Conscience, Contraception, and Catholic Health-Care Professionals

The Linacre Quarterly 77(2) (May 2010): 204-228.

Reproduced with permission

Janet E. Smith, Ph.D.*

Author's Note:  The following is an edited transcript of a talk given at the first annual symposium for health-care professionals, "Conscience and Ethical Dilemmas in Catholic Healthcare," hosted by the Archdiocese of Baltimore Respect Life Office and Baltimore Guild of the Catholic Medical Association, Baltimore, MD, May 9, 2009. The text is more conversational than a written paper and not as closely documented as a professional piece. Much of the material was accompanied by PowerPoint slides.

Abstract

In 1968 Pope Paul VI issued the encyclical Humanae vitae, which hit the world like a bomb. In it he affirmed the Church's longstanding teaching on human sexuality and condemned contraception in particular. Today scientific advances such as in vitro fertilization and embryonic stem-cell research, as well as the challenges in making moral decisions about end-of-life care, make it increasingly difficult for health-care professionals to practice in accord with their deeply held moral convictions. Developing a properly formed conscience, which is the voice of God, is essential in dealing with these contemporary issues and making right choices. This essay outlines the process for properly forming the conscience. It also explains why prescribing contraception is morally wrong.

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Introduction and Historical Perspective

In 1968, Humanae vitae hit the world like a bomb.1 The world was expecting the Church to "finally" enter the modern age and accept contraception.  The Catholic Church was not going to go the way of the Amish was it? We weren't going to be doing laundry down by the riverside-it was time to come up to speed and accept the discoveries and conveniences of modern medicine.

It really surprised and distressed the world and many in the Church when Pope Paul VI pronounced that the Church's condemnation of contraception is God's law, not man's law; it's something Catholics are committed to and have always taught and always will teach. The resistance to and rejection of the teaching was swift.

Fr. Charles Curran, who was a young professor of moral theology at Catholic University of America, held a press conference within twenty-four hours of the promulgation of Humanae vitae.2 It was surprising to have a priest/moral theologian so immediately and so publicly express dissent. Since Humanae vitae was released long before fax machines and the Internet, few had access to the document; and thus few were able to respond to Curran's dissent.

Dissent, now common in the Church, was then a new phenomenon. Priests and theologians who for decades had been the foremost defenders of Church teaching were now in the forefront publicly rejecting Church teaching. Fr. Curran announced to the world that Catholics were not obliged to follow the teaching of Humanae vitae; he judged that it was based on an inadequate understanding of natural law and thus Catholics were free to follow their conscience in regards to this teaching. Regrettably, Fr. Curran's position was taught in seminaries in the United States and around the world. Priests came to believe they should not trouble the consciences of the faithful over this issue.

Dissent was evident even at very high levels. Although many bishops around the world issued statements in support of Humanae vitae, some of those statements were lamentably weak. For instance, the Canadian bishops stated:

In accord with the accepted principles of moral theology, if these persons [people who do not accept Humanae vitae] have tried sincerely but without success to pursue a line of conduct in keeping with the given directives, they may be safely assured that whoever honestly chooses that course which seems right to him does so in good conscience.3

The line "chooses that course which seems right to him" is problematic, as is the conclusion that this can be done "in good conscience." Here we have an elevation of individual judgment over Church teaching. Should a Catholic prefer his own judgment over Church teaching? Certainly Catholics should act in "good conscience," but what does that mean, especially when one's judgment goes against Church teaching?

Cardinal John Henry Newman, one of the great writers about conscience, talked about people who took refuge in "conscience" to do whatever they wanted. He said:

When men advocate the rights of conscience, they in no sense mean the rights of the Creator, nor the duty to Him, in thought and deed, of the creature; but the right of thinking, speaking, writing, and acting, according to their judgment or their humor, without any thought of God at all.4

Regrettably, we are all susceptible to such behavior; we will say that our conscience did not really bother us when we took a couple reams of paper from the office, because we reason that we worked three hours overtime on Saturday. We consider the reams of paper as a kind of compensation.

The problem is not so much that we took the paper, and we may even be right that we are justified in taking the paper. The problem is that we did not consult our conscience; we just made a quick judgment about taking some paper when we wanted it and came up with some rationalization for taking it. We often never really ask the question "What does God think?" or "What would God think about this action?" We just ask whether we feel justified. The conscience, however, seeks to know how God would evaluate an action; it does not seek to determine how the agent evaluates an action or how guilty or not guilty an agent will feel about an action.

It was not always that way. In her book Catholics and Contraception, Leslie Woodcock Tentler tells us that from the early decades of the twentieth century until about 1960 Catholics were very well instructed on the Church's teaching on contraception.5 Parishes regularly hosted missions during Advent and Lent led by Passionists, Redemptorists, and Jesuits. During those missions, usually on a Wednesday night, they would give a talk about sexual morality. Often basing their instruction on personalist principles, they would teach the Church's teaching and speak against fornication, adultery, masturbation, and contraception.  They did not threaten hellfire and damnation for those who did not abide by sexual morality, but urged individuals to realize that sexual immorality was against their human dignity and other human goods, that they were more likely to find happiness following the Church's teaching than violating it. Studies show that Catholics found these presentations persuasive and for the most part lived by the Church's teaching on sexual morality.

