Hellegers, Andre E.

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The Linacre QuarterlyVolume 38 | Number 3 Article 16August 1971Contraception in Psychiatric DiseasesAndre E. HellegersFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationHellegers, Andre E. (1971) "Contraception in Psychiatric Diseases," The Linacre Quarterly: Vol. 38 : No. 3 , Article 16.Available at: http://epublications.marquette.edu/lnq/vol38/iss3/16in moral presuppositions is not nec-essarily to predict the downfall of all sexual norms. But to refuse to acknowledge this change in perspective in changing cultural circumstances, and to refuse to re-evaluate sexual ethics today may be to reject emerging sexual values and to discourage finding the means for minimizing sexual dis-values. Perhaps we should acknow-ledge more freely , as did the Fathers of Vatican Council 11,4 that we have not yet arrived at a difmitive under-standing of how the various benefits and potentialities offered to man in his sexuality should in every case be synthesized and reconciled. I suspect that Christian sexual ethics will have a brighter and more helpful future if it begins to emphasize a morality of growth. Contemporary theology has pointed to neglected per-sonal dimen sions of the sexual experi-ence, but have done relatively tittle to relate this to real life. ln fact, in many cases they have done little more than reject or alter or qualify norms. We need to move beyond the "up-dating" of norms , in spite of the fact that there is great pressure on the theolo-gian from laity and clergy to remain at that level of discourse. Furthermore, the discussions on situationism and the need to compromise encourage a new casuistry which may serve to relieve consciences in moments of distress but which do little to indicate what the future should hold in store for man who by nature seeks to deepen the personal meaning of his own sexuality. Love is not just a command, it is an inner law that has its own dynami sm and its own laws of growth. A relevant sexual ethic is one which speaks a language of values and thought-ness that strikes a chord of recognition in the hearer and challenges him to pursue the good. I believe that such an ethic can be found in the language of morality centering on personal growth 192 toward sexual maturity and generou~ love. This growth should not focus or an overly standardized goal, for thi· would probably signal a bourgeoi psycho-emotional mediocrity and . task~ntered morality. The emphas• should, instead, be placed on max mizing the growth which the ind vidual is capable of at his level < development without belittling in a vance what the law of love will enab him to accomplish in his life. It seems undeniable from the vie point of Scripture and the history sexual ethics as we have seen it - , well as from that of social anth: pology, psychology , philosophi ethics and theology - that there s need for specific and concrete nor s to govern human sexual behavior, a J that these norms need to be inculcal :1 with a certain clarity and firmnes~ s part of a suitable moral pedagog1 11 process. But our dominant heresy n sexual ethics has been a pedagog ,( one: the teaching that one could av d moral guilt and be all right with Go 1f he observed the commonly tau :t sexual prescriptions. That is a pract tl heresy because it denies the law >f man's growth and thwarts the :!-mands of dynamic love . The future of sexual ethics calls H the development of a Christian se: Jl morality of growth if today's cui r-ally and historically conditioned x-perience of life in general and se> al behavior in particular is to be b-jected to the radical demands of (, ·e. REFERENCES l. Much of this can be found explai . :din Franz Boeckle's aJticle, "Sexu itaet und sittliche Norm," in Stirn me der Zeit 80 (1967), 249-267. 2. John T. Noonan, Jr., Contracepti n: A History of Its Treatment by the < 'tho· lie Theologians and Canonists ' am· bridge, Mass.: Harvasd University -Tess, 1965), 45. 3. Cf. Rollo May, Love and Will New York: W. W. Norton, 1969). 4. Church in the Modern World, pa 51, speaking of responsible parenthoo . Linacre Quart .:rly Contraception in Psychiatric Diseases Andre E. Hellegers, M.D. Dr. Hellegers \WS born June 5, 1926 in Venlo, Holland. He received his medical degree from Edinburgh in 1951. He \WS an obstetrical resident at Johns Hopkins from 1953 to 1956. The following year he served as a research fellow at Yale. From 1960 to 1967, Dr. Hel/egers was a Senior Research Scholar with the Kennedy Foundation, and in 1964, he was appointed to the Pope's Commission on Population; he served in Rome until 1966. President Johnson subsequently appointed him to the President 's Committee on Popu· lation and Family Planning in 1968. Dr. Hellegers was appointed Associate Professor of Obstetrics and Gynecology at Johns Hopkins in 1962, and he was appointed Professor of Obstetrics and Gynecology at George-town in 1967. He was made Professor of Physiology and Biophysics in 1969. August , 1971 INTRODUCTION In an article entitled "Psychiatric Indications for the Use of Contra-ceptives" (Linacre Quarterly, May 1969) John R. Cavanagh, M.D. de-fends the Hceity of the use of contra-ceptives in psychiatric diseases. His defense can be divided into three main subsections as follows: I. Pope Paul VI in "Humanae Vitae" , paragraph 1 5, and Pope Pius XII in "Morality and Eugenics: An Address to the Seventh Hematological Congress" imply that contraceptive agents, taken on the advice of a physician as a necessary remedy for a condition of the uterus or of the organism excercise their sterilizing effects indirectly, and are therefore permitted. Dr. Cavanagh defends the thesis that psychiatric diseases are 193 diseases of " the organism" as implied in the Papal teachings. 