Rheumatoid Arthritis and Birth Control

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Defender23

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Hello,

I recently submitted this question to the ‘ask an apologist’ form, but I was also interested in hearing what members of this board have to say on the issue (I hope that is acceptable and not against the rules, I’m not intending to be a spammer!).

I am currently dating a devoutly Catholic girl who happens to have rheumatoid arthritis. She is on medication for her illness, and if she wasn’t on this medication, her joints would be damaged each day simply from movement. Unfortunately, a side effect of this medicine is that she’s unable to become pregnant while on the medication (if she wanted to become pregnant, she could temporarily come off the medication, but she would be damaging her joints each day that she’s off the medication).

My question is, would it be acceptable for her to be on this medication since she seems to need it for her health, and the fact that she’s unable to become pregnant while on the medication is simply an unintended side effect? Also, if she were married, would she be permitted to have sexual intercourse with her spouse while on this medicine despite her not being able to be open to pro-creation while on it?

I just wanted to see what the Church would teach about these things before becoming heavily emotionally invested into the relationship. Thank you very much!
 
She is probably on methotrexate, or similar drug, which is an abortifacient and used for that purpose. It is very effective against RA, which is an extremely debilitating disease, and is commonly prescribed. Doctors give in-depth counseling about the drug to women of childbearing age before prescribing due to the very high risk of a fetus being harmed or killed. It’s crucial that she not conceive while taking the drug.

As to the rest of your question, I’ll let the parlor theologians answer that.
 
Defender23 said:
I am currently dating a devoutly Catholic girl who happens to have rheumatoid arthritis. She is on medication for her illness, and if she wasn’t on this medication, her joints would be damaged each day simply from movement. Unfortunately, a side effect of this medicine is that she’s unable to become pregnant while on the medication (if she wanted to become pregnant, she could temporarily come off the medication, but she would be damaging her joints each day that she’s off the medication).

My question is, would it be acceptable for her to be on this medication since she seems to need it for her health, and the fact that she’s unable to become pregnant while on the medication is simply an unintended side effect? Also, if she were married, would she be permitted to have sexual intercourse with her spouse while on this medicine despite her not being able to be open to pro-creation while on it?
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Based on what you have written, she is perhaps on a drug that can cause severe birth defects or death in the prenatal. So, if that is the case, then the drug is not a contraceptive, and if she has relations with a spouse while on the medication, there is a grave risk of death or severe harm to the prenatal.

Even if a bad consequence is unintended, the act which results in such a consequence is not necessarily moral. In order to be moral, an act must have three good fonts of morality:
  1. intention
  2. moral object
  3. circumstances
If the reasonably anticipated bad consequences outweigh the reasonably anticipated good consequences, then the act is objectively a sin. If the bad outweighs the good to a grave extent, then the act is an objective mortal sin.

The good of having marital relations is gravely outweighed by the bad consequence of death or severe birth defects in the prenatal. So having marital relations in this circumstance would not be moral.

Even if the couple were to use NFP strictly, conception is still a significant possibility, and so the risk of death or severe harm to the prenatal still makes the act immoral.

Consider it this way: If a married couple knew that having marital relations on a particular occasion would possibly cause death or grave harm to an existing (born) child, would it be moral for them to do so? Not at all. So the same applies to the death or harm of a prenatal child.
 
Ron_Conte said:
Even if the couple were to use NFP strictly, conception is still a significant possibility, and so the risk of death or severe harm to the prenatal still makes the act immoral.

Consider it this way: If a married couple knew that having marital relations on a particular occasion would possibly cause death or grave harm to an existing (born) child, would it be moral for them to do so? Not at all. So the same applies to the death or harm of a prenatal child.
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Please explain, this, Ron. How can conception be a *significant possibility *when abstaining during fertile periods?
 
Hi everyone,

Thank you very much for the posts, it’s much appreciated. So just to make sure I understand right… Ron is saying that she should abstain from sex in marriage while on the drug, while PaulinVA is perhaps saying that it would be acceptable for her to have sex in marriage while carefully using NFP?
 
Defender23, are you really asking if it would be acceptable to use artificial birth control because of the danger to the baby if she were to get pregnant while on her arthritis medication?

If so, the answer is the same as it always is. While the use of hormonal medications like the birth control pill may be acceptable in some cases when the pill itself is treating an illness, the birth control pill may never, ever, ever be used for the purpose of preventing pregnancy. It does not matter what the circumstances are, personal or medical, how dangerous a pregnancy would be to mother or baby - there is no circumstance in which the pill may be used to prevent pregnancy without committing a mortal sin. The same goes for the mechanical means of pregnancy prevention - condoms, IUDs, etc.

