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What the new Vatican document says about hysterectomy

The surgeon team are operating carefully and concentricallyUpdate, January 4, 2019 at 10:52 am: Due to responses, some of the wording and implications in this article have been clarified.

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On Thursday, January 3, a document further exploring the morality of hysterectomy was published by the Vatican on behalf of the Congregation for the Doctrine of the Faith (CDF). It was released in response to questions that arose after an initial 1993 document regarding the same issue.

But before we get into the contents of this new document, let’s define some terms:

hysterectomy — total removal of the uterus
morally licit — morally acceptable or allowed
morally illicit — nor morally acceptable, not morally allowed
extreme cases — very specific circumstances (note: “extreme” does not necessarily mean “rare”)

Okay, here we go.

This new document (officially titled “Response to a question on the liceity of a hysterectomy in certain cases”) does not address hysterectomy in general. Both general and specific questions were addressed in the original 1993 document. Thursday’s response, though, answers questions about extreme circumstances proposed after the publication of the first.

Here are a few key pieces from the response and an explanation for each. The full response is available at the bottom of the page here.

Question: When the uterus is found to be irreversibly in such a state that it is no longer suitable for procreation and medical experts have reached the certainty that an eventual pregnancy will bring about a spontaneous abortion before the fetus is able to arrive at a viable state, is it licit to remove it (hysterectomy)? 

Response: Yes, because it does not regard sterilization. 

In other words, all three of the following conditions must be met before a hysterectomy could be considered morally acceptable for a cycling woman:

  1. The woman has sufficient fertility to make conception possible.
  2. The woman has a uterus that is permanently unable to sustain new life (i.e. due to disease or severe damage, etc.), thus ensuring a miscarriage.
  3. Doctors are totally sure that said future babies don’t stand a chance of survival.

The direct, succinct response the CDF provides before its fuller explanation may seem odd to our ears. “It” refers, of course, to a hysterectomy under the previously stated conditions. The rest of the answer would perhaps be better phrased as, “Yes because, under these circumstances, hysterectomy has nothing to do with sterilization.”

Here the CDF explains its moral reasoning:

We find ourselves within an objective context in which neither procreation, nor as a consequence, an anti-procreative action, are possible.

That is to say, a hysterectomy is immoral insofar as it’s anti-procreative. In normal circumstances, this is always true. But in a circumstance where procreation can’t happen in the first place, anti-procreative action is impossible. Therefore, a hysterectomy in these conditions can’t be immoral.

The CDF’s illustrative note goes on to make several important clarifications:

Here it is not a question of difficulty, or of risks of greater or lesser importance, but of a couple for which it is not possible to procreate. … Therefore, we are not dealing with a defective, or risky, functioning of the reproductive organs, but we are faced here with a situation in which the natural end of bringing a living child into the world is not attainable. 

This moral claim about hysterectomy is restricted specifically to situations in which procreation is totally biologically unsustainable. Situations in which a pregnancy is possible but risky (either super risky or only a little risky) are a totally different situation. The same goes for situations in which a pregnancy is undesirable or merely inconvenient. Here, the CDF specifically refers to situations in which a baby is 100 percent doomed to die before a stage of viability (usually around 21 weeks).

We must admit, at this point, that this reasoning on the part of CDF is somewhat surprising. As Catholics, we believe that life begins at conception. As such, it’s difficult to understand why the child’s last chance of survival (the very existence of the uterus, even if incapable of its proper functioning) could be taken away with moral liceity. It seems to this author that perhaps this applies to the smallest of extreme circumstances, when the uterus is — according to medical verification — totally ruined. It is then no longer able to function as a reproductive or procreative organ and therefore its removal is an option. It’s also important to remember that while conception is a single moment, procreation is a process that envelops the whole of development within the mother. Perhaps this has some bearing on the Congregation’s logic.

CCL looks forward to further clarification from the CDF on this subject (though hopefully before the expiration of another 25 years).

[Note: It’s important to note that the CDF is not recommending a hysterectomy in these circumstances, but merely entertaining the theoretical moral question of such a procedure in the given case. As they later state (see below), the practice of NFP is one of several alternatives for a woman who finds herself in this unfortunate and limited scenario.]

This brings up an important problem: Doctors are often wrong. How could anyone possibly know for sure if a future baby is 100 percent certain to be miscarried?

The problem of the criteria to evaluate if the pregnancy could, or could not, continue on to the state of viability is a medical question. From the moral point of view, one must ask if the highest degree of certainty that medicine can reach has been reached, and in this sense the response given is valid for the question, as it has been proposed in good faith.

Basically, the CDF admits that whether or not a pregnancy is truly viable is a medical question, and a complicated one at that. Morally speaking, all we can do is strive for the highest degree of certainty that medicine can provide and trust the answer, so long as it has been provided in good faith.

“Good faith,” of course, means that the answer must be honestly researched, carefully considered and as accurate as possible. In other words, if a doctor is biased towards performing a hysterectomy and therefore affirms its necessity, the answer has not been given in good faith. Second opinions and honest doctors are critical to finding the highest degree of medical certainty!

The reverse, however, is true as well. If a couple has ulterior motives for obtaining a hysterectomy and doesn’t really try to discover the true state of their fertility, they likewise haven’t satisfied their moral duty.

But, despite all this, there is one further clarification to make.

The response to the question [given in this document] does not state that the decision to undergo a hysterectomy is always the best one, but that only in the above-mentioned conditions is such a decision morally licit, without, therefore, excluding other options (for example, recourse to infertile periods or total abstinence). It is the decision of the spouses, in dialogue with doctors and their spiritual guide, to chose the path to follow, applying the general criteria for the gradualness of medical intervention to their case and to their circumstances. 

In other words, just because the Church laid out the moral criteria for a hysterectomy doesn’t mean it’s a good choice to get one. This document doesn’t condone hysterectomies but rather affirms that, in limited circumstances, they can be morally acceptable. Still, there are often alternative approaches to such serious problems. After all, the removal of reproductive organs is always serious and shouldn’t be taken lightly. It’s ultimately up to the couple to decide their course of action, bolstered by Church teaching, a good spiritual director and a trustworthy doctor.

— Forest Hempen
Marketing and Communications Associate