Wednesday, October 26, 2011

Indirect Sterilization

The genetics lecturer yesterday had dozens of case studies. Here's one, which mainly surprised me because of the polled response she received from the audience. (Because of a technical difficulty, the audience excluded me and everyone at my site; only the remote sites to which the talk was teleconferenced were able to vote.)
Mrs. _____ has a family history of breast cancer. She wants a TAH/BSO [total abdominal hysterectomy and removal of both ovaries] for prevention. You offered her genetic counseling and genetic testing which she declined. Do you comply with her request?
  1. Yes
  2. No
  3. Maybe
As soon as the question appeared, I snorted a quiet "no" to myself. This is indirect sterilization: a procedure resulting in loss of fertility (direct sterilization is a procedure that brings about the loss of fertility as its only purpose.) Then the results appeared:
  1. Yes - 47%
  2. No - 17%
  3. Maybe - 36%
I was shocked that the largest group of my peers would remove this woman's healthy generative organs. Since this poll was on my mind, I looked up the relevant Church teaching.
In a 1953 address to the Congress of Urology, Pope Pius XII articulated the conditions under which an amputation (specifically, a sterilization) may be performed:
Three things condition the moral permission of a surgical operation requiring an anatomical or functional mutilation;
  1. that the preservation or functioning of a particular organ provokes a serious damage or constitutes a threat to the complete organism [this is the 'principle of totality'];
  2. that this damage cannot be avoided, or at least notably diminished, except by the amputation in question and that its efficacy is well assured; and
  3. that it can be reasonably foreseen that the negative effect, namely, the mutilation and its consequences, will be compensated by the positive effect: exclusion of a damage to the whole organism, mitigation of the pain, etc.
Then, Pope Pius adds a comment that sounds like he is speaking directly to my lecturer.
...[T]he conditions which would justify disposing of a part in favor of the whole in virtue of the principle of totality are lacking. It is not therefore morally permissible to operate on healthy oviducts if the life or (physical) health of the [woman] is not threatened by their continued existence.
The Pope knows that there is a dignity to the feminine organs. Of course, they confer a woman's special ability to carry a child, but they also maintain a balance of hormones particular to her, which helps her relate to her husband, children, friends, self, and world. I am heartily grateful the Church has always been supportive of women in disallowing divorce, counseling against the Culture of Death, and cautioning against sterilization. (Catholics, clearly, are not to undergo vasectomies or tubal ligations at all, and are not to submit to prophylactic oophorectomies or hysterectomies lightly.)

I found the Pope Pius XII quote on EWTN.


  1. Isn't this so sad? Last year in one of our PBL's we had a case about a 16 year old who had an ectopic pregnancy and elected to terminate it. I tried not to raise too much of a stink about that but then when we were told to put her on birth control afterwards I couldn't hold it in any longer. I think there was one person in my group (of about 30 med students) who agreed with me. One girl told me I would be doing a disservice to my patients if I didn't prescribe BC. I'm glad to see you weren't the only one to choose 2. Also on a more practical and less ethical basis, those physicians would never be reimbursed for the surgery by insurance because she has no proof of carrying a BRCA mutation and therefore no real definitive proof of necessity of intervention. :)

    Glad to 'meet' another Catholic Med Student!

  2. Thanks for reading, Katie! I'm glad to meet you, too. I have heard the same "disservice" comment, but from online sources. (There is an interesting thread on SDN: