Question Three: On Cooperation in Sterilization

I. Cooperation is called every concurrence afforded to the action of another; in the present case, concurrence afforded to a sterilization to be decreed or performed by another.

It can be given in diverse ways. One kind is cooperation in the broad sense, which occurs through a moral influence upon the will of another, whether directly and positively, as by commanding, counseling, requesting, seducing, consenting, and so forth; or indirectly and negatively, by not admonishing or not impeding, when someone can and ought to admonish or impede. Another is cooperation in the strict sense, which occurs through a real or physical influence, as by assisting, partially causing, supplying means, and so forth. This is immediate or mediate, according as the cooperator executes the work itself with the principal agent, as if he takes away another's property by carrying it together with a thief; or only supplies means by which the other can perform the work, or can perform it more easily. In the latter case the cooperation can be more proximate or more remote, according as the means exercises a greater or lesser influence and is more or less connected with the work of the other.

By reason of intention, one kind of cooperation is formal, when the cooperator consents to the will of the principal agent and intends the latter's work; another is merely material, when he does not consent to the latter's intention, but acts from another intention with foresight that the other will use it to perpetrate his work.

Now the question is asked whether it is licit to cooperate in sterilization.¹ Here the question concerns illicit sterilization; for if the sterilization is licit, it is also licit to cooperate in it, provided this is done by means which are not evil.

¹ Cf. Grosam, Die Sterilisation auf Grund privater Auktorität und auf Grund gesetzlicher Ermächtigung, in Theologisch-praktische Quartalschrift, 1930.

II. Formal cooperation, which proceeds from an evil intention and from approval of illicit sterilization, is always evil and prohibited. Indeed, it is a sin of the same species as sterilization, as a concurrence formally intending and approving it. Hence it is a special sin against justice.

Such are not only those who spontaneously offer themselves to be sterilized, but also physicians who, on their own initiative and without being bound by a public office, deliberately carry out an illicit sterilization; editors and writers who recommend and propagate it from conviction; deputies who approve by vote a law that sterilization is to be performed; and spouses who consent to the sterilization of their consort. Indeed, negative cooperators could in this way be guilty, namely, magistrates, officials, and agents who knew that evil sterilizations were being performed in their territory, provided they could and by reason of office ought to impede them, and could do so without inconvenience, but did not.

III. Merely material but real cooperation, whether immediate or mediate, proximate or remote. Merely material cooperation is that which, without an evil intention or consent to another's sin, someone freely affords to the action of another, but rather unwillingly, in order, for example, to avoid an inconvenience or loss, or to procure gain for himself.

1. If it is immediate, it is always evil, because it consists in the execution of the evil action itself. There is an exception when external goods of fortune are involved, to the removal of which the owner can consent; but this exception does not come under consideration in the question of sterilization, to which it is licit for no one to consent unless it were necessary for bodily health. Hence immediate cooperation in the action of decreeing or performing sterilization is intrinsically evil, just as sterilization itself is, and indeed it is a sin of the same species as the work itself.

Thus physicians who perform the operation unwillingly because they are compelled by law themselves cooperate immediately in the execution of a wicked law; or two physicians who together immediately execute the operation of sterilization itself.

2. Mediate cooperation, however, is that which supplies the means required for performing sterilization, by preparing or assisting. This also is of itself illicit unless there is a grave reason, and indeed a proportionately grave one; that is, a reason graver in proportion as the cooperation is more proximate and in proportion as it is more necessary, that is, as the sterilization would more probably be prevented if the cooperation were refused.

For it is licit to place a cause good or indifferent in itself which has two equally immediate effects: one good, which alone is intended, and the other evil, provided there is a proportionately grave reason for acting. But merely material mediate cooperation has immediately a good effect which alone is intended. Therefore it is licit, provided the action is not evil in itself and there is a proportionately grave reason or a sufficient cause for cooperating.

Such cooperators are assisting physicians and nurses; a nurse who, for example, under the direction of a physician, attends to a Roentgen apparatus; subordinate officials who, by writing records or giving some assistance, cooperate in the execution of the law; workers who prepare the instruments or keep them clean or heated; and a fortiori those who hand instruments to the physician during the operation.