2 . In an article by Swanson et al.: "The Use of Norethynodrel in Psy-chotic Females" (Am. J. Psychial. 110 , 1101 , 1964) they reported this agent as useful in the treatment of psychotic female patients, particularly where their symptoms were more severe premenstrually. 3. Based on the above information and after addjng some case histories of patients whose mental state improved after having their fear of pregnancy removed by the use of contraceptives, Dr. Cavanagh concludes: " In . the mentally ill woman , where the cause of the illness, is the result of unre-solved connicts over pregnancy 0; fami ly size, the use of contraceptives in its treatment is indirect sterilization according to Pope Paul and Pope Pius." It is the purpose of this brief article to: I. Question whether Dr. Cavanagh's conclusion in subsection three above necessarily follows from the mforma-tion given in subsections one and two and to: 2. Suggest that an alternative analysis of the use of contraceptive agents in psychiatric illnesses may be, at least in part. useful. CRITIQUE OF THE CAVANAGH ANALYSIS It should be stated at once that the use of such words as " the organism" in Papal teachings is very unfortunate unless the words are designed to be deliberately vague. S~.;itable as medical phraseology in days when we spoke of .. humors'' and "spirits". they have 194 little value in modern medicine whid seeks increasing specificity of defin tion. The medical vagueness lend itself to misinterpretation by not theologians and confusion in discu sions between them and scientists. Personally I believe that the Pap teaching means to be applicable on where the pharmacologic agent. surgical procedure, is necessary for t. correction or elimination of a biolo• cal/y defective action of any organ the body and is specific for tl disease. It may be asked how su . specificity is determined or how it c at least be logically concluded. I wo1 , suggest that the agen t should be use for the cure of " the organism" it. 1 cloistered nun , in a post rnenopau · patient or in any patient in whom 1 ability to reproduce is not the crux the psychiatric disease. Stated another way it would say that ; ability to reproduce should never considered a primary disease in ib• regardless of how other organs .. organisms" (including the mi• would react to that ability to rt!J duce. Swanson et al. a<>serted .: usefulness of Norethynodrel in tfl ing psychotic diseases of some wor '1 even when I hey could not reprodt In their paper I believe one C\ d describe the contraceptive actiou f Norethynodrel as only indirectly l>l t-lizing. I do not, however, believe l 11 this can be extended to the ~_ ~s described by Dr. Cavanagh where 1e use of the contraceptives would h ve had no '' therapeutic" effect if ne women had been sterile . A fortion as pointed out in the brief edih• 1al accompanying the article. it se ns untenable to me to assert that he contraceptive may be given to a p. ty other than the primary patient (e.r to the spouse). Indeed the "cure" a Linacrc Quarll ly patient by the administration of an agent to a different person precisely points out that there was no ''disease" in the primary patient t!Xcept the fear of the abili ty to reproduce. It is scientifically inconceivable that person A can be cured from an existing djsease by adrrun istering a drug to person B. It is true that administration of agents to one person may prevent diseases from occu1 nng in another person, but I can think ol no case in which the primary pat ient can be cured of any disease without being rurnself or herself reached by a thera-peutic intervention, unless. of course, the disease disappears spontaneously. One cannot, however, I believe, speak of a spontaneous cure when it depends on an intervention in another person. ln summary I believe that agents which have a sterilizing effect can only be considered to have an indirect sterilizing effect if they are similarly effective in the cure of patients who are not at risk of pregnancy. AN ALTERNATIVE ANALYSIS Patients with certain psychiatric diseases, which as a non-psychiatrist, I shall not further specify, may find themselves in a state where they are incapable of positing a human act in the realm of intercourse. A human act is one wh ich issues from the will acting freely, with antecedent knowledge of the nature and the end or purpose of the act and with accompanying ad-vertence. By and large persons who have reached puberty are supposed to have sufficient knowledge of inter-course to be able to enter into mar-riage (canon 1082, § 2 " Haec igno-rantia post pubertal urn non praesu-mitur). Yet Sanchez, in speaking of marriage, the object of which is inter-course , felt that knowledge of the nature , object and properties of mar-riage was not enough to enter a valid August, 1971 marital contract. h required a definite degree of deliberation and maturity of judgment . It is, of course, well known to most Catholics, that certain mar-riages have been annuUed on the grounds of men tal disease in either of the partners. While, in general , it used to be held that persons with mental disease might well have entered mar-riage in a lucid moment and it there-fore had to shown, for annullment, that they were not lucid when they contracted it, there has been a gentle shift away from that stance in recent times. The most recent trend has been to require that it be shown that a person was indeed lucid if, at the time of the legal proceedings, he or she was f.i. a chronic schizophrenic. What is not clear in the question of the liceity of the