Paganelli, Vitale H.

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The Linacre QuarterlyVolume 44 | Number 1 Article 5February 1977An Update on SterilizationVitale H. PaganelliFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationPaganelli, Vitale H. (1977) "An Update on Sterilization," The Linacre Quarterly: Vol. 44 : No. 1 , Article 5.Available at: http://epublications.marquette.edu/lnq/vol44/iss1/5An Update on Sterilization Vitale H. Paganelli, M.D. Following a cursory review of the last fifteen years of magister-ial teach ing related to steriliza-tion, I shall discuss the principle of cooperation and attempt to relate the princ iple to the prob-lem of sterilization in the light of the magisterial teach ing. Albeit not exhaustive, the re-cent teaching begins in 1931 with the publication of Casti Connf,lbii in which there is at least one reference to mutilation as well as several references to contraceptive practices. The key concept is expressed , " ... indi-viduals hl!-ve not absolute control . over their bodies. God alone has that . The individual may not de-stroy or mutilate any part of his body by medical or surgical means, unless no other means are available for t he health of the whole body." 1 There is found chrono another mention o f mut i Gaudium et Sp es, " . . . whatever violates t rity of the human pe rsot muti lat ion ... all the;, and others of their lih famies indeed."2 Humanae Vitae (7 /2 ther refined· the teachit " Equally to be exclud teaching authority of t has frequently declaret steril ization, whether or temporary, whetr man or the woman."3 gically tion in 1 965) · in teg-such as things are in-•.38) fur-to wit: t , as the · church is direct erpetual of the T.he preceding 10tation, which is taken out of . context, ·can be more clearly 1derstood in its pejorative sens( ,f it is re-lated to the precedin. paragrap~ of the encyclical ,, 1ere it ts stated that abortion is absolutelY excluded."4 Thus a• o is direct ------------------------------------------------ --------Do ctor Paganelli, a general practitioner in Glens Falls, N. Y., received the 1971 Thomas Lin-acre Award for his article on "The Catholic Physician, the Teaching Magisterium and the Theologian." He is an associate editor of Linacre. This paper represen ts an edit-ing of the author's notes prior to his presentation on the· title sub-ject at the 19 76 Chicago NFCPG meeting. 12 sterilization excluded absolutely. In t he section of the encyclical following the above, a qualifying statement is introduced which in effect _and in fact, defines (with-~~t usmg the term) indirect ster-ilization, viz., " the Church o n t~e contrary does not at all con-Sider illicit the use of those thera-peutic _means truly necessary to cure ?•seases of the organism , even. If an impediment to pro-creatiOn, which may be foreseen shou~d result therefrom, provided such Impediment is not, for what-ever motive, directly willed." !t would be appropriate at th is romt_ then , to define direct steri-.. •;a~IO n_ as any steriliza tion hlCh rums, either as a means or an e_nd _in itsel f, to render child-bearing Impossible. "6 Lastly in this brief and in-complete scan of the teaching ~urch is the March , 1975 reply th the Sacred Congregation fo r (~D Do_ctrine of t he Fait h f F) m response to questions 0 the North American Episco-Pate. A translation of this d ocu-lllent was published in the Au-&Uat, 1976 Linacre Quarterly. 7 d ~ again, direct sterilization efmed, following which it is categorically that direct .c,--.. ,;t;lliT.I n is "absolutely_ for-according to the doctrine the Church. " The Sacred Con-th th~n went on in answer e questions put to it by the American Hierarchy to that the principles of com-good , totality or con trary - --d ..,_u• may be invoked to justi-lrect sterilization. It does ' 1977 specifically uphold Article 20 of the Ethical and R eligious Direc-tivesB approved by the National ~onference of Catholic Bishops m 1971 and again in 1973. Becoming more specific and referring to the management o f Cat holic hospitals, the SCDF a~ain denies the permissibility of ~tr ~ct st:eril ization, absolutely (It~.hc~ mme) condemning it as bemg 111 the