Cooperation that is altogether proximate, such as that of assisting physicians or nurses who attend to the apparatus, demands a most grave cause, for example, if they would lose their means of support but nevertheless could not impede the sterilization. It would very rarely be licit for Catholic Sisters, for example, if otherwise they would be expelled from the institution with great harm to religion.

Proximate but more remote cooperation requires a lesser cause, yet one still grave, for example, a grave inconvenience, and a greater cause in proportion as the cooperation is more proximate.

Cooperation can be altogether remote, for which the reason of one's office itself suffices. Thus it is licit for servants to keep the operating room or chamber clean or heated.

In a case in which there is not a sufficient reason for mediate cooperation, there is a sin against the virtue which is injured by the action of the principal agent; in the present case, against justice, because it is to assist in injuring justice by an unjust sterilization, although the sin is not of the same most specific species or the same gravity. Moreover, scandal, which can arise, is to be avoided; concerning it only those who know all the circumstances of places and persons can judge. This is not always easy. Hence, if it is doubtful whether scandal is to be feared in the concrete case, judgment concerning it in determinate circumstances pertains to the local Ordinaries, who are able to know and estimate all the circumstances.

IV. Moral cooperation is especially that by which someone positively influences the will of him who does evil, and it coincides with direct scandal or scandal inducing one to sin. It is committed, for example, by commanding, counseling, praising, requesting, protecting the sin, in the present case sterilization, or consenting to it.

This is a sin against charity, because it is scandal; and at the same time against the virtue which it induces one to violate, because it directly induces one to this. In the present case it is against justice, which is injured in a special manner whether by private sterilization or by public sterilization.

Such are those who by private authority decree that someone is to be sterilized; those who summon a physician and request sterilization for another; those who command sterilization or invite another to it; and those who report the sick in order that they be sterilized.

V. Observation. Illicit cooperation is not only a sin against the virtue or precept to whose violation concurrence is afforded; it is also against charity when the sin would be prevented if the cooperation were omitted.

VI. Applications. From the foregoing it follows:

1. It is illicit to recommend or counsel sterilization, to request it or formally consent to a request for it, to present a report or vote concerning persons infected with hereditary disease in order that they be sterilized, or to summon a physician for this purpose; because to recommend, counsel, request, or in any way procure a thing intrinsically evil, and so forth, is likewise intrinsically evil. But merely to report or explain the law of sterilization without approval, merely to indicate diseases or merely to report sick persons while nevertheless knowing that they are to be sterilized, and to summon a physician without saying anything, are not intrinsically evil. Hence, by these means, merely material cooperation can be licit for a grave cause and with scandal excluded. Scandal, however, could easily arise from a public explanation of the law made ex officio.

2. It is illicit for physicians to perform the operation of sterilization or to take active parts in carrying out the very act of sterilizing, because this is to do something intrinsically evil. On the contrary, to be present or assist during the operation, to hand over instruments, or to watch over the patient is not of itself intrinsically evil. Wherefore, merely material cooperation in this manner can be licit, but only for a graver cause, because it is altogether proximate cooperation.

3. Likewise, it is illicit for a physician to persuade patients to present themselves for the execution of sterilization, even if he acts thus from the obligation of a public office or of the law, and after the tribunal has pronounced a sentence of sterilization, because to counsel a thing intrinsically evil is always intrinsically evil. Nevertheless, perhaps it would not be illicit to say, "You know the provisions of the law," and merely to declare them without adding persuasion, but only for a graver cause, because this is proximate cooperation.

4. Likewise, it is illicit to present oneself voluntarily for sterilization, because this is to request and consent to a thing intrinsically evil, even if it is done lest a person, after the sentence of the tribunal has already been pronounced, suffer force through compulsion. Rather, he ought not yield except to violence. It is sufficient, however, that force begin to be applied, for example, if an official places his hand upon the shoulder, or if he declares that he has come to employ the force of compulsion. It is not necessary to offer further resistance, because it is then evident to all that the person does not proceed voluntarily but yields to compulsion.