Until I read Tentler's book I had thought that prior to Humanae vitae Catholics probably accepted the Church's teaching on contraception largely out of obedience and not because they had received good instruction on the teaching. In the 1950s, my own parents, who had four children in six years, were living on the low end of the economic scale.  My mother went to her doctor and asked, "Dr. O'Connor, John and I are having so many children so quickly, what can we do?" And he replied, "Well, you're Catholic and I'm Catholic, so that's the end of that." My mother went home and my father asked, "What did Dr. O'Connor say?" and she told him, "Well, he said that he's Catholic and we're Catholic, so that's the end of that." My parents practiced rhythm, heroically, for seven years; and then within two years had two surprise pregnancies. My dad said it worked out well, that he always wanted two children and my mother wanted four, so they both got what they wanted. My father also said that if there is one thing he regrets, it is that he did not have more children. He said that his children are what gave him the most meaning, the most happiness in his life.6 The testimony of my parents is simply that they were faithful Catholics, and they had a faithful Catholic doctor, and for them it worked out very well.

Sadly, since Humanae vitae, Catholics have been neither instructed to be obedient to the Church nor instructed on the justification for the Church's teaching on contraception. In 1990, the Philippine bishops acknowledged their failure to do their job with respect to this teaching in a remarkable statement.

I know there are many people who may have good reasons for limiting their family size. I am not one of the people who think that the Church teaches that married women are meant to have as many babies as their bodies can bear. It is true, however, that for most people, raising children is the most important, wonderful thing that they have ever done. Nonetheless our culture has convinced us that it is somehow foolish to want to have a large family or that there is something wrong with that. Sadly, since Humanae vitae, Catholics have been neither instructed to be obedient to the Church nor instructed on the justification for the Church's teaching on contraception. In 1990, the Philippine bishops acknowledged their failure to do their job with respect to this teaching in a remarkable statement. They said:

It is said that when seeking ways of regulating births, only 5 percent of you consult God. In the face of this unfortunate fact, we your pastors have been remiss: how few are there among you whom we have reached. There have been some couples eager to share their expertise and values on birth regulation with others. They did not receive adequate support from their priests. We did not give them due attention, believing this ministry consisted merely of imparting a technique best left to married couples. Only recently have we discovered how deep your yearning is for God to be present in your married lives, but we did not then know how to help you discover God's presence and activity in your mission of Christian parenting. Afflicted with doubts about alternatives to contraceptive technology, we abandoned you to your confused and lonely consciences with a lame excuse: "follow what your conscience tells you." How little we realized that it was our consciences that needed to be formed first. A greater concern would have led us to discover that religious hunger in you.7

I did not think I would live long enough to see such a statement. An apology from bishops for not teaching what they were supposed to be teaching! Honestly, I suspect the bishops were badly formed. They were probably poorly instructed in seminary or were confused by top theologians rejecting Humanae vitae.

Conscience and Culture

The good news is that seminaries are very different today. One of the biggest, best stories of the turn of the century is the reform of Catholic seminaries in the United States. All are better than they were twenty years ago, and some of them are spectacular. I happen to be at one of the spectacular ones, Sacred Heart Major Seminary, in Detroit. Our young men are leaving the seminary with a zeal that is remarkable. We have a group of men every week who go to a strip joint to stand outside and pray for the women who work there and pray for the men who patronize the joint. Of course, our culture is such that the police have come to harass the seminarians and tell them that they are not allowed to be there. The seminarians are just praying; they do not do anything else; they do not talk, they do not shout, they do not have posters; they just pray. Regrettably it bothers the people inside that there are men outside praying. Following consultation, a lawyer provided the seminarians with a statement making it perfectly clear to the police that they have rights too that cannot be taken away from them and they have a right to be there. These are remarkable young men and their love for women has made them show up outside a strip joint to protest in a quiet and prayerful way that this should not be going on as it is disrespectful to women.

Pretty much from the first moment we awake an interior dialogue begins. One voice says, "It's time to get up, and get moving and get to the responsibilities of the day." The other voice says, "I don't want to…."

We have such conversations all day long, not just with our good and bad angels-or perhaps just our good and bad appetites- but with other voices, the voice of our culture and our peers, for instance. One of the loudest voices in my head is my mother's voice: "Janet, have you cleaned up after yourself? Have you put everything away?"

The voice we need to train ourselves to listen to most closely is the voice of God because that is the conscience.

LLearning to distinguish God's voice from all the other voices competing for our attention requires that we should be people of prayer. It is not exactly easy to become a person of prayer. I have been working on it for years. When you first start out, five minutes of silence can seem like torture. Then you keep trying to move it up to an hour-which also seems like torture. When you persist, however, you will endure the wait because you know that God will eventually speak to you in some way. You will find the Holy Spirit guiding you and your actions. You may even sense that you hear a voice instructing you. That guidance of the Holy Spirit is the conscience. When you consult your conscience you are seeking the guidance of the Holy Spirit. You are listening for the voice of God and allowing that guidance to help you shape your choices and your life.

Sometimes I wonder if the only thing they would die for is actually the 5,000 songs on their iPod and that is about it. Sadly they have been taught that there is no such thing as truth, so why would anybody lay down his or her life for anything?

Veritatis splendor, one of John Paul I's outstanding encyclicals, discusses the conscience at some length. He talks about the very erroneous view of conscience that moderns have. We live in a society that tends to think there is no such thing as truth. Here is what Veritatis splendor  says:

Once the idea of a universal truth about the good, knowable by human reason, is lost, inevitably the notion of conscience also changes. Conscience is no longer considered in its primordial reality as an act of a person's intelligence, the function of which is to apply the universal knowledge of the good in a specific situation and thus to express a judgment about the right conduct to be chosen here and now.8

Too many, however, have an erroneous view of the conscience- they do not seek the truth; they simply act in accord with their "own" truth. Veritatis splendor says:

Instead there is a tendency to grant to the individual conscience the prerogative of independently determining the criteria of good and evil and then acting accordingly. Such an outlook is quite congenial to an individualist ethic, wherein each individual is faced with his own truth, different from the truth of others. Taken to its extreme consequences, this individualism leads to a denial of the very idea of human nature.9

Let me give you an example of this individualistic understanding of "truth." In a seminary one of the most challenging things we have to help the young men learn how to do is to prepare couples for marriage. More than 90 percent of couples who come for marriage prep are already having sex. Somewhere between 60 and 90 percent are living together.

