Sterilization Dilemma

[raff]

Due to severe menstrual bleeding, my wife was advised to undergo a hysterectomy by Dr. Thomas Hilgers of The PP VI Institute.

Our local doctor concurred with Dr. Hilgers but recommended a uterine ablation instead, due to reduced surgical risk (One year prior to all this my wife suffered a massive spontaneous carotid artery dissection, mini strokes, and was diagnosed with 3 different blood clotting disorders).

Dr. Hilgers rationale for the hysterectomy was that it was the definitive treatment for uncontrollable menstual bleeding.

In the end our local doctor agreed to perform the hysterectomy, but strongly recoommended the ablation instead, with one condition. He insisted that we allow him to perform a tubal ligation if we opted for the ablation over the hysterectomy. In fact, he would not do one without the other. He said another preganancy for my wife could be very dangerous due to her past history of blood problems without even considering the additional risk posed by pregnancy after ablation.

Up to this point we had four live children and six miscarriages.

We grappled with his proposal, prayed, and sought the adivice of CCL in Cinn. OH as well as from the National Catholic Bioethics Center. While we knew direct sterilization was wrong, we wondered if our circumstances fell into that category. We had always been an Natural Family Planning couple and were deeply saddened by either option.

It seemed to be an impossible situation. If we chose the hysterectomy, the bleeding would be stopped and there would be no chance of future preganancy. However the surgical risks of blood clots would be much greater. On the other hand if we chose the ablation, the bleeding would be stopped (if done right) but the possibility of pregnancy would still remain. We figured we could have tried to use NFP to prevent pregnancy, but were concerned about error. Or we could have chosen to live without marital relations altogether.

In the end we agreed to the ablation and tubal procedure beleiving it to be the safest route to take. Our rationale being that we could have just as easily in good concience choosen the hysterectomy, in which case the fallopian tubes would have been severed to remove the uterus anyway.

I have waffled over the decision ever since it was made and often times wished I (we) had decided on the hysterectomy instead. Why? Because I feel guilty about allowing the tubal ligation. I also feel guilty about having relations with my wife during what would have been her fertile period of her cycle thinking that I am in some way benefitting from a sinful act. I have confessed all these things to a priest who tells me that our decision was sound. Others have told me that if someone undergoes sterilization they are obliged to confess their sin, but not necessarily to reverse the process ( in this case the tubes were removed so it would be impossible to reverse) or to practice any particular abstinence because of it. To further complicate matters, my wife believes our decision, though painful, was the right one, and that my guilt is the unfounded result of a tender conscience.

Lastly, the sterilization was not our idea. We didn’t desire it or seek it. If fact we lamented it. We only wanted to do what was best.

My Questions:

1. Is my guilt justified?
   2, Is what we did wrong?
2. If so how can I make it right?

Thankyou and god bless your work.

raff

 

[marybee]

I’m not sure, but I will pray for you!

 

[Seatuck]

The doctor had no right to insist upon sterilization.He did have the responsibility to explain the risks of pregnancy after ablation. Did you explain to him the religious significance? Blood clots are a risk factor post endometrial ablation as well as hysterectomy , some of the literature seems to imply the risk is smaller. In the end the , technically speaking sterilization was done to prevent pregnancy, which is not allowed. It was a difficult situation. You have confessed this now it is time to accept forgiveness and move on.

I am also praying for you to find peace after this and for others in this situation.

As you have said it is not required to practice a form of periodic abstinence but perhaps in your case it might be beneficial to do so. Discuss that with your spiritual director. Several years ago I made the sinful decision to have a tubal ligation for what now appear to me to be selfish weak reasons. At the time I didn’t have a clue about the church teaching . After I figured it all out and went to confession I did make the decision with my spiritual director/confessor to abstain during fertile times as an act of reparation.

 

[Dan_Grelinger]

Raff, I may be able to offer some help with your challenges.

