Jimmy Akin

A reader writes:

Your post on Avoiding Temptation and NFP got me to wondering how you would respond to my situation. I was prescribed a Selective Serotonin Reuptake Inhibitor (SSRI) as an off-label treatment for a problem with prematurely completing the marital act. Besides helping with this problem (a good thing) it also decreases libido to some extent (a bad and good thing.) I say a good thing because it seems to have helped reduce much of the temptation to sin that I’ve had in the past. I truly believe that the sacrament of confession has done more to help but I can’t discount the effects of the SSRIs.

Would you consider this to be a legitimate method even though it decreases my natural sexual desire? I do feel I need to take low doses of a drug to help me complete the marital act occassionally but I do find it somewhat liberating that I have less unwanted lustful thoughts. It seems to me that taking the drug only for the purpose of reducing temptation may not necessarily be prudent but since it has the benefit of an improved marital situation the double effect principle could come into play.

It seems that there are two questions here: First, is it legitimate to use medicine to help avoid prematurely completing the marital act, and second, is it legitimate to use medicine to help avoid sexual temptation.

With regard to the first question, it would seem to be legitimate in principle. The condition the reader is taking the treatment for is a real one that can cause significant marital frustration, and it is legitimate to use medical means to treat it. This treatment would be subject to the usual conditions, such as that the treatment must not cause worse problems than it cures. In the reader’s case, it does appear to cause some problems in that he also needs to occasionally take a drug to help complete the marital act, but it sounds as if he has a way of dealing with those side effects.

Another standard condition for medical treatment is that there not be a better alternative (e.g., one that wouldn’t have the side effects in question). If a better solution shows up, it might be prudent to investigate using it, but what works for an individual can vary significantly from person to person, and it would not be morally obligatory to rush out and try each new thing that’s proposed.

The bottom line on this question is that the use of medicine in addressing this problem is not illegitimate in principle and, as long as its use does more good than harm then it is morally legitimate to do so.

As to the second question, the use of medicine to treat temptation, this subject has not been dealt with that extensively by Catholic moral theology, though I know that some work on the question has been done.

Personally, I do not see a problem in principle. Temptation–like physical illness or psychological illness–is a disorder in the human condition, and God means us to deal with it as best we can. If we have medicines that can help with it, I don’t see a problem with using those medicines, just as we have medicines to help with physical or psychological disorders.

For example, if someone has a problem with alcohol or drug abuse and there are medicines that will help them diminish their cravings for these substances then it would be legitimate to have recourse to them.

In the same way, if there were a drug that eliminated homosexual temptations it would seem legitimate for people to have recourse to that.

And so the fact that one is dealing with more common temptations in this particular case does not seem to alter the principle: If medicine can help address a disorder in the human condition then, all things being equal, it can be used to do that.

This is not the same as saying it would be appropriate for all people to use medicine in this way. The usual conditions would have to be met. There would have to be an absence of serious side effects, there would need to be no better solution, the person would have to be able to reasonably afford the treatment, etc.

I can think of some cases in which the use of libido-lowering medications could be legitimate (especially, e.g., the situations of people who do not have a legitimate outlet for sexuality). Examples might include:

* Convicted sex offenders.
* Individuals with strong homosexual desires that are resistant to treatment.
* Celibate clergy who find themselves facing grave temptations.
* Married people who cannot safely have conjugal relations with their spouse.

You will note that one item I did not put on that list is "single heterosexual men." While single men (and especially young ones) often have grave temptations in this area, using medicine to diminish their libido could result in causing a problem worse than the cure: It could diminish their incentive to get married.

St. Paul tells us that it’s better to marry than to burn with passion, and extending that principle to the age of modern medicine, it’s better to marry than to medicate away one’s passions.

The same thing goes within marriage under normal circumstances. The key reason we have sexual desire is to get us to get married and to have babies, and the existence of medicines that lower libido must not be allowed to frustrate the basic purposes of sexual desire, which is oriented to the generation of families.

In pathological cases (as with sex offenders or people with strong homosexual desires that are resistant to other treatments) or in cases where circumstances do not allow marital relations (as with celibate clergy or married people who can’t safely have relations), the use of medicine as part of temptation management would be legitimate, but it could not be looked upon as a morally appropriate solution for all cases of sexual temptation.

A reader writes:

Some NFP manuals say that it is only
morally permissible to use NFP under the condition that the use of
periodic abstinence does not present the spouses with a serious
temptation to impurity of any kind.

