A Recent Decision of the Holy See
Implications for Medical Practice
A recent decree of the Sacred Congregation for the Doctrine of the
Faith (May 13, 1977) suggests a review of the ecclesial concepts of male
potency and impotence with regard to marriage in order that the
physician dealing with the Catholic patient may more easily coordinate
the canonical concept of impotence with the medical meaning and
thus be in a better position to advise and counsel the patient when
questions arise in this regard.
At the outset it is extremely important to clarify the proper medical
and canonical concepts of impotence and sterility. Canonically,
impotence means the inability to perform the marriage act. Note
that the question of precisely what the marriage act implies, on the
part of the male partner, will be, to a large extent, the subject matter
of this article. Sterility refers only to the inability to generate
offspring. Thus it is clear that although these two concepts can be said
to overlap to some extent, the meaning of each term is clearly defined.
After hysterectomy a woman would be sterile, but still capable of
the act of intercourse and hence not impotent; whereas a woman who is
incapable of marital intercourse because of the smallness of an abnormal
vagina, but capable of being artificially inseminated, would be
physically impotent but not sterile (1).
The clarity of the distinction is important because sometimes medical
writers use the terms somewhat indiscriminately, even though the proper
medical definitions correspond quite well with the canonical concepts.
Thus Dorland's Medical Dictionary defines impotence as "lack of
power, chiefly of copulative power of the male..." and sterility as
"the inability to produce offspring, that is, the inability to
conceive or to induce conception." (25th edition, 1974,
Philadelphia, Saunders).
The reason why it is important to stress that impotence (the
inability to perform the marriage act) and sterility (the inability to
conceive or to induce conception) are distinct concepts is twofold: (1)
in this article we are discussing only the concept of male impotence,
and (2) the Church teaches that while impotence, if antecedent to the
marriage and permanent, makes marriage impossible; while sterility
neither invalidates marriage nor makes it illicit. (canon 1068).
It should be noted that it is the practice of the Church "not to
hinder marriage" when impotence is doubtful, either "in
law" (i.e., in the natural law, as far is it can be discerned,
there may be a doubt as to whether or not a specific physical limitation
constitutes impotence) or "in fact" (i.e., where it is clear
that a physical limitation does constitute impotence, but there is a
doubt whether or not such a limitation is present, or is permanent).
This does not mean that where the impotence is doubtful the marriage is
certainly valid. It means only that it is canonical practice to permit a
presumption in favour of the validity of the marriage when there is a
reasonable doubt about impotence.
If the presumption later yields to the certainty of antecedent and
perpetual impotence, the marriage would be declared invalid as from its
beginning.
These distinctions may seem dry and technical, legalistic and perhaps
even too biological; but it must be remembered that the beauty and
holiness of Christian marriage is much more than this. But even these
prosaic elements are important. To ignore them may seem to give wider
range to short term goals, but at the same time ultimately distort and
destroy what the holiness and happiness of marriage is meant to be.
Certainly the concept of Christian marriage includes, as essential,
the mutual, exclusive and perpetual right to those "acts which are
of themselves suitable for the generation or children". (canon
1081) This, however, is a formula which requires careful understanding.
While the act of marital intercourse may be (and indeed usually is)
sterile, whether because of the natural rhythm of the woman's ovulation
cycle or even because of some permanent defect (such as the
absence of viable spermatozoa in the male ejaculate or the irreversible
occlusion of the female fallopian tubes) nonetheless the act of marital
intercourse is that kind of an act which is proper to
human generation, whether or not it is, or even can be, generative.
At this point it seems appropriate to review, in some detail, the
historical development of the question to which the Holy See has
recently offered in authoritative answer. Surely physicians are
interested not only in the proposed solutions, but also in the
background and development of the questions. And the question here is
precisely what, in the teaching of the Church, is required in the
ejaculate of the male in order that it may properly be called "true
semen" and thus adequate for a true marital act.
Before approaching this question in its historical and
contemporaneous development it is necessary to comment on the technical
term: "semen". Although the Latin word itself means
"seed" and thus, in terms of reproduction, would seem to imply
spermatozoa (when applied to the human male, the English derivative
(semen) is not used that strictly in either medical or canonical usage.
Webster's New Collegiate Dictionary defines semen as "the viscid
whitish fluid produced in the male reproductive organs which contains
the spermatozoa and hence serves to fertilize the eggs". Likewise
Dorland's Medical Dictionary defines semen as "the thick, whitish
secretion of the reproductive organs in the male; composed of spermatozoa
in a nutrient plasma, secretions from the prostate, seminal vesicles and
various other glands, epithelial cells and minor constituents."
Thus each definition includes the idea of present spermatozoa but not
explicitly as an essential constituent and indeed without specifying the
condition of the spermatozoa. Indeed it seems clear that the
"seminal vesicles" are called seminal more in relation
to the "viscid whitish fluid" than to the presence or absence
of spermatozoa. The point of all this is that the canonical term
"true semen" has at times, as we shall see, left the question
of the presence of spermatozoa, or the condition of the spermatozoa, if
present, a somewhat open question.
