Wednesday, November 24, 2010

The Arithmetic of the Pill

I hate to keep writing about the minutiae of below-the-belt issues, as I'd like to think our religion consists of a lot more than that, and the modern obsession with it is unhealthy. Nevertheless, the frenzy of discussion online (much of it filled with ignorance, confusion, misunderstanding, or downright misinformation) following the Pope's recent condoms comments has inevitably brought up a lot of interesting questions and thoughts. I had one just now concerning the morality of the birth control Pill.

I already explained in another post the difference between contraception and sterilization. Contraceptive methods change the very structure of the sex act (usually by preventing the depositing of the semen in the vagina). Sterilization, on the other hand, destroys fertility in an invisible manner before any sex ever even begins. If sex does follow, the sex itself may not, in fact, be a sin against chastity (as the sin is in the initial act of mutilation itself). Any sex that follows may still be natural/valid structurally inasmuch as the procreative "syntax" is maintained on the phenomenological level.

This is why a man who gets a vasectomy is not required to reverse it after confession, why infertile couples may still have sex, why NFP may be used, etc. Sex in such an infertile state is not a sin, as that is still the procreative "type" of act; fertility is not essential to the validity of sex. Whether it is caused artificially or "naturally" is not relevant on that level. Now, if such a state of infertility is caused intentionally, this is a sin, but the sin is in the initial mutilation itself, not necessarily the sex that may follow it (which may still be of the natural type if everything perceptible is the same).

In that post, I pointed out how it might be possible to see the Pill (a sterilizing method) as different than something like a vasectomy or hysterectomy inasmuch as, while they all mutilate the body's fertility...the Pill would seem a less grave action given that it is non-invasive, that its effects are only cumulative (ie, taking it once doesn't do much), and that the sterility it causes is temporary and reversible. A hysterectomy done solely to sterilize is clearly a major mutilation of the body. The Pill would seem less so.

I said that the Church might judge that any deliberate mutilation of fertility is a grave mutilation intrinsically, but there is still a distinction in the magnitude of that gravity to consider. It even seems to me like that, since mutilation admits of degrees and can also be justified for a proportional medical reason, whether sterilization on the Pill was a mortal or merely a venial mutilation...would be a casuistic question which the Church could not declare "on principle" and would perhaps better leave to confessors and individual consciences to determine under the general caveat that mutilation (including sterilization) without medical justification is sinful (but that which mutilations are major and which are more subjective).

This would certainly take care of the objection that 80% of Catholic couples "contracept" or whatever, because in most cases I think that refers to married couples using the Pill to space births (which is quite a different moral animal, I think). And saying that 80% of couples venially a lot easier to swallow than saying they all mortally sin.

Still, I was thinking today after reading some of the comments online about the Pope's comments...there are some "arithmetic" questions that the unique nature of the Pill raises, morally speaking. I said above that one trait of the Pill that might affect its gravity compared to other sterilizing methods is that the infertility caused by the Pill is a cumulative effect. A woman must take her Pill every day, whether she's planning to have sex that day or not.

So I was thinking...if a woman takes the Pill every day for a month, as she's "supposed to," is that 30 separate mortal sins? We are supposed to confess mortal sins by kind and number inasmuch as it is possible, after all, so this is not an irrelevant moral question. And yet, she might only have sex once that month, or no times! Is that only one sin then? Well, no, as I said above...the sin in sterilization is the initial mutilation itself, whether sex follows or not.

So 30 separate sins? And yet, the woman would be infertile just naturally 3 weeks out of the month anyway. On those days, the Pill isn't adding anything, is it? So is it only 7 sins for the seven days she would have otherwise been fertile? And yet, the effect on the hormone cycle is cumulative, so if she hadn't taken it for the other three weeks, it might not be effective on those 7 days, so they seem to constitute an essential part of the morality of it all.

So we're back to 30 sins? And yet, if she took the Pill for only 14 days during the infertile part of the month, and then stopped taking it, the effects might wear off in time for the fertile period. So, if she was intending to do it that way from the start...has she really committed any sin at all during those 14 days?

In other words, the question is raised: is every act of taking the Pill in the morning really a separate moral act given how the induction of infertility with the Pill is an ongoing process? How exactly does the arithmetic of all this work morally?