The only thing that trumps preserving the potential for life (physical fertility) is the perservation of existing life itself. This is very important to your situation in two ways. Firstly, your wife must not be exposed to significant risk of death if it can be reasonably prevented. The means of prevention should be biased towards the method that would most reduce that risk, weighed against the potential harm it may do. The doctor who performed the procedure on your wife appears to have taken the protection of her physical life seriously. If all his (and your) decisions were focused on addressing real risks to the life of your wife, and the decision landed upon was the one that best eliminated those risks of death, then you picked the most moral choice.

The second consideration is for your existing children. You did not mention any ages, but if any of them were under the age of 18, then you and your wife have an even greater moral need to preserve her life. These children, already in existence, have very definite needs that cannot be sacrificed by taking unnecessary risks with your wife’s life.

If you would have chosen a course of action that would have not been consistent with the preservation of your wife’s life being of the greatest moral concern in this situation, you would have erred.

The only possible way anything could be wrong with what you and your wife did, was if there was some consideration given, during the decision making process, to a** desire ** (an intent)to end her fertility. Intent matters in moral matters. But, from what you have written, this appears to be not an issue with you at all.

1. Is my guilt justified? Conciences need to be correctly formed. In these times, the vast majority of the problems people face is that they let their selfish desires run all over their conciences. It is possible, however, for conciences to be incorrectly formed in the other way, i.e. their consciences dictate that what is good is really bad. Does your guilt have a purpose? I suggest yes, it does. It made you take very seriously the moral issues that surrounded your wife’s illness. Is it justified today? I think not, for the reasons stated above.

2, Is what we did wrong? If your wife’s life was at risk, and you followed the plan that would most reasonably remediate that risk to her life, no. In fact, it appears likely that a hysterectomy would have been the moral error, if it would have presented a greater risk of death to her than the combination of ablation and ligation.

1. If so how can I make it right? Not applicable. I think the only real concern you have today is for your wife. Please assure her that your concern for her life is your ultimate concern, and that you know your decision was not wrong. It would not be good for her to feel that you were willing to take risks with her life, for reasons that should be secondary in situations such as this.

I am humbled by your concern to do what is right.

Sincerely,

Dan

 

[larry85704]

I was faced with a similar situation and solved it in a similar way. As Dan said existing life is always more important than potential life. Seems to me like this is good stewardship of the gift that God gave us, our bodies.

Now, sad to say, a priest told me what I did was wrong. His boss, my pastor, told me what I did was right. I guess it is sad that there is such **** in the Church. As we get old we find that sometimes there are no easy answers to life’s situations. I think to the extent you do things out of love, with no regard for yourself, you are probably ok.

 

[chrysostom15]

From my understanding of what you have said, the solution here is very simple. The answer is found in the “Our Father” prayer. “forgive us our day our daily tresspasses as we forgive those who tresspass against us.” You are very busy worring if what you did was wrong. You’ve gone to Confession, now forgive yourself, as God has already forgiven you.

While you are at it, make yourself at-peace with the doctor also .

 

[drafdog]

You did the best you knew how for your wife. As a spouse, that is what you are called to do. That is the act of confering the sacrament daily to one another.
If you have confessed the possibility of wrong-doing, and received absolution, you are past this event and should get on with loving your wife. Remember that no matter what was done, it meant that she would no longer be able to have children. This is a blow to the heart of any woman. She must grieve over the loss and you are the shoulder for her to cry on. Be a good husband and hold her and comfort her.
Remember that you have saved her life for your children, grandchildren and yourself. All in all a good work, I would say.

Matthew

 

[aurora77]

I think Dan summed it up well. It sounds like you had two choices and either of those would have ended up with your wife being infertile. It’s a difficult spot to be in and I’m very sorry.

 

[duskyjewel]

I think you are fine. Personally, I would not have an ablation without also having my tubes cut or occluded. The ablated uterus must be a very unforgiving place for a conceived child to try and land. In fact, I didn’t even know it was possible for pregnancy to occur after an ablation! But, I think the chances must be greater than not that a conceived child would not be able to implant, meaning that your actions, health-motivated as they were, led to a conceived child dying. So I think it would be only moral to make sure that conception could not take place in that circumstance, because there is either no or only an inhospitable place for him to implant and grow, and more likely would be death. And, you are right in that either decision would leave your wife infertile. Intent is very important, and I think that you and your wife had correct intent. God bless…

 

[lifeisbeautiful]

I wasn’t going to post but I have to point out that there is a moral difference between the two procedures you were contemplating (if I understood what you are saying correctly).

