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

interpreting them in light of the Gospel”; therefore the Reframing the Church must explore new avenues to enable the teaching of Humanae vitae to be received more perfectly.5 While ontraception ebate the phrase “natural family planning” may (or may not) C D be widely understood, exploring alternative terminology might prove beneficial. Although the term “natural” has a rich history of The HHS mandate has had a significant impact on ­significance within the Catholic tradition, it might not 1 the American Catholic Community. The mandate, ­issued ­afford the Church the clearest means for ­communicating by the Department of Health and Human Services, the core reality of the sexual practices of responsible requires that all health ­insurance plans cover women’s ­parenthood in the context of contemporary American so-called preventive services, such as sterilization and culture. In a world devoid of traditional Aristotelian– ­contraceptives, including some ­abortifacients. Discussion Thomistic metaphysics, the particular significance that of the Church’s teaching on contraception is once again in Catholic tradition ascribes to the term is easily lost in the air, and two things have become apparent. translation. Thus in a world dominated by the ­materialism First, for many Catholics the teaching remains, as of Darwin, what is natural is typically dichotomized it were, unreceived. Insofar as the teaching remains with what is artificial. This tends to erect a “natural-is- ­unreceived, the entire Church suffers. For instance, good / artificial-is-bad” opposition that is inconsistent with ­commentators on all sides of the debate surrounding the Catholic tradition. HHS mandate cite the questionable statistic put out by the Guttmacher Institute that 98 percent of Catholic women Second, the term “family planning” is equally prone who are sexually active do not avoid pregnancy by a to unhelpful ambiguity. For instance, the term could lend means that Church teaching affirms.2 Commentators often credence to the idea that NFP is morally good because cite such statistics to argue that, while the Church teaches it produces a good outcome, namely, that the family is that contraceptive practices are immoral, lay Catholics do indeed “planned.” This focus on the “planned” status of not actually find them objectionable. The effect of these the outcome feeds into an assumption, evident in the CDC arguments is to isolate the bishops from the laity.3 Such report, that NFP is just Catholic contraception. In this view, division is seen to undermine the legitimacy of a Catholic NFP is just another form of contraception that helps those opposition to the mandate. who are “at risk of unintended pregnancy.” 6 In truth, the Second, in the eyes of many people the distinction Church does not support NFP because it produces fami- ­between sexual practices of responsible parenthood—­ lies that are planned. The Church supports NFP because specifically, avoiding pregnancy through the couple’s it helps couples regulate births in a morally responsible awareness of the fertility cycle—and contracepted way, regardless of whether they are “planned” or not. In sexual acts is ambiguous. For instance, a report put the Catholic tradition, the means matter. out by a ­department of the Centers for Disease Control Third, the objective of all forms of NFP is to gain an and ­Prevention indicated that 99 percent of sexually awareness of the couple’s fertility and then make ­decisions ­experienced women have used some form of ­contraception consistent with responsible parenthood based on that in their lifetime, counting “periodic abstinence—­calendar awareness.7 Perhaps, then, the phrase “practice of ­fertility rhythm” and “periodic abstinence—natural family awareness” might better express the actual practice in ­planning” as two of twenty-one contraceptive methods which the couple engages.8 After all, it is through the 4 that women used. As indicated by the CDC report, choice to become aware of their fertility that the couple many consider these respective behaviors ­exclusively seeks to make the further choice to either abstain from in light of the outcome of avoiding pregnancy. The ­persistence of such confusion surely has some effect on the degree to which the teaching is received among Catholics, ­reinforcing perceptions of hypocrisy for some September 2012 Volume 37, Number 9 or ­disillusionment among others who strive to hold to the teaching. Once again, the whole Church suffers. Reframing the Contraception Debate Ambiguous Language A Teachable Moment for the Church According to Gaudium et spes, “the Church has always Elliott Louis Bedford, MA had the duty of scrutinizing the signs of the time and of

Defending the Dignity of the Human Person in Health Care and the Life Sciences since 1972 Ethics & Medics September 2012 intercourse at a specific time or pursue ­pregnancy. In open the door—even if slightly—to behaviors and ­attitudes addition, we need to emphasize the increasing techno- of ­manipulation, domination, and uncharitableness logical sophistication of the ­techniques by which couples ­between spouses, especially because the sexual urge is so become aware of their fertility, the ­continuous research powerful and affective. into these techniques, and their ­potential therapeutic uses The practice of fertility awareness itself is not a to counteract misperceptions that the Church supports ­panacea to these harmful attitudes and behaviors. For 9 only an archaic, nonmedical rhythm method. Hence, we instance, sexual intercourse, or the prospect of sexual can say that the practice of fertility awareness—and not ­intercourse, can be used manipulatively even when a of contraception—is an element of truly reasonable and couple is ­practicing fertility awareness, for example, when responsible parenthood. a wife withholds intercourse to get her way or when a Further, it is imperative to distinguish practices of ­husband makes his wife feel bad that she is fertile and responsible parenthood from contracepted sexual acts in “denying him ­intercourse.” 