is distinguished from indirect mutilation, which is not intended in itself either as an end or as a means. The former is an action which immediately tends toward nothing other than mutilating; the latter is an action which immediately tends toward something else, although mutilation also arises from it. Direct and indirect killing are distinguished in the same way.

Now it is evident that an action which mutilates indirectly is licit for a proportionately grave reason, or because of a greater good which follows immediately from the action itself and not through the mutilation. Hence we inquire concerning the liceity and morality of direct mutilation and sterilization.

II. Direct sterilization is not licit except for the good of the whole body. No private person can mutilate himself or mutilate another, because man is not the master of the human body, over which he does not have full and perfect dominion, but only its use or a certain useful dominion. It is nevertheless licit if it is necessary for the health of the whole body, because it is right to remove a part in order to preserve the whole. As St. Thomas says, II-II, q. 65, a. 1:

"Since a member is a part of the whole human body, it exists for the sake of the whole, as the imperfect for the perfect. Hence the members of the human body are to be disposed of according as it is expedient for the whole. Now a member of the human body is indeed per se useful for the good of the whole body; nevertheless, per accidens it can happen that it is harmful, for example, when a putrid member is corruptive of the whole body. Therefore, if a member is healthy and remains in its natural disposition, it cannot be cut off without detriment to the whole body.... But if a member, because of putrefaction, is corruptive of the whole body, then it is licit, with the will of the person whose member it is, to cut off the putrid member for the health of the whole body, because to each person is entrusted the care of his own health. And the same reason holds if it is done by the will of him to whom it pertains to care for the health of the person who has the diseased member. But otherwise, to mutilate someone in a member is altogether illicit."

Hence, apart from a case in which the operation is necessary for the health of the body so that it cannot otherwise be obtained, direct sterilization is intrinsically evil,² because it is contrary to natural law. It is also a notable or grave mutilation, as depriving a person of the function of generating, which is of the greatest importance. And therefore it is a grave sin.

² Some say that sterilization is not evil of itself, a manner of speaking which could be understood badly. Certainly it is not evil of itself in the sense that it is not essentially and always evil, as are idolatry, blasphemy, lust contrary to nature, lying, and so forth, since it can sometimes be good. Nevertheless, sterilization not necessary for the health of the body is naturally and intrinsically evil, because it is contrary to natural law; but everything which contradicts natural law is intrinsically evil and evil according to itself, from its proper object and independently of circumstances, as contrary to the order of nature. The private homicide of an innocent person is also naturally and intrinsically evil; not essentially, because it would be performed licitly at God's command. Cf. Summa Theologiae Moralis, I, n. 258.

It cannot be considered slight:

a. From the fact that, as someone has said,³ some sterilization, such as vasectomy, is performed without pain and danger; that it is not injurious to health or character; and that it is performed in a short time because the amputation is minimal. These circumstances do not aggravate the operation; but the operation is not to be judged grave or slight according to circumstances, for example, from danger or pain, duration, extent, or the size of the member. Before all else, the object is to be attended to, which is the deprivation of the very function of generating. But this is grave, in the same way as the cutting of the optic nerve, which deprives the eye of the faculty of seeing, is a grave mutilation by reason of the function of which it deprives.

³ Donovan, in Ecclesiastical Review, 1910.

b. Nor from the fact that sterilization does not always remove every organic function, since in vasectomy and fallectomy the usefulness for the well-being of the whole body remains from internal secretion, and only the ejaculation of seed or the descent of the ovum into the uterus is impeded; therefore, it is said, there is no destruction of the genital function.⁴ For it suffices for grave mutilation to deprive one of a faculty of great importance, or of one principal function. In the case, although one function is not impeded, another of the greatest importance is impeded. And certainly, if a physician cut the nerve which governs the reflex movement of the arm, the mutilation would not be slight because another function of the arm remained and one could still extend the arm.

⁴ Thus Mayer, Gesetzliche Unfruchtbarmachung Geisteskranker, 1927.

c. Nor from the fact that someone can renounce the right of procreation. He can indeed renounce the use of the right, but cannot take away from himself the radical right and faculty of generating, or the natural function thereof, because he does not have dominion over it.