I'm not saying the Church should approve of the Pill or even say that its mutilation is necessarily only venial compared to graver methods (albeit I could see that argument as not going against orthodox; its temporary nature, reversibility, and cumulativity seem, to me, to at least make it less grave than more permanent mutilations). But there is certainly an interesting moral theology and pastoral question here about just what constitutes the moral "completion" of the act of sterilization while on the Pill. Because taking it merely once, on one isolated day, doesn't seem to be enough to constitute such a complete act of sterilization. So just when exactly is that line crossed?

Of course, there is still something very much Brave New World-ish about the current status quo regarding the Pill. In a thoroughly Catholic society where couples (whose cycle was too irregular for NFP to be used effectively or easily) used the Pill to space births...I could see the argument that this wouldn't be a "big deal." But in a world where the majority of women deliberately make themselves barren (at least for long stretches of their lives), there is something much more disturbing and potentially warping about this. Within already procreative marriages, the connection between sex and children remains clear even if the births are spaced. In NFP the connection is definitely still maintained, as it's the fertile days which are abstained on. But in a world were most women have made themselves sterile, people can start to (subconsciously at least) "forget" the connection between the reproductive system and reproduction! It becomes just a sort of vestigial thing, those organs mere "pleasure buttons" to be used however.

The Pill spacing births within marriage is one thing, creating a society where most women are sterile and enabling fornication is another, especially given how it changed the "natural" dynamic between men and women (whereby women were more discriminating sexually, for fear of pregnancy). Now, some might point out that we've reached a population situation where people maybe should only have, usually, 2 or 3 kids. And that the reproductive urges thus are largely "vestigial" (inasmuch as, if used purely "functionally," people would have sex only 2 or 3 times in their life!) especially given that people also now marry a decade or two after puberty, that there should be some "outlet." But even ignoring the fact that sex isn't a physical necessity, that people can be chaste (or at least limit themselves to solo release), and that there is always NFP (and 9 months of "free" sex during pregnancy without any further pregnancies, and even longer if breast-feeding is done the right way)...this still raises another question: if the sex drive truly has become disproportionate to how much mating we actually need...then, it seems to me, the "solution" would be suppressing the drive itself, not merely the consequences.

It could be done. If the sex drive is stronger than the current need for babies requires...then, by all means, medically suppress the drive, not just the fact that it leads to babies! Just like in the case of eating, an appetite suppressant would be one thing, "virtual food" quite another, morally speaking. And yet, people resist the idea. Why? Well, because the experience of satisfying a drive (whether it actually is or not) is pleasurable, I assume. And, more darkly, because meaningless sex sells. Consumerism wouldn't work nearly so well without people needing to nurse that drive. So, instead of quieting the unruly drive, they just get rid of its intrinsic meaning, and fill it with products instead. It really is quite an evil system...


Andrew said...

It would seem that confessing something akin to, "I have been using birth control pills (contraceptively, of course) for X days/months/years..." would be sufficient. It would be akin to confessing something habitual in which frequency would be a more accurate and humane way of expressing it.

I would not limit the birth control pills effect to the actual complete act of sterilization. It would seem that aside from some other possible medicinal non-contraceptive use, what would be the point of taking it at all, even if it was only once? Thus, even if sterilization has not taken place, it would seem a mortal sin still possibly took place (assuming the three conditions).

A Sinner said...

Well, I don't know if it would have a point, but not everything has to have a specific intention to be moral.

My point was just...taking the Pill on one isolated day (in the middle of the infertile period especially) wouldn't "do" anything, really, so is it a sin?

Furthermore, it seems that you need to take it for some time to "complete" sterilization, so what exactly is it before that line is crossed? Only a venial sin? Any sin at all?

I think this is something moral theologians could explore more. Is it really a separate sin every time she takes her pill? Or is it more cumulative somehow depending on how much is needed to complete the process of sterilization in a given month, etc?

sortacatholic said...

"Hey, this looks like a good cobblestone. Better keep it handy for those bawdy women."

In all seriousness, many women (more than you would suspect) take the Pill for the regulation of menses and as a hormonal supplement. Do some women use this as a pretext to contracept? Honestly, I could care less. That's their business.

