A Commentary of The National Catholic Bioethics Center on Health Care and the Life Sciences

and thus decide that it is prudent to try to have a child. In amily lanning as other situations, there may be maternal or paternal health F P factors (such as the need to recover following a major debilitating illness or the discovery of metastatic cancer) Nature Intended which could lead the couple to decide to postpone having children for the present time or even indefinitely. Economic factors may lead a couple to recognize A family should be planned. Many people incorrectly­ that they have been blessed by economic prosperity and think that Catholic teaching is “to breed like bunny ­desire to go against a mentality that often overemphasizes ­rabbits” and would even wrongly invoke God’s ­command pleasure and well-being to the detriment of the sacrifice in Genesis 1:28 to “go forth and multiply.” Pope John Paul inherent in having a child. Or if a couple is suffering from II stated that, “unfortunately, Catholic thought is often severe financial hardship or is in an instable transitional misunderstood on this point, as if the Church supported ­period (such as spouses in graduate school), then the an ideology of fertility at all costs, urging married couples couple might decide that they cannot responsibly bring to procreate indiscriminately and without thought for the another child into the world at this time.5 future. But one need only study the pronouncements of the Psychological reasons may encourage a couple to 1 Magisterium to know that this is not so.” A married couple have more children—perhaps the couple sees that ­having has a serious task in deciding just how many children to another child would be to the psychological benefit responsibly bring into the world. of an existing offspring. Or there are instances where Deciding to Have a Child ­having another­ child could bring excessive anxiety to the family, for example, if the mother or father are already The Second Vatican Council, in its document Gaudium ­overburdened or are already caring for children with et spes, gives the couple some helpful advice: special needs, or if they suffer from the “debilitating stress Let them thoughtfully take into account both their own that can arise from having a large family in societies where welfare and that of their children, those already born large families are no longer valued.” 6 and those which the future may bring. For this account- Social factors concern the cultural environment, which ing they need to reckon with both the material and the could be blooming and thus encouraging a couple to bring spiritual conditions of the times as well as of their state in life. Finally, they should consult the interests of the forth new life. Or it may be that the social conditions are family group, of temporal society, and of the Church unsuitable, such as a state of war or severe shortage of food. herself. The parents themselves and no one else should All of these conditions need to be considered so that ultimately make this judgment in the sight of God.2 the couple can make an informed decision to have another John Paul II also provided guidance to husbands and wives: child or to delay childbearing for the foreseeable future. In deciding whether or not to have a child, [spouses] Modern Natural Family Planning Methods must not be motivated by selfishness or carelessness, but by a prudent, conscious generosity that weighs the The basic principle underlying natural family planning­ possibilities and circumstances, and especially gives is that the female body naturally follows a biological priority to the welfare of the unborn child. Therefore, rhythm consisting of monthly cycles and that a woman is when there is a reason not to procreate, this choice fertile only at certain times during each cycle. There are is permissible and may even be necessary. However, there remains the duty of carrying it out with criteria and methods that respect the total truth of the marital act in its unitive and procreative dimension, as wisely December 2012 Volume 37, Number 12 regulated by nature itself in its biological rhythms. One can comply with them and use them to advantage, but amily lanning as ature ntended they cannot be “violated” by artificial interference.3 F P N I The Urgent Need for Education Responsible parenthood means that the parents take into consideration their physical, economic, psychological, Rev. James McTavish, FMVD, MD and social conditions when deciding how many children to have and when to have them.4 Scandal and the Komen Fiasco Physical conditions include the couple’s bodily health Why Catholics Should Keep Their Distance and capacity to raise a child. It might be that the spouses Edward J. Furton, MA, PhD are young and in their physical prime and in good health

Defending the Dignity of the Human Person in Health Care and the Life Sciences since 1972 Ethics & Medics December 2012 certain changes in a woman’s body that can help her to 6. NFP becomes sustainable from generation to genera- know which stage of her cycle she is in: most noticeably, tion. Mothers can readily pass on the practice of NFP that her body temperature rises prior to ovulation and that to their daughters. the consistency of her cervical mucus becomes thinner 7. NFP involves a joint decision by the couple. Neither during the fertile period. partner feels being used by the other. It is an ideal way of exercising shared parenthood. A “contraceptive The secret of natural family planning is to determine mentality” is avoided. when the woman is fertile and when she is not; thus 8. NFP engenders sexual discipline for the spouses most of the methods are known as fertility-awareness- through periodic