15 The truth is that ­fertility sober terms that resonate with contemporary experience awareness ­requires sensitivity and perseverance by both of American Catholics, specifically regarding how these spouses. However, the practice assists them. ­Consider practices affect meaningful human relationships. how fertility awareness ­provides a wife with a support- The tradition already recognizes that the power of ive backstop;­ her will is not all that remains between her the sexual urge, and the influence it can have on human ­husband and intercourse. Beyond her will, he faces the ­behaviors and attitudes, is immense.10 This honesty is a sobering ­reality that is ­human fertility itself; namely, solid starting point, especially in the highly sexualized the reality that if they engage in intercourse at this time, setting of contemporary American culture. As a further then a child might come into being. Hence, in ­practicing point of honesty, we must admit that, for many people, the fertility awareness, spouses encounter a reality that one moral status of contracepted sexual acts is not ­necessarily cannot argue with and is not itself subject to petty or immediately apparent, even to people long aware of the manipulative ­attitudes. The practice thereby disposes Church’s teaching. I would suggest this is because, in spouses to relate to each other in light of this reality and one sense, the evil of contracepted sexual acts is so small provides them a preliminary stopgap against (perhaps that it is not apparent.11 For instance, people might argue unconsciously) manipulative and uncharitable attitudes that because contracepted sexual acts achieve the same and behaviors—though it does not guarantee these things ­outcome as periodic abstinence there really is no differ- will be prevented automatically. ence. In another sense, the evil of contraception is so large In contrast, contracepted sexual acts deny and that it cannot be seen from up close. Pope Paul VI suggests, distort this ­reality. This denial amounts to a slight for example, that the full impact of contraceptive practices pivot on the ­fulcrum which morally virtuous (that is, only becomes evident over the extended course of human good) ­relationships ­balance. The disposition of each relationships or on a societal level.12 In either case, the real spouse ­toward the other is then shaped according to evil of contracepted sexual acts lies in their deceptiveness, this ­distortion. Yet we can see how distorting a reality their seeming innocuousness or even goodness. that ­mediates the spousal ­relationship undermines the Because of this ambiguous deceptiveness, the differ- ­pilothouse of virtue that is marital life: as noted above, ence between the choice to contracept and the choice to it opens the door, slightly but assuredly, to abusive and practice responsible parenthood—from the perspective manipulative inclinations, ­attitudes, and behaviors. The of the acting person in today’s culture—is extremely preliminary stopgap is removed. slight, a difference of only an inch. Yet, to paraphrase Thus, both fertility awareness and contraceptive prac- G. K. ­Chesterton, the difference of an inch is everything tices cultivate distinct dispositions that affect how couples when we are striving to balance on the virtuous mean.13 relate to one another. One inclines the couple ­toward ­charity in truth—that is, toward a charitable ­regard for Harmful Attitudes each other grounded in respectful regard for the ­reality Consider the case of a husband consumed by sexual of their embodiment; the other cracks open the lid of desire who approaches his wife only to find she is not, as Pandora’s box. Paul VI perceived this truth resting at the it were, “in the mood.” Now, she might offer any number heart of the married relationship. Hence, in Humanae­ vitae, of reasons why they should not have intercourse (for he predicted that acceptance of ­contraception would lead ­example, she is tired or has a headache). Yet when the to a general degradation of morality, harm the relationship couple practices contraception, all that really remains between men and women, and capacitate governments to between the man and intercourse is his wife’s will; and a attempt to solve social­problems through the imposition of will can be manipulated and dominated.14 One can envi- ­contraceptive ­practices.16 Fertility awareness, in contrast, sion a husband angrily arguing, “It’s not like we’re going disposes couples toward—but does not guarantee—honest to get pregnant!” Furthermore, the raw power of the and undistorted relationships that can authentically affirm sexual appetite can ­desensitize a person from an aware- the dignity of our social nature. The Church’s teaching ness of his or her manipulative attitudes or behaviors. By that contracepted sexual acts distort the social nature of ­capacitating this desensitization, contraceptive practices human beings and thereby contradict human dignity is 2 Ethics & Medics September 2012 ­ not true simply because the Pope said it. The Pope said it for bringing about a more human order in society. . . . All because it is true. programmes of ­economic ­assistance aimed at financing campaigns of sterilization and contraception, as well Presenting the Message as the ­subordination of economic assistance to such In confirming Humanae vitae’s prescience, the HHS campaigns, are to be morally