Conflicting Absolutes Revisited (Part II)

Given that conflicting moral absolutes exist, they often rear their ugly head in the hard case. Say a married woman has a debilitating disease which requires a potentially abortifacient drug.

What to do?

Here are the options on the table (saying nothing about their relative morality at this point):

1) don’t take the drug and do no family planning

2) take the drug and do no family planning

3) take the drug and do family planning

a. Use NFP or NAAC

b. Render reproduction surgically impossible

c. Take a contraceptive pill

What to do? Pretend you are counseling a couple in this. Give reasons why/why not for each number and letter.


Which is the lesser evil?

Which is the graver evil?

BTW, this isn’t just for my amusement. I want to be prepared for real life situations.


Erich Heidenreich, DDS said...

At the risk of seeming uncaring, I would choose 1) don't take the arthritis drug and do no family planning.

Interestingly enough, a recent study indicates she might be worsening her arthritis by contracepting. That aside, it might also be worthwhile pondering what the countless women with "debilitating arthritis" did in the millennia previous to the advent of modern medicine. Modern medicine is often treated as a necessity - even a right - when, in fact, it is a luxury. I'd better stop there on that issue before I get into politics. ;-)

I'm also not sure the only possible treatment option for this woman would be a potentially abortifactient drug. I'm not even sure there are any potentially abortifactient arthritis drugs.

I guess the point I'm getting at here is that one must first determine if there is, in fact, a case of conflicting absolutes. I would suggest that in most cases there is NOT. We try to create case of conflicting absolutes in many areas of our lives: "I had to do it because otherwise...."

So, I think the first pastoral concern should be to (in a loving way) assure the couple has truly examined the situation to determine if this is truly a case of conflicting absolutes. Such cases are rare.

If all you really want to do here in this post is simply explore how to give pastoral advice in a true case of conflicting absolutes, I'd suggest changing your hypothetical case to a woman with a cancer requiring chemotherapy to survive. In that case I'd recommend taking the chemo and using any and all non-abortifacient, reversible, contraceptive methods possible during the chemo - even in combination, and including complete abstinence, as the couple finds practicable.

If it is further determined that the woman will remain forever at high mortal risk from a future pregnancy, I'd suggest permanent surgical sterilization of the woman.

We need to remember that the true case of a moral dilemma regarding procreation is rare. By far the vast majority of cases a pastor is going to have to deal with are selfish concerns such as careers, money, fun, etc. Many pastors will probably NEVER run into the true moral dilemma. But you are right, Pr. Conner, to be prepared.

Conner7 said...

You’re right; you sound uncaring. :)

The article your referenced was interesting, but it talked about reducing the risk of arthritis and not dealing with it once a person has it. I’m assuming a woman who has a debilitating disease who rejects contraception and is torn by how to proceed.

What people did 100 years ago really doesn’t matter. People 100 years ago didn’t take chemo as you suggested a woman with cancer do today. Modern medicine certainly isn’t a right nor necessarily and necessity. That, however, doesn’t make it evil (not that you called it that!). And I think it’s more than a luxury. New cars are luxuries. Medicine (that counters the fall) is a blessing (which is why contraception isn’t a blessing – it breaks what works instead of fixing what’s broken).

While there may be other possible non-abortifacient treatment options available, it’s possible they’re not as effective. And I agree all treatment options should be examined before proceeding.

“Don’t take the drug and don’t family plan” might be the most faithful option (I’m not sold on it yet). Personally, I’d have a hard time telling my wife, “Sorry honey, I know you have an awful disease, but you’re going to have to live with it.”

And I couldn’t criticize a couple who out of respect for life (i.e. the fear of terminating a life and the desire to preserve the mother’s life) decided to use NFP or maybe even sterilization (although this would be a last resort). Yes, contraception is a sin, but everywhere we look is sin. Sin, sin, sin! One could even make the argument (I’m not saying I would make this argument) that not taking the drug would be sin because you intentionally neglected a person’s life to protect a life that didn’t even exist.

As a side note, why would you recommend the woman with cancer be sterilized? Wouldn’t her body have been through enough? Why not sterilize the man?

And I realize the vast majority of “moral dilemmas” regarding procreation are about money, cars, lifestyles, fun, etc. I’m not talking about those instances. The person with a debilitating disease requiring potentially abortifacient drugs who wants to honor life and receive the blessing of children is faced with some very difficult decisions (even life threatening decisions) and does face a moral dilemma. It might not be an extremely hard case, but for the couple facing those decisions, it’s hard enough.

At some point, I think a couple has to choose from a list of bad options and pray for Christ’s mercy.

Anonymous said...

Let me begin by acknowledging that I am not a pastor and, therefore, lack any authority or expertise in addressing this issue. It is because pastors must face these type of issues that I keep you in my prayers. As C.S. Lewis wrote in Mere Christianity, "I am not a woman . . . nor am I a priest. I did not think it my place to take a firm line about pains, dangers and expenses from which I am protected; having no pastoral office which obliged me to do so." With that said, I will offer my opinion, with the understanding that I lack authority and expertise and that my opinions are not to be understood as "tak[ing] a firm line." That is, take my answer for what it is worth, which is not much.

Option 1 is certainly licit.

