Unintentional contraception

by Anders Sandberg

The pope approves of the use of condoms to fight AIDS: according to an upcoming book he says it is acceptable when the intention is to reduce the risk of infection. While he still views abstinence as the proper way of fighting the disease, "In certain cases, where the intention is to reduce the risk of infection, it can nevertheless be a first step on the way to another, more humane sexuality." Now, how does this fit with the doctrine of double effect? According to this doctrine, it is sometimes permissible when acting towards a good result to bring about a foreseen side effect that on its own would be impermissible. Is contraception hence a permissible side effect of trying to reduce infection risk?

The New Catholic Encyclopedia gives four conditions for the application of the principle (here copied via the Stanford Encyclopedia):

  1. The act itself must be morally good or at least indifferent.
  2. The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.
  3. The good effect must flow from the action at least as immediately (in the order of causality, though not necessarily in the order of time) as the bad effect. In other words the good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed.
  4. The good effect must be sufficiently desirable to compensate for the allowing of the bad effect“ (p. 1021).

In the condom case the first condition is fulfilled (lowering infection risk is morally good). The second condition is trickier – there are some infection risks that can be reduced in other ways, but clearly there are some that cannot. There might even be unknown diseases that are hence diminished. Condition three is fulfilled – the condom does contraception and infection protection through the same mechanism, and it appears hard to disentangle them technically.

What about the fourth condition? The doctrine of double effect is often invoked in serious conditions: Thomas Aquinas used it to argue the permissibility of killing in self defense, it has been widely invoked in discussion about end of life decision making (especially terminal sedation), abortion, military ethics, self-sacrifice and many domains. To my Scandinavian mind it appears that the act of causing contraception is of a far smaller magnitude than killing people, hastening death or performing an abortion, but of course the intended good need to be sufficiently large too. In this case it is reducing risk of infection, something that can (and does) destroy lives. That seems to be more than enough. There is of course no certainty that any infection will destroy a given life, but even the potential of a dangerous infection might keep a couple from enjoying their relationship fully.

So from this reading it looks like the doctrine of double effect supports the unintentional but foreseeable contraceptive effect of condoms. I have no illusions that this will be the position the Vatican takes, of course.

A likely attack on the above argument is to argue that I am wrong about the proportionality between the good and the harm. This is of course one of the main problems with the principle in the first place: there doesn't seem to be a principled way of comparing the good and harm. From my perspective the harm in this case is minimal, even illusory, but others may consider it a serious harm. The harm from the mere possibility of infection is also hard to quantify: people can pick up serious sexually transmissible illnesses even when living monogamously, but how to convert these probabilities and disease harms into the currency of harms appears to be troublesome. At what probability per year of acquiring AIDS does the potential benefit of avoiding transmission become significant enough to overcome the harm of contraception? It appears that we end up with something suspiciously like a consequentialist calculation.

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10 Responses to Unintentional contraception

  • Wouldn’t they just deny premise (1)? Acts of non-procreative sex are alleged to violate natural law and hence be intrinsically bad. I’m not super familiar with the view, so may be wrong, but I wouldn’t expect natural law theorists to say that contraception is a “bad effect” or harmful consequence. Rather, it changes – “perverts” – the nature of the act itself. (Or so they might claim. It all sounds pretty nutty to me.)

  • G. Owen Schaefer says:

    The Doctrine of Double Effect seems to be strictly at play here only on a secondary level. In particular, the pope reiterates that the correct, morally obligatory action (for, one presumes, unmarried couples) is abstinence. This would be the correct action even under Double Effect, due to the clause in Condition 2 you point out: one could indeed obtain the good effect (avoiding infection) without the bad effect (both contraception in itself, as well as intercourse outside marriage), by by being abstinent; given this is an option, Double Effect cannot apply at the primary level of telling an individual what is permissible, full stop. Instead, the pope seems to be emphasizing a second-best option: you ought not to have sex with a partner to whom you’re not married; but if you do, then it is permissible (or perhaps even responsible) to at least use a condom to prevent the spread of HIV.

    I take it, though, that you’re running DDE to show why that second clause is true: given a man will have sex outside of marriage, it is permissible for that man to use a condom. Condition 2 can then be dealt with relatively easily, as you outline above. As for Richard Chappell’s suggestion that the Vatican would consider act itself is wrong, rather than the effects, thus violationg condition 1 – indeed, that sort of reasoning is often used to argue DDE doesn’t even allow for abortion to protect the life of the mother (the act of killing the fetus is bad in itself, not bad due to its effects).