A friend of mine had an abortion. I tried to dissuade her from the act. She nevertheless went ahead with it. I helped her afterwards. Never did I say something like, "YOU ARE DAMNED!1!11!1!" or similar. I just sat with her and listened to what she had to say.

We men should keep our noses out of women's business. Yes, if a friend is contemplating abortion, by all means try to dissuade her from murdering her child. Yet if a woman is taking the Pill or had an abortion, etc. the response is not to shun or speculate on women's lives. Time to get off the pelvic issues track.

A Sinner said...

Oh, I'd probably agree. There are just some interesting questions there from the theoretical moral theology perspective.

A Sinner said...

I have discussed before the difference between contraception on the one hand, and sterilization on the other. Contraception involves actually preventing the depositing of semen and is a sin only if it is actually prevented (ie, merely putting a condom on isn't a sin, the sin is if you ejaculate in it). It does not count as valid consummation for marriage, etc; contraceptive sex is equivalent to impotence rather than mere infertility.

Whereas sterilization involves inducing infertility and the sin is in the very act of mutilation itself, whether sex follows or not (ie, a man who has a vasectomy isn't required, on the one hand, to get it reversed...but, on the other hand, the act of mutilation is in-itself the sin whether he actually has sex afterward or not). The sex following an act of sterilization, however, is not necessarily sinful (whereas contraception always is).

Sterilization, however, like all bodily mutilations, is not exactly an absolute evil; it may be justified for a proportionate cause for the good of the whole body. Having a hysterectomy for no good reason (or, even worse, to become infertile for the sake of barren sex) would not be allowed. But if necessary to cure cancer, it would be.

The Pill seems to fall under this category of sterilization. It does not prevent the valid depositing of semen. A woman on the Pill is in the exact same state as an infertile woman (or any woman most weeks out of the month), so the sex is still, presumably, the reproductive TYPE of act, structurally speaking, as long as semen is still deposited. The sin must be in the mutilation itself, not the sex.

However, my thought goes, while contraception either happens or it doesn't, and is always a mortal sin...mutilation, on the other hand, admits of degrees (and can be justified for proportionate cause). It's clear that most sterilizing mutilations (hysterectomy, vasectomy, tube-tying, etc) are grave mutilations and thus are only justified by a grave medical need (cancer, etc).

The Pill's mutilation (though still definitely a mutilation) seems different, though, inasmuch as its mutilation is TEMPORARY, reversible, and non-invasive (and, as I said in this post, cumulative in its effect; when exactly has a woman "crossed the line"? After taking only one Pill? Two? A month's worth?)

Furthermore, even the Church seems to treat the Pill's effects as less grave. I don't think our bioethics would ever allow a woman to get a hysterectomy merely to cure acne. That simply wouldn't be considered a proportionate need to justify the gravity of a hysterectomy. Yet we DO let women take the Pill to cure acne, I believe, as well as to regulate menses, etc. This implies that, as a mutilation, it is much less grave.

A Sinner said...

I'm definitely NOT saying that deliberately causing infertility can ever be a valid motive for taking the Pill or that the desire to not conceive (even in cases of potentially dangerous pregnancy) justifies the mutilation. What I am saying is that by the Church's own actions, the Pill's mutilation/sterilization seems to be treated much less gravely, in itself, than something like a hysterectomy (if only because the Pill's is temporary and reversible).

If merely treating acne or regulating menses is considered a proportionate medical need justifying the mutilation of the Pill...I have to wonder if that mutilation IN ITSELF amounts to mortal sin, or whether it is merely a minor/venial mutilation in itself (separate from the question of intent).

Now, very probably the Church would conclude that the INTENT of preventing conception for the sake of sex without consequences is itself a mortally sinful and lustful intent (even if the mutilation used to accomplish it were, in se, minor.) So, for example, they might argue that a woman merely randomly taking the Pill (for no good reason) is merely committing a venial sin of mutilation, but that if she is doing it specifically for a positively BAD reason (ie, having deliberately sterile sex) then the act becomes mortal due to mortally sinful intent.

Still, these are distinctions that should be made rather than lumping it all under the one header "contraception"...which leads to a lot of intellectual confusion (and makes our argument look weaker). There may be different degrees of gravity involved between, say, taking the Pill on the one hand, and a hysterectomy on the other. Certainly, to me, the former seems the lesser evil (if only because of its reversible nature).