Luc Bovens on Catholicism and HIV

Luc Bovens of the London School of Economics, maintains that the Catholic church should permit condom use for discordant heterosexual couples (those where one partner has HIV and the other doesn't) on grounds of consistency with other doctrines, such as that of Double Effect.

Listen to Luc Bovens on Catholicism and HIV

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Comments

[Tristan]

I appreciate Bovens's attempt to reason through Catholic moral teaching (even if he disagrees with the Catholic approach to ethics). However, I think he does not quite have the doctrine of double-effect right.

We must distinguish between the means and the end of action (both of which are necessarily intended), and the consequence of the means (which may be unintended, even if it is completely foreseen). According to the doctrine of double-effect, and action can be good, even if a consequence of the means is bad, so long as (1) the intended end is good, (2) the intended means is good, (3) the evil consequence is unintended, and (4) the evil of consequence does not outweigh the good of the end (this is condition of proportionality). Another, more subtle condition, is that of immediacy (I believe Elizabeth Anscombe is responsible for introducing this). I'll discuss it below.

Bovens gives a good example: saving the life of a pregnant mother by removing a cancerous uterus. This action can be good (on the Catholic view) if the evil consequence is unintended (and it can be unintended even if it is completely foreseen). This is because the end is good, the means are good (i.e., there is nothing morally objectionable about the act of removing a uterus), and the evil of the consequence (the death of the fetus) does not outweigh the good of the end (preservation of the life of the mother).

Bovens claims that, if the above action is good on those grounds, then so too is the use of a condom to avoid infecting your spouse with HIV. However, there is an important difference between the two. The use of a condom is not a consequence of the means, but is itself the means. The good end is to avoid infection. The means to that end is the use of a contraceptive. This is an evil means. And as a means, it is intended. Thus, the action intentionally commits an evil.

Consider a third case, which (I believe) is more like the second, than the second is like the first. A large man is stuck in a man-hole. Beneath him are ten people who, because he is stuck, are trapped. The tunnel they are in is filling with water, so unless the large man can be removed, they will drown. If someone dismembers the man to save the people below, he might try to justify his action by appealing to the doctrine of double-effect. He'll say: "I didn't intend to kill the large man. I intended to remove him from the man-hole (means) so as to free the people trapped below (end)." His claim that he did not intend to kill them man is false because there is no distance, so to speak, between dismemberment and killing. Thus, to intend to dismember is to intend to kill.

Arguably, there is not sufficient distance between the use of a condom and contraception. Therefore, intending the one is intending the other.

Anscombe has an excellent discussion of the Catholic view of contraception here: http://www.orthodoxytoday.org/articles/AnscombeChastity.php

[Bear]

Tristan's comment is very accurate.

This is an interesting argument, and Bovens does spell out the objections. However, there is a problem: Bovens contradicts himself.

Early on he acknowledges that the use of the contraceptive pill is permitted if it is used medicinally. Later in the podcast he then contradicts this when he refers to the unitative end of sex.

[Jim Vaughan]

Admirable project Luc Bovens, that could save many many lives!

Having read Tristan's comments I see what he's saying. However, I want to go back a step, and challenge the definition that the act of "union" (for unitative ends) is when semen hits cervix.

Why is the male but not the female gamete relevant? Isn't this definition based on the ancient but incorrect idea of conception as the planting of male "seed" in the fertile ground of the cervix? Surely even in cases of aspermia, the act is unitative?

I would want to redefine the unitative moment as a mental/spiritual moment e.g. the moment of orgasm. The use of condoms therefore ceases to be "evil" or even relevant. They do not prevent the unitative end from being attained (which is one "Good"), only the generative!

[Peter Hardy]

I very much agree with Jim's point, but I dispute that this would save many lives.

Catholic doctrine is idealistic -it is designed to create saints- and its relationship with practice very complex. While contraception is certainly considered sinful (because it says 'no' to the creation of new life) the prohibition on it is not a solemn dogma, let alone an infallible teaching. Secondly, we read in The Catechism of the Catholic Church that couples should organise their sex lives through prayerful use of their God-given consciences. And of course consciences sometime disagree with Vatican, particularly where one partner is not Catholic.

The main thing I stress on this issue again and again is that the Church does not teach, and has never taught that contraception can cause AIDS. That is anti-Catholic propaganda. It's true that many ignorant and irresponsible ministers -not just Catholic ones- in the developing world have taught people that condoms can cause AIDS, but that has never been the position of the Vatican and they condemn that behaviour. We must, however, call on the Vatican to take a lot more action to censure those they are responsible for when they spread unscientific information, especially in such situations when it can be so harmful. Note that this requires the Church to be more authoritarian, not less!