condemned as affronts to 20 mandate affords the Church a teachable moment of special the dignity of the person and the family. significance on several fronts. For one, in once again noting The passage suggests an intimate link between the the degree to which the teaching of Humanae vitae remains choices of individuals in concrete circumstances and unreceived by many Catholics, the inviting words of the ­general developments, either positive or negative, within Second Vatican Council echo once more: “theologians, the social realm. In effect, what is normative in the oikos, within the requirements and methods proper to theology, the home, becomes normalized in the polis, the city. If are invited to seek continually for more suitable ways of people are willing to use contraceptive practices in their communicating doctrine to the men of their times; for the pursuit of “the good life,” why should government not deposit of Faith or the truths are one thing and the manner promote these practices, by controlling costs and lowering in which they are enunciated, in the same meaning and health risks for mother and child, to help the body politic understanding, is another.” 17 pursue “the good life”? The Church must always proclaim the truth that the In part, this is the philosophical reasoning behind the Blessed Trinity has revealed about human sexuality. At the HHS mandate. Ambiguity between the moral status of same time, she must soberly scrutinize whether the truth ­contracepted acts and of acts of responsible ­parenthood that she is attempting to proclaim is being communicated can lead to serious social consequences. Yet with a clear in the most effective manner. view of the moral difference between the two, it also ­becomes apparent that contraceptive practices­ ­undermine The signs of the time indicate that this scrutinizing the sum total of social conditions and ­relationships gaze should fall on the terminology of NFP to help refine ­necessary for all to flourish, that is, the common good, just it and dispel certain distortions and misperceptions about as they damage human relationships on the ­individual the Church’s teaching on responsible parenthood. That level. As contraceptive practices contravene human is, the Church’s teaching about the regulation of birth is ­dignity within the oikos, so too do they contravene human in reality a universal call that “all the faithful are invited dignity when promoted as policy of the polis. The Church, and obliged to holiness and the perfection of their own for her part, must continue to articulate this message in state of life.” 18 This invitation needs to be continually and ever new and insightful ways both to her own sons and ­intelligibly communicated as such. While it would seem daughters and to “all nations” (Matt. 28:19). naive to think that a simple development of terminology would catalyze widespread reception of the Church’s Healing the Wound teaching, it could nonetheless be a helpful first step for The fact that the teaching of Humanae vitae ­remains some persons, opening the door for Catholics to reconsider largely unreceived causes the Church to suffer in both the teaching in a new light. direct and indirect ways. The HHS mandate pulls back As another teaching point, the Church can now the bandage of the status quo and casts a diagnosing light concretely illustrate how the Catholic understanding on on this unhealed wound in the Body of Christ. The Divine personal sexual morality always have social repercussions. Physician seems to also suggest a treatment plan. He calls In other words, for the Church, life ethics and social eth- all toward holiness, even in the smallest and seemingly ics are, as Pope Benedict XVI suggests, integrally linked most innocuous decisions. elements of the Church’s single magisterium, which safe- Given this opportunity, the people of God cannot fail guards a truth about the human person that it does not to heed the words of St. Paul: “Do not be conformed to this create but ­receives.19 The Compendium of the Social Doctrine world but be transformed by the renewal of your mind, of the Church illustrates this link quite clearly: that you may prove what is the will of God, what is good Concerning the “methods” for practising responsible and acceptable and perfect” (Rom. 12:2). The Church must procreation, the first to be rejected as morally illicit are do her part to enable this renewal of mind by taking up ­sterilization and abortion. . . . Also to be rejected is recourse the opportunity at hand. She must explore more perfect to ­contraceptive methods in their different forms: this language to communicate the truth about the actions of ­rejection is based on a correct and integral understanding responsible parenthood and also illustrate the significance of the person and human­ sexuality and represents a moral that those practices have at both the personal and societal call to defend the true development of peoples. On the other level in terms that resonate with contemporary human hand, the same reasons of an anthropological order experience. justify recourse to periodic ­abstinence during times of Elliott Louis Bedford, MA the woman’s fertility. Rejecting contraception and ­using natural methods for regulating births means choosing to Elliott Louis Bedford, MA, serves as the Ethics Fellow at base interpersonal relations between the spouses on mutual ­Ascension Health. He is currently pursuing his doctorate in respect and total acceptance,­ with positive consequences also health care ethics at Saint Louis University after having ­received 3 The National Catholic Bioethics Center

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

Volume 37, Number 9 September 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.