use of contraceptive agents in certain psychiatrically iU patients is whether ~urch practices in the realm of judging marriage con-tracts can be extended to practices in the realm of intercourse. Briefly the question may be put as follows: If, by virtue of psychiatric djsease, a person is judged by the Church incapable, on mental grounds, of entering into a marriage contract, can such a person validly ha~e intercourse as a human act? If a person cannot enter into a contract, the object matter of which is intercourse , can the person enter into intercourse itself? And if a person cannot have intercourse as a human act, (as defined above) can such a person then practice, or be judged capable of practicing, contraception as condemned in®turch teacffings? Not long ago thls question came to the fore, when persons in imminent danger of rape in the Congo used " the pill" to avoid becoming pregnant as a result of a non human act of "inter-course'', namely rape. The matter is 195 treated by J. C. Ford and G. Kelly in: Contemporary Moral Theology /1: Marriage Questions pp 365-367 (West-minster, Md.: Newman , 1964), who concluded that the Jiceity of the use of contraceptive agents under these cir-cumstances was at least solidly proba-ble. Whether "intercourse" against the will (rape) can be equated with "inter-course" in the absence of valid consent (statutory rape) has not, to my know-ledge, been analyzed by moral theo-logians. I do, however, believe that it would be difficult to maintain that mentally ill persons could not give consent to marriage but could give consent to the object of the marriage contract. The question does not imply that under certain circumstances ·con-traception is permitted by the Catholic Church; it does imply that under certain circumstances the use of con-traceptive agents does not belong to the species of condemned acts, namely the interference with a human act (as above described) of intercourse. There remains the question of what, in the light of these questions (if they have validity), constitutes ethical behavior by the patient and by the physician. Foregoing an analysis of the ethical behavior of a schizophren ic patient , I do believe that guidelines may be established for the psychiatrist or obstetrician who does not have the time to await an opinion of the Rota. It would be my contention that a physician , faced with a psychiatrically ill patient , and convinced that the patient could not validly enter into a marriage contract, can ethically pre-196 scribe contraceptive agents to such patient until he is reasonably co1 vinced that in the realm of intercour she can act with the degree of adve tence requ ired for contractil marriage. SUMMARY AND CONCLUSION The analysis of whether the admi stra tion of contraceptive agents con -tutes direct or indirect sterilizat ior s not the sole criterion for the anal) s of whether it is licit to administer SL h agents. A separate analysis demand a consideration of whether the patien IS capable of positing a human act in e realm of intercourse. It may be reas• ,J-ably concluded that if the physiciar is convinced that the patient is not i1 a state of mental health to permit en y into a valid contract of marriage, sh is incapable of validly entering into ,e object of that contract , namely in· r-course. In arriving at a sound judgm. ll in this matter it is wise to remem er that the psychical capacity for n r-riage (and therefore for intercou ~) "must be placed within the gras1 >f the vast majority of people"; "r r-riage" (and therefore intercou e) " may not be, as it were, placed e-yond the psychological range of 1e average person, or even beyond n 1y whose psychological range is be ,w average" (W. M. van Ommeren in Mental Illness Affecting Matrimt ial Consent, p. 102. Catholic Unive1 ty of America Press, Washington, I C., 1961). Linacre Quartl!rly ~ I I 1 ' i ! J Physician And Tutor In ISO I, in his 40th year, Linacre's role as Royal physician was cast: he was appointed a court physician in charge of the health of King Henry VII, one of the highest honors a doctor of medicine could at that time achieve. But he also was entrusted with the health-care of Prince Arthur, the young Prince of Wales, brother of Henry, future King Henry VIII , and *Adapted f rom an address before The Osler Society, Baylor Uni-versity College of Medicine, The Texas Medical Center, January 6, 196/ . Part I appeared in the May, 1971 issue of L.Q. August, 1971 THOMAS LINACRE* Humanist, Physician, Priest Fred M. Taylor, M.D. It is in life as it is in ways, the shortest way is commonly the foulest, and surely the fairer way is not much about. Part II Bacon, Advancement of Learning, Book II. Chap. 23, pp.45, 1605 Princess Mary, the elder son and daughter of Henry VII and Elizabeth of York. In addition , he was appointed their Royal tutor. 4 4 It is of interest that Lin acre had already translated for Arthur, Proclus' astronomical treatise , De Sphera, and in 1499 had it printed at Venice by Aldus Romanus.4 5 Linacre described Princess Mary as having not only a "marvelous disposition to every vir-tue ... but a noble and instinctive genius to learning ... " 4 6 At seven-teen, however, in the interest of the King's diplomatic foreign policy, she would marry and become Queen Mary of France. Linacre, in an early gram-matical effort, had prepared for Prin-cess Mary a Latin grammar in English which was the forerunner of a famous publication, the Rudimenra Gram-malices (Rudiments of Grammar) 197 

Contraception in Psychiatric Diseases

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Contraception in Psychiatric Diseases

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