One priest told me that 100 percent of those coming to him for marriage prep were already having sex. The priest invites the couple in and he starts a conversation: "So, I see you share the same address. Does this mean that you've already begun your intimate relationship?"

And they say, "Oh, yes, Father," without even the slightest embarrassment.

"Are you aware that the Church teaches that having sex outside of marriage is seriously wrong?"

"Oh, yeah ... I remember that. In tenth grade, the priest came in and gave us a lecture…. Well listen, I mean, the Church has a right to its opinion and I have a right to mine, right? The Church is not going to tell me what to do in the bedroom, is it?"

 Many believe that Church teaching is just an opinion! Teenagers and many adults think that their opinions are just as valid as the Church's. It's all the same, right? "The Church has its truth. I have my truth. And who is to say?"

They have little awareness that the Church has been thinking about these issues for millennia and is guided by the Holy Spirit. On the one hand the best minds in the history of mankind have been thinking about these issues and discovering the logic and principles and evidence that support Church teaching. On the other hand there are those who have not given the issue more than a moment's thought and believe that their opinion is equal to the Church's teaching!

Veritatis splendor also says:

Although each individual has a right to be respected in his own journey in search of the truth, there exists a prior moral obligation, and a grave one at that, to seek the truth and to adhere to it once it is known. As Cardinal John Henry Newman, that outstanding defender of the rights of conscience forcefully put it: "Conscience has rights because it has duties."10

The Catechism, quoting Gaudium et spes, provides an excellent description of the conscience:

Deep within his conscience man discovers a law which he has not laid upon himself but which he must obey. It's voice, ever calling him to love, to do what is good, and to avoid evil, sounds in his heart at the right moment…. For man has in his heart a law inscribed by God…. His conscience is man's most secret core and his sanctuary. There he is alone with God, whose voice echoes in his depths.11

Notice here the claim that there are laws within us that we did not lay upon ourselves but we know we must obey.  Most of us, when we were small children, stole something like a candy bar or told some lie, and we knew it was wrong. We also know that we did not decide that it was wrong, we did not make that up. Although our parents told us it was wrong, we knew it was not just our parents' view of things. We knew that the act was simply "wrong."

Later, as teenagers, many of us told lies, big fat lies in response to the question "Where were you tonight?" "Oh, I was over at my friend's watching a movie." In actuality we were drinking and lied and knew we were lying.  We also knew that what we had done was wrong and that lying is wrong.  We knew that we were not the ones who decided lying is wrong. We know that there is something inside of our system that says, "That's wrong, it's low, it's base, and it's not up to our dignity as human beings." The reason we lie is because we are desperate and we do not want to get in trouble.  Ultimately, though, we know it is wrong.

The following passage is marvelous: "His conscience is man's most secret core and his sanctuary. There he is alone with God whose voice echoes in his depths."12

 Christ promised us he was going to dwell within us, and on that basis we can find that voice and ask God what He thinks and what He wants.

One time, at a conference, a woman told me that her conscience was perfectly clear in regards to contraception. I said, "Really? I'm a little surprised at that."

She asked why, and I said, "I suspect John Paul II prayed between four and five hours a day. He was asking the Holy Spirit to guide him because he was trying to be a good shepherd, and he did not want to put any burdens on us that we should not have. He did not want to lead us anywhere that we should not go. He never heard the Holy Spirit tell him that contraception was moral. But somehow the Holy Spirit has decided to let you know that contraception is O.K. and has not been able to get through to John Paul II. How likely is that?"

I did not mean to mock her and embarrass her, but it was a question that needed to be asked. I do not think she had ever thought of it that way. When she consulted her conscience she asked, "Am I comfortable with contraception?" and apparently she was. She was not asking the question "What does God think; what is God's view on this issue?" That is an entirely different question.

The Catechism says:

Moral conscience, present at the heart of the person, enjoins him at the appropriate moment to do good and to avoid evil. It also judges particular choices, approving those that are good and denouncing those that are evil. It bears witness to the authority of truth in reference to the supreme Good to which the human person is drawn, and it welcomes the commandments. When he listens to his conscience, the prudent man can hear God speaking.13

Too many people think that the commandments of God are designed to rob us of pleasure: no fornicating, no adultery, no contraceptives. It can seem like God does not want us to have any fun. All these unreasonable demands!

However, God is telling us what is poisonous to our lives. The commandments are like the little skulls on cleaning fluids. You do not want these chemicals in your system because these will kill you. God is not just putting up arbitrary fences to keep man out of the gardens of delight, and telling us that if we manage to stay between these arbitrary fences we will get a big present at the end of time. That is not what he is doing. He is saying, "I want to shape you. I want you to be beautiful in every way. When it's all over, I'm not going to have to give you anything, because you will already be gorgeous! You will be beautiful. You will be absorbed into the divinity because you are already pure and good."

