The Critical Calling: Reflections on Moral Dilemmas Since Vatican II

16. Sterilization: The Dilemma of Catholic Hospitals

Chapter 16 Sterilization: The Dilemma of Catholic Hospitals In a report in The Washington Post (22 May, 1977), the Worldwatch Institute called sterilization "the contraceptive phenomenon of the 70's."1 In one-third of all married couples in the United States trying to avoid conception , one or other partner has undergone sterilization. This trend has continued into the eighties. Sterilization now exceeds any other single preventive family planning measure. Bruce Stokes, author of the report, stated that the figures for the United States were based on a 1973 National Survey of Family Growth by the National Center for Health Statistics of the then Department of Health, Education and Welfare. How do Catholics fit into these trends? Writing in Family Planning Perspectives (1977), Charles F. Westoffand Elise F. Jones (both of Princeton University, Office of Population Research) stated, on the basis of comparative figures for 1970 and 1975, that "within several years, even sterilization will probably be adopted by the same proportion of Catholics as nonCatholics . ... "2 After noting that three-fourths ofthe women surveyed are using some form of contraception (79.9 percent for non-Catholics and 76.4 percent for Catholics), they presented the following results on sterilization for 1975: Non-Catholic Catholic Wife sterilized 13.9 9.8 Husband sterilized 12.4 9.9 Dr. Conrad Taeuber and Dr. Jeanne Clare RidleyofGeorgetown Uni- 274 / Richard A. McCormick, S.J. versity have provided even more recent (1976) statistics similar to those of the Westhoff-Jones study. Using a computer tape file from the nationwide Family Growth Survey carried out under the direction of the National Center for Health Studies, the researchers note that "the conclusion that there has been a significant increase in the contraceptive use of sterilization since 1970 is clearly established, and there is little doubt that the rate for Catholic couples has increased more rapidly than the rate for couples identified as non-Catholic."3 This conclusion supports the Westoff and Jones prediction that "sterilization ... will probably be adopted in several years by the same proportion of Catholics as non-Catholics, judging from recent trends." The Westoff-Jones prediction appears to be on target when evidenceof another kind is assembled. For instance, in a 1986 letter to American bishops on the "Charles Curran affair," John F. Kippley, president of the Couple to Couple League and an advocate of natural family planning as the only morally acceptable form of birth regulation, noted that 95 percent of Catholic couples are using "unnatural, immoral methods."4 Only 2-3 percent of nonpregnant newlyweds start their marriages with some form of natural family planning. Another indication is the Notre Dame Study of Parish Life entitled "Pastors and People: Viewpoints on Church Policies and Positions."5 Opposition to Humanae Vitae was reported as very strong, especially among the better educated and those under fifty. Support for the encyclical was found only among pastors as a group, with large numbers dissenting.6 This trend presents a real dilemma for at least some, possibly very many Catholic hospitals. The problem is above all tubal ligation, the severing of the fallopian tubes to make meeting of sperm and ovum impossible. Vasectomy, male sterilization, is not necessarily a hospital procedure. There are repeated instances often involving so-called "medical indications ," like renal or cardiac disease, when both the woman and the physician judgethat another pregnancy would endanger the life or health of the mother or the fetus. They therefore judge that sterilization is the only solution and is in the overall best interests of the woman, her marriage, her family. Thus, in a survey of Catholic hospitals, published in the American Journal of Obstetrics and Gynecology, 20 percent (66 of 336 responding) permitted sterilizations for medical reasons.7 This number would be higher had all hospitals responded and had some hospital personnel realized what constitutes a prohibited sterilization, as I note below. Forty-seven percent of the 270 not permitting sterilization reported that their medical staffs were interested in doing sterilizations. In my own discussions with Catholic physicians and health care providers throughout the country, I have found that heavy majorities believe that sterilization is at times a justifiable response to a critical medical problem. Sterilization: The Dilemma of Catholic Hospitals / 275 I have also discovered a great disparity of practice and no little confusion . For instance, some hospital administrators assert that they follow the Ethical and Religious Directives for Catholic Health...