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The Linacre QuarterlyVolume 15 | Number 3 Article 6July 1948Supression of Ovarian Function to PreventMetastasisCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationCatholic Physicians' Guild (1948) "Supression of Ovarian Function to Prevent Metastasis," The Linacre Quarterly: Vol. 15: No. 3,Article 6.Available at: http://epublications.marquette.edu/lnq/vol15/iss3/6'1'1-IE LINACltF~ - QUAIlTEIlLY :J7 SUPPRESSION OF OVARIA)[ FUNCTION TO PREVENT METASTASIS Is oophorectomy permissible in the case of a married woman of child-bearing age to prevent metas-tasis from carcinoma of the breast? Also, is the suppression of ovarian function by irradiation permissible for the same purpose? Principle The general principle govern-ing all treatments and operations that interfere with bodily integrity was clearly stated by Pius XI in the Encyclical on Christian Mar-riage. After condemning the theory of eugenic steriliza tion and insist-ing that the state has no power over the bodies of innocent per-sons, the Pope went on to explain the limited right that the individ-uals have over the members of their own bodies: "Furthermore." he said. "Chris-tian doctrine establishes. and the light of human reason makes it most clear. that private individuals have no other power over the mem-bers of their bodies than that which pertains to their natural ends; and they are not free to destroy or mutilate their members . or in any other way render them -selves unfit for their natural func-tions. except when no other pro-vision can be made for the good of the whole body." (Encyclical on Marriage, America Press Edition . pp.21-22). As his words indicate. the Pope was not enunciating a new doc-trine; he was simply restating a principle long known and defended by Catholic moralists as a part of the natural law. Since this prin-ciple will be used. not only in an-swering the present questions. but also in solving many other medico-moral problems. it may be helpful to note here some of the points brought out by theologians when they explain the principle. Sacrifice of an O rgan for Good of Body In general. theologians speak of three cases in which an individual may licitly sacrifice an organ or a function for the good of the whole body. For example. if one's foot is diseased and the disease cannot be cured by treatment . one may have it amputated to prevent the disease from spreading to the rest of the body. Again . if one's per-fectly healthy foot is caught in a railroad track. one may cut off the foot in order to avoid being killed by the train. Finally , if one's enemy would point a gun at his head, with the threat, "Cut off your foot , or I'll blow your brains out," the helpless victim could licitly sacrifice the foot to preserve his life. The third case may sound fan-tastic (although . as a matter of fact it has been verified more than once in our modern "refined" civil-ization) , but both it and the second case illustrate a point to be kept in mind in this discussion: namely. that to justify a mutilation it is not always necessary that the organ or function be .. diseased" in the tech-nical sense; it suffices if the organ or function is a real source of harm to the body and the excision or suppression would benefit the body by removing the source of harm. In all the examples cited the organ was sacrificed in order to ward off the danger of death . These were merely examples. It is not necessary that there be dan-28 THE LINACRE QUARTEIlLY ger of death in order to justify a mutilation. For instance. theolo-gians would generally admit. 1 think. that a man could cut off a hand or foot in order to escape from a long and unjust imprison-ment. Similarly. a mutilating oper-ation is permissible in order to re-move a source of great pain or a condition which incapacitates a person. even though it does not endanger his life. Statement of the Holy Father The Pope said that mutilation is permissible only when "no other provision can be made for the good of the whole body." Do these words mean that therapeutic treat-ment must always be preferred to surgery? I doubt if they need to be interpreted so absolutely. Cer-tainly they do mean that a con-venient and effective treatment must be used in preference to mutilation; but there is room for discussion. I believe. regarding cases in which the only available treatments would be doubtfully ef-fective or when a treatment could be employed only with great in-convenience to the patient. A good working rule regarding the preference of mutilation (by surgery or X-rays) over treatment might be stated thus: good medi-cine is good morality. This rule might or might not admit of occa-sional exceptions according to what some might consider "good medi-cine"; but in general. if medical authorities agree that mutilation is the advisable course. the mutilation may be considered as morally jus-tifiable. If the authorities disagree. and both sides offer sound argu-ments. the patient (or the patient's physician) is entitled to solve the doubt in his favor and to permit or request the mutilation. This point concerning the pref-erence of mutilation over treatment will very likely come up again in this column when we consider cer-tain definite procedures. What has been said will suffice for the pres-ent. And to square my explana-tion with the Pope's statement, I might paraphrase his words thus: mutilation is permissible when there is no other reasonably available means that would be equally bene-ficial to the whole body. Application to Reproductive Organs The preceding remarks concern-ing the licitness of mutilation ap-ply -also to the mutilation of the reproductive organs. provided the operation or treatment is not directly contraceptive. 