The commandments are keeping poison out of our system. These commandments are not something from a wicked God who will not let us have fun. Yes, it is really hard not to have sex before marriage. It is hard to be faithful during marriage. It is hard not to look at pornography. It is also very hard not to be proud, not to be lazy. It is hard to eat well and exercise regularly. Generally, what is good for us requires some self-denial, some self-discipline; but the results of failing to exercise that discipline are often disastrous, and the results of gaining self-discipline are beautiful.

Formation of Conscience

It is important for every person to be sufficiently present to himself in order to hear and follow the voice of his conscience. This requirement of interiority is all the more necessary as life often distracts us from any reflection, self-examination, or introspection. Return to your conscience: question it…. Turn inward, brethren, and in everything you do, see God as your witness.14

Following the conscience means aligning our will with God's will.  I do not know about you, but I spend a lot of my time trying to get God to do my will instead of trying to do His. I also feel like I say too many prayers on the fly. Too often as I am walking to teach a class, I pray: "I'll prepare well next time, Lord, but just save me today."

 There will be times when we cannot help but pray on the fly, but we should be making time to pray and when possible in front of the Blessed Sacrament. There you can just empty yourself and ask God to talk to you.

I always need a full hour of Eucharistic adoration, because the first twenty minutes are devoted to me talking. "Now listen: I need this, I need that, I'm in trouble with this, and do something about that. Other people need this and that; please give it to them."

Then, after about twenty minutes, I hear a voice that says, "Janet, I know about all those things. I know everything that is inside of you. But you don't know what I want from you. You need to listen. I don't need to listen to you, because I already know everything that you want. Why don't you just sit back and listen?"

I thought I was the captain of the ship: "You're God, you're all-powerful, I'm telling you what needs to be done, and you're not doing it and it needs to be done now!"

God says, "Wait a second. I am a good God. What makes you think I'm not doing something about it? What makes you think I'm not doing exactly what is necessary?"

Following our consciences means learning to listen to God's voice and following that voice.

Despite our best efforts, trying to form our consciences does not always result in the right answer. Sometimes we need the wisdom to turn to advisors for help about issues. Unfortunately, sometimes they may give us wrong or bad advice. I have heard from too many people that they have heard from priests that in their case, contraception, sterilization, or in vitro fertilization would be permitted. These acts are never right, but some people are misinformed about them. We need to seek reliable, faithful advisors.

Yet the conscience is so important that we must follow it even when it is wrong. The Catechism says:

A human being must always obey the certain judgment of his conscience. If he were to deliberately act against it, he would condemn himself. Yet it can happen that moral conscience remains in ignorance and makes erroneous judgments about acts to be performed or already committed.15

The point is that if you really examine your conscience and you really believe that God is forbidding you to do something, you should not do it; and if he is calling you to do something, you have to do it. Because the conscience is authoritative, you need to work really hard making sure your conscience is right. Let us say you thought adultery in your case was morally permissible-your spouse has been distant for years and finally you have found someone who appreciates and understands you. Of course, you are likely rationalizing, and you really do know down deep that adultery is wrong; but let us just suppose that your conscience is invincibly ignorant about the wrongness of adultery in your case. So, following your conscience, you perform an act of adultery. Now, even though you may not be morally culpable for your act of adultery, the act will nonetheless likely be devastating to your marriage-even though you thought you were doing a morally justifiable action. The damages will be there whether you thought it was right or wrong and hence the importance of informing and properly forming your conscience.

Not all ignorance is invincible or excusable ignorance. Sometimes, not knowing what is right or wrong is your own fault. This is the case when an individual "'takes little trouble to find out what is true and good, or when conscience is by degrees almost blinded through the habit of committing sin.' In such cases, the person is culpable for the evil he commits."16

For instance, consider a doctor who, because he is in a hurry to play golf, does not read a patient's chart carefully. He writes up a prescription and is on his way. He did not take the trouble to inform himself about the medical condition of his patient. Under the influence of such negligence, he could well prescribe penicillin for a patient who was allergic to penicillin. When questioned why, he would say, "I didn't know the patient was allergic to penicillin." The information, however, was clearly on the patient's chart, and he would have noticed that if he had read the chart before writing an order. The law will not be on the physician's side because he did not inform himself of the patient's allergy.

The usual sources of ignorance are these:

• Ignorance of Christ and His Gospel

• Bad example given by others

• Enslavement to our passions

• Assertion of a mistaken notion of autonomy of conscience

• Rejection of the Church's authority and teaching

• Lack of conversion and charity

These are the sources of errors in judgment of moral conduct. We should be trying to know Christ better all the time. We should follow the example of good and not of bad people. We should be trying to be free of the domination of our passions. We should strive to understand the nature of conscience and Church authority. We should undergo conversion and practice charity because if we did so we would be less likely to commit errors of judgment.

This I find to be a foolish rationalization, just like wanting my weight to be less but not getting on the scale. This line of reasoning works against me and not for me. We have to realize and admit to ourselves how many times we willingly choose not to know.

Yet not all ignorance is culpable; sometimes we are what is called invincibly ignorant-perhaps like the individual mentioned above who came to convince himself that adultery would not be wrong in his case.

If ignorance is invincible, or the moral subject is not responsible for his erroneous judgment, he is not morally culpable for the wrong he has done. It remains no less an evil, a privation, a disorder; and he will likely suffer because of it. One therefore must work to correct errors of moral conscience.17

They do not hear it from the priest in the pulpit. They do not hear it from those in the Church they look to for answers. Most Catholics get all their understanding of the Church from Mass on Sunday. They are not reading encyclicals; they are not reading the Catechism; they do not read the diocesan newspaper, or any Catholic newspaper for that matter; and they do not read any Catholic publications. While they may be at fault for that, who, on the other hand, has told them they should be doing that? How many times have we been told from the pulpit, "You ought to read the diocesan newspaper; you ought to be reading the Catechism."