The problem is the tubal ligation is a procedure that was done to avoid pregnancy. Any procedure done to render the marital embrace sterile is wrong. As you said Dr. Hilgers suggested the hysterectomy to stop the bleeding problem. While it is true that a hysterectomy would have rendered your wife sterile, the purpose of the surgery would have been to stop the bleeding. Sterility is ok as a side effect, not as the reason for the procedure. I have no idea of what the risks (pros and cons) of the two different procedures are and am not aware of what Dr. Hilgers told you and your wife about why he chose the hysterectomy as opposed to the ablation, but I can tell you that I do know that one cannot in good faith chose a procedure simply for sterilization knowing the Church’s stance on this (which may be something you guys didn’t know at the moment).

With that said, God is willing to forgive us if we go do a complete confession and it would probably be a good idea to go and talk to a good orthodox priest and explain what happened. We are so lucky and blessed to have that wonderful sacrament!

 

[lifeisbeautiful]

I just wanted to make sure you understand I am not trying to judge you in any way, just trying to answer your questions, was it wrong/against Church teachings and what can be done.

God’s mercy is infinite and only He can see what you both knew and were thinking, so we cannot really tell you if you are guilty of anything or not, but we can refer you to what our Church says.

BTW, it is true that even people that purposefully and knowingly sterilize themselves without having any medical reasons or anything can still participate in the marital embrace after a valid confession

 

[puzzleannie]

bear in mind that even after repeated D&Cs and tubal, a hysterectomy may still be needed, and that tubal, ablation, and other procedures offered as alternatives to hysterectomy have their own set of side effects and problems. As a general rule, if you don’t trust your doctor and don’t want to follow his advice, it is surely a waste of money to consult him. Find a doctor you trust and allow him to direct your treatment. You got excellent advice from Dr. Hilgers, you know best why you are not following it, but if personal experience is any help to you, under similar circumstances I wish I had had the hysterectomy years ago instead of undergoing years of side effects and problems caused by other procedures. Don’t even consider the alternative procedures if they do not identify and at least help correct the underlying condition or problem. Your goal should not be to prevent conception because of the possible ill effects of pregnancy, it should be to diagnose and treat the cause of the abnormal bleeding or other conditions.

 

[Dan_Grelinger]

The problem is the tubal ligation is a procedure that was done to avoid pregnancy. Any procedure done to render the marital embrace sterile is wrong. As you said Dr. Hilgers suggested the hysterectomy to stop the bleeding problem. While it is true that a hysterectomy would have rendered your wife sterile, the purpose of the surgery would have been to stop the bleeding. Sterility is ok as a side effect, not as the reason for the procedure. I have no idea of what the risks (pros and cons) of the two different procedures are and am not aware of what Dr. Hilgers told you and your wife about why he chose the hysterectomy as opposed to the ablation, but I can tell you that I do know that one cannot in good faith chose a procedure simply for sterilization knowing the Church’s stance on this (which may be something you guys didn’t know at the moment).

From the OP;

However the surgical risks of blood clots [associated with the hysterectomy] would be much greater [than the oblation and ligation].

This much greater risk was of enough concern that the doctor warned against the hysterectomy. It is much more ‘invasive’ and ‘destructive’ surgery than the alternative, and from what is reasonable to ascertain from the information we have, would have represented a significantly increased risk to the life of the woman.

Any procedure done to render the marital embrace sterile is wrong.

That is very true. “To render” is intent. If the intent had been such, then it would have been wrong in this case as well. However, the sterilization was an unintended consequence of selecting the course of action that valued life at the highest, that is, most removed the real risk of death of a valuable human life. If a hysterectomy is licit, but more dangerous, then the combination of oblation and ligation surgery, when done for motivations that are in total alignment with life’s value, must also be licit. To suggest that it is not is turning the principle of the ultimate value of life on its head. It is suggesting that the value of fertility is greater than the value of life itself. That is not in alignment with Church teachings.