5. Likewise, it is illicit for anyone to permit sterilization to be performed upon himself; rather, he ought to avoid it insofar as is morally possible for him, and to withdraw himself from the sterilization to be imposed.

6. Likewise, it is illicit to compel the sick by force to present themselves for sterilization, even if someone acts thus after the sentence of the tribunal has been pronounced and from the obligation of his office, because this is to compel another to a thing intrinsically evil. This is to be understood of officials who act by their own authority and according to their own judgment, but not of altogether subordinate agents who merely ministerially execute orders by leading persons to a determinate place, and who do not always understand the nature of the thing prescribed or to be executed. These appear to be excused by reason of their office, unless something were demanded of them out of hatred of religion or something manifestly dishonorable.

7. Likewise, it is illicit to discharge the office of judge in a special tribunal instituted solely to treat cases of sterilization. A fortiori, it is illicit to pronounce a decretory sentence that sterilization is to be executed, because this is to command a thing intrinsically evil.

Let it not be thought that the judge only pronounces that the conditions indicated in the law have been verified, upon the presence of which the law itself commands sterilization. On the contrary, the judge does not merely declare the law, but as a superior applies the law by his authority to particular cases and persons. For these he commands in the concrete, authentically intimates the obligation to them, and renders them liable to sterilization, since the law commands that they be rendered liable. Hence he establishes and introduces a new obligation, wherefore his sentence is like a particular law.² But directly to command a thing intrinsically evil and to oblige one to it is illicit.

² St. Thomas, II-II, q. 67, a. 1.

The judge, namely, cannot licitly apply an iniquitous law; iniquitous, I say, not only by reason of incompetence, because it is enacted concerning things not subject to the civil power, for in that case the Church could sometimes concede this or renounce its right; but iniquitous by reason of the matter or the thing prescribed, because it commands against the natural law. It is never licit, namely, to command a thing intrinsically evil and contrary to natural right.³

³ St. Thomas, II-II, q. 60, a. 5, ad 1.

You will object: a. The judge does not act spontaneously and freely, but is compelled by the force of law. Therefore he is not responsible for the effect of the law. One who is compelled appears to afford only merely material cooperation, which can be licit for a grave cause.

Response. He is compelled not by physical force but by moral violence which leaves freedom. What is done from fear is involuntary in a qualified respect, because it is done with repugnance, but is voluntary simply. The judge acts as an agent, while the legislator gives the mandate. Just as the legislator is responsible for the mandate of the law, so the judge is responsible for the execution of the mandate or law. And just as it is not licit to command something intrinsically evil, neither is it licit to execute it. Thus the judge cooperates immediately in the execution of the iniquitous law; and he formally moves another toward a thing intrinsically evil by commanding it, which is direct scandal.

b. St. Thomas says that it is licit for a judge to condemn an innocent man whom he knows by private knowledge to be innocent, but who publicly and juridically has been convicted of a crime.⁴ In judgment he ought to be directed not according to what he himself knows as a private person, but according to what becomes known to him as a public person.

⁴ St. Thomas, II-II, q. 67, a. 2, and q. 64, a. 6, ad 3.

Response. It is one thing to apply a law which is just in itself and favors the common good but which per accidens has an evil effect; it is another to apply a law unjust according to itself. It is one thing to compel him who has been juridically convicted of a crime according to laws just in themselves; it is another to compel him who is plainly manifest to be innocent and whom iniquitous laws alone intend to oblige to something intrinsically evil. This latter plainly cannot be licit, whereas the former could appear licit in certain circumstances.

c. According to many, it is licit for a judge to pronounce a civil divorce, which nevertheless is intrinsically evil.

Response. Those who think thus say that civil divorce is not intrinsically evil, because it does not dissolve the marriage but only the civil contract, and removes civil protection from the marriage, and consequently the opposition of the law to new civil nuptials. It is altogether another thing to command something intrinsically evil, which is never licit. Hence, if the pronouncement of civil divorce were evidently intrinsically evil, neither could it ever be licit.

No solid probability belongs to these and other similar little arguments which could be adduced. Wherefore it is in no way probable that it is licit for a judge to pronounce the execution of sterilization.