So, I do not know how guilty they-the uninformed-really are. The example that I often use to explain invincible ignorance to my students is that of a thirteen-year-old girl being taken to Planned Parenthood for an abortion by her mother. The girl is being told by her mother, "Oh, you're just removing some tissue"; but her daughter is doing something really, really wrong because she is killing her baby and committing a mortal sin. Yet she is likely not sinning at all, because she does not know what she is doing. She does not know what is really happening.

Nevertheless, she will suffer from having had an abortion. In all likelihood when she is eighteen, thirty, forty-five, she will look back on that day and say, "I killed my first baby!" She might even say, "I didn't want to do it; I didn't know," but it will still affect her. That is a truth. The reality of this situation is that she participated in an abortion, and the damage is still done even if she might be completely innocent.

Recall that in 1969 the Canadian bishops basically told Catholics they were free to follow their consciences about contraception. In 1974, however, they somewhat backtracked on their original statement. They said:

A believer has the absolute obligation of conforming his conduct first and foremost to what the Church teaches because first and foremost for the believer is the fact that Christ, through His Spirit, is ever present in His Church and the whole Church to be sure, but particularly those who exercise services within the Church and for the Church. The first of which services is that of the Apostles.18

The Canadian bishops are essentially saying that although "we told you to follow your conscience, we did not do a good job telling you how to form your conscience, so we are issuing this second statement." They go on to say that Catholics have a responsibility to form their conscience in respect to what the Church teaches. Now, how do we do that? I suggest that we read Church documents, commentaries, studies, and articles on various matters. We consult with the wise, we go to various conferences, and we pray. Through prayer we ask God what He wants to teach us.

Conscience Formation for Physicians

I once had the pleasure of hearing a Protestant minister address a crowd of priests-Rex Moses was his name-and he, along with a large number of family members, had converted to Catholicism the preceding Easter. During his address he held a copy of Humanae vitae up in the air and said, "You priests think that if you start preaching this people are going to leave the Church. I want to tell you that people are going to come in. I sat down and I read this document; I read it once, I read it twice, I read it three times. I wanted to belong to a Church that teaches something like that."

He said if priests started preaching the truth of Humanae vitae, it would draw people into the Church and not drive them away. I suspect that Rex Moses was particularly susceptible to accepting the truth about contraception because he was already very active in the pro-life movement.  We need to read and study Church documents and ask God, "If this is true, open my mind, open my heart to it. Let me be shaped by your word and your teaching."

This is what Humanae vitae states:

The Church can only conduct herself as did the Divine Redeemer: she knows mankind's weakness; she has compassion on the multitude, and she forgives their sins. She cannot, however, do otherwise than to teach the law which is proper to human life restored to its original truth and guided by the Spirit of God. The teaching of the Church about the proper spacing of children is a promulgation of the divine law itself.19

The Church is essentially saying, "We cannot change this teaching, any more than we could say adultery is right or abortion is right." This is God's law, not man's law. The document continues:

The teaching of the Church about the proper spacing of children is a promulgation of the divine law itself. No doubt many will think this teaching difficult to keep, if not impossible. And truly, just as with all good things outstanding for their nobility and utility, [keeping] this law requires strong motivation and much effort from individual Men, from families, and from society. Indeed, this law is not able to be kept without the abundant grace of God, upon which the good moral choices of Men depend and from which they get their strength.

Moreover, those who consider this matter thoroughly will see that [their] efforts [to keep God's law] increase human dignity and confer benefits on human society.20

The Church knows it is going to be hard for us to accept and live by the truth about contraception. Thus we have to ask God for the graces to help us do what is difficult to do. This is what Humanae vitae says to health-care professionals:

Likewise we hold in the highest esteem those doctors and members of the nursing profession who, in the exercise of their calling, endeavor to fulfill the demands of their Christian vocation before any merely human interest. Let them therefore continue constant in their resolution always to support those lines of action which accord with faith and with right reason. And let them strive to win agreement and support for these policies among their professional colleagues.

Moreover, they should regard it as an essential part of their skill to make themselves fully proficient in this difficult field of medical knowledge. For then, when married couples ask for their advice, they may be in a position to give them right counsel and to point them in the proper direction. Married couples have a right to expect this much from them.21

Dr. O'Connor saved my parents from contraception. They have been married for sixty-two years. They are very average-John and Anne Smith are their names. If you met them you would think, "These are just the most normal human beings I've ever met in my life." They have got their faults and their flaws, but they are two of the happiest married people I have ever met in my life. Who knows what would have happened if they had contracepted?

Mother Theresa's nuns all learn natural family planning, and they teach it world-wide.

Another exemplary physician is Dr. Tom Hilgers, a man of incredible wisdom and scientific knowledge.23 When he read Humanae vitae, he decided, "As a health-care professional, this sets my agenda for the rest of my life. I have to learn the most scientific way to help women control their fertility and then teach it to them." Few physicians world-wide know more about a woman's fertility cycle than Tom Hilgers.

A book available from One More Soul, Physicians Healed, features the testimonies of fifteen courageous physicians who do not prescribe contraception.24 They testify to how hard it was for them to stop doing something that their practice and training taught was good to do but how satisfying it is to practice medicine in accord with God's will and with a clear conscience.

Let me recommend a few items to you.

