Note on the Use of the Condom by a Spouse within Marriageto Prevent the Transmission of HIV.  

Luke Gormally FAITH Magazine July-August 2006

[1]
It is being argued that condom-use for intercourse within marriage would be permissible to prevent transmission of HIV between spouses. The reasons offered for this view are the following:

  1. The use would not be contraceptive but would be intended to prevent the transmission of a potentially lethal virus.
  1. One should permit a lesser evil in order to prevent a greater evil (in this case infection and the premature death of a spouse).

Both of these reasons are at odds with the Church’s teaching about marriage and about moral responsibility.

[2]
The first reason proposes that condom use would be acceptable because not contraceptive in intent. It is possible that it might not be contraceptive in intent. (But in the case of fertile couples this would be unusual, since apart from not wishing it to be the case that HIV is transmitted to a spouse they would also not wish to conceive a child with HIV, and so would also wish to prevent conception by condom use.) In those cases in which there is no contraceptive intent there is nonetheless a quite fundamental reason why condom use should never be adopted. Condom use would render the sexual activity of the spouses non-marital.

It is a condition of sexual activity being marital that it should be a generative or procreative type of act [1] – the type of act which, if the couple are fertile, can lead to the conception of a child. It is a condition of intercourse being generative that the husband ejaculates into his wife’s reproductive tract. Precisely that is deliberately prevented by the choice to make use of a condom. If intercourse is not of the generative kind then it cannot be unitive.

That is what is meant by the solemn teaching of Humanae Vitae #12 when it speaks of the inseparability of the unitive and procreative meanings of the marital act. To allow condom use within marriage even if there is no contraceptive intent would amount to an abandonment of the Church’s fundamental teaching on what is required for sexual activity truly to realise the ‘one flesh’ unity of the couple and so to be morally acceptable. [2]

  [3]
The second reason offered for permitting condom use within marriage represents a misunderstanding of what traditional Catholic teaching had in mind when it spoke of ‘permitting the lesser evil’. Traditional use of the phrase related to the toleration or ‘non-impeding’ by ‘rulers’ of the sins of other persons, and not to what may be chosen or counselled. But advocates of the acceptability of condom use do not have in mind ‘tolerating’ what some of them would concede is not in itself desirable but rather counselling the acceptability of condomistic intercourse to avoid HIV infection.

The first point to acknowledge in considering this view is that the Church has always taught that it is incompatible with an authentic sense of moral responsibility deliberately to choose what is known to be morally wrong, however good and desirable one’s further purpose might be.

When people speak of ‘permitting the lesser evil’ they may have one or other of a number of different comparisons in mind, either between greater or lesser moral evils, or between what they think of as greater or lesser ‘pre-moral’ evils. On any accurate analysis of the choices which are at issue in the comparisons, it will always be the case that one term of the comparison will involve the choice to engage in condomistic intercourse.

In condomistic intercourse aimed at reducing HIV infection, what is chosen (what tradition calls the ‘object’ of the act) is, as we have seen ( [2] above) an essentially non-generative type of sexual act, chosen with the further intention of reducing the risk of infection. What is chosen therefore is one of those types of act which “in the Church’s moral tradition have been termed ‘intrinsically evil’ ( intrinsice malum ): they are such always and per se , in other words on account of their very object, and quite apart from the ulterior intentions of the one acting and the circumstances.” [3] It is never morally acceptable to choose to act in such ways.

[4]
Many couples will reasonably conclude from acceptance of the teaching that condomistic intercourse is intrinsically unchaste, that the only alternative for them is abstinence, which will indeed be a demanding cross for many of them. The Church’s response to their situation should be to help them to embrace that cross in their lives as the instrument of their salvation. It is precisely in embracing what makes its appearance as the cross in one’s own life that one experiences the power of the Resurrection. It is no part of the Church’s mission to suggest or allow behaviour which defiles the sacred bond of marriage.

Abstinence is not necessarily the only reasonable alternative to condom use. While it is not reasonable for an infected spouse to demand marital intercourse when their spouse is unwilling to be exposed to the attendant risks, it may be reasonable for an uninfected spouse willingly to accept the risks associated with marital intercourse. These will vary according to which of the two spouses is infected, the phase of the menstrual cycle during which intercourse occurs, the stage of infection and the efficacy of medication in reducing infectivity.

A couple, one of whom is infected, cannot be condemned as necessarily unreasonable for having intercourse with a view to having a child. For a child is a great good, and we rightly do not condemn couples who seek to conceive a child though they run some quantifiable risk of conceiving a child with, say, a genetically determined lethal condition. The risk of a child getting HIV is greatest if the mother is infected at the time of conception when 13-35\% of the newborn infants may be infected. [4] If the mother is not infected there is no risk to the infant.
 
[5]
In explaining the Church’s teaching to individuals, pastors may readily concede that a particular couple could greatly reduce the risk of HIV transmission through the use of a male condom. [5] The essential case against condom use in marriage is that it is gravely unchaste, not that it is risky.

On the other hand, when pastors teach publicly that condom use is morally acceptable they should recognise that their message will influence a varied population whose behaviour in using condoms may in the long run be significantly hazardous. One should bear in mind that studies of populations show that condom use for contraceptive purposes has a failure rate of 12\% [6] - where ‘failure’ means conception, which can occur only once a month, whereas HIV can be transmitted any day of the year.

The Church’s ministry to couples, one of whom has HIV, is a challenging ministry. The challenge is evaded and they are betrayed if pastors think they can serve the good of couples and the good of their marriages by approving condom use.

Luke Gormally, May 2006   

 

 

[1] “a conjugal act which is suitable in itself  for the procreation of offspring, to which marriage is ordered by its nature and by which the spouses become one flesh”, as the Code of Canon Law #1061 §1 puts it.

 

[2] For an explanation of the wrongness of condomistic intercourse in the absence of contraceptive intent see Luke Gormally, ‘Marriage and the prophylactic use of condoms’, The National Catholic Bioethics Quarterly 5 (2005): 735-49; reprinted in Faith 38/2 (March-April 2006): 16-24.

 

[3] Pope John Paul II, Veritatis Splendor #80.1.

 

[4] About half of these infections occur in utero and the others at the time of delivery. See Ambrosiak J, Levy J A ‘Epidemiology, natural history and pathogenesis of HIV infection’. In Holmes K K et al. (eds) Sexually Transmitted Diseases (3rd edition), pp. 251-8.

 

[5] Consistent use of a male condom has been shown to reduce the risk of HIV transmission by approximately 85\%. [Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention, 2001. National Institute of Allergy and Infectious Diseases, National Institutes of Health, US Department of Health and Human Services.] Sufficiently motivated individual couples would no doubt be capable of further reducing the risk.

 

[6] Trussel J et al. ‘Contraceptive failure in the United States: an update’. Studies in Family Planning 32 (1990): 51-4.

 

Faith Magazine

July - August 2006