A ZENIT DAILY DISPATCH

Reasons for Postponing a Pregnancy 

More on Ventilator Care

WASHINGTON, D.C., 30 JUNE 2010 (ZENIT)
Here are two questions on bioethics asked by ZENIT readers and answered by the fellows of the Culture of Life Foundation.

Q: Thank you for responding to the question regarding when natural family planning (NFP) is appropriate to use. [...] I can understand why the Church has never formally identified "just causes," but nevertheless, in our world today, I believe we thrive on tangible examples and responses to help us make good decisions rather than simply on abstract concepts.  In your article, you suggested that you could further provide specific examples of what is meant by "just causes" to postpone children. While I know that no list will be complete and it really depends on each couple's situation, [...] I would appreciate the further explanation. Sincerely — K.M., Lake Worth, U.S.A.

E. Christian Brugger offers the following response.

A: I am happy to speak further on the question of "just causes" for spacing births. Some may believe that only extraordinary situations can constitute legitimate reasons for practicing NFP to defer pregnancy (e.g., severe illness of a spouse; extreme financial difficulties; mental breakdown, etc.). In my opinion, this extreme interpretation is incorrect and can result in avoidable harms.

Recall the moral norm I formulated in my last piece on NFP, in which I drew on the reasoning taught in "Humanae Vitae," No. 10: "If a couple have serious reasons [i.e., just causes — "iustae causae"], arising from the physical or mental condition of themselves, their children, or another for whom they have responsibility, or from the family's economic or wider social situation, they may defer having children temporarily, or, if the situation is serious enough, indefinitely, providing they use morally legitimate means. Recourse to natural fertility cycles to space births (NFP) under such circumstances is an example of a morally legitimate means. Contraception is not." (This wording is mine, not that of "Humanae Vitae")  In order to translate the generality of this norm into more concrete terms, we need to attend to the pivotal concept "iusta" (i.e., the adjective "just") in the long-standing Catholic teaching. The correlative noun is "justice". In order to rightly apply the Catholic teaching on "iusta causa" I suggest that we attend to the concept of justice as an interpretive lens (a "hermeneutical principle") through which to assess whether in any concrete situation a serious (iusta) reason (causa) to space births is present. 

All people have duties arising from their morally significant relationships: spouses to each other; parents to children; children to parents; employees to employers; employers to employees. Generally speaking, the closer the relationship, the more serious the duty. The fulfillment of these duties is the domain of justice. So, for example, a man who neglects his family in favor of unreasonable participation in a leisure sport such as golf or fishing commits an injustice toward his family. The classical definition of justice is "rendering to each person what is due to him based upon the relationship that we have to (or with) him." This sounds very general, but applying it in most situations is quite straightforward. An employee who has committed himself to eight hours of work per day should work for eight hours per day (if he is able); and his boss should pay him the agreed upon wage for working eight hours.  

Now husbands/fathers and wives/mothers have very serious obligations in justice to the members of their families, chiefly to their dependent children, especially those who are most vulnerable to harm (e.g., infants, small children, and infirmed and disabled children). Perhaps it need not be said, but parents' duties to their existing children are prior to children they have not yet procreated.  When discerning another child, couples therefore should ask: Can I fulfill well my existing duties while bringing another child into the world and fulfilling well my duties to that child? Absolute certainty, of course, is not required. But I think reasonable certainty based upon objective criteria is required (e.g., family relationships are in order; mother and father's mental and physical health are stable; finances are in order; etc.). 

If one has reason to believe that a relationship for which one has some duty will unfairly (and hence wrongly) suffer if another child is brought into the world, then, as an issue of justice, one ought to abstain from bringing another child into the world.  God has a personal and unrepeatable plan for every Christian's life. This is his or her "personal vocation." Husbands and wives too have personal vocations. At the center are the overarching commitments of marriage and parenthood. But their personal vocations might include other commitments as well, commitments that must be compatible with the fulfilling of their marital and parental duties. God may give to one woman an ability to organize people, to another the capacity to sing opera, and to another the personality to make friends easily. Because a woman believes God has called her to be married and to become a mother, does this mean she must set aside founding an organization for the defense of the unborn, or being a part-time opera singer, or a university professor? If God has given her special aptitudes, desires and opportunities, this is an indication that he may be calling her to use them in specified ways.