I believe Options 2 and 3c are sinful as they increase the risk that an embryo will come into existence who will then have a heightened risk of being aborted. While that is not the intent, assuming the woman knows of the risk, the actions offered would be reckless and, if she did not know the risk and could have learned of them simply by asking, the actions would at best be negligent. Any death that resulted would, in my mind, be in violation of the fifth or sixth commandment (depending on how one numbers them), as I understand the Hebrew term translated "kill" in the KJV and "murder" in many modern translations to actually mean to cause the death of another human intentionally, recklessly or negligently.

That leaves options 3a and 3b. I believe 3a is licit under the circumstances described and I, unlike Catholics, do not believe NAAC is illicit under circumstances in which NFP would be licit. (Neither is licit merely for the purpose of limiting family size.)

As to 3b, I have problems with sterilization performed strictly to render a person infertile. I will not go so far as to say that there are no situations in which it would be licit to be sterilized -- indeed, I believe it is licit where the sterilization is an unintended consequence of a procedure needed for other purposes, such as a hysterectomy or orchiectamy performed because of cancer. As I have not faced a problem of the nature you posit, I am reluctant to say that sterilization would never be a licit option. It would be, at best, an option which I would consider a last resort.

Anonymous said...

I forgot. You did not offer total abstinence as an alternative. While I believe total abstinence within marriage would normally be sinful, the circumstances you described would justify that option.

Erich Heidenreich, DDS said...

Pr. Conner,

You ask: "As a side note, why would you recommend the woman with cancer be sterilized? Wouldn’t her body have been through enough? Why not sterilize the man?"

Simply because the man might remarry if the wife dies and then have more children by his second wife.

Anonymous said...

>>>You ask: "As a side note, why would you recommend the woman with cancer be sterilized? Wouldn’t her body have been through enough? Why not sterilize the man?"

Simply because the man might remarry if the wife dies and then have more children by his second wife.<<<

That sounds crass and even hardhearted, but I agree. Of course, there is always the chance that the wife would survive her cancer and once again be healthy enough to procreate either with her first husband or with a second husband should the first husband die. That is, sterilizing the ill wife rather than the healthy husband might result in sterilizing someone who could have procreated in the future while leaving unsterilized the spouse who in fact could not procreate in the future because he died or was otherwise rendered infertile. So, again, sterilization should be viewed as a last resort.

There can be no doubt that the Early Fathers considered sterilization sinful and had Scriptural text to back up their teaching. It may be the best available option under some circumstances, but it should be a last resort.

Erich Heidenreich, DDS said...


My original comment was as follows:

"If it is further determined that the woman will remain forever at high mortal risk from a future pregnancy, I'd suggest permanent surgical sterilization of the woman."

We were friends with a couple where the wife had a brain tumor that it was believed would begin growing again if she became pregnant. The husband had a vasectomy. The vasectomy didn't work, however, and they had another child. The brain tumor did NOT begin to grow again. That was 15 years ago, and the woman is still fine.

Anonymous said...


I understood your caveat. My point was merely that doctors are wrong some times, as your friends' case illustrates. While sterilization can be reversed, there is no guarantee that reversal will be successful. The potentially permanent impact of sterilization in a world of uncertainty and change is one of the reasons why I consider it to be an option of last resort.

Conner7 said...

I asked, “why would you recommend the woman with cancer (or any debilitating disease) be sterilized? Wouldn’t her body have been through enough? Why not sterilize the man?”

You replied, “Simply because the man might remarry if the wife dies and then have more children by his second wife.”

Here I would have to disagree with you. In my mind this is where the husband should lay down his life for the wife and protect her from an unnecessary hardship. Even more, husbands are called to lay down their life for their current wife, not to save it for a potential future wife. I really don’t think a husband should ever think, “Well, I better keep myself fertile for my next wife.”

Having said that, the decision will ultimately be the couple’s to make.

But I agree it should be a last resort.

Erich Heidenreich, DDS said...

Speaking in generalities certainly is not the best way to handle these difficult cases. Every couple would present with different circumstances. I can foresee situations in which is would be the loving thing for a man to "lay down his life" as you say. But in general, a 20-30 minute laparoscopic tubal ligation procedure is not something the husband would need to lay down his life over. The woman's body in this case is the one requiring this treatment, not the man's body.

We agree this should be a last resort, thus implying that there are other potential mitigating circumtances. My suggestion simply a general one that intends to preserve as much as possible the future potential for life in a situation where the wife is gravely ill and sterilization is considered the lesser evil. But, as I said, it is possible given individual circumstances that sterilization of the man could be considered the lesser evil.

This brings up and important aspect of the ethical theory of conflicting absolutes. It is rarely possible to determine with any degree of accuracy what the "lesser evil" would be. Making the correct choice is not the essential feature of conflicting absolutism. The essential feature is the certainty of forgiveness in Christ when faced with a moral dilemma.

This also shows the weakness of the graded absolutism theory, for one must choose the absolute which represents the greater good in order to receive a pass on the other absolute.

In many cases of conflicting absolutes, one simply doesn't even have the time to deeply ponder the choices at hand. One must simply make the best decision he can in the time given, resting in the sure comfort of Christ's forgiveness.

So, in trying to be "prepared" for these circumstances it is only possible to speak of generalities that may or may not be helpful in assessing a particular set of circumstances.

The best preparation is faith in Christ.