Bottom line, this combination procedure was not done for sterilization. It was done quite obviously to protect the life of the woman against grave danger. The sterilization was an unintended result. All information from the OP indicated that this couple grieved the loss of their fertility.

Another situation that we can learn from is the actions that are licit responding to an ectopic pregnancy. Abortion, when intended to dispense with a child, is evil, immoral, wrong. However, aborting an ectopic pregancy is considered licit, as its true motivation is for life itself. It could be argued that this situation is very much graver, as it is not just fertility that is unintentionally sacrificed, it is the actual life of the child, who will absolutely and unconditionally die as a result of the termination of the ectopic pregnancy.

Life is the ultimate value. This is also the very root of the teaching that fertility must be protected. However, choosing a course of action that values fertility over life itself would be incorrect. It would be using the premise of the ultimate value of life against itself.

Dan

 

[lifeisbeautiful]

From the OP;

This much greater risk was of enough concern that the doctor warned against the hysterectomy. It is much more ‘invasive’ and ‘destructive’ surgery than the alternative, and from what is reasonable to ascertain from the information we have, would have represented a significantly increased risk to the life of the woman.

From what I read it seems that Dr. Hilgers recommended the hysterectomy over the other procedure. Like I mentioned, I do not know all that was explained to the OP nor do I know the actual pros and cons of each procedure, I just know what the Church has to say.

That is very true. “To render” is intent. If the intent had been such, then it would have been wrong in this case as well. However, the sterilization was an unintended consequence of selecting the course of action that valued life at the highest, that is, most removed the real risk of death of a valuable human life. If a hysterectomy is licit, but more dangerous, then the combination of oblation and ligation surgery, when done for motivations that are in total alignment with life’s value, must also be licit. To suggest that it is not is turning the principle of the ultimate value of life on its head. It is suggesting that the value of fertility is greater than the value of life itself. That is not in alignment with Church teachings.

Bottom line, this combination procedure was not done for sterilization. It was done quite obviously to protect the life of the woman against grave danger. The sterilization was an unintended result. All information from the OP indicated that this couple grieved the loss of their fertility.

The dr. said he would perform a tubal ligation for sterilization. That was the purpose of the tubal ligation.

Another situation that we can learn from is the actions that are licit responding to an ectopic pregnancy. Abortion, when intended to dispense with a child, is evil, immoral, wrong. However, aborting an ectopic pregancy is considered licit, as its true motivation is for life itself. It could be argued that this situation is very much graver, as it is not just fertility that is unintentionally sacrificed, it is the actual life of the child, who will absolutely and unconditionally die as a result of the termination of the ectopic pregnancy.

Life is the ultimate value. This is also the very root of the teaching that fertility must be protected. However, choosing a course of action that values fertility over life itself would be incorrect. It would be using the premise of the ultimate value of life against itself.

Dan

I’m glad you brought up the ectopic pregnancy. An abortion is Never licit, not even in a situation like the ectopic pregnancy. It is licit, nevertheless, to remove the “diseased” area of the tube that would cause the mother’s death, even if that part happens to be where the baby is and the baby’s death would be an unintended side effect. Killing the child itself is not ok, but treating the woman with the death of the child as an undesired side efffect is ok (in the case of the ectopic pregnancy where the child will not survive and the mother will die if the child remains there). The same goes with the hysterectomy to treat the bleeding vs the tubal ligation to sterilize.

 

[seekerz]

Dan, your responses make total sense and must be reassuring for to the OP. I also don’t think they did anything wrong. Few things in life are as simple as they sound and these decisions can be painfully confusing for many people, added to which they often receive conflicting advice. Kudos on being a voice of reason.