But one thing parents know with certitude is that if they already have committed themselves to being spouses and parents, then their personal vocation right now (immediately, presently) includes fulfilling well those responsibilities. They know that they have a moral duty to ensure (as best they can) that new commitments they assume are compatible with being a spouse and parent. If they judge that their existing children will be unfairly harmed by mommy choosing to sing opera professionally, or found a pro-life organization, or daddy taking a new job that will keep him away from the home, then they ought to set aside those alternatives as incompatible (at least for the time being) with their personal vocation.  

My purpose here is not to criticize generous couples for welcoming many new children into their families. Such couples are a salutary expression of respect for a culture of life. And they should be encouraged and supported by their brothers and sisters in the Christian community.   But couples who for good reasons refrain from having more children (which for them can be painful) should not be considered less generous. Our generosity is first and foremost assessed relative to Jesus' will. We want to 'do whatever he tells us' (cf. John 2:5). Both excesses and deficiencies in this regard are moral problems. So Christian family planning means assessing prudently and prayerfully the family size God wants us to have, which means the size that is as compatible as possible with our resources (spiritual, emotional, physical, material and relational).   A few concrete examples of "iustae causae" for deferring pregnancy might include: 

1) Physical or mental illness of one of the spouses;

2) Serious financial instability (e.g., during a period of unemployment);

3) Needs arising from caring for "high-needs" children;

4) The instability of transitional periods such as spouses in graduate school;

5) Debilitating stress that can arise from having a large family in societies where large families are no longer valued (see "Gaudium et Spes," No. 50).
 
Husbands need to be especially attentive to the welfare of their wives when assessing whether or not to have more children. Since wives will bear the exclusive burden of gestating their children, and the disproportionate burdens associated with nurture and education in the early years, husbands should listen very carefully to their wives' input. Most happily married pro-life wives find it difficult to resist their husband's solicitations for more children. But if as a result of caring for one or more small children, one's wife is experiencing long-term exhaustion or depression, or if she has fallen into the habit of chronically doubting her worth as a wife and mother, and she has doubts as to whether she can fulfill peacefully the duties associated with caring for another infant, then a husband should assist her in expressing those doubts, and avoid manipulating her in accordance with his own will. Doubts, of course, can be unreasonable, based on non-rational diffidence or immoderate caution. And spouses should assist one another in judging whether such doubts are expressive of or temptations away from Jesus' will. But if in the face of just reasons a husband disregards the clear doubts of his wife (even if communicated non-verbally), he may commit an injustice toward his wife. The same can be said of wives toward their husbands.

Although serious reasons ("iustae causae") ordinarily pertain to the welfare of the members of the family, they also can arise from a commitment to apostolic works. A pro-life Ob-Gyn might be called to open an NFP-only practice, or a parent caring for a child with Down's Syndrome a Catholic daycare for disabled children, or an attorney a pro-bono practice for Christians being denied their civil rights. They might reasonably judge that a period of disproportionate investment of time is necessary to set the new initiative on a stable foundation. If they discern that Jesus wants them to do this; and they also believe that doing it is morally inconsistent with having another baby; then they can confidently conclude that Jesus wants them to postpone having another baby until the practical conditions change.  One final question. Acknowledging that good reasons justify periodic abstinence, do they morally oblige a couple to abstain? I would say that if either spouse has reasonable doubts that he or she can fulfill well present responsibilities and, in addition, the duties of care to a new child, then the couple should not pursue another child (at least until the conditions giving rise to the doubts are overcome). It would be unfair to those for whom we have responsibility to freely pursue a state of affairs in which we are unable to render what we owe to others in justice.   Having said that, individual spouses, who have reasons based upon their own welfare — and not the welfare of another for whom they are responsible — are free to adopt personal sacrifices that exceed what the moral law requires. So, for example, a mother with chronically severe headaches or a father with non-incapacitating M.S. may choose — in consultation with his or her spouse — to pursue more children knowing that the "cost" to him or herself likely will be considerable, presuming they have good reasons to believe they still will be able to meet their duties.  But although one is free to exceed the demands of the moral law in one's own life, one is never free to make that choice for another. 