One is the testimony of Dr. Kim Hardy, whose CD is available from One More Soul; he is one of those doctors who prescribed contraceptives for years and has the most amazing testimony about his deciding not to do so and starting a practice in which contraception was not involved. I have coauthored a book, Life Issues, Medical Choices, with Christopher Kaczor.25 William May has written a superb book, Catholic Bioethics and the Gift of Human Life.26  These are the sorts of materials that Catholic health professionals should be devouring.

Another item that physicians should familiarize themselves with is the Ethical and Religious Directives for Health Care Services issued by the U.S. Bishops.27 In directive 70 we find:

"Catholic health-care organizations are not permitted to engage in immediate material cooperation in actions that are intrinsically immoral, such as abortion, euthanasia, and direct sterilization."

The footnote to directive 70 reads:

Any cooperation institutionally approved or tolerated in actions which are in themselves, that is, by their nature and condition, directed to a contraceptive end … is absolutely forbidden. For the official approbation of direct sterilization and, a fortiori, its management and execution in accord with hospital regulations, is a matter which, in the objective order, is by its very nature (or intrinsically) evil.

Not only are institutions that perform or permit such actions as abortion, euthanasia, sterilization, and contraception engaging in intrinsically evil actions, they are also causing scandal. The Directives state: "The possibility of scandal must be considered when applying the principles governing cooperation."28

Here we have a situation where Catholic doctors are scandalizing people by leading them into sin instead of away from it. Consider how powerful would be the witness of a Catholic physician who stopped prescribing contraceptives. Most who do so initially suffer significant financial loss, the loss of patients from their practice, and the loss of the respect of some of their colleagues. Some people, on the other hand, observing their brave witness, might be moved to imitate their brave action and put aside sin in their lives.

There are a number of reasons why Catholic doctors continue to prescribe contraception. Many want to help women avoid unwanted pregnancies and abortions. I know about this temptation from my experience in helping at a pregnancy center. In spite of my strong opposition to contraception I would sometimes want to urge a young woman who had already had several children born out of wedlock to learn how to use contraception reliably. Upon reflection, however, I realized that contraceptives would just enable her to maintain the lifestyle that was already making a mess of her life. I knew that I did not want to be just another voice that offers her a way to continue the lifestyle that is so destructive for her. I knew that I did want to tell her that there is another way, that these contraceptives are bad for her, that she already has two children, that maybe it is time to really put a stop to child bearing and sex until she gets married. While the world was giving her the message that her choices were sensible-if she only used contraception-what she really needed was someone to help her see that they were not and that contraceptives could not convert her foolish choices into sensible ones. I decided we needed to address what choices were causing her so much trouble rather than enable her to continue making those bad choices.

Some argue that "kids are going to do it anyway; kids are going to have sex anyway, give them a contraceptive." Yet we do not say that kids are going to smoke anyway and then give them low nicotine cigarettes; rather, we tell them that smoking is bad for them. So if we say, "If you're going to have sex, at least do it safely," it is the same as saying, "If you're going to smoke, at least smoke low-nicotine cigarettes," or, "If you're going to drink and drive, make sure you wear your seatbelts and drive slowly in uncongested areas. If you're going to drink and drive, we want to minimize the damage that you do." Why would we say, "If you're going to have sex outside of marriage, at least contracept, because that will minimize the damage that you do"? Sex outside of marriage and contraceptive sex in general are dangerous. Why should we be facilitating such bad choices?

Consequences of Contraception

One lady doctor, who said that she prescribed contraceptives for years, told me that when she stopped prescribing them, she was amazed at how some young women responded. When they would ask for contraception, she replied, "As your doctor, I can't give you a contraceptive. It's bad for you. I don't prescribe things that are bad for people. It's bad for your health, and furthermore, you're not married. You may well get a sexually transmitted infection, or get pregnant. You may even be tempted to get an abortion." Some of these young women would tell their boyfriends, "My doctor refused to prescribe contraception for me; it would be bad for me. We can't have sex." Some of the young women wanted someone to help them say no.

In our times, of course, physicians prescribe the hormones found in contraceptives for various conditions. Certainly, I have heard from doctors that the hormones in contraceptives are helpful for management of a few conditions. The Church teaches that it is morally permissible to prescribe the hormones in contraceptives for conditions for which they are helpful as long as the primary intention is not to cause infertility.

Humanae vitae states:

The Church, moreover, does allow the use of medical treatment necessary for curing diseases of the body although this treatment may thwart one's ability to procreate. Such treatment is permissible even if the reduction of fertility is foreseen, as long as the infertility is not directly intended for any reason whatsoever.30

Certainly physicians should try to determine whether vitamins or natural sources for hormones might help, but if the hormones that are present in the Pill are truly necessary to treat a condition, it is morally permissible to prescribe them. I want to make it very clear that those women taking the hormones in contraceptives who are not doing so with a contraceptive intent. In fact, they are not contracepting, and the physicians are not prescribing a contraceptive. They are prescribing the hormones that are in the contraceptive. Contraception as a moral category is deliberately doing something that interferes with the sexual act in such a way as to specifically prevent conception. Those taking the hormones that are in the Pill for various medical conditions are not doing so to prevent conception; their infertility is a side effect of their choice.

Contraception, I believe, is basically an insult to women. It contributes to the mindset that a fertile woman's body is defective. It is as if something is "wrong" with the fertility cycle that needs correcting. I also think it is an anti-woman act to prescribe contraception to a healthy woman.

Now, let us review some of the bad health effects of contraception on women. One news report tells us:

Johnson and Johnson spent at least $68.7 million to settle hundreds of lawsuits filed by women who suffer blood clots, heart attacks, or strokes after using the company's Ortho-evra birth control patch, court records show. Johnson and Johnson, the world's largest maker of health-care products, avoided trials through confidential settlements and hasn't released the financial details to investors.31

About thirty women using the patch died of heart attacks and strokes.  They were young, many in their early twenties. These are not the usual causes of death for a woman in her twenties.

Contraception also causes breast cancer. The journal of the Mayo Clinic published a key article in its October 2006 issue titled "Oral Contraceptive Use as a Risk Factor for Pre-menopausal Breast Cancer: A Meta-Analysis," authored by Chris Kahlenborn, M.D., et al.32 That article reviews studies that support a connection between contraception and breast cancer.

Consider one of the most common sexually transmitted diseases, chlamydia. The Centers for Disease Control reports: Chlamydia is a bacterial infection that can easily be cured with antibiotics, but usually occurs without symptoms and often goes undiagnosed. Untreated, it can cause severe health consequences for women. Up to 40 percent of females with untreated chlamydia infections develop pelvic inflammatory disease (PID)-a condition which can lead to long-term complications such as infertility, ectopic pregnancy, and chronic pelvic pain. This is what the Centers for Disease Control (CDC) says:

"The most reliable ways to avoid infection with an STD are to abstain from sex (i.e., anal, vaginal, or oral sex) or to be in a long-term, mutually monogamous relationship with an uninfected partner."33

Is not the best way to have a monogamous relationship to be found in marriage? Here we see the Centers for Disease Control finally getting sane!

A major consequence of contraceptive sex is out-of-wedlock births.  Women use contraceptives carelessly or the contraceptives fail and pregnancies result. Last year, for instance, 40 percent of the babies born in the United States were born to single mothers. Many of these unwanted pregnancies end in death for the unborn child. Eighty-three percent of the women going to abortion clinics were unmarried, and well over 50 percent say they were using a contraceptive at the time that they got pregnant.

Divorce rates have skyrocketed since contraceptives became available. In 1960, nine out of every 1000 women were divorced, and by 1980, 23 out of every 1000 were divorced.34 Sexually transmitted infections have led to a huge increase in infertility since 1960. So now we have the phenomenon of test tube babies, where we are creating embryos in petri dishes, implanting some (few of whom survive) and discarding others or using them for the purposes of experimentation. The list of the bad consequences of contraception is long. Suffice it to say that it is bad for the health of women, facilitates sex outside of marriage, facilitates bad relationships, increases incidences of sexually transmitted diseases, leads to unwanted pregnancy and single parenthood, causes and leads to abortion, contributes to divorce, and contributes to social chaos.

I mentioned previously that I teach in Detroit, and I think might it be one of the few cities that rivals Baltimore in categories like crime, violence, and drug addiction. Sadly, 75 percent of children are born to single mothers. Tell me there is not a connection between these behaviors and being raised by single parents. There is virtually no tax base in Detroit. It is very hard to have decent schools, a strong police force, drivable roads, and for people to afford health care. I propose that people stop fornicating and see what the consequences would be. Can you imagine what a change there would be in the world? The single biggest cause of poverty in the United States, or at least the largest number of people living in poverty in the United States, is single women and their children.35 How did that happen? What caused them to be single with children?

I said, "I'm sorry, but I have to challenge that statement. First of all, we're not talking about 'preferences' here, but about deeply held moral convictions." Our culture does not even know what a deeply held moral conviction is. "You think abortion is OK, I think it's not OK. You like chocolate ice cream. I like vanilla. Who is to say? It's all the same." One person says, "I don't want to do it. I don't want to kill unborn babies!" Another responds, "I understand you have that preference, but my preference is that I should be allowed to have an abortion if I want one."

In our culture, one's views on abortion are considered just a matter of preference. So when someone says that he or she will not perform an abortion, that he or she would die rather than do it, people think that person is being ridiculous. It is just a preference, it is no big deal. I said that at one time we were proud of those who refused to do what they thought to be killing. Those who resisted the Nazis are considered to be heroes, but those who refuse to perform abortions or refuse to prescribe abortifacient contraceptives because they believe they kill innocent human beings are considered to be imposing their preferences on others. My point about the difference between a preference and a deeply held moral conviction did not seem to register with the lady lawyer with whom I was debating.

I also challenged her claim that the pharmacist who refused to fill a prescription for contraceptives would be refusing health care to a client. I argued that contraception is not health care; it cures no diseases and in fact suppresses natural healthy fertility. Contraceptives are prescribed not to cure a disease but to facilitate lifestyles. The lady lawyer could no more understand this point than she did the clarification of the distinction between preferences and deeply held convictions. Her reasoning was very simplistic in that she believed that since physicians are responsible for health care, and since they prescribe contraceptives, contraceptives therefore must be health care.

We discontinue antibiotics, high blood pressure medicine, and chemotherapy when they are no longer needed to advance the health of a patient. If contraceptives were a medication for an unhealthy condition, once the woman achieved health, she would discontinue the use of the contraceptive.

In my view, no doctor, Catholic or non-Catholic, should be prescribing contraceptives. Catholic physicians have a special responsibility not to prescribe contraceptives because they belong to a Church that has preserved wisdom on sexuality that many in the Church have forgotten.

They have an obligation to form their consciences in accord with this teaching, but no physician should be prescribing drugs that heal no condition and that pose significant danger to physical health and facilitate serious social dysfunction.

