Double effect and the birth control debate

Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental ... . Thomas Aquinas, (Summa Theologica, Secunda Secundae Partis, Q. 64)

The best way to start the day is with a little Aquinas! The misty realms of memory and a youth misspent in theological education brought this jingle to mind when I read an article in the Huffington Post  that took a swipe at one of my colleagues at GetReligion.  The article by Reuters correspondent Nicole Neroulias entitled "I was a Virgin on Birth Control" (catchy, no?) asserts that Mollie Ziegler Hemingway’s (MZH) report entitled “No such thing as free contraception” fails the test of good journalism.

Is this a fair summary of the issues or a fair comment? Not really. Ms. Neroulias bases her argument on a faulty premise, while the story as a whole has not been thought through. Yet, the HuffPo story raises a valid point that the press has not done justice to the ethical as well as scientific issues at play in the controversy surrounding the government's bid to require all employers and institutions to provide contraceptive coverage in their health insurance packages.  Ms. Neroulias writes that:

as a religion reporter weary of oversimplified culture wars, and personally, as someone who took birth control pills long before becoming sexually active, I feel disappointed by most of the reporting so far.

She recounts the furore surrounding the debate -- Rush Limbaugh, Sandra Fluke, congressional hearings, Catholic bishops -- and then presents her thesis. Ms. Neroulias writes:

Yet, as [Georgetown University law student Sandra Fluke]tried to explain in her opening statement, both frames miss the big picture: Women take the pill to address myriad health issues, from ovarian cancer, menstrual problems, hormone imbalances and fertility treatments to cystic acne, et al.

This is the angle I've been waiting in vain for religious and mainstream journalists to acknowledge and investigate. As a teenager, I had debilitating menstrual cycles, but the perceived stigma of going on the pill deterred me from getting the help I needed. I finally started taking it in college, as a virgin with no foreseeable pregnancy panic, buoyed by all other the young women around me who were taking it for a variety of reasons.  ...

Since then, my mother and sister have also taken the pill on medical grounds, as have dozens of our relatives and friends. ...

So how about some coverage of where these outraged clergy and institutions stand on using contraception in all these medical cases? And even if they technically allow it, does that translate to allowing their health insurance policies to include it? Mollie Ziegler Hemingway, a conservative commentator who has slammed media "misrepresentation" of the HHS mandate at GetReligion, shrugged me off with "presumably" when I brought up this angle. Needless to say, "presumably" isn't good enough in journalism, especially when the story concerns fundamental questions about freedom and morality.

And logically, even when clergy approve of contraceptives for unrelated medical reasons, how would they have their institutions apply these directives? Should women who work at Catholic hospitals and schools get a doctor's note for their bosses before requesting insurance reimbursement for the birth control pill? Would ovarian cysts and infertility make the cut, but acne and bad cramps be more along the lines of God's will? And what if religious authorities and their hospitals disagree on these theories in practice, as they have in cases of abortion to save a woman's life?

These questions are founded upon a flawed assumption and propose a straw man argument -- an Aunt Sally -- based upon the premise that taking a birth control pill for medical reasons other than contraception is immoral in the eyes of "outraged clergy."

The 1968 encyclical Humanea Vitae which governs Catholic teaching on birth control contains a chapter which discusses this point.  Paragraph 15, entitled "Lawful Therapeutic Means” states:

On the other hand, the Church does not consider at all illicit the use of those therapeutic means necessary to cure bodily diseases, even if a foreseeable impediment to procreation should result there from—provided such impediment is not directly intended for any motive whatsoever.

The encyclical cites two speeches by Pius XII for its authority on this point. It puts into words the long standing moral teaching expressed by Thomas Aquinas, among others, as the principle of double effect.

This moral teaching can be seen in the case of a woman who has a hysterectomy due to cancer.  The principle intent is to excise the cancer.  The secondary end, infertility, does not forbid the surgery as the intent is the cure of disease not birth control.  A second example would be surgery to remove a fallopian tube because of an ectopic pregnancy.  While an abortion is a medical procedure whose primary end is a dead child – and is thus considered illicit -- the death of the pre-natal child in a surgery to correct an ectopic pregnancy is an unavoidable side effect.  The surgery is licit even though one of its ends is death.

Closer to home, and working in a Sandra Fluke angle, you can see the practical effect at work in the Georgetown University Student Handbook. The student health department is allowed to dispense the pill for non contraceptive medical ends.

Q. Are pre-existing conditions covered?

A. Pre-existing conditions are covered if the condition or treatment is not specifically excluded or limited per the Exclusions and Limitations in Description of Benefits Booklet.

(Note: Although birth control is not covered, medications used for birth control that are required to treat other medical conditions are covered. Your provider may submit requests for such coverage in the form of a "Prescription Override" by faxing the details of the diagnosis and treatment to ...)

Ms. Neroulias is quite right in saying the press has let down its readers by not developing this angle -- focusing the debate on those who shout the loudest, not upon the critical issues. This is a big country, and I am sure one can find "outraged clergy" somewhere who would make the argument that the use of birth control pills for acne treatment is a sin -- or we should let women die of ovarian cancer because a total hysterectomy causes a women to become infertile and is thus EVIL. Such people doubtless exist, but their voices do not represent the mainstream.

A little research by reporters would reveal that this issue was recently addressed in the press coverage of a Lancet article that urged nuns to take birth control pills as a prophylactic against the medical effects of nulliparity. In December I posted a story to GetReligion noting how ABC had addressed these issues, killing the canard that nuns were forbidden to take birth control pills for non-contraceptive medical reasons.

Did MZH (the reporter not the Bulgarian Ministry of Agriculture & Food) make a journalistic error in not engaging with Ms. Neroulias questions? Not to my mind. GetReligion reports on the reporting -- not on the topics being reported. If I were in MZH's position I would not have engaged either for the aforesaid reason and because of the false assumptions being put forward about the ethical issues.

Am I too quick to defend, too quick to judge? Does the press understand the nuances of Catholic moral teachings or the Theology of the Body? What say you GetReligion readers?

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