objective order of its very nature (or intrinsically) evil. In a final two paragraph state-ment and qualified by the fol-lowing phrases, " utmost pru-dence" (once), "if the case war-rants" (twice), " great care (must be) taken against scandal" and against " danger o f any misunder-st~ding," it approves the appli-~atlOn of the principle o f mater- · 1~ co~peration with all its proper histon cal theological distinctions. Unmentioned in this brie f re-view are the many teaching state-ments of the same period which cond em n co ntraception, fre-que~~ly ? efined as a "temporary sterihzat10n." Thus, if these ref-erences were added to the few c~ted above, which have referred either to mutilative procedures or permanent sterilization, the frequent condemnation of direct sterilization can leave no doubt as to the mind of the teaching Church on this subject. (Proper recognitio~ is made of the surgi-c~ potential to repair some sur-giC~ sterilizations thereby con-vertmg a permanent sterilization to a temporary sterilization. This has little bearing on this im-mediate discussion .) 13 . . .. The Principle of Material Cooperation The explicit concept of mater-ial cooperation can be traced to the time of St. Alphonsus in the 18th century9 although both St. Thomas (13th century) and St. Augustine (5th century) refer to "tolerating evil" in order to have a greater good prevail or to avoid a more serious evil . As will be seen shortly these two qu alifying conditions still prevail regarding the application of the principle of material coop-eration. Again ce rtain definitions appear to be in order. First, for-ma l coo p e r ation in activity which is objectiveiy evil must be distinguished from material co-operation . . BY the former it is un -qerstood that th e cooperating in-dividual assen ts, either explic itly or implicitly, to the evil act or to the evil inten t of the principal agent. By material cooperation it is understood that the cooper-ating individual d oes not in any way assent either to the evil act or to the evil intent of the princi-pal agent but cooperates either (a) to avoid a greater evil, or (b) to achieve a greater good. It will be recognized immediately that the two qualifying condi-tions dating to Augustine for "tolerating an evil" are inherent as well in the definition and ap-plication of material cooperation . Before leaving the subject, it may be said briefly and succinct-ly that formal cooperation is neuer licit. Thus the physician 14 may never directly interv perform an abortion, a st tion (permanent or temp or;. act of eu thanasia, or a foe t Several ~heologians h a· lenged the concept th at act can always, everyw.1 at all t imes be relegated · egor y of acts which in tr tive order (in themsel · evil. In fact, a challenge made regarding the ve tence of such a categor· evil in themselves. Nei presentation at the me < this summary are pre1 .e to iliza· y), an ide. chal-given e and a cat· o bjec· ~ l are s been exis-)f acts er my 1g nor :ed to meet these o bjections v 1ch are currently confined to 1 • arena of theological and phil ophical speculation. St ill other questions I ve been raised attempting to 1uantify various evil acts (e.g. :.. direct abortion m ore evil in 1 elf than is direct sterilization? and to dra w distinctions bet een the negative and positive : .peels of moral acts. These qu es ons have been touched upon in 1.1agisterial stateme n ts bu t they, t< v , are be-yond the scope of this n•view. F inally, how an acl J:-. constitu-ted as objectively evil and mo~ generically the questw n of evil itself are even Less the p rerogative of this discussion. In addition to the important qualifiers mentioned above, viz., avoidance of greater evil and more importantly pursui t of a greater good, there are o ther c.on· ditions imposed on the apph~~ tion of the principle of materJ . cooperation. Cooperation can be . •· or said to be either '"pro:omate )\' Linacre Quarter· " remote" depending on the near-ness in time, place and person of t~e c?operating agency. Coopera-tion IS also referred to as being "necessary" or "free" in relation to the more or less required pres-ence of the cooperating agency. Thus, for