Fr. Serpa's Sub-Catholic Answer Regarding the Birth Control Pill

In a thread on the Catholic Answers Forums entitled "Pill allowed as an abortifacient?" Fr. Vincent Serpa, O.P. addresses the question of whether a sexually active woman may take the abortifacient birth control pill for "medical reasons," such as to treat irregular cycles. Fr. Serpa answers that she may. Basically, his reasoning is that, since the woman taking the pill intends the pill's therapeutic effect, but does not intend its abortifacient effect, she is therefore not responsible for any abortions which it in fact may cause. Hence she may take the pill with impunity. Fr. Serpa is absolutely wrong, and even though he posted his answer to this question about four years ago, it is still hurting people. Below is the text of the thread, and my response.

Yesterday you mentioned that the Church allows the use of the Pill for medical purposes other than birth control. Isn't it true that the patient should abstain from marital relations while taking the Pill? I understand that the Pill can cause an unintended abortion of a fertilized egg before it has a chance to implant. Therefore, abstinence is the only way to be safe. I just wanted to clarify that point from yesterday. Am I mistaken?

Dear MKMMOM,

This is a very important matter that is widely misunderstood:

The Church considers a miscarriage to be a physical evil. Since abortion DELIBERATELY causes a miscarriage, it is therefore also a MORAL evil. The Church sees an UNintended miscarriage as only a physical evil since it is not deliberately caused by the couple.

The use of the pill for medical reasons may cause an UNintended miscarriage. Women often have unintended miscarriages—sometimes without even knowing it. It is only miscarriages that are INTENDED that the Church considers immoral. The Church never allows the pill to be used as an abortifacient. But it does allow the use of the pill for medical reasons with the possibility of producing an unintended miscarriage—without obliging the couple to abstain from sexual relations during that time.

Fr. Vincent Serpa, O.P.

Fr. Serpa is correct that actions take on moral content, good or evil, only in so far as they are voluntary. However, he falsely assumes that, so long as a woman who is on birth control does not deliberately intend to cause a miscarriage, any miscarriages which might occur are therefore completely involuntary and hence not her responsibility. He forgets that we are responsible for the foreseeable consequences of our voluntary actions, even if we do not intend those consequences.

Consider an analogy. I own a factory. First scenario: I kill one of my workers in cold blood. I am guilty of murder. Second: There is a freak accident in my factory, which I could not have foreseen nor prevented, and a worker dies. I am guilty of nothing. Third: I save myself some money by providing sub-standard safety for my employees, and a worker dies in an accident which I could easily have prevented. I am guilty of criminal negligence.

The first scenario corresponds to deliberate abortion, and the second scenario corresponds to a truly involuntary miscarriage. The analogy is not perfect with respect to the third scenario (I will explain why soon), but roughly it corresponds to a sexually active woman who takes oral contraceptives resulting in the death of her child(ren).

As a criminally negligent factory owner, I certainly did not intend for my worker to die, and in fact would rather he had not. My intention was simply to make more money. Nevertheless, I, through a deliberate and voluntary act (cutting corners on safety), created conditions which were hostile to life and likely to eventuate in a person's death. Therefore I caused the person's death, and am responsible for it.

Similarly, the sexually active woman who takes oral contraceptives does not intend to cause her child to die. Her intent, if she is on the pill for medical reasons, is to obtain certain health benefits (this, as far as I can tell, is the only difference between the woman on the pill and the criminally negligent factory owner: the good which she directly intends is health, instead of money). Nevertheless, she, through a deliberate and voluntary act (taking the pill), creates conditions in her womb which are hostile to life and likely to eventuate in a person's death. She emaciates her endometrium with the result that, if she conceives a new life, that person will probably be unable to implant and thus will be flushed out in an early chemical abortion. To that extent she causes her child's death and is responsible for it.

The only conceivable avenue I see open by which a sexually active woman might justify taking oral contraceptives is the principle of double effect. In certain circumstances, we are indeed allowed to perform an action even if we foresee that it will have serious negative consequences such as the death of a person or persons.

Here's the rub: in order to justify an action under the principle of double effect, we must establish, among other things, that the good which we intend outweighs the negative consequence which we do not.