Imagine the following scenario: the wife has some sort of condition
such that a pregnancy will severely endanger her health or life.
However, the husband thinks that periodic abstinence will present him
with temptations to impurity that he will not be able to resist.
Therefore, he concludes that he has a moral obligation not to use
NFP, and so he insists on the "marriage right," against the wishes of
his wife.

He does this to avoid the sin of impurity. But certainly it is a sin
for him to insist on relations against her will, in two ways: first,
it’s the sin of lust (treating his spouse as an object by insisting on
sex against her will); and second, it’s the sin of endangering his
wife against her will.

Obviously it is morally wrong to sin in these ways, even in order to
avoid the sin of impurity. There can be no moral obligation to sin.

So my question is: is it official Catholic teaching that it is wrong
to use periodic abstinence if it presents a serious danger of
temptation to impurity?

I don’t know if this is a real situation or not (the reader says "Imagine the following scenario"), but I hope it is only theoretical.

To answer the question, it is not official Catholic teaching that it is always wrong to use periodic abstinence if it presents a serious danger of temptation to impurity.

The statements of the kind being encountered in NFP manuals are pastoral exhortations intended to address the situation of people who are inclined to use NFP without sufficient reason. For example, some couples just coming off of contraception might have the idea that they can just sub in NFP without recognizing the human realities of periodic continence. One partner, for whom periodic continence does not pose a challenge to purity, might then be insensitive to the needs of the other. By encouraging the partners to face the issue of whether periodic continence will pose a challenge to chastity, the partners are encouraged not only to be sensitive to each other’s needs but also to weigh the question of whether periodic continence is really justified in their circumstances or whether their situation is such that they should go ahead and have relations during a time when the act may be capable of producing new life.

Such pastoral exhortations need to be phrased carefully, however, because while it is true that one should not use periodic continence if there is a serious danger to chastity all things being equal, all things are not always equal, as in the scenario the reader describes.

I’m not sure that I agree with everything in the reader’s analysis of the scenario. For example, I wouldn’t be quick to say that "the sin of lust" is being committed. Lust is a vice–something that inclines toward sin (specifically, it’s disordered desire for sexual pleasure)–but it’s not sin itself. Lust may be a contributing factor to the situation (as may an innocently-held but misguided notion that one can never use NFP if it poses a risk of impurity), but I’d be more inclined to point out as a problem the insisting of conjugal relations without adequate regard for the wife’s physical condition and her legitimate wish to protect it.

What the husband risks doing in the scenario is the flipside of what the pastoral exhortations are meant to prevent: Being insensitive to the danger that the use or non-use of periodic continence may create.

In the scenario the reader describes, the use of periodic continence places the husband in spiritual danger (of impurity) and the failure to use periodic continence places the wife in physical danger (per the scenario, "a pregnancy will severely endanger her health or life").

At this point some could be tempted to say that spiritual dangers are incommensurate with physical ones (mortal sin–i.e., spiritual death–is worse than physical death), and so the danger to the husband in this case trumps the danger to the wife, but to immediately conclude this would be too facile.

For a start, would putting the wife in a situation where she might be in danger of her life possibly cause her to be in danger of some kind of mortal sin (e.g., misuse of the will based on anger toward her husband, or a desire to secretly use contraception, or even a desire for an abortion or miscarriage)? One can’t just look at the spiritual effects of the decision on the husband without looking at the spiritual repercussions for the wife.

More fundamentally, the "spiritual danger trumps physical danger" solution would seem to proceed from an attitude that says temptation must be avoided at all costs, and–whatever may be said for this attitude–it does not seem to be God’s.

God could effortlessly remove all temptation from the world (I say effortlessly because, as an infinite being, he has infinite resources and thus everything is equally easy to him; he does not strain or diminish his resources by doing one thing rather than another), yet he does not.

Why this is is partly a mystery, but it seems that in God’s mind there is a value to allowing us to struggle with temptation and, by his grace, grow in the spiritual life and cultivate virtue and, in the end, overcome temptation and the vices that incline us toward it.

This has implications for the way we conduct our own lives. It is not within our power to avoid all temptation, and the attempt to do so is inconsistent with living in modo humano ("in a human manner"), which moral theology holds that we are called to do. At some point, attempts to avoid temptation become counterproductive. Imagine, for example, the case of a person who attempts to avoid even the mere sight of a member of the opposite sex, lest temptation arise. Such a person is more likely to foster temptation than diminish it, since the mere sight of the opposite sex would have such an aura of forbiddenness and would induce such anxiety that the person would constantly be obsessing about the matter and stirring up temptations that otherwise wouldn’t be there.