There is another question which you have not asked outright, and to which I don’t really have an answer. That is, if one enters marriage with the intention of never having a child, is the marriage valid?

If your relationship with this lady is getting serious enough to consider marriage, I suggest you consult your priest about the questions you have.

Betsy
 
Hi Betsy,

Thank you for your response. No, I wasn’t asking if it would be acceptable to use birth control, as I do know that using birth control for the sole purpose of preventing a pregnancy would be immoral. I was asking if it would be acceptable to use NFP. Ron seemed to indicate that it would be too dangerous and thus be immoral, while PaulinVA seemed to indicate that it would be acceptable.

Technically, my girlfriend did say that she could temporarily come off of the drug she’s on and switch to another one if she wanted to get pregnant in order for an unborn baby to unharmed, it’s just that it may harm her body a bit. I suppose this is a hard situation.

Otherwise, would it mean that this girl simply can never have sexual relations even in marriage and she just has to take up that heavy cross?

Thanks again.
 
Defender23 said:
Hi everyone,

Thank you very much for the posts, it’s much appreciated. So just to make sure I understand right… Ron is saying that she should abstain from sex in marriage while on the drug, while PaulinVA is perhaps saying that it would be acceptable for her to have sex in marriage while carefully using NFP?
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My wife was diagnosed with RA around ten years ago. The drugs (as well as the fatigue and the possible crippling damage to joints) are a valid reason, in my opinion, to postpone pregnancy.

We have been using the sympto-thermal method of NFP for over 20 years, to achieve pregnancy and to avoid, at the appropriate times. For us, it works as advertised. Others on CAF have not had the same experience.

You should seek the counsel of a trusted priest to determine what the implications are if you enter a marriage knowing that to have children someone must go off their meds. It would not be a fun year, I can tell you that!

As for Ron’s opinion, yes, the seriousness of birth defects or death of the child is indeed daunting. But, we were already using NFP, and it was working for us, so we continued to use it.
 
PaulinVA said:
Please explain, this, Ron. How can conception be a *significant possibility *when abstaining during fertile periods?
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The significance of the possibility (of pregnancy and grave harm), in terms of moral weight, is based on (1) the chance of pregnancy, and (2) the chance of grave harm to the conceived prenatal.

Even though individual couples using NFP strictly may say that it has been very effective for them, perhaps with no unplanned pregnancies, this type of report is anecdotal. When using NFP, the chance of pregnancy is not zero or nearly zero. There is a chance of conception on ‘infertile’ days. There is also a chance that the couple will err and misread the chart (for the ST method), or that the woman’s cycle will not be regular every month (an earlier ovulation than usual), or that the couple will not use NFP strictly on all occasions. Also, conception despite using NFP is less likely in older couples, because of a natural decrease in fertility in both the husband and wife, but more likely in younger couples, who are more fertile.

The chance of pregnancy with the strict use of NFP is small, but not trivial. It is a matter of degree, and various factors influence the degree. It is not all or nothing. So-called ‘infertile times’ are not entirely devoid of the possibility of conception.

But the moral weight of this relatively small chance of pregnancy also depends on the likelihood of harm and the gravity of that harm. The death or severe birth defects, caused by certain drugs used during pregnancy, is a severe consequence. So the moral weight of the relatively small chance of conception (with strict use of NFP) is increased by the severity of the harm that would likely occur.
 
Hi PaulinVA,

Thank you very much for your post, I really appreciate that. So it sounds like it might be possible for this girl to simply use NFP within marriage. Technically, she would be able to switch medications if pregnant; it’s just that such medications would not be as effective as the one she’s currently on (which can cause birth defects). But if I’m reading what you wrote correctly, it sounds like perhaps it is possible for her to have a relatively normal marital sexual life via NFP.

Thanks again for your post!
 
Do yourself a favor;

talk to your parish priest about this, and ask him for some resources or ministries within your diocese that you can access to help you work through this. Also, look for a Catholic medical doctor to help you. Talk to people who are experts in medical and ministries that deal with this to help you sort out the principles of morality and how they apply to your particular situation.

Looking for opinions of those here is fine as far as it goes, but when it comes to very serious decisions such as these, consult professionals with experience in pastoral care. No offense to anyone here, but that isn’t goint to be present in an internet forum.
 