Theology of the Body

If you want a lifetime relationship with someone, however, a baby is not scary; it is, in fact, welcome. We Catholics believe that the act of sex inherently expresses the desire to be in a lifetime relationship with someone. Couples are doing with each other something they should do only with a person to whom they have made a lifetime commitment. They engage in sexual intercourse because they love each other so much that they want to be in a lifetime relationship with each other and in fact not just a lifetime relationship but an eternal one. I heard one wife say that she did not like the line "until death do us part." She did not want death to part her from her spouse; she wanted an eternal relationship. Those who have a child with another, in a sense, have an eternal relationship.

Engaging in sexual intercourse during the fertile time is an invitation to God to create a new immortal soul. Those who do that should be married and prepared for a child. The acts of sexual intercourse of such couples speak the language of "I am willing to be a parent with you; and if I'm willing to be a parent with you, I'm willing to be in an eternal relationship with you." Contracepted sex, on the other hand, says, "I want to have this momentary act of pleasure with you now, and what tomorrow brings, I don't care." There simply is no way that contracepted sex can express commitment; non-contracepted sex, however, does so inherently.

In our culture, most people have committed serious sins in respect to sexuality. Most Catholic health-care professionals have violated Church teaching in serious ways. Many of them have done so out of a desire to attempt to relieve people's suffering. Much experience shows that violation of Church teaching more often than not leads to heartbreak and tattered, if not shattered, lives.

Christ came not to make us feel miserable about our bad choices but to relieve us of the guilt and misery that we may experience because of our bad choices. He not only forgives us but gives us the graces to help us change our ways and make better choices. We have an all-powerful Father who sent us the guidance of His Son, of the Holy Spirit, and of the Church, and our consciences to follow him and do what is right. We Catholics should take full advantage of the gifts that God has given us. I hope that this presentation has been a beginning for many in the process of informing their consciences about the wrongness of contraception.

References

1.  Pope Paul VI, encyclical letter Humanae vitae (1968).

2.  Father Curran has published a large number of works about contraception and dissent; e.g., Charles E. Curran, Contraception, Authority, and Dissent (New York: Herder and Herder, 1969).

3.  "The Winnipeg Statement: Canadian Bishops' Statement on the Encyclical Humanae vitae (On Human Life)," n. 26, in The Birth Control Debate, ed. Robert G. Hoyt (Kansas City: National Catholic Reporter, 1968), 169-170; also see http://catholicinsight.com/online/church/humanae/article_960.shtml.

4.  John Cardinal Newman, "Letter to the Duke of Norfolk," sect. 5, in the Newman Reader; The Works of John Henry Newman (1910; Pittsburgh; The National Institute of Newman Studies, 2007).

5.   Leslie Woodcock Tentler, Catholics and Contraception: An American History (Ithaca, NY: Cornell University Press, 2007).

6.  Mr. John Smith passed away several months after this presentation was delivered in Baltimore.

7.  Catholic Bishops' Conference of the Philippines, "Love is Life," October 7, 1990.

8.  Pope John Paul II, encyclical letter Veritatis Splendor (1993), n. 32.

9.  Ibid.

10.  Ibid., n. 34. The quotation is from John Henry Newman, "A Letter Addressed to His Grace the Duke of Norfolk," in idem, Certain Difficulties Felt by Anglicans in Catholic Teaching, vol. 2, (London: Longman, Green and Company, 1868-1881), 250.

11.  Vatican Council II, Gaudium et spes (December 7, 1965), n. 16, quoted in Catechism of the Catholic Church, 2nd ed. (Washington, D.C.: United States Catholic Conference, 1997), n. 1776.

12.  Vatican Council II, Gaudium et spes, n.16.

13.  Catechism of the Catholic Church, n. 1777, emphasis added.

14.  Ibid. The quotation is from St. Augustine, In epistulam Johannis, 8, 9.

15.  Catechism of the Catholic Church, n. 1790.

16.  Ibid., n. 1791, quoting Vatican Council II, Gaudium et spes, n. 16.

17.  Catechism of the Catholic Church, n. 1793.

18.  Canadian Catholic Conference, "Statement on the Formation of Conscience," December 1, 1993.

19.  Paul VI, Humanae vitae, n. 19.

20.  Ibid., n. 20.

21.  Ibid., n. 27.

22.  Dr. Billings passed away in 2007. See http://www.nfpandmore.org/

23.  For the work of Dr. Tom Hilgers, see http://www.popepaulvi.com/

24.  Physicians Healed, ed. Cleta Hartman (Dayton, OH: One More Soul, 1998).

25.  Janet E. Smith and Christopher Kaczor, Life Issues, Medical Choices: Questions and Answers for Catholics (Cincinnati: Servant Books, 2007).

26.  William May, Catholic Bioethics and the Gift of Human Life, 2nd ed. (Huntington, IN: Our Sunday Visitor Press, 2008).

27.  U.S. Conference of Catholic Bishops, Ethical and Religious Directives for Health Care Services (2001)

28.  Ibid., dir. 71.

29.  Janet Smith, "Contraception: Why Not" available from Trinity Formation Resources.

30.  Paul VI, Humanae vitae, n. 15.

31.  David Voreacos, "J&J Paid $68 Million to Settle Birth-Control Cases" (Update3), Bloomberg.com, October 16, 2008.

32.  Chris Kahlenborn et al., "Oral Contraceptive Use as a Risk Factor for Premenopausal Breast Cancer: A Meta-Analysis," Mayo Clinic Proceedings 81 (2006): 1290-1302.

33.  "Protect Yourself & the People You Love from Common STDs"

34.  Cf. Monthly Vital Statistics Reports, table "Divorce Rates"

35.  Cf. Robert E. Rector et al., "Increasing Marriage Would Dramatically Reduce Child Poverty," Heritage Foundation, Center for Data Analysis, report no. CDA03-06, May 20, 2003.