a master’s in philosophy with a concentration in bioethics 9 See Richard J. Fehring, “Efficacy and Efficiency in Natural from the Franciscan University of Steubenville, Ohio, and a ­Family Planning Services,” Linacre Quarterly 76.1 (February ­master’s in moral theology from Aquinas Institute of Theology 2009): 9–24; Richard J. Fehring, “The Catholic Physician and ­Natural ­Family Planning,” National Catholic Bioethics Quarterly in St. Louis, Missouri. 9.2 ­(Summer 2009): 305–323; and Ferris, “Fertility Awareness­–

1 Based Methods.”­ “Women’s Preventive Services: Required Health Plan Coverage 10 Guidelines,” U.S. Department of Health and Human Services John Paul II, Love and Responsibility (San Francisco: Ignatius, 1993), 45–69. Administration, accessed July 18, 2012, http://www.hrsa.gov 11 /womensguidelines/. John Paul II both affirms the Church’s teaching that­contraceptive acts are always contrary to human dignity and notes their 2 Rachel K. Jones and Joerg Dreweke, Countering Conventional ­relative gravity. He does not speak to the specific gravity of Wisdom: New Evidence on Religion and Contraceptive Use (New ­individual contraceptive acts (save those that cause ­abortions) York: Guttmacher Institute, 2011), http://www.guttmacher.org but rather focuses on the danger of the “contraceptive /pubs/Religion-and-Contraceptive-Use.pdf. On the questionable ­mentality.” John Paul II, Evangelium vitae (March 25, 1995), n.13. status of these statistics see Michael B. Dixon et al., “Facing the 12 See Paul VI, Humanae vitae (July 25, 1968), nn. 17–18. Pill ‘Head On,’” St. Louis Review, March 29, 2012, http://stlouis 13 See G. K. Chesterton, Orthodoxy: The Romance of Faith (New York: review.com/article/2012-03-29/facing-pill-head. 3 Image Books, 1990), 100. Paula A. Johnson, “Commentary: Religious Exemption for 14 Lundy Bancroft, Why Does He Do That? Inside the Minds of Angry Contraception Is Bad Medicine,” February 21, 2012, http:// and Controlling Men (New York: Berkley Books, 2003), 171–190. commonhealth.wbur.org/2012/02/limiting-contraception-is 15 John S. Grabowski, Sex and Virtue: An Introduction to Sexual Ethics -bad-medicine/; and Keith Soko, “Bishops Don’t Speak for Most (Washington, DC: Catholic University of America Press, 2003), Catholics on Contraception,” CNN.com, February 4, 2012, http:// 125. www.cnn.com/2012/02/03/opinion/soko-catholic-contraception 16 Paul VI, Humanae vitae, n. 17. /index.html. 17 Vatican Council II, Gaudium et spes, n. 62. 4 William Mosher and Jo Jones for the National Center for Health 18 Vatican Council II, Lumen Gentium (November 21, 1964), nn.39–42. ­Statistics, “Use of Contraception in the United States: 1982– 19 Benedict XVI, Caritas in veritate (June 29, 2009). On the unifying 2008,” Vital Health Statistics 23.29 (August 2010): 18, table 1. effect of Benedict’s linkage between life ethics and social ethics 5 Vatican Council II, Gaudium et spes (December 7, 1965), n. 4. see J. Brian Benestad, “Three Themes in Pope Benedict XVI’s 6 “As defined in this report . . . , at risk of unintended pregnancy Caritas in veritate,” Nova et Vetera 8.4 (Fall 2010): 723–744. ­includes all women who are not using contraception but who 20 Pontifical Council for Justice and Peace, Compendium of the Social had had intercourse in the last 3 months, plus those who are Doctrine of the Church (June 29, 2004), part II, chapter 5.III.b, having intercourse and are using contraception. Those using nn. 233–234, emphasis added. contraception are ‘at risk of unintended pregnancy’ because there is a risk that their use of the method could fail and result in unintended pregnancy.” Mosher and Jones, “Use of ­Contraception,” 8–9. 7 John F. Kippley and Sheila Kippley, The Art of Natural Family Catholic Press Association Award Planning, 4th ed. (Cincinnati, OH: Couple to Couple League General Excellence in a Newsletter International, 1996), xii. 8 Ronald Ferris, “Fertility Awareness–Based Methods for Family Third Place to Ethics & Medics Planning and as an Alternative to Hormonal Contraceptives Congratulations to Our Authors! for Therapeutic Reasons,” Linacre Quarterly 78.2 (May 2011): 175. 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.