At this point, it will be helpful to bring in another analogy. A pregnant woman is diagnosed with a potentially deadly illness, such as cancer. If she undergoes treatment, it might kill her child, but if she postpones treatment until after delivery, she herself might die. To decide whether to undergo treatment she must look at the proportionate risks to her own life and the life of her child. If the treatment poses a low risk to her child, but she will almost certainly die if she does not start before delivery, she can clearly justify taking it. On the other hand, if the treatment will almost certainly kill the baby and she can go a few more months without it with low risk to her own life, she cannot justify taking it. The bad consequence of such an action (the high risk of death to her child) would outweigh the good which she intends (the mitigation of an already small risk to her own life).

So, what is the good which a woman intends to achieve by taking oral contraceptives, and what is the foreseeable negative consequence? The foreseeable negative consequence is nothing less than the death of one or more of her children by early chemical abortion (exact numbers do not exist; Randy Alcorn conservatively estimates one or two abortions per decade in Does the Birth Control Pill Cause Abortions? (Gresham, OR: Eternal Perspective Ministries, 7th Edition, 2004) pp. 52-57). As such, the good to be achieved had better be something serious, such as saving her life, if she hopes to justify her action.

But the fact is that the good which she intends is not at all proportionate to such a serious negative consequence as potentially killing a child. Women have survived irregular cycles without the pill for centuries, and still do, in less developed parts of the world. Furthermore, the birth control pill does not actually produce regular cycles, but simply the appearance of them. It only treats the symptom. Still more, alternative treatments (which, incidentally, address the disease itself) exist which a woman may avail herself of instead of the birth control pill. In light of all this, I'm not even sure that there exists any legitimate medical reason to take the birth control pill whatsoever. But even granting that it may have some real, if marginal, beneficial effect for a woman's health: is that the sort of thing one should be willing to risk causing the death of one's children for? Such a callous attitude towards one's embryonic children is morally reprehensible.

I include here a real moral theologian's treatment of this issue: Germain Grisez, The Way of the Lord Jesus, Vol. 3, Difficult Moral Questions (Quincy, IL: Franciscan Press, 1997) p. 308, 310-311. A Catholic doctor asks:

The pill has certain therapeutic benefits distinct from its contraceptive effect, and these sometimes make it appropriate to prescribe it. As you are probably aware, its primary action is to suppress ovulation, but there is a significant chance of breakthrough ovulation, so that the pill achieves its high rate of effectiveness by acting as an abortifacient perhaps one time in fifty (or more often, depending on which version of the pill is used). Should this secondary action of the pill be taken into account in prescribing it for noncontraceptive purposes?

Germain Grisez responds:

...Your... question, about prescribing one of the pills for therapeutic benefits independent of its contraceptive effect, poses a real and special problem that confronts many physicians. If the patient is known to be sterile or does not engage in sexual intercourse, prescribing one of these drugs involves no moral questions other than those raised in prescribing any other medication. But if the patient does engage in sexual intercourse and is reasonably presumed to be fertile, the possibility of unfairness to embryonic individuals who might be killed must be taken into account.

The possible bad side effects that argue against prescribing many drugs in various other cases almost always are far less significant than risk to a third party's life. So, if a presumably fertile patient engages in intercourse, the reasons for therapeutic use of one of the pills must be serious indeed to warrant it. When the condition being treated is relatively minor or you could use adequate alternative therapy with less serious side effects, prescribing the pill plainly would unfairly risk abortion. In less clear cases, the Golden Rule must be applied, taking fully into account the personhood of the embryonic human individual even at the very earliest stage of his or her life. On that basis, a risk of the abortifacient side effect would be justified if, for example, the therapy would forestall an even greater risk to the mother's life.

Grisez's bringing the Golden Rule into this discussion makes the conclusion all the clearer. Suppose I had the flue, and I possessed a pill which would immediately cure my flue, but which had a 1/100 chance of causing Fr. Vincent Serpa to drop dead. Would Fr. Serpa appreciate my taking this pill? I have a feeling he would strenuously object. And rightly so. As such, he needs to tell women to treat their embryonic children with the same respect with which he wishes to be treated.

Ben Douglass
April 26, Anno Domini MMVIII