Vatican’s Moral Shift on Hysterectomies Shows Way Forward on LGBT Issues

A new pronouncement from the Vatican which expands the grounds upon which a hysterectomy is morally licit could have implications for LGBT issues.

In December, Pope Francis approved a responsum ad propositum dubium (response to doubt) prepared by the Congregation for the Doctrine of the Faith (CDF) on the question of the permissibility of hysterectomies. This document, which builds on a similar responsum issued by the Congregation in 1993, explained, via Vatican News:

“In recent years some very specific cases have been submitted to the Holy See also concerning the hysterectomy, which, however, present a different issue from that which was examined in 1993, because they regard situations in which procreation is no longer possible. The question and the response, accompanied by an Illustrative Note, that are now being published refer to this new particular case and complete the responses given in 1993.

Question: When the uterus is found to be irreversibly in such a state that it is no longer suitable for procreation and medical experts have reached the certainty that an eventual pregnancy will bring about a spontaneous abortion before the fetus is able to arrive at a viable state, is it licit to remove it (hysterectomy)?

Response: Yes, because it does not regard sterilization.”

In an “Illustrative Note,” the CDF said the difference from 1993 is that medical experts are now more capable of being certain that “the birth of a living fetus is not biologically possible.” While maintaining church teaching against direct sterilization, the CDF wrote that hysterectomies would be licit in such “extreme” cases.

The key quote for LGBT issues is in the responsum’s deference to medical experts and conscience:

“The problem of the criteria to evaluate if the pregnancy could, or could not, continue on to the state of viability is a medical question.  From the moral point of view, one must ask if the highest degree of certainty that medicine can reach has been reached, and in this sense the response given is valid for the question, as it has been proposed in good faith.

“Furthermore, the response to the question does not state that the decision to undergo a hysterectomy is always the best one, but that only in the above-mentioned conditions is such a decision morally licit, without, therefore, excluding other options (for example, recourse to infertile periods or total abstinence).  It is the decision of the spouses, in dialogue with doctors and their spiritual guide, to choose the path to follow, applying the general criteria of the gradualness of medical intervention to their case and to their circumstances.”

There are at least two significant points implications for issues of sexuality and gender.

First, the Vatican’s review of this moral question is in response to advances in medicine. They exhibit a willingness to engage positively with scientific developments and to incorporate them into ethical reflection. Pope Francis’ encyclical Laudato Si on care for creation revealed this same willingness. But so far, the Magisterium has refused to engage LGBT issues in light of contemporary knowledge. As Jamie Manson pointed out a few weeks ago, Pope Francis and the Vatican are seemingly reliant on discredited junk science to uphold their teachings on homosexuality. What would teachings on sexuality and gender look like if modern biology, psychology, etc. were fruitfully engaged? It is an exciting question that many theologians have fruitfully taken up.

Second, the determination of whether a hysterectomy is licit is left up to the person undergoing surgery in conjunction with medical providers and spiritual guides. In other words, the Vatican is deferring to conscience and a trust in people that they will discern the choice prayerfully in their unique context and circumstances. This stance is tied to the gradualist approach to theological ethics reflected elsewhere in Pope Francis’ writings and the Synod on the Family. (Gradualism is the idea in theological ethics that people’s lives most often do not conform to moral ideals, but that people should be pastorally accompanied to advance towards these ideals rather than being criticized for failing to meet them.) The implications for trusting people to make healthcare decisions informed by Church teaching, but ultimately decided by conscience could be revolutionary for LGBT people and all female-bodied people.

A CDF document could not make the headlines that Pope Francis’ change in magisterial teaching against the death penalty garnered, a decision which itself proved the Church evolves and has implications for LGBT issues. But the lack of attention it received should not detract from the positive step which this responsum is for Catholic theological ethics, including the possibilities it has for LGBT issues.

—Robert Shine, New Ways Ministry, January 16, 2019