In dealing with temptation, what we are called to is not absolute risk avoidance but rational risk avoidance as part of overall risk management. The absolute avoidance of temptation is impossible for us in this life and the attempt to achieve it will be counterproductive. What we must do is take rational measures to manage the temptations we are subject to and thus minimize the chance of falling into sin.

What measures are rational depend on a variety of factors that vary by individual and by what state the individual is in at present. It also includes factors like what effects our temptation avoidance measures will have on others.

In the scenario described by the reader, the two parties need to be as prayerful and open to each other’s situations as possible and arrive at an overall assessment of the proper approach for them to take as a couple, taking into account both the risks that the wife is subject to and the risks that the husband is subject to. Neither automatically trumps the other, and thus neither party should start with the assumption that their risks should automatically govern the situation.

Both should be asking questions like "Just how much physical risk would a pregnancy entail?" "Just how much temptation would I actually be subject to?" "What would the effects be if I insist on my way in this situation?" "What does common sense say?"  "Is there some other way that we haven’t thought of–within the bounds of Church teaching–that the risks to me and my spouse could be managed?"  and especially, "What would be the most loving thing to do?"

A reader writes:

       First off before I start I am absolutely convinced that the Church is
correct in its teaching regarding contraception. I do not want the
Church to change it ever because the Church is right about the proper
place of conception in the context of marriage.

       But I have a problem.  My wife is battling for her life…she has Stage
IV metastatic cancer.  One thing that is never in the debate is what
about the scenario where someone is taking Chemotherapy and they MUST
use birth control (or abstain completely) if they are to be on it.
Additionally with something like her type of cancer there is the added problem
that someone who is fighting it hard is likely to be on Clinical trials
which absolutely require the use of contraception.

       OF COURSE I could abstain.  And truthfully I try very hard to do that.
But what do I do in the instance where my wife comes to me needing the
comfort that the marriage act can provide?  I MUST comply with her
desires and CAN NOT REFUSE her. It is morally wrong for me to in the
normal course of events so it is certainly reprehensible for me to
refuse her when she needs the comforts of the marriage act.

       I can’t even say that SHE is sinning (at least not willfully) when she
requests this of me. So I have come to the following conclusion.  My
will is severely compromised in this regard.  I cannot risk my wife’s
harm and I cannot deny her needs.  As a result, this is simply not a
mortal sin for me.  Don’t get me wrong…I don’t want to commit even the
slightest venial sin (and this is NOT a trivial sin it is very serious)
with abandon, but this is an issue that is impossibly difficult for
me.

       The problem I have is this logic is what caused the Anglican communion
to head down the slippery slope of even accepting abortion.  I don’t
want to contribute to the "contraceptive mentality" and perhaps I am a
victim of it.

       So the long and short is this…dare I ever mention this in a public
forum?  It seems to me that this sort of struggle is one that couples
with cancer are just going to face if the want badly to be faithful
Catholics.  I would gladly give my Life for the faith.  But to sacrifice
the love of someone I love for the faith…that is the kind of caritas
that only the greatest of saints can have.  I fear I just will never be
capable of that kind of sanctity (God forgive me).

First, let me say that I grieve for your situation and I ask all my readers to pray for you and your wife and all in similar situations.

I will do my best to shed what light I can on the moral aspect of the situation.

It is not clear to me the reason why the use of chemotherapy–or this kind of chemotherapy–is thought to require the use of contraception. I can see two possibilities: (1) If it is hormonal contraception, it is to regulate a woman’s hormones since the chemo somehow messes with those (i.e., the use of the Pill has a therapeutic effect in this case) or (2) it is to prevent the conception of a child, either because the child could suffer birth defects, could miscarry, could not be carried to term, or because getting pregnant would further harm the mother’s health. The latter could be either hormonal or non-hormonal contraception.

If the first is the case then the use of the Pill is not contraceptive; it is therapeutic. As a result, it is potentially justifiable under the law of double effect. In that case, the contraceptive effect would be a side effect of the hormone regulation. It would not be a means or an end of the hormone regulation. For a sufficient reason, a side effect of infertility can be tolerated under the law of double effect.

If, however, the intention behind the act is to prevent the conception of a child–for whatever reason–or if it is to prevent the conception of a child in order to help the mother’s health then the contraceptive effect is either an end or a means, and the act of contraception is not morally justifiable.