 

[lifeisbeautiful]

Here are some related questions from Ask An Apologist area:
forums.catholic-questions.org/showthread.php?t=26292
forums.catholic-questions.org/showthread.php?t=30575

And here is a quote from the VADEMECUM FOR CONFESSORS that can help too:

1. The Encyclical Humanae Vitae declares **as illicit “every action which, either in anticipation of the conjugal act, or in its accomplishment, or in the development of its natural consequences, proposes, whether as an end or as a means, to render procreation impossible”. **And it adds: “To justify conjugal acts made intentionally infecund, one cannot invoke as valid reasons the lesser evil, or the fact that such acts would constitute a whole together with the fecund acts already performed or to follow later, and hence would share in one and the same moral goodness. In truth, if it is sometimes licit to tolerate a lesser evil in order to avoid a greater evil or to promote a greater good, it is not licit, even for the gravest reasons, to do evil so that good may follow therefrom, that is, to make into the object of a positive act of the will something which is intrinsically disorder, and hence unworthy of the human person, even when the intention is to safeguard or promote individual, family or social well-being. Consequently it is an error to think that a conjugal act which is deliberately made infecund and so is intrinsically dishonest could be made honest and right by the ensemble of a fecund conjugal life” (Paul VI, Enc. Humanae Vitae, July 25, 1968, n. 14).

 

[Dan_Grelinger]

The dr. said he would perform a tubal ligation for sterilization. That was the purpose of the tubal ligation.

Is the doctor infallible? No. All of the other information presented indicated that he mispoke. The tubal ligation was performed for the intention of protecting the life of the woman.

I’m glad you brought up the ectopic pregnancy. An abortion is Never licit, not even in a situation like the ectopic pregnancy. It is licit, nevertheless, to remove the “diseased” area of the tube that would cause the mother’s death, even if that part happens to be where the baby is and the baby’s death would be an unintended side effect. Killing the child itself is not ok, but treating the woman with the death of the child as an undesired side efffect is ok (in the case of the ectopic pregnancy where the child will not survive and the mother will die if the child remains there). The same goes with the hysterectomy to treat the bleeding vs the tubal ligation to sterilize.

This is a good case to study, and will help us. I am glad that you are glad I brought it up.

What would a doctor do, in the case of an ectopic pregancy, if he intended, not to treat the woman, but to kill the child? What procedures would he follow? What incisions would he make, what tools would he use, what wounds would he sew up?

Now, consider what a doctor would do, in the case of an ectopic pregancy, if he intended, not to kill the child, but to treat the woman, as you suggest?

Do you realize that he would DO exactly the same thing? The only difference is his intent! All his actions are the same! His intent justifies the act that he performs, that will, as a direct result, kill the child.

With one intent, he commits the act, and is guilty of murder. With a different intent, he commits exactly the same act, and is credited with saving the life of the mother.

Do you see the parallel with the OP’s case? If the doctor intends to protect this woman’s life from serious risk of death, the same actions that would condemn him if his intent was truly to sterilize her, are instead licit. Precisely because he has placed the value of life at the highest level.

Respectfully and sincerely,

Dan

 

[Dan_Grelinger]

Here are some related questions from Ask An Apologist area:
forums.catholic-questions.org/showthread.php?t=26292
forums.catholic-questions.org/showthread.php?t=30575

And here is a quote from the VADEMECUM FOR CONFESSORS that can help too:

Where is treatment for ectopic pregnancy allowed in this teaching? Where you are able to find that it is licit to remove a woman’s reproductive organs (sterilization) you will find the justification for the OP. An ectopic pregancy (as well as many other conditions) may be licitly treated with the removal of reproductive organs (also known as sterilization by the medical community). If there is allowance for this, for protection of life, there is the justification for the OP.

Again, respectfully and sincerely,

Dan

 

[lifeisbeautiful]

Is the doctor infallible? No. All of the other information presented indicated that he mispoke. The tubal ligation was performed for the intention of protecting the life of the woman.

I’m sorry but I respectfully disagree. A tubal ligation is for sterilization. The ablation was for correcting the problem. The OP clearly states it(I added italics/bold): “On the other hand if we chose the ablation, the bleeding would be stopped (if done right) but the possibility of pregnancy would still remain. We figured*** we could have tried to use NFP to prevent pregnancy, but were concerned about error.*** Or we could have chosen to live without marital relations altogether.”
“He insisted that we allow him to perform a tubal ligation if we opted for the ablation over the hysterectomy. In fact, he would not do one without the other. He said another preganancy for my wife could be very dangerous due to her past history of blood problems without even considering the additional risk posed by pregnancy after ablation.”

