Question 70

HARD CASES 

Faithful Catholic doctors, trained in NFP, report that they hear from various priests difficult medical cases which would seem to justify using contraception. “Surely God would not expect the impossible from a couple who find it extremely difficult to use NFP. Would not then this hard case be an exception to the general rule?” some priests ask. This NFP Q&A looks at some of the factors involved in these requests. 

Case #1: A married woman has mental health problems and severe post-partum psychosis. She has one child, and claims that she suffered dramatically after childbirth and became suicidal just in dealing with the one child. Furthermore, she has an irregular cycle, and has difficulties monitoring her fertility through charting. She claims “The ramifications of bringing another child into the family too soon, or at all, could almost certainly cause my mental health to spiral out of control, causing death. 

“My mother’s pregnancy with me was very risky. She had three pulmonary emboli during the pregnancy, was hypertensive, and had gestational diabetes, just to name a few.” 

She continues: “I have an obligation to the child He has blessed us with; my son has a God-given right to have his mother, and my husband has a God-given right to a healthy wife. Because of these factors, we chose to use oral contraception, not for the goal of not having children, but because of the goal of maintaining mental health, and even life.” 

She then writes: “Therefore, I must choose to act in accordance with my conscience. The Catechism of the Catholic Church, #1786-88, states: ‘Faced with a moral choice, conscience can make either a right judgment in accordance with reason and divine law or, on the contrary, an erroneous judgment that departs from them. Man is sometimes confronted by situations that make moral judgments less assured and decision difficult. But he must always seriously seek what is right and good and discern the will of God expressed in divine law. To this purpose, man strives to interpret the data of experience and the signs of the times assisted by the virtue of prudence, by the advice of competent people, and by the help of the Holy Spirit and his gifts.’”

It is obvious that this wife and mother has very good reasons for delaying another pregnancy, perhaps indefinitely. If she is physically, and mentally, unable to cope with the natural challenges of another pregnancy, then she must respect her limitations. For most women, the child is a great blessing, not however without some hardships and challenges. 

But is contraception the answer? Did God make a mistake in teaching, through His Church, that contraception is an objectively moral evil which is to be avoided always and everywhere? Are there hard cases that would merit being considered an exception to the moral rule, and make contraception to be a good thing? 

From a medical perspective, Dr. Mary Martin, M.D., Ob/Gyn, observes: “Contemporary NFP is as, or more, effective than current contraceptives. This couple has prudent reason to avoid the fertile phase. But if called to have more children, the wife can be treated. Her mother’s medical problems are another reason for the wife to avoid chemical contraceptives, as there may be a heritable predisposition toward blood clots.” 

Thus, simply from a medical perspective, the Pill is not a panacea. It presents multiple potential side effects. Nor is it 100 percent effective as a form of birth control, unless it is also abortifacient. NFP is just as effective, or more, as any form of contraception in regulating one’s fertility. And NFP is totally morally good, because it never turns against the goodness of one’s fertility, and allows the couple to make the total gift of self to each other, as God designed the spousal act to be. 

NFP can effectively serve this couple. What is required is that they learn the method thoroughly, and then apply it methodically. The husband can help with the charting to compensate for his wife’s mood swings. The couple can use the more generous ranges of potential fertility in their calculations. Because NFP is both effective and responsible, it serves all their needs. 

From a moral perspective, it is wrong to think that God would present a couple with a catch-22 situation, with a problem that is impossible to resolve using morally good means. Our God is a reasonable, as well as a good and just God. He designed human nature, and He gave us our fertility. He knows all the complications that these can offer various couples. That is why the Catechism teaches that “Conscience, faced with a moral choice, must make a right judgment in accordance with reason and the divine law or, on the contrary, an erroneous judgment that departs from them” (#1786). Because God alone is the Creator, He alone determines the moral order, what is morally good and what is morally evil. We are not to presume that we can improve God’s moral order by redefining it according to our perceived needs and wants. 

It is a serious mistake to think that we are to consider all our options, make a sincere decision, and then consider that decision to be morally good, even if it flies in the face of divine law. That is pure subjectivism, and it drifts very quickly into moral relativism. 

It could very well happen that a couple is being asked by God to practice total abstinence. Think of the many spouses who are seriously ill, or confined to their beds. The ultimate expression of love and devotion for the healthy spouse is to devotedly take care of the other during the time of their needs. This is a fulfillment of the wedding vows, “I promise to love you, and care for you, … in sickness and in health, … all the days of my life.” 

Hard cases prove the general rule because they force us to probe more deeply into the values of the moral law.

It is evident from the above question, and many like it that come to us at NFP Outreach, that today's clergy have a serious obligation to be knowledgeable about basic information regarding natural methods of family planning and their underlying moral principles, if they wish to be relevant to the 21st century parishioner.

Cordially yours,
Fr. Matthew Habiger OSB
mhabiger@kansasmonks.org