Natural Family Planning International, Inc. (NFPI)
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Some issues have clear cut answers because there is authoritative Catholic teaching about it. On other issues there is no clear Catholic teaching, and on some matters there never will be anything specific. That, however, doesn't mean that a strong case cannot be made. In some cases it is simply a matter of applying a universal principle to a particular case. In other cases, the principle of the "double effect" can greatly clarify the issues and what can be done or not done.

In some cases, the subject matter is the grave matter of mortal sin; in other cases the subject is the matter of venial sin, and in still other cases there is a moral dimension that may be better described in terms of ordinary obligations rather than in terms of sin. That doesn't mean that issues of venial sin and ordinary obligations are unimportant. After all, as I learned as a child, while mortal sin is the worst evil in the world, deliberate venial sin is the next worst. All sin involves turning away from God to some degree. -JFK

Q. What is the principle of the double effect?

R. This is a common principle in moral theology. It says that it can be morally permissible to perform an action that has two effects, one good and one bad, under certain conditions. Those conditions are four.

  1. The action to be done must be good in itself or at least be morally indifferent.

  2. The good effect must not be obtained by means of the evil effect. That is, the bad effect must be only an incidental by-product and not an actual factor in the accomplishment of the good effect.

  3. The evil effect must not be intended for itself but only permitted. All bad will must be excluded from the act.

  4. There must be a proportionately grave reason for permitting the evil effect. At least the good and evil effects should be nearly equivalent.

The application of this principle must fulfill all four conditions. If it does meet all four conditions, the act is morally wrong.
    Reference: Rev. John A. Hardon, S.J. Modern Catholic Dictionary (Eternal Life, 1999)

We are publishing this principle here because discussions about morality will sometimes refer to the principle of the double effect without definition or clarification. It is not always easy to apply the principle correctly, and certainly the application of the fourth condition requires good judgment, prudence, and a right outlook on life.

Q. Birth control for medical reasons? My wife and I practiced NFP based on your books (we were married in 1995). My wife is now 49 and it has been 7 years since she has been pregnant. Over the past 5 years or so we have not paid attention to her fertile/infertile times, and she still has not become pregnant. However, I have a question that doesn't really concern her becoming pregnant or not. My wife has fibroid tumors in her uterus and in the past 6 months or so they have caused her excessive bleeding. Her doctor gave her a few options on dealing with the tumors-1. do nothing and live with it, 2. use the pill permanently to control bleeding and periods, 3. have them surgically removed. We agreed on option three. However, until the time of her surgery (about seven weeks from now) she is taking the pill to control her periods and bleeding. I told her that I would abstain from relations with her while she is on the pill so as not to take the chance of her becoming pregnant and avoiding the possibility of the pill acting as an abortifacient.

My question is: Considering that it has been 7 years since she has been pregnant (and she is 49) and 5 years since we've actually used NFP to avoid pregnancy and the fact that she is NOT on the pill to avoid pregnancy but for medical reasons, would it be licit for us to have relations while she is on the pill? -M

R. I think you made the proper decision to abstain from the marriage act until after the surgery. There are just too many ifs. We simply do not know if your wife is still ovulating, or if she would ovulate between now and the time of the surgery, or if the pill would act as an abortifacient in this particular cycle. If it were not for the abortifacient factor, then we could correctly say that your wife was taking the medication to control bleeding and that its probable sterilizing effect was strictly a secondary and unwanted side effect. However, the possibility of it acting as an abortifacient is the determining factor. In terms of the principle of the double effect, there is not a proportionately grave reason for running the risk of an early abortion. That's why I congratulate you for having made the right decision the first time. -JFK

Q. Is there a moral dimension to electing a C-section just for convenience, that is, without any medical need? The NIH says that families that plan to be open to more than two children should avoid C-sections to preserve fertility.

R. I think there are two moral dimensions. First, we are called to be the stewards of God's creation. That means taking care of the gifts he has given us. Any surgery carries a risk, and in case of surgery necessary for one's life and health, we simply accept that risk as the price of staying alive or recovering our health. As you indicated, the NIH indicates that C-sections can reduce the health of the uterus for future pregnancies. Further, sometimes unexpected things can happen. I knew a mother who had several medically indicated C-sections. Her uterus apparently healed well, but her external incisions healed very poorly and required much care and patience. This is not the place to open the debate about having vaginal deliveries after a previous C-section, but it should be noted that many physicians do not want to attempt a vaginal delivery if there has been even one previous C-section.

Second, who is going to pay for the medically unnecessary C-section? Is it fair to the rest of those who pay insurance premiums that they should pay for convenience-only surgery? If the users of convenience-only surgery paid the full cost and/or if physicians and hospitals could not get third-party reimbursement, such expenses might greatly reduce the incidence of convenience-only surgery. -JFK

Q. Is it morally okay to use a medication to alleviate a medical condition called "erectile dysfunction"?

R. When a husband experiences such difficulty in having or sustaining an erection that he cannot start or complete the marriage act, then he has a condition for which medication is morally licit. These drugs, however, have potentially harmful side effects and should be used only under medical supervision. There are also some mechanical devices that can be used to alleviate this situation, and your doctor or urologist can inform you about these.

There are two non-medical problems associated with these drugs. One is mass media marketing which makes it appear that these drugs are for increasing one's lust and consequent immoral activities, or that a man's new sexual satisfaction is going to make him the hero of the office. The other is the marketing of the idea that this drug will improve marriage relationships by reason of improved sexual performance. Yes, in true cases of ED, the inability to consummate the marriage act can have unwanted effects on their marriage relationship, especially if the husband becomes either withdrawn or more demanding in other ways. But the downside of the advertising is the marketing of the idea that men should be able to have sex whenever they feel like it and that the satisfaction of a husband's every sexual inclination will translate into greater satisfaction and happiness on the part of his wife. Life is not so simple. Unfortunately, there is no money to be made in marketing the concept that what most wives want the most is a husband's caring love as exhibited in helping with the kids and with all the household chores-and his doing it cheerfully and not just as advance payment for sex. In other words, the self-giving involved in the real acceptance of mutual responsibility in raising the children and the work of the household is a form of marital courtship and a real builder of marital happiness including mutual self-giving in the bedroom.

Q. Is there an official Catholic opinion about Clomid? My pro-life doctor put me on Clomid this cycle because my estrogen and progesterone levels are low. It has side effects, though, like producing more than one egg, and mucus production is changed. This, to me, sounds like an unnatural method of tricking your body. I don't want to use this drug just because I'm desperate to conceive. It's even more important for me to be true to my Faith. Thanks for any help you can provide. -PK

R. I don't think there is an "official" Catholic teaching on Clomid, but Catholic theology supports efforts to make up for the defects in nature so long as such efforts are not immoral and do not have other effects that are even more disastrous than the original problem.

Clomid is a powerful drug and doctors need to know what they are doing with it. In the case at hand, Clomid is being used for the good purpose of trying to increase your fertility. Because it can cause multiple ovulations, the doctor's experience and knowledge play a key role in prescribing the proper dosage. If it causes more than one ovulation, well, there's nothing immoral about that. It happens in nature with fraternal twins, triplets, etc. I suppose we can say that every medicine "tricks nature" in some way, but a better way to say it is that the proper use of every medicine seeks to remedy some defect in nature.

The short answer is this. Pray that the drug will accomplish its intended effects and that the Lord will grant you a baby. Depending upon dosage, you may have to be prepared to take care of more than one. -JFK

Q. Is there a moral obligation to breastfeed your baby?

R. I would hope that almost all parents agree that they have a general obligation to do what is best for their children within their circumstances. That certainly doesn't mean giving them lots of toys and games, nor does it mean sending them to a private school that the parents cannot afford on one income. When it comes to the various methods of feeding and baby care, there is no longer any question that breastfeeding and full-time mothering are best for the baby. So the question really becomes, under what circumstances should parents consider feeding and baby care practices other than breastfeeding?