abstinence. The practice of NFP based ­methods. There are six generally accepted natural­ ­manifests a conscious familiarity with the natural ­family planning methods: basal body temperature rhythm of the human body, mutual caring between method, Billings Ovulation Method, Two-Day method the spouses, and the development of self-control that is (this is a new method that is still under evaluation), carried over in the upbringing of the children. Sympto-thermal Method, Standard Days method, and 9. Couples who use NFP seldom or never resort to ­Lactational Amenorrheoa­ Method. Temperature observa- ­abortion. They manifest an innate respect for human tion is the basis of the basal body temperature method. life. They welcome every child as a gift from God—even The Billings­ Ovulation Method and the Two-Day Method in the eventuality of an unexpected pregnancy. rely on ­observations of the changes in cervical mucus. 10. Couples who use NFP seldom or never end up in The ­Sympto-thermal Method involves observation of separation or divorce. NFP enhances communication ­between spouses and promotes a wholesome family life.8 both temperature­ and cervical mucus. The Standard Days method calculates statistically when the woman is The New Evangelization known ­to be fertile (on days eight through ­nineteen of her Much ignorance surrounds natural family planning. ­cycle). The ­Lactational Amenorrheoa ­Method relies on the Just ask any body to name even one modern method of natural period of infertility­ during breast feeding post- NFP; most people probably cannot name any. (And do not partum. Planned Parenthood even notes that, when used give them a point for “the rhythm method,” because it was ­correctly, natural family planning methods are 95 ­percent introduced in the 1930s.) Most medical, nursing, and the- to 99.6 ­percent effective.7 ology schools give scant attention to natural family plan- Advantages of Natural Family Planning ning. No wonder it is a rarity, then, to find a serious and credible NFP program in a hospital, community health It is possible to misuse natural family planning center, or parish. Sadly, many international organizations ­methods by having a “contraceptive mentality,” for ignore natural family planning and instead put billions ­example, when a couple avoids the birth of a child for of dollars into ­spreading contraception. It is hardly sur- selfish reasons. But when used correctly, natural family prising that only a ­minority of Catholic couples are using ­planning methods are a way of spacing births that the natural family planning as a means to plan their family. Church wholeheartedly approves. Thus it is important to educate couples about these methods so they can What is needed is a renewed effort. Perhaps we could ­responsibly plan their families and have the number of even consider it part of the new evangelization to provide children they desire. education regarding the various methods of natural family planning. Until this occurs, the vast majority of Catholic There are also many benefits to the couple who uses couples will continue to think that the only way to plan natural family planning in their marriage. Archbishop the size of their family is to use contraception. ­Antonio Ledesma, SJ, of Cagayan de Oro, Philippines, offers ten advantages of using natural family planning Rev. James McTavish, FMVD, MD methods: Fr. McTavish is a Catholic missionary priest with the Verbum 1. Normal intercourse is preserved. Couples can plan Dei missionaries and is involved in formation and apostolate the size of their families and space births the natural work in Manila, Philippines. way. They do not resort to artificial means. 1 2. NFP is morally acceptable to people of all religions John Paul II, “Parents Are God’s Co-workers,” Sunday Angelus and cultures. It does not separate the love-giving and meditation, July 17, 1994,” L’Osservatore Romano, English ed., life-giving dimensions of the marriage act. The unitive July 20, 1994. 2 Vatican Council II, Gaudium et spes (December 7, 1965), n. 50. See and procreative ends of marriage are kept whole. also, Paul VI, Humanae vitae (July 25, 1968), n. 10. 3. There are no inherent health risks in NFP methods. No 3 John Paul II, “Parents Are God’s Co-workers.” pills, drugs, injections, devices or operations are used. 4 Paul VI, Humanae vitae, n. 10. A healthy body does not need this kind of “medical” 5 See “Reasons for Postponing a Pregnancy: More on Ventilator treatment. Care,” Zenit, June 30, 2010, http://www.zenit.org/article 4. Modern NFP methods are effective and reliable. -29757?l=english. 6 They are based on scientific studies and are time- See Ibid. 7 tested. ­Simplified methods are easy to learn. Some NFP Planned Parenthood website, “Fertility Awareness-Based Methods (FAMs),” http://www.plannedparenthood.org/health-topics/ ­methods may be combined to reinforce each other. birth-control/fertility-awareness-4217.htm. 5. There is no cost involved once the method has been 8 Antonio J. Ledesma, “Pastoral Guidelines and Core Values in NFP learned. Couples are empowered not to rely on health Promotion,” Pastoral Companion (blog), April 30, 2009, http:// centers, donor agencies, or drugstores. NFP is pro-poor, archbishopledesma.blogspot.com/2009/04/pastoral-guidelines and not for profit of outside companies. -and-core-values-in.html. 2 Ethics & Medics December 2012 The Moral Analysis Scandal and the The Komen Foundation controversy opens a window on an important distinction between cooperation and Komen Fiasco scandal, and it shows how scandal may ­negate cooperation with an organization that would ­otherwise be acceptable. In fact, ­nothing really changed in Komen’s relationship to Planned ­Parenthood; only our judgment has. The present Numerous reports indicate that fund-raising for situation is what existed prior to the public controversy. the annual Susan G. Komen Race for the Cure is off If nothing has changed, why has the Center reversed its ­significantly this year.1 Various reasons are given by position? Why did we feel that participation in the Komen organization officials, but one of the key factors is clearly for the Cure Race was justified in certain limited cases the recent controversy over Komen’s funding of Planned prior to the public blow up, but not after? Parenthood. Many Catholics who previously participated The difference is scandal. By the term “scandal” I do in the Komen effort felt betrayed by the organization’s not mean what the media often think of by this word, but reversal of its much-admired, if briefly held, decision to refer instead to its theological sense: the capacity for an end its tawdry association with that organization. action to lead others into sin. The Catechism of the Catholic Statement of The NCBC Church gives this description: “Scandal is an attitude or behavior which leads another to do evil. The person who Prior to the public flap, The National Catholic Bioethics gives scandal becomes his neighbor’s tempter. He damages Center had taken a nuanced view of Komen, but following virtue and integrity; he may even draw his brother into Komen’s re-embrace of Planned Parenthood, we recom- spiritual death. Scandal is a grave offense if by deed or mended against further participation in its charitable omission another is deliberately led into a grave offense”­ programs: (n. 2284). We are social creatures whose moral life is The Komen Foundation for the Cure has learned ­influenced by those around us. the hard way that you do not cross the pro-abortion Catholics who support an organization that has offered lobby without suffering a swift reaction. After little such a public embrace of a notorious abortion provider will more than twenty-four hours, Komen has reversed itself and will now provide Planned Parenthood with not surprisingly lead others to think that our opposition hundreds of thousands of dollars from its massive and to abortion is not as serious as it seems. We have a duty to ­well-publicized funding campaign. ensure that there is no doubt in the minds of others about The result of this double reversal will be to solidify the where the Catholic Church stands on this issue. opinion of pro-life persons throughout the country that Nonetheless, had it not been for the Komen Founda- the Komen Foundation cannot be trusted with their tion’s very public declaration of support for Planned donations. Parenthood, our prior position would have remained We urge Catholics and all pro-life citizens to refuse to unchanged. As noted, that position was highly nuanced participate in Komen-sponsored events.2 because, quite frankly, the facts were complex. Some In a website posting only two days earlier, we had ­Komen organizations are franchised, meaning that they lauded the Komen Foundation for its decision to end its operate with a measure of independence from the national support of Planned Parenthood, which, we noted, received organization. These chapters may have different policies nearly a quarter of a million dollars from the Komen or contracts and indeed might be populated by those who Foundation the previous year.3 We wrote, “Catholics and are pro-life. Thus it may be that one chapter of the Komen all who support the pro-life cause can freely renew their Foundation supports a local Planned Parenthood office, support for the Susan G. Komen Foundation for the Cure. while another would never think of doing so. This step in the right direction should be immediately Also, some Komen branches earmark or specify funds rewarded by increased pro-life support for the walks and for some of the few morally legitimate projects Planned runs that are the centerpiece of its fund-raising efforts.” Parenthood does carry out. For example, one Planned But we also warned, in the closing paragraph of that Parenthood branch may provide information about breast posting, that “we can expect the Komen foundation to come health and referrals for breast cancer screening, while under intense pressure from those who favor abortion­ in another may provide clinical breast examinations on site. an effort to persuade them to relent on their ­decision and Efforts like these have been subsidized by local chapters of to once again provide funding for an organization­ radically­ the Komen Foundation. But since Planned Parenthood also committed to the killing of the ­unborn. We hope and pray has among its basic purposes the destruction of unborn that the directors of ­Komen will have the strength to re- children, even the desire to support a morally legitimate main steadfast in their ­decision.” Regrettably, they did not. cause still requires a strong justification. After just one day, under an­extraordinary barrage of anger Let us suppose for argument’s sake that there are no and vilification from those who support unrestricted access other organizations in an area that perform breast cancer to abortion, the organization­ did indeed reverse its course screening, which is indeed important to women’s health. and renew its support for Planned Parenthood. If so, then it might be permissible to give money to a 3 The National Catholic Bioethics Center

6399 Drexel Road, Philadelphia, PA 19151-2511 www.ncbcenter.org

Volume 37, Number 12 December 2012 Views expressed are those of individual authors and may ­advance positions that have not yet been doctrinally settled.Ethics & Medics makes every effort to publish articles consonant with the magisterial teachings of the Catholic Church.