    Still, this indicates that the pope is shifting from the stance that condom use is a categorically impermissible act, perhaps diverging in a major way from the natural law tradition on the subject. He could do this either by a) saying it is actually the effects of using a condom(inhibiting procreation) not the act itself which makes the action wrong, or b) that the act is still inherently wrong, but not categorically so. Interestingly, though, this divergence is not justified by an appeal to the value of lower HIV infection rates; rather it is seen as a “first step in the direction of a moralization,” a way to get an individual to understand “that not everything is allowed.” That is quite surprising indeed; while the risk of disease and death itself is not enough to justify a shift in the morality of contraception, the value of moral education is sufficient to do so…

  • Peter Wicks says:

    This “doctrine of double effect” seems to embody essentially utilitarian thinking, in the sense that it involves a weighing of good (benefit) and evil (cost). That’s fine with me, but what about those who reject utilitarianism as a moral framework? On what basis does one then decide on the appropriate course of action when both desirable and undesirable effects can occur?

  • Dmitri Pisartchik says:

    Peter,

    DDE is about as far from utilitarianism as it gets since the weighing of harms and benefits (good and bad) is so severely constrained by conditions 1 through 3. In fact, if you reject utilitarianism, DDE should be all the more appealing to you since the Intended vs. Foreseen distinction at the heart of DDE severely cripples any utility analysis of outcomes.

    DDE makes morally permissible the bringing about of “undesirable” effects when they were the unintended consequences of bringing about the “desirable” effects of some act. Utilitarians, or consequentialists more generally, would ignore any consideration of intension and simply weight the desirable against the undesirable.

    For a consequentialist the fact that the undesirable effect was intended (or not) is irrelevant. Its not how the effects were brought about (intentions) but what effects were brought about (consequences) that matters for the consequentialist. DDE adherents, on the other hand, make a categorical distinction between undesirable effects that were intended (absolutely forbidden) and undesirable effects that were merely foreseen (sometimes permissible). The primary concert is the “how” and not the “what.”

    I hope that makes the difference between the two positions more clear.

  • Peter Wicks says:

    Dmitiri, I agree that conditions 1 and 3 depart from strict utilitarianism (by indeed constraining the cost-benefit calculation), but I’m less sure about condition 2. Why would anyone, utilitarian or otherwise, *intend* harm? It seems to me that both DDE and utilitarianism are at one in saying that harm can only be accepted as an inevitable consequence of an action that will produce net good. If another course of action is available that would produce the good without the harm then both demand that we opt for it. But perhaps I’m missing something…

  • I’m with Richard Y C’s analysis here, and posted a thing about that: http://philosophicalcomment.blogspot.com/2010/11/new-ruling-on-condoms-from-roman.html.

    @Dimitri: the thing with utilitarianism is that, whatever your intentions were, they have no bearing on the morality of your actions. This is a clear, inescapable difference to the DDE. This is also made clear in the philosophical source of the DDE, Thomas Aquinas’ writings on killing, self defence and capital punishment – where intention – not actual outcome – is clearly pointed out as essential for the moral assessment of actions.

  • Kathryn says:

    I’m in general agreement that double effect allows for the use of condoms even if intentionally preventing pregnancy via artificial contraceptives is wrong but the act in question here isn’t lowering infection risk. That’s what the act does–not what it is.

  • Kathryn says:

    Also, with respect to Richard’s comment- they can’t deny that non-procreative sex is morally wrong because Catholic teaching allows natural family planning. According to them, it’s as effective (when used properly) as artificial contraceptives. If couples engage in NFP, presumably it is precisely because they would like to have sex with the diminished likelihood of conception. If artificial methods are no more effective, they cannot be any more non-procreative, yet NFP is permissable.

  • Kathryn: as far as I have understood it from reading several Catholic scholars and letters/declarations from the Vatican on these matters, the key word is “natural” – which, in this case, signals the idea of being condoned by God through the way in which the creation has been designed (evidence being the design and function of the menstrual cycle, in this case). In other words, the view seems actually to be that marital sex without an intention to procreate is wrong when undertaken under those conditions where it has a “natural” possibility to result in procreation (which it has not during the “safe period”). Obviously, use of human artifacts cannot be used as a reason to claim the absence of a “natural” possibility to procreate, according to this idea. And that, of course, is where the real troubles start, philosophically speaking….

  • SimonM says:

    So it only counts for ill health and or death from AIDS or should we include anything sex related that can cause ill-health and or death? 🙂

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