example, an anesthes-iologist compared to an orderly would be spoken of as a proxi-mate agent compared to a re-mote agent in the preparation of a ~atien t fo r an abortion. If only ~ smgle h?spital had the capabil-Ity of performing a procedure (e.g., heart transplant) it would be considered a " necessary" agent as compared to a hospital which was among one of several capable of performing a proce-du~e (e.g., open heart su rgery) ~htch would be said to be " free" (I.e., either free to perform the Procedure or refer it to a sister h~pital) . The two sets of quali-fYing adjectives m ay be and USually are combined in refer-ence to given situations. Thus for ' . example, an agent or agency lllvolved in material coop eration tnay be both proxim ate and nec-essary or proxim ate and free or ~ ' mote and necessary or remote and ' free de pending on circum-stance. . In addition to the above con-lideration there is an ele ment of Proportionality that must be IUpe . 1\ nmposed on all the above. Us the m ore proximate or nee-~ the agent involved in rna-. ~ cooperation of an act ob-~Ively evil, the greater propor-~ately must be the good to be be ed. (or conversely the evil to IVOided). ' 1977 Similarly, the more evil the act posited by the primary agent, proportionately greater must be the good to be derived in permit-ting an application of material cooperation. Thus, material co-operation in an act of abortion would require proportionately greater good to be derived than would materially cooperating in a direct sterilization because of the greater evil associated with abortion than with sterilization. The documen t of the SCDF has explicitly stated in respect to the management of a Catholic hospital that "any cooperation (italics mine) with direct sterili-zation is absolutely forbid-den." lO *( In my Chicago presen-tation I gave as an example of mater ial proximate necessary co-operation the case o f a Catholic hospital providing its facilities for a direct sterilization proce-dure by a non-Catholic doctor . This example was intended to demonstrate an application of the principle of material coopera-tion. It was an unfortunate choice for an example since the docum ent of the SCDF makes explicit condemnation o f either formal o r material cooperation in direct sterilization by anyone, Catholic or non-Catholic M.D., in a Catholic institution.) Indirect sterilization, for ex-ample, h ysterectomy for a cancer of the u terus, bilateral oophorec-tomy for cancer of the breast bi-lateral orchiectomy fo r cance~ of the prostate, does not faU under the aegis of the principle of mater-ial cooperation and hence is not 15 . . .. ·. treated by the Roman document. Then what conceivable licit application is there of the prin-ciple of material cooperation in respect to direct sterilization? Since it is apparent that at least within the walls of a Catholic hospital there can be no applica-tion, it must be assumed that the Roman document refers only to application of the principle of material cooperation to direct sterilization outside a Catholic hospital. It intends an applica-tion of the principle , for ex-ample, to Catholic personnel in non-Catholic institutions - the Catholic anesthesiologist, nurse, clerk, orderly, or administrative personnel, etc., employed in non-Catholic institutions. For practical purposes, even here the principle of material cooperation will have ~ exceedingly rare ap-plication since the conscience clause has been upheld in the courts. It would be a rare situa-tion indeed in which the Catholic anesthesiologist, resident, intern, OR or floor nurse, etc.,could not exercise this right of conscience and be replaced in the conflict situation by other non-Catholic personnel. It is, however, not in-conceivable that in a small, non-Catholic hospital in a remote area the only available anesthe-siologist or OR nurse, for ex-ample, is a Catholic. In this in-stance, there may be a place for the licit applicaiton of the prin-ciple of material cooperation . *( In Chicago, the question was raised whether a Catholic OB-G YN surgeon could perform a Caesarean section and then step 16 out of the operating arem rhile a non-Catholic colleague id a