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Follow up: Ventilator Care

Q: Is it all right to withdraw a medical ventilator from a PVS patient? As you know a medical ventilator is a machine designed to mechanically move breathable air into and out of the lungs, to provide the mechanism of breathing for a patient who is physically unable to breathe. Is the removal of a medical ventilator licit when there is no chance of recovery for a tetraplegia-born patient who has been in this vegetative state for more than one year and is only kept alive thanks to artificial nutrition and hydration and a medical ventilator? Should we consider the removal of the respirator as an euthanasic act? — Father J.B., OSB, Flavigny, France

E. Christian Brugger and William E. May offer the following response.

A ventilator is rightly regarded as "ordinary" or "proportionate" care and hence morally obligatory for tetraplegic (=quadriplegic) persons said to be in a persistent vegetative state if the procedure does not impose an excessive burden on the patient and family and is not futile. Four ways that a ventilator might be judged burdensome include (we do not mean these to exhaust the possible ways): if it causes serious pain; if its imposition prevents patients from carrying out legitimately desired plans or from fulfilling serious moral obligations (e.g., effectively communicating, praying); if its cost is so prohibitive that long-term treatment threatens to deplete the savings of patients or cause them to incur excessive debt; or if the procedure causes a patient serious psychological distress (e.g., some people experience a morbid fear of ventilator intubation).

There is disagreement among moral theologians as to what circumstances rightfully constitute a judgment of futility. Some believe that a procedure is futile if it promises a patient no reasonable hope of recovery from a serious medical condition. Thus, the scenario that Father J.B. describes would constitute a case of medical futility and the ventilator could be considered disproportionate or extraordinary care and rightfully be removed. Other moral theologians, including ourselves, would argue that so long as patients are not actually in the dying process nor in danger of dying here and now; and so long as the ventilator is necessary to keep them alive and is effective in doing so; then it is not a futile treatment. Ordinarily, a person said to be in the vegetative state is in a stable condition and is not in danger of death.

The same can be said about patients suffering from tetraplegia. Without ventilator-assisted breathing, the patient Father J.B. describes likely will die by asphyxiation. If treatment on the ventilator is not otherwise judged excessively burdensome (as discussed above), then we think it should be considered proportionate or ordinary care and morally required.   Our judgment follows reasoning similar to the reasoning used by Pope John Paul II in his March 2004 address on artificial nutrition and hydration (ANH) for PVS patients. The address makes clear that ANH is not a "medical treatment" for it is not aimed at alleviating a symptom of an underlying pathology or injury; rather it aims to sustain a patient's life. If it adequately fulfills this aim, then it is considered ordinary care due to a patient. We know that ventilator care and providing ANH are not strictly analogous; and that conventional language would certainly consider a ventilator a "medical treatment." Our reasoning follows the premise that in regard to duties to care for the disabled, providing the means to breath and providing the means to nourish persons are morally analogous. Both should be carried out if doing so is neither futile, nor excessively burdensome. Although it is likely that ventilator care will be judged burdensome more often than ANH, the principle in both cases remains the same.

* * *

E. Christian Brugger is a Senior Fellow of Ethics at the Culture of Life Foundation and is an associate professor of moral theology at St. John Vianney Theological Seminary in Denver, Colorado. He received his Doctorate in Philosophy from Oxford in 2000.

William E. May, is a Senior Fellow at the Culture of Life Foundation and retired Michael J. McGivney Professor of Moral Theology at the John Paul II Institute for Studies on Marriage and Family at The Catholic University of America in Washington, D.C.

[Readers may send questions regarding bioethics to bioethics@zenit.org. The text should include your initials, your city and your state, province or country. The fellows at the Culture of Life Foundation will answer a select number of the questions that arrive.]

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