1 can ex-plain this limitation more clearly by examples than by a theoretical discussion. As we all know. the removal of a cancerous uterus or of cancerous ovaries is permissible, even though the operation inevit-ably results in sterility. In such cases, the patient's life is saved . not by the loss of fertility, but by the removal of a diseased condi-tion. This is obvious from the fact that a mere sterilization (e.g. by fallotomy) would not produce the desired result. On the other hand. when the reproductive organs themselves are neither diseased nor a source of harm to the body. they may not be mutilated merely to prevent a pregnancy which would be dan-gerous by reason of some other physical condition such as a weak heart. An operation of this kind is directly contraceptive: it pro-duces its_ good effect precisely by inducing sterility. Why do Catholic theologians insist on this distinction? Because they hold firmly to the principle that God has given to private indi-viduals "no other power over the members of their bodies than that which pertains to their natural ends." The reproductive function. TI-H, LINA C HE QUAHTERLY 29 as such. is not subordinated to the individual's well-being; hence an operation or treatment which is immediately directed to a suppres-sion of this function is contrary to the purpose of the faculty. and is therefore not in accord with sound moral principles. On the other hand. when the loss of fertility is merely the indirect result of a treatment or operation . it may be permitted for a proportionate rea-son. just as other unwanted but inevitable evil effects may some-times be permitted (e.g. the death of the fetus when a cancerous pregnant uterus must be removed) . Conclusion We can now apply the principle to the questions proposed . According to a theory to which many eminent medical authorities subscribe. ovarian secretion. espe-cially follicular hormone. stimulates the growth of neoplastic tissue. Hence the ovaries. though not technically "diseased." are a real source of harm to the woman afflicted with carcinoma of the breast; and the removal of the ovaries tends to benefit the whole body by diminishing or eliminating the danger of metastasis. This good effect cannot be produced without at the same time rendering the woman sterile; but it is not precisely by steriliza tion tha t the good is accomplished. The desired good . if accomplished at all. is brought about by a suppression of the endocrine function of the ovar-ies ; and a mere sterilization (such as fallotomy) would not serve the purpose. The sterility. therefore. which is induced in the present cases is indirect and not contra-ceptive. As I understand the matter. there is some controversy among medical men concerning the value of oophorectomy or irradiation of the ovaries for the prevention of metastasis . But the theory that supports it seems to be well-founded and solidly probable; hence the patient or the patient's physician may resort to the opera-tion or the irradiation , provided there is no equally effective but less drastic procedure available. I have on hand two Hospital Codes. recently published with ecclesiastical approval. both of which allow oophorectomy or ir-radiation of the ovaries for the prevention of metastasis. The one condition they lay down is that the hospital may demand consulta-tion. In other words, according to these codes, if prudent medical judgment considers either proced-ure (surgery or X-rays) advis-able, it is also · morally justifiable . I think that expresses our conclu-sion very neatly. References The standard moral theology texts do not. as far as I know, treat the present topic. In general. the authors cited in the sub-joined references seem to admit that the destruction of the ovaries is per-missible if required to cure or im-pede the growth of cancer. Some, however, question the utility or necessity. The Linacre Quarterly, X (Jan-uary. 1942) 4-5. In an article entitled" Steriliza tion ," Father John Ford, S.J. , allows the destruc-tion of the ovaries when this is necessary " in order to cure cancer of the breast, or to cure other malignant growths - or at least diminish such growths." He in-sists . however, that in procedures that result in sterility there be no contraceptive intent. The Ecclesiastical Review, CVIII (April. 1943) 271-73. Writing about irradiation of ovaries in can-cer of the breasts , Father Peter Kremer, O.S . Cam . , shows that the sterility induced by this treat -:10 TI-I E LI NAC' R E QllA H'l'EItL Y ment is only indirect . It is not clear to me tha t he is actually de-fending the treatment as permis-sible. but he seems to imply it. He concludes with the s tatement that "all cancers of the breast are likely to grow slower a nd spread less ra pidly if not affected by ovarian secretion. than if this secretion were present. " Th e Ecclesiastical R eview, CIX (August. 1943) . 125-27. Writing on "The Moralit y of Indirect Sterili za tion." F a ther Honoratus Bonzelet. O .F.M .. admits that the irradiation of the ovaries for the cure of cancer of the breast would be an indirect steriliza tion . but he ex presses his opinion tha t it would be illicit in the cases referred to by F ather Kr e mer b e c a us e there would not be a proportiona te rea-son for it. I am not sure that Father Bonzelet touches the point a t issue in the questions proposed to me. He seems to be thinking only in terms of curing the pri-mary cancer of the breast by means of suppressing ovarian secretion . and not of preventing metastasis . He cites a Mayo authority to the effect that the procedure of choice would be removal of the breast carcinoma followed by roentgen therapy of the excised area . Theological Studies, IV (De-cember. 1943). 588-89. In review-ing the articles written by Fathers Kremer and Bonzelet. Father John Ford. S . J .. agrees with Father Bonzelet that there must be a pro-portionate reason for indirect ster-ilization. but he believes that the judgment of this reason is chiefly a medical one. Medical Ethics [or Nurses, by C ha rles J. McFadden . O .S .A .. Philadelphia , F . A. Davis Co .. 1946. See pp. 224-25 . Father Mc-F adden says practica lly the same as Father Bonzelet. as referred to above. ORCHIDECTOl\IY FOR CAItCIN OMA OF PHOSTATE Question : Is it permiss ible [or a doctor to perform an orchidectomy , primarily [or the relief of pain , on a patient who has carcinoma o[ the prostate gland? Previous D iscussion The problem presented here is quite similar to the question con-cerning the suppression of ovarian function in cases of carcinoma of the breast, a question that was dis -cussed in Ho s pital Progre ss , XXIX (April . 1948) . 147-48 . It was pointed out in that dis-cussion that a treatment or muti-la tion of the reproductive organs which results in sterility is morally justifiable only wh en these condi-tions are fulfilled : (I) the purpose of the treatment or opera tion must not be contraceptive ; (2) the pro-cedure must offer some hope of benefit to a patient who suffers from serious pathology; and (3) a less drastic procedure which offers more or less equal hope of benefit is not reasonably available. In the article referred to . I indi-cated how these three conditions might be fulfilled in the case of oophorectomy or irradiation of the ovaries for the prevention of me-tastasis from carcinoma of the breast. First , these procedures are not precisely contraceptive meas-ures , because they are directed to the suppression of the endocrine. 

Suppression of Ovarian Function to Prevent Metastasis

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Supression of Ovarian Function to Prevent Metastasis

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