Ron_Conte said:
Consider it this way: If a married couple knew that having marital relations on a particular occasion would possibly cause death or grave harm to an existing (born) child, would it be moral for them to do so? Not at all. So the same applies to the death or harm of a prenatal child.
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I ended up in a conversation teh other day where i was asked would it be immoral/mortal sin for a couple to engage in sexual relations when the wife was a heavy drinker/smoker? Knowing what we know about what alcohol and smokes can do to teh foetus, would the husband be at fault in that he was risking the health/life of the foetus if concieved by engaging in relations with a woman who drinks and smokes and has no intention of stopping during pregnancy?

Is this the same kind of thing?
 
DanMan-916 (lol nice name), thank you very much for your post. Perhaps you are right. I will contact a priest and see what he has to say about the matter. Thanks for your advice!
 
vera_dicere said:
I ended up in a conversation teh other day where i was asked would it be immoral/mortal sin for a couple to engage in sexual relations when the wife was a heavy drinker/smoker? Knowing what we know about what alcohol and smokes can do to teh foetus, would the husband be at fault in that he was risking the health/life of the foetus if concieved by engaging in relations with a woman who drinks and smokes and has no intention of stopping during pregnancy?

Is this the same kind of thing?
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It is not the same type of moral decision, since heavy drinking and heavy smoking is sinful due to the harm that occurs to any individual, not only to a prenatal. Also, if a woman becomes pregnant, she can quit drinking and smoking while pregnant. If she continues to drink and smoke heavily while pregnant, knowing that it will harm the child, then she sins. But the sin is not having marital relations.

Speaking in general, I suggest that devout Catholic men and women be more discerning about whom they marry. A good marriage begins with a good choice about whom to marry. The decision should not be based merely on whomever you ‘fell in love’ with (emotionally). A faithful Catholic should prefer to marry another faithful Catholic, one who is of good moral character, without attachment to any grave sin, one who would make a good father or mother as well as a good husband or wife, in the largest sense of those roles in the plan of God. The true spiritual love of the spouses for one another and for God is the only sound foundation for a marriage in Christ.

“Many marriages are not good; they do not please Our Lord and are not of God.” – Our Lady at Fatima
 
Defender23 said:
Technically, she would be able to switch medications if pregnant; it’s just that such medications would not be as effective as the one she’s currently on (which can cause birth defects).
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Technically? This important information would have been helpful at the outset of this thread. In that light, I’ll have to amend my post above. If she can switch medications as soon as she realizes she is pregnant, and if no harm is likely to the prenatal at that early stage (not sure if that is true or not, depends on the particular medication), then no grave harm is likely. This changes the moral evaluation substantially.

Also, a moral evaluation applies to the decision as to which medication to use. If one medication is somewhat less effective, but has little chance of grave harm to the prenatal, she might choose – depending also on medical advice from her physician – the less harmful medication.

On the other hand, if the medical situation means that she must be on the medication that harms the prenatal, and if switching after she realizes she is pregnant does not prevent grave harm, then my previous moral evaluation would apply, in my opinion.

I note that in medical ethics, often the medical evalutation of the patient’s condition and treatment options can substantially affect the moral evaluation. So consult a physician (and perhaps get a second medical opinion).

However, intrinsically evil acts are always immoral, regardless of intention or circumstances.
 
Hi Ron,

Thanks again for the post. Hahaha, yes I’m sorry, I was not as descriptive as I meant to be in my original post.

Essentially, if she wanted to become pregnant, she would go off of her medication (methotrexate) for about six months before attempting to get pregnant. She would go on a medicine for that time that would be much less effective, and possibly cause some damage to her joints. Then she would attempt to get pregnant, and switch back to methotrexate after giving birth.

As for the medicine, methotrexate is definitely the most effective for her sickness, and the medicine that is the ‘next step down’ is much less effective and would likely cause her to be physically disabled in someway by the time she turned 40. So unfortunately, it looks as if methotrexate is by far the best medicine in her case.

I really appreciate your help with this, it is a challenging situation. I agree that the most important thing to discern over before dating someone is what kind of lifestyle they want to live (a Catholic one). She seems to want to live a Catholic lifestyle, and would use NFP if she did not have this condition. Apparently, she is on birth control at the moment and she sometimes ovulates even while on it.

I guess my question is, is there ever a case similar to this one in which a girl simply can not be sexually active in marriage?

Also… if a woman is on birth control for a medical reason that the Church deems acceptable (so a reason that is NOT simply because they don’t want to get pregnant, but the inability to conceive while on birth control is an unintended side effect), is such a woman allowed to have sex in marriage?

Thanks so much again for your help.
 
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