What the Church does say -and has been right about thus far- is that the shift in cultural attitudes to sex brought on by the widespread availability and popularisation of contraception will tend to increase rates of unwanted pregnancies (and thereby abortions) and sexually transmitted infections. Of course the Church concedes that this is counter-intuitive, contraception by definition protects against unwanted pregnancy, and condoms do prevent the spread, through genital intercourse, of STIs (contrary to what this research popularised by this Cardinal in 2003 suggested: http://www.guardian.co.uk/world/2003/oct/09/aids?INTCMP=SRCH - note the deliberately misleading generalisation from one Cardinal acting alone to 'The Catholic Church is teaching...').

So how then is what the Church teaches true?

First, we must distinguish between the use of contraception in theory and the use of it in practice. In theory it should work every time. In practice people become over-reliant on contraception and expect to be able to have sex whenever they want without risking pregnancy. This spreads a culture of causal sex and 'riskier' forms of sex. This culture has now had several generations to develop unchecked, with increasing complacency about the depth of the link between sex and procreation.

So with the amount of causal sex having dramatically risen its obvious that the rates of unwanted pregnancies and transmission of disease will rise too. This can occur for four reasons. First, people do not develop a healthy attitude of temperance towards sex, such that when contraception is not available they will have sex anyway, too impassioned to appreciate the gravity of the risk and deluding themselves that 'it cannot happen to me'. Second, it only takes a condom to be fitted improperly once for unwanted pregnancy to occur. Third, it is likewise the case with condoms splitting, it only needs to happen once. Even high quality ones can do this, it happens every day. But the condoms available in developing countries are very seldom of a high quality. This is not only because they can only afford the worst quality but because it has not been possible to enforce and regulate production standards like we do in developed countries. So the forth reason is that condoms in the developed world are unfortunately more likely to fail at least one time. And it is only one time that is needed to spread a fatal disease. So the only way to protect 100% against AIDS is through abstinence and/or fidelity to one partner. And if you really do care about human life, you should respect as superior the one method that guarantees 100% protection.

Next, I urge you to read this short article (from a secular and reputable news source) which cites empirical evidence for the Church's stance being correct: www.washingtonpost.com/wp-dyn/content/article/2009/03/27/AR2009032702825.html

Having read that you may agree that yes, in practice the Catholic method is safer than the contraception method, but maintain that this view of the practicalities of the situation is flawed because it is itself dependent on the theory that all Catholics in countries effected by the AIDS pandemic will be able to be abstinent or keep faithful to one partner. That is to say, the Church's teaching that the use of contraception is sinful does cause a substantial amount of suffering because while they are not supposed to, in reality many Catholics will spread AIDS by having sex with multiple partners without using protection. Now, at first glance that may look like a reasonable objection, but there is a gaping hole in the logic.

Did you spot it? It imputes no small amount of irrationality to these people to suppose that they would disregard the Church's central dogma on sex- that sexual relations are to be reserved for husbands and wives within a monogamous marriage (which Christianity inherited from Judaism), while remaining obedient to the Church's much less important teaching on contraception. Of course if they are prepared to commit the grave sin of adultery they are not going to be concerned about the comparatively trivial sin of using a condom. So when a Catholic does have unprotected sex where there is a risk of transmitting a fatal disease they cannot be doing so out of obedience to Catholicism; it is their own selfish interest in pleasure and disregard for the safety of their sexual partner that is to blame and not the Church.

Finally, the charitable arm of the Catholic Church is the single largest provider of care for AIDS victims in Africa, so it is very unlikely that they would devote so much resources for tackling a problem if it could reasonably shown the particularities of their teaching was causing it. Indeed the evidence shows that countries with small proportions of Catholics tent to have higher HIV/AIDS infection rates, not lower ones. So to conclude, while the Church does need to do a lot of work to clarify it's view here, particularly on the ground level in the affected areas, the the Church and its particular doctrine here are certainly not in themselves making the pandemic worse.

[Wendy Watson]

I have just listened to this podcast and concur with the comments of Peter Hardy. If someone claims to be Catholic why would they need a condom to prevent the spread of STD's? They should only be having sex with the person they are married too. If you are having sex out of marriage you cannot claim to be a practicing Catholic. It would only be an issue for discordant couples where one of them has contracted HIV/AIDS through non-sexual transmission.