This is a good case to study, and will help us. I am glad that you are glad I brought it up.

What would a doctor do, in the case of an ectopic pregancy, if he intended, not to treat the woman, but to kill the child? What procedures would he follow? What incisions would he make, what tools would he use, what wounds would he sew up?

Now, consider what a doctor would do, in the case of an ectopic pregancy, if he intended, not to kill the child, but to treat the woman, as you suggest?

Do you realize that he would DO exactly the same thing? The only difference is his intent! All his actions are the same! His intent justifies the act that he performs, that will, as a direct result, kill the child.

With one intent, he commits the act, and is guilty of murder. With a different intent, he commits exactly the same act, and is credited with saving the life of the mother.

Do you see the parallel with the OP’s case? If the doctor intends to protect this woman’s life from serious risk of death, the same actions that would condemn him if his intent was truly to sterilize her, are instead licit. Precisely because he has placed the value of life at the highest level.

Respectfully and sincerely,

Dan

Actually there are different approaches that a dr. can take (and are taken) with an ectopic pregnancy. One is to perform a direct abortion on the baby, using methotrexate to kill and then remove the baby alone. Another is removing the part of the tube where the baby is. Even if they are both performed to save the mother, the first method is not licit while the second one is. In the first case the abortion is the action, in the second it is the side effect.

In the OPs case, hysterectomy had a side effect of sterilization (which would be ok because it was not the purpose of the operation) while the tubal ligation had the purpose of sterilization.

BTW, I wanted to restate to the OP that I am just trying to answer your question as to what the Church has to say about this since you asked. In no way am I trying to judge your actions or anything. God knows your reasons and your thoughts when making your decision.

 

[seekerz]

I’m sorry but I respectfully disagree. A tubal ligation is for sterilization. The ablation was for correcting the problem. The OP clearly states it(I added italics/bold): “On the other hand if we chose the ablation, the bleeding would be stopped (if done right) but the possibility of pregnancy would still remain. We figured*** we could have tried to use NFP to prevent pregnancy, but were concerned about error.*** Or we could have chosen to live without marital relations altogether.”
“He insisted that we allow him to perform a tubal ligation if we opted for the ablation over the hysterectomy. In fact, he would not do one without the other. He said another preganancy for my wife could be very dangerous due to her past history of blood problems without even considering the additional risk posed by pregnancy after ablation.”

Actually there are different approaches that a dr. can take (and are taken) with an ectopic pregnancy. One is to perform a direct abortion on the baby, using methotrexate to kill and then remove the baby alone. Another is removing the part of the tube where the baby is. Even if they are both performed to save the mother, the first method is not licit while the second one is. In the first case the abortion is the action, in the second it is the side effect.

In the OPs case, hysterectomy had a side effect of sterilization (which would be ok because it was not the purpose of the operation) while the tubal ligation had the purpose of sterilization.

BTW, I wanted to restate to the OP that I am just trying to answer your question as to what the Church has to say about this since you asked. In no way am I trying to judge your actions or anything. God knows your reasons and your thoughts when making your decision.

What you seem to be forgetting here are the following:

1. because of previous health complications, a hysterectomy (major surgery) would have put her life at risk, it was not just a question of here are two treatments, choose which one you want to have; she needed treatment for a serious condition and the ablation allowed her to avoid the life-threatening risks of hysterectomy (in her case; not so in all cases)
2. ablation changes the interior of the uterus in such a way that any future pregnancies would either be prevented or plagued by life threatening complications for both mother and child; so choosing the safer procedure (ablation) would not safeguard the woman’s life if done without the tubal ligation because she would be avoiding the high risk to her life posed by hysterectomy only to replace it with the high risk to her life posed by abnormal attachment of the placenta in any future pregnancy.

It’s a catch-22 situation, but I do believe (not 100% sure) that there are situations where the Church does allow sterilization when there is a clear and high risk of death from future pregnancies. Maybe someone with expertise in this area would care to clarify.