bilateral tubal ligation. an· swered that it was possii P for this situation to be consic r red a licit application of the p · tciple of material cooperation n so responding, I did not it 1d to pre-empt the Bishops' ' nmit· tee. Perhaps the guideli· , that the Bishops' committee now drawing will prove my firma· tive response to be in e1 .r. If .I was in error, I shall be pl :sed to be corrected . However, e ·h case must be considered ind ·dually on its own · merits sit e that which conditions the ap tcation of the principle of mater l coop· eration, as earlier indi· ted, is dependent on meeting <' .lUmber o f qualifying condi ti , ts, i.e., remote-proximate, etc. ) For example, considt the sit· UiJ.tion of a small, rem< te, non· Catholic hospital wh o~-;e onlY OB-GYN staff surgeon i., a Cath· olic. After he has performed a Caesarean section, he i ~ followed by a non-Catholic general sur· geon who performs a dtrect ster· ilization. Given these circum· stances, it is conceivable t hat the principle of material cooperation may be licitly applied to the Catholic OB-GYN surgeon. Ob· viously, circumstances ad in· fini tum can be envisioned which influence also ad infinitum the probable licitness with which the principle may be applied. Herein I have cited one possible rela· tively realistic situation. It should be further noted that the principle of material coopera· Linacre QuarterlY tion may not be applied solely for material gain. Thus , for ex-ample, the moonlighting Catholic an~sthesiology resident may not dehver anesthesia for direct ster-ilizations · if his sole purpose is to augment his income. Concluding Thoughts In reference to " Sterilization Committees In Catholic Hospi-~ls," it would appear t hat in hght of the d ocumen t from the SCDF the very terms of the phrase involve a contradiction in terms. Direct sterilization is "ab-solutely" excluded in Catholic hospitals, thus no need exists for such committees. Properly de-fmect indirect sterilization is not a problem. Wit~ reference to counseling C~thohc personnel in non-Cath-~c i~stit~tions who have con-ct sttuatwns, the formation of a d' . locesan medical-moral com-nuttee would be a worth while consideration. Such a committee should include the ordinary theologians and Catholic attor~ n~ys, administrators and physi-~ with knowledge of medi-lu _moral problems and their so-tto_ns. This committee could ::de solid advice for those . tng it. The matter of apply-lbg P_roperly the principle of =rial _cooperation with all its r· ces lS a complicated matter. 1r tnally, worth quoting and ~~ conside~ing: " ... when ilf Is _a questwn of harmoniz-conJugal love with the re-'1977 sponsible transmission of life the moral aspect of any procedure does not d epend solely on sin-cere intentions or on an evalua-tion of motives. It must be deter-mined by objective s tandards. " Relying on these principles sons of the Church may not un~ dertake ~ethods of regulating pro c r ea tion which are found blame~orthy by th e teaching authonty of the Church in its un-folding of the divin e law."ll Re-markably' this quote is lifted from Gaudium et Spes, Vatican II. REFERENCES 1. Casli Connubii Paulis t Press, 1944, p. 18. • 2· The Documents of Vatican 11 Herder & H erder Associated Press: Walter M. Abbott, S .J ., p . 226 para· . graph 27, " Gaudium et Spes." ' 3. Humanae Vitae, United States Catholic Conference , July 25, 1968 paragraph 15. ' 4. Idem., paragraph 14. 5. Idem., paragraph 1 5. 6· Pius XII, Pope, " Allocution to Midwives ,". Oct. 29 , 195 1, A c ta Apos· to/1cae Sed1s, 1940, page 73 cr Th H B , r ., e uman ody, St. Paul edi tion Boston 1961, page 161. ' ' 7. The Linacre Quarterly " Te t of Doctrinal Congregation St~teme~t ~r" Sterilization," August 1976, p . 210 8. The Ethical and Religious Dir· ec_twe~, National Conference of Cath· ohc B1shops, article 20 . 9. Private communications from the .Rev. Anthony K osnick, S.T.D., SS. C~nl and Methodius , Orchard Lake M1ch. ' 10. 1dem., 7. 11. Idem., 2, paragraph 51, p. 256. 17 . . .. 

An Update on Sterilization

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An Update on Sterilization

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