Here it is not clear to me whether the reader’s wife is currently using contraception or not. If she is using contraception and cannot reasonably be dissuaded from using it (e.g., if she is too emotionally strained and alarmed by her situation to be able to grapple with the question) then the Church would not hold that it is a sin for the reader to pay the marriage debt to her.

Catholic moral theology recognizes that, when one partner (culpably or inculpably) insists on using contraception then it is possible to continue conjugal relations if other partner does what is possible to change the situation (e.g., praying about the matter and waiting for a favorable time to revisit the situation) and as long as he (or she) is not being required to do anything immoral (as would be the case, for example, if a wife insisted on her husband using a condom; that would require the husband to do something immoral, or alternately if a husband insisted on his wife using the Pill, which would require the wife to do something immoral). Further discussion of this matter is provided in the Vademecum for Confessors (see section 3:13).

If, however, the reader’s wife is not currently using contraception or if she can reasonably be dissuaded from using it then this is what needs to be done. It does not seem to me, however, that this automatically means a discontinuation of marital relations.

Your wife has a grave reason to be on chemotherapy, and it is justified that he remain on it. The question is what kind of conduct is morally appropriate given that fact.

It is true (I assume) that the state you and your wife find yourself in is one in which there would be dangers to a child you might conceive, but there are many couples who are in that situation naturally–quite apart from chemotherapy. Lots of couples are in situations–due to genetic factors, physical factors, or other factors–where any child they conceive is at risk. Some are incapable of carrying a child to term, so every child they conceive will automatically miscarry, or they have genetic disorders such that every child they conceive will have birth defects.

Yet the Church has never told these people that they must stop having sex or stop trying to conceive a normal child if, by some miracle, they were able to have one.

The children they have might have birth defects and might die, but these are physical evils, and one thing is true of all physical evils in this life: They are temporary. It doesn’t matter how deformed a child is in this life or how short his life is. Those things won’t apply in the resurrection. In the resurrection, God will give any child you conceive infinite physical life in perfect health. These factors have to be taken into consideration when making decisions about what risks are acceptable in conceiving a child that might have birth defects or a short life in the present age. We cannot proceed from a caculus that treats this life as if it is all there is and that regards birth defects and death as horrible, irremediable evils. They’re just not.

If the choice is between not having a child at all and having one who will live only a finite amount of time, to be followed by an infinity of physical life without suffering then the latter would seem to be the one that benefits the child. Never having existed is a worse fate, if I may put it that way, than living only a short time and then having endless life without suffering.

It is true also (I assume) that getting pregnant could harm your wife’s health and limit her chances for survival. But it is up to her to determine what risk she would be willing to take in this matter. Knowing the odds regarding survival with or without a pregnancy, if she determines that lovemaking involves an acceptable level of risk then you should respect that decision. It is not a sin. The situation is similar to that of the many women whose health or life for natural reasons could be jeopardized by a pregnancy but who decide that they are willing to accept the risk.

I therefore do not see the continuation of chemotherapy as requiring a choice between contraception and abstinence, and Catholic moral theology certainly looks with compassion on the situation of a husband and wife seeking to comfort each other as they face a grave, life-threatening situation and make decisions about how to spend the time they may have left with each other.

Before closing, I’d like to touch on one additional point. I hate to look at one part of the situation here with cynicism, but I suspect that much of the "You must go on contraception" pressure that the couple is getting is due simply to the desire of doctors not to be sued. They don’t want to be sued if a child is born with birth defects, or if a child miscarries, or if a pregnancy harms a woman’s health. They are thus likely exaggerating any "need" for contraception in this case.

In this connection, the reader mentions that the clinical trials available to his wife absolutely require contraception, and he may mean that you have to agree to use contraception in order to be let in on these clinical trials. Again, the pressure is likely to be due simply to doctors’ desires not to be sued.

So fine. Don’t sue them. If need be, have a lawyer draw up papers saying that you waive any right to sue that you might have in case of birth defect, miscarriage, or pregnancy. If you really need to, use a mental reservation regarding the use of contraception. But don’t let them tell you that you need to use contraception when you don’t.

In conclusion, this is a complex situation, I hope that everyone will keep the reader and his wife in prayer as they deal with the situation and ask that God will give them special comfort and wisdom and surround them with his life.

THIS POST IS SUBJECT TO RULE 20.