Can Contraceptives Be Taken for Therapeutic Purposes?

DIFFICULT MORAL QUESTIONS: What does Humanae Vitae mean when it talks about the “licitness of therapeutic means?”

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Q. I decided finally to read John Paul II’s “Theology of the Body” (TOB). But before I did, I read “Humanae Vitae” (HV), since TOB is heavily based on that papal encyclical. I see paragraph 14 condemns the use of contraception for the direct interruption of the generative process. I get that. But the next paragraph (No. 15) talks about the “licitness of therapeutic means” that may impede procreation. I’m a little confused on what the pope is talking about. What are licit therapeutic means? Are contraceptives sometimes okay to for therapeutic reasons? —William, Palm Beach, Florida 

A. In order to address your excellent question, let’s look at what comes just before the section you refer to. In paragraph 14, HV condemns “direct abortion.” “Direct” here means intentional; and “abortion” is the killing of a child in the womb. So the text teaches that the intentional killing of a child in the womb is always wrongful.

This implies (although the text doesn’t say it) that an “indirect” (i.e., unintentional) abortion could be licit. What would be an example of this? The classic instance is the case of a pregnant woman who has advanced-stage uterine cancer who will die if her uterus is not taken out soon, but whose baby is non-viable. In this case, her uterus licitly could be removed, even knowing that as an unintended side-effect, her baby would die (i.e., the removal would cause an indirect abortion).

We see the term “direct” used again in the next sentence, which teaches that “equally to be condemned … is direct sterilization, whether of the man or of the woman, whether permanent or temporary.” Again the text qualifies its condemnation with the term “direct,” meaning that this kind of harm (namely, the rendering of one non-procreative by surgical means) is always wrong to intend.

Here too the text implies, but again does not state, that a procedure that’s not intended to render a person sterile, but that might be needed for some other legitimate health reason — say, for example, chemo or radiation for cancer, which might have as one of its indirect side-effects the rendering sterile of the patient — wouldn’t be direct sterilization, and so wouldn’t fall under the description of the act condemned by HV.

In both examples HV is careful to single out only those harms that are intended — that is, that a person aims at, or sets out to accomplish.

We now get to one of the most important statements in encyclical: 

“Similarly excluded is any action which either before, at the moment of, or after sexual intercourse, is specifically intended to prevent procreation — whether as an end or as a means.”

This statement is more precise than the two we’ve just looked at. The text is saying that anything done at any time — timing is irrelevant; could be before, during or after sexual intercourse; it doesn’t matter — with the intent to render procreation impossible is, morally speaking, contraceptive and therefore wrongful.

It is important to see that the complicated statement, “specifically intended to prevent procreation — whether as an end or as a means,” is simply another way to say “direct contraception.” The text is strictly consistent across the three issues: acts of intentional killing, sterilization and contraception are always wrongful.

But just like with the two prior kinds of harm (abortion and sterilization), here also, the text implies that the unintentional impeding of procreation could sometimes be legitimate.

This is where your question specifically comes in. At the beginning of the next paragraph (No. 15), HV teaches the following:

“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.”

Notice it does not use the term “contraception” and certainly never says that contraception is “sometimes okay.” What’s said is that at times a “therapeutic means” may be necessary “to cure bodily diseases,” and that sometimes these “means” may pose an “impediment to procreation” — but so long as the impeding of procreation is not what is “directly intended,” such a means could be morally legitimate to choose.

So, for example, hormone therapy might be needed to treat infertility issues, or acne, or mood disorders, or perimenopause issues; and a side-effect of this therapy might be that it temporarily renders a woman sterile. But if she is neither intending the sterility as her end or her means, but only accepting it as a side-effect of her otherwise legitimate act of hormone therapy, then her act is not, morally speaking, contraceptive.

This kind of act, although it might look like contraception from a third party perspective — “Hey, she’s taking contraceptive pills!” — is a completely different kind of act, morally speaking. It is not contraceptive. Humanae vitae does not condemn it. Whether prescribing hormones in this way is good medicine is another question. But at least it is not contraceptive.

One last point. We should avoid saying that the Church teaches the contraceptives can be taken for therapeutic reasons. This is an ambiguous use of language. Contraceptives can never be taken — if by “taken” we mean “intended as contraceptive” — for any reason.

But drugs that are sometimes also used as contraceptives may be used for non-contraceptive purposes. In this case, as we have said, that drug is not for purposes of this treatment — a contraceptive.