The aforesaid doctrine is now found altogether confirmed in the encyclical Casti connubii:

"That private persons themselves have no other dominion over the members of their own body than that which pertains to their natural ends, and that they cannot destroy or mutilate them, or by another way render themselves unfit for their natural functions, except when the good of the whole body cannot otherwise be provided for, Christian doctrine establishes and it is altogether evident from the light of human reason itself."

Here three things are to be noted: 1. it is Christian doctrine, not mere opinion; 2. this doctrine belongs to natural law, for it is evident by the light of reason; 3. an action by which one renders oneself unfit for a function is affirmed to be equivalent to mutilation.

III. Corollary. From this it follows that mutilation:

1. is not licit unless the immediate end of the work is the health of the body;

2. is in no way licit for prophylactic, eugenic, economic-social, or social-hygienic reasons, for the hygiene of the stock, or in order to avoid conception;

3. neither is it licit for a spiritual good, both because a member is immediately ordered only to the good of the body, and because the spiritual good can be obtained in another way, and therefore the operation is not necessary. Hence St. Thomas, loc. cit., ad 3:

"A member is not to be cut off for the health of the whole except when aid cannot be given otherwise. But aid can always be given to spiritual health otherwise than through the cutting off of a member, because sin is subject to the will.... And therefore in no case is it licit to cut off a member in order to avoid any sin whatever."

In these cases the principle must be applied: Evils are not to be done that goods may come about.

IV. Observation. Some regard mutilation licit for the health of the whole body as indirect. The indirect is licit for a proportionately grave reason, because its effect is twofold: the good, which is intended, namely, the health of the body; and the evil, which is permitted, namely, deprivation of the member; but the good prevails in the case. The only difference is in the manner of speaking, although that manner is not correct. For although sterility follows as a mediate effect, the sterilization itself, at least generally, is immediate and direct. The direct removal of a genital organ, namely, or the direct impediment of generation, is the means for procuring the good effect, the health of the body, or for averting danger.

V. Question: Whether sterilization is licit for a man abnormally and pathologically erotic, in order that he may be cured? Some affirm that vasectomy is a remedy for erethism, satyriasis, nymphomania, or an abnormal inclination toward masturbation. Hence many have said that it is probably licit in the case,⁵ because it is immediately for the good of the whole body or of the nervous system, if a good effect can truly be obtained from it and cannot be obtained otherwise.⁶ But this becomes more doubtful from day to day, since the aforesaid defects are not indeed of the physical order but of the psychic order. Even granting that the effect is obtained, the operation is directed rather to a spiritual good than to the health of the body. Moreover, the effect does not appear to be immediate, but rather to be obtained through the evil effect.

⁵ Thus they wrote especially before the encyclical Casti connubii.

⁶ Some say the same concerning castration, because they regard it as more efficacious for this end. But the greater efficacy appears to be attributed in part to the subjective influence of imagination or suggestion.

Wherefore, according to Antonelli,⁷ it would not be licit unless two conditions were verified: 1. that all therapeutic means had been employed without any successful outcome; 2. that it be certain that, unless the erethism is calmed, death or some grave illness will follow from it. These two conditions will never, or at least very rarely, be present.

⁷ Medicina Pastoralis, III, n. 678, F, p. 434.

They indeed say that the good effect is immediate, since health proceeds from a modification of the organism. But it should rather be said that it proceeds from a modification of the organism as impeding generation.

In practice, so long as it is not established that sterilization is a means of cure, and that in a determinate case it is the sole means, it is illicit to employ it for the sake of cure.

Dr. Pöllmann describes 800 descendants of an alcoholic woman, of whom 107 were illegitimate, 102 beggars, 181 prostitutes, 75 delinquents, and 7 murderers; for all of them the government paid 6,030,000 marks. Dr. Vervaeck relates concerning a criminal born in 1720 that he left 2,000 descendants, of whom 1,500 were subjected to examination: of these 197 are criminals, 300 beggars and vagrants, 440 feeble, drunkards, and abnormal, 50 given to prostitution, 213 upright, and 300 dead in infancy, and so forth.