The most significant early ecclesiastical declaration on the matter
of male potency is to be found in the papal document known (from its
opening words) as the Cum frequenter, issued by Pope Sixtus V in
1587, in response to a question submitted by the Bishop of Navarre Lis
as to whether or not eunuchs should be allowed to marry.
The Cum frequenter replied in the negative, and
contained three reasons for this reply: that eunuchs were frigid by
nature and unsuited for matrimony, that they were incapable of the
marriage act, and that by their futile efforts to perform the marriage
act and by their substitutions for it, they themselves sinned and were
an occasion of sin to others.
The interpretation of this document by the canonists and moralists
was that in order to have "true semen" (or marital potency)
the male ejaculate must contain some products of the testicles. Indeed
after the publication of the Cum frequenter. It was
not without reason that men without testicles were presumed to be (or
soon would be) incapable of the marital act.
It is one thing, however, to have said, at a certain stage of medical
knowledge, that active testicular tissue was de facto necessary
for the ability to perform the marriage act (and that is all the Cum
frequenter really said). It is quite another thing to conclude
that, de jure (i.e., according to the natural law) the presence
of either testicular tissue itself, or something elaborated in the
testes, is essential to the idea of marital potency. The Cum
frequenter merely acknowledged a fact which was quite true and
presupposed in the sixteenth century. But in subsequent years many
canonists and moralists drew the unwarranted de jure conclusion
that the natural law demanded testicular tissue for marital potency. It
must, however, be said in their defence that there was no reason to
suspect otherwise, in the generality of cases, until the synthesis of
pharmacological testosterone (the principal male hormone) in the
twentieth century. Galen (130-200 A.D.) concluded that there was a
relationship of functional similarity between the female ovaries and the
male testicles, but it was not until 1939 that Butenandt of Berlin and
Ruzicka of Zurich shared a Nobel prize for their work on the isolation
of sex hormones during the previous decade, although as early as 1775
Theophile de Bordeu of Paris had suggested that the loss of sexual
vigour which followed castration was probably due to the loss of some
substance that was produced by the testicles and passed directly into
the blood stream. Thus with the steady advance of medical knowledge and
surgical technique, it is not surprising that the canonical questions
concerning male impotence and sterility took on new and sometimes
somewhat confusing dimensions. The more detailed clinical knowledge of
the physiology and function of the male testicles, including
identification of the seminiferous tubules with their epithelial cells
in various stages of spermatogenesis (transforming progressively into
spermatagonia, spermatocytes, spermatids and spermatozoa, to be
delivered ad extra through the vasa deferentia) and
the interstitial cells of Leydig elaborating the internal hormone
secretions which are directly picked up by the blood stream and
are responsible for secondary sex characteristics as well as sexual
vigour, all had to be evaluated in relation to the meaning of the
marriage act and integrated into the ecclesiastical concept of marital
potency and impotence.
It was realized that, either by natural occlusion or surgical
intervention, the pathway of spermatozoa to the ejaculate could be
effectively blocked without disturbing the production of the male
hormones in the testicles and their direct delivery into the system. In
such cases a man is capable of an apparently normal ejaculate, lacking
only the microscopic presence of spermatozoa, and containing nothing
that has been elaborated in the testicles. Hence the question arose: can
such an ejaculate be considered "true semen" in the canonical
sense that such an act of intercourse, apart from its sterility, can be
said to be that kind of act which otherwise would be a true and proper
act of marital intercourse.
That is the kind of question which obviously demands a great deal of
the kind of scientific research and theological reflection which goes
into what is legitimately called the development of doctrine. As this
process progressed two theories emerged, and it is important to
understand the scene and nature of their emergence.
The Roman Rota (the chief marriage tribunal of the Church), which
obviously seeks to render its decisions in accord with Catholic teaching
but whose competence is juridical rather than doctrinal habitually
followed the traditional interpretation of the Cum frequenter and
held that such an ejaculate could not be considered to fulfil the idea
of "true semen", and that although the absence of healthy or
developed spermatozoa implied only sterility, the proper concept of
"true semen" required at least something in the ejaculate
which had been elaborated in at least one testicle. The Rota, of course,
pointed out on more than one occasion that to impede marriage the
impotence must be perpetual, as well as certain; and the importance of
this consideration increased as the surgical reanastomosis of the
vasectomized male became more frequent and more successful
Meanwhile another agency of the Holy See, the Congregation for the
Doctrine of the Faith (which, prior to 1965 had been known as "The
Holy Office" and whose competence is much more doctrinal than
merely juridical) had occasion to render a significant decision
in a more general context. Under the Third Reich there was a fairly
widespread practice of legally imposed sterilization by double
vasectomy. The Bishop of Aachen petitioned The Holy Office for a
decision regarding impotence or sterility in these cases. In a private
reply to the Bishop of Aachen the Holy Office stated, without explaining
its reasons for the reply, that marriage was not to be hindered. This
was no more than a "straw in the wind", and could be
interpreted either as indicating a reasonable doubt about the necessity
of testicular products in the ejaculate, or about the certainty
of the permanence of these sterilizations, or even possibly
foreshadowing a development of doctrine. Subsequently, and much more
significantly, there were five other private replies by the same
Congregation, to cases involving even the total absence of testicles but
in which the man was still capable of an act of intercourse (2). These
replies noted their own rationale: that the question of testicular
products being required for "true semen" was still unsettled.