Susan G. Komen chapter, which, in turn, would give a justification for supporting the legitimate efforts of local ­portion of its income to Planned Parenthood specifically chapters has been swept aside by the national scandal. for such screening. After all, one’s donation would be made to Komen, not to Planned Parenthood, and it would be Support for Charity ­ earmarked specifically for a legitimate purpose. Those who support abortion will obviously be proud We are called to love others as ourselves and so to give to run in the Komen Race for the Cure. They want every- support and ­comfort to the afflicted. This is the essence of one to know that the organization represents their values. the Christian mission in this passing world. Requests to Catholics must look elsewhere. For us, this was never a participate in events such as the Komen Race for the Cure debate about abortion; it has always been an effort to help often come from those whom we know as our neighbors. those in need. They may themselves suffer from cancer or may have We cannot give aid to every organization that comes children who have this serious illness. our way. We must seek out those honorable charities that How difficult it is to tell these good people that we deserve our support. But we can also hope that, at some cannot help them! How difficult it is to say no because point, every such organization will realize that it is wrong the organization that sponsors the charity has a link to politicize an act of charity. to the evil of abortion. How can we place this concern, Edward J. Furton, MA, PhD which may seem to some to be quite far removed from the immediate­ purpose of the event, above the good of Dr. Furton is editor of Ethics & Medics at The National ­Catholic helping our neighbor? Bioethics Center in Philadelphia. And so it seems reasonable, in view of the fundamen- 1 Kim Hilsenbeck, “Komen Facing Record-Low Donations, Race tally Christian desire to help those who are suffering, to Entrants,” Hays Free Press, October 3, 2012, http://haysfreepress leave the door open just a little. In those cases where a local .com/2012/10/03/komen-facing-record-low-donations-race -entrants/; Erin Mulvaney, “Houston Komen Race Sees Decline chapter of Komen does not support abortion, it restricts the in Registration, Fundraising,” Houston Chronicle, October 3, 2012, use of its funds to legitimate purposes, and it maintains http://www.chron.com/news/houston-texas/article/Houston a sufficient independence from the national organization, -Komen-race-sees-decline-in-registration-3915875.php; and then cooperation may indeed be permissible. There are, in ­Stephanie Cary, “Komen Fundraising Affected by Planned fact, local chapters of Komen that meet these restrictions. ­Parenthood Controversy,” Los Angeles Daily News, October 3, 2012, http://www.dailynews.com/health/ci_21692483/komen Regrettably, the whole of this analysis has been -fundraising-affected-by-planned-parenthood-controversy. ­submerged under a wave of scandal so large that it washed 2 National Catholic Bioethics Center, “Susan G. Komen Foundation away all of our nuanced and detailed reasoning. For the Applauded for Severing Relationship with Planned Parent- Susan G. Komen Foundation to openly and publicly ­affirm hood,” news release, February 1, 2012, http://www.ncbcenter its commitment to Planned Parenthood, which is dedicated .org/page.aspx?pid=1263. 3 National Catholic Bioethics Center, “NCBC Responds to Komen’s to unrestricted access to abortion and carries out this Reversal and Urges Catholics to Not Support the Foundation’s nefarious activity, has made cooperation impossible. It is Events,” news release, February 3, 2012, http://www.ncbcenter impossible not because the facts have changed but because .org/page.aspx?pid=1263. 4

Ethics & Medics is a publication of The National Catholic Bioethics Center. Regular annual subscription rate for 12 issues includes both the print version by mail and online access at www.ncbcenter.org/em: U.S. A. $28; foreign $38; institutional $55. Individual copies are available at $3.00 each. TO SUBSCRIBE, please write to The National Catholic Bioethics Center, 6399 Drexel Rd., Philadelphia, PA 19151-2511, e-mail [email protected], or phone (215) 877-2660. Publisher: John M. Haas, STL, PhD; Editor: Edward J. Furton, MA, PhD. Contents © 2012 The National Catholic Bioethics Center. ISSN 1071-3778 (print), ISSN 1938-1638 (online). For permission to reuse material from Ethics & Medics, please access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, ­Danvers, MA 01923, phone (978) 750-8400.