For centuries, there were only two alternatives to maternal breastfeeding. The parents could hire a wet-nurse or they could try the milk of other mammals such as cows and goats. Hiring a wet-nurse raised the question, "Who is this other woman who is going to nurse not only her own baby but somebody else's also?" In some cases, it was another married woman who was quite capable of caring for both babies. In other cases, the prospect of earning wet-nurse money led some women to seek pregnancy out-of-wedlock. In both cases, there was the danger that the wet-nurse might neglect her own child in favor of the income-producing child. The milk of cows and goats was frequently not healthy for the infant and sometimes it was fatal. So there were real moral problems with both of these alternatives. Accordingly, the Catholic Church taught that mothers were obliged to breastfeed their own children.

The development of formulas was a great improvement over the milk of cows and goats, and for more than 50 years in the 20th century it was commonly thought that formula-feeding was just as good as breastfeeding or maybe even better. Research over the last 20 years, however, has made it clear that not only is breast milk nutritionally superior to any formula but that the process of maternal breastfeeding is also superior to any form of bottle feeding, even if the bottle contains the mother's own milk. The process of breastfeeding is an anti-infection system built into human nature by God himself.

Today we know more than ever before about the great health and emotional benefits of maternal breastfeeding. So it is in the light of the current knowledge that parents need to consider whether they have an obligation to breastfeed as part of their ordinary obligation to do what is best for their children within their ordinary circumstances. -JFK

Q. In the light of the previous response, what might be some causes that would excuse the parents from this ordinary obligation of parenthood?

R. The first thing that needs to be understood is that the general obligation to do what is best for our children according to our circumstances is not imposed from the outside by the Catholic Church or by the hosts of this website or anyone else. It is an obligation that springs from the very nature of being human. When parents are properly educated about the alternative methods of feeding and child care, they almost always want to breastfeed.

The question of excusing causes arises because practical problems arise. A premature birth. Newborn health problems that require infant hospitalization. Sore nipples. Insufficient milk supply. Failure to latch on properly, And others. Suffice it to say that sometimes there are real challenges, but let it also be said that determined parents can work their way around most of the difficulties with sufficient support.

Q. I tried hard to overcome the difficulties I experienced. I wanted very much to breastfeed, but for reasons I can't explain, my best efforts failed. I had to switch to formula-feeding for the health of the baby. Are you trying to make me feel guilty?

R. No. No one who has given her best effort to breastfeed should feel the least bit guilty if she becomes convinced that her efforts are failing to provide proper nourishment for her baby. There are always a few mothers who go to great lengths to breastfeed a baby but whose best efforts aren't enough. It is for such mothers that we are glad that there are good formulas available. When you really give it your best shot, you have utterly no reason to feel guilty. You can still give your baby many of the emotional benefits of breastfeeding by holding him and feeding him pretty much in the same position as you would a breastfeeding baby.

Q. We are ready to seek pregnancy, but I just got an invitation to be in my sister's wedding nine months from now, and it will be more than a thousand miles from my home. If I become pregnant now, I might miss the wedding entirely, or I would be very uncomfortable, so it would be much more convenient to postpone pregnancy for four or five months. In the light of Catholic teaching that a couple need sufficiently serious reasons to use NFP to postpone or avoid pregnancy, can a couple be morally justified in using NFP to postpone pregnancy for a few months for reasons of convenience?

R. A providentialist might say to seek pregnancy now and put the whole matter in the hands of the Lord. If he doesn't want you to become pregnant right now, he will close your womb, so to speak. I do not criticize anyone who would take that position for his or her own case, but I don't think it's the only morally acceptable possibility. In my opinion, the need for a serious reason to postpone pregnancy is related, at least in some cases, to the duration for which the couple seek such postponement. It seems to me that using NFP to postpone pregnancy for just a short time, say two or three months, would not require much of a reason. A postponement of four to six months would need something more. Something more than a year would require a substantial reason. In the case at hand, a combination of charity to your sister and health considerations would seem to be sufficient to postpone pregnancy for a few months so you would be only four to six months pregnant at the time of the wedding. -JFK