Thus it was clear that in the opinion of the Congregation for the
Doctrine of the Faith the necessity of testicular products in the
ejaculate was at least doubtful (dubium juris: i.e., a doubt
regarding what was required by the natural law or by the very nature of
marital intercourse) and that therefore marriage was not be
hindered.
Finally, on 13 May 1977, the Congregation for the Doctrine of the
Faith, now clearly exercising its doctrinal competence, stated, with the
explicit approval of the Roman Pontiff, that the authentic current
teaching of the Church is that while impotence is indeed an impediment
to marriage, the concept of canonical potency does not necessarily
require anything in the ejaculate that has been produced in the testicles.
As a decree of the Congregation for the Doctrine of the Faith,
this becomes normative for the whole Church and is of considerable
doctrinal authority, although it is, of course, neither infallible nor
irreformable.
At this point it will be helpful to review the text of this most
recent decree of the Congregation for the Doctrine of the Faith, issued
on 13 May 1977 and which Pope Paul VI "approved and ordered to be
published".
The Congregation issued the decree in the form of two questions and
two answers: 1) Whether impotence, which renders matrimony invalid,
consists in the incapacity, antecedent and perpetual, whether absolute
or relative, of performing conjugal copula." Answer:
"Affirmative". "2) In view of the above affirmative,
whether ejaculation of semen that has been elaborated in the testicles
is necessarily required for conjugal copula." Answer:
"Negative" (3).
Finally, then, it is important to review and summarize what the
decree obviously means, and what it obviously does not mean.
The decree means that it is the current teaching of the Church that
the doubly vasectomized male is capable of a marriage act provided
erection, penetration, and the ejaculation of secretions from the
prostate, seminal vesicles and various other glands is possible; that
the grossly normal ejaculate is sufficient to fulfil the canonical
concept of "true semen" and to achieve that kind of an
act which otherwise would be generative, even though in this case the
ejaculate is sterile and contains nothing elaborated in the testicles.
While the decree does not explicitly mention that this is likewise true
of the castrate, it is clearly implied and the implication is confirmed
by the earlier replies of the same Congregation referred to above, which
explicitly dealt with cases of castration. Moreover clinical experience
indicates the practicality of androgen hormone therapy in cases of
castration.
The decree does not mean that double vasectomy is a morally
acceptable contraceptive technique, nor does it in any way imply any
change, or even "shadow of change" in the Church's teaching
regarding the intrinsic evil of contraception or contraceptive
sterilization.
Nor does the decree have any implication regarding marital potency
after so-called transsexual surgery. The idea that an identifiable male
can be changed into a female by plastic-surgical constructs of external
genitalia and the application of synthetic hormones is to suppose that
the beauty, dignity and integrity of human sexual differentiation is
merely a question of functional instrumentation. Sex is a marvellous
modification of the whole human person and not merely a fabricated
adjustment of external organs and hormone sufficiencies. And it is the
teaching of the Church that marriage is a union of a man and a woman.
It would be inappropriate to close these considerations regarding the
decree of the Congregation without recalling again that the beautiful
and holy dignity of Christian marriage is much more than these technical
and biological decisions, and that such decisions seek only to support
and develop the total and true meaning of that divine institution whose
sacramental sign reflects the intimate and loving union of Christ and
his Church—his pilgrim people. And it is
important that each of us, who are his pilgrim people, recognizing and
loving him in his Church, see beneath the surface of decrees of
Congregations. His Church trying to pick its way through such pedestrian
problems under the guidance of those entrusted with its teaching
authority, deserves our reverence and love. The Lord Jesus comes to us
in his Church, and each pedestrian action of Christ as he walked this
earth was not as significant as his sermon on the mount or his sacrifice
on Calvary. And yet when be only picked his way through the crowded,
twisting streets of Jerusalem on an ordinary day, his footsteps left the
ground holy where he walked. So too, his gentle love and holiness are
reflected in every action of his holy Church.
NOTES
1) This reference to artificial insemination is made simply by way of
an example, without implied approval of the process and without going
into the many-faceted moral aspects of artificial insemination and
artificial aids to natural insemination. For a full treatment on the
Church's teaching on artificial insemination see: O'Donnell, S.J.,
Thomas J., Medicine and Christian Morality, New York, Alba House,
1976, pp. 263-270.
2) Cf. Silvestreli, A., "Circa l'impotenza c l'inconsumazione
nella giurisprudenzia canonica anche del S. Ufficio.", Monitor
Ecclesiasticus, 98 (1973) 112-130.
3) Acta Aposiolicae Sedis, LXIX, 7 (31 July 1977). p. 426.
|
