Contraceptives and the Single Person

The development of effective oral contraceptives and their distribution through the medical profession have involved the physician in the complexities of sexual ethics. For Protestants, the greatest tension is likely to be over whether contraceptives should be prescribed for the unmarried girl. The physician may come to this question with one of several perspectives: (1) neutrality; (2) reluctant sanction; (3) broad permissiveness; (4) the historic Christian position.

Neutrality. The physician who assumes a neutral position denies that any ethical choice is involved in his prescribing contraceptives for single girls. He may say the decision belongs entirely to the person who makes the request. But the idea that the physician can remain neutral is illusory. In every moment of the physician-patient relationship there is communication, verbal or non-verbal, that is bound to disclose the physician’s own philosophy of life and ethical stance. If his response serves, however subtly, to favor the patient’s decision to use contraceptives, his claim of neutrality is invalidated.

To comply with an unmarried girl’s request for contraceptives is not simply to transfer the ethical decision to her; it is to take part in the decision. Considerable professional authority is bound up in the role of a doctor. Every prescription he gives is considered to reflect what he feels is best for the patient, and the patient’s acceptance of a prescription implies confidence in the doctor’s ability to make a wise choice. The doctor is paid to make choices for his patients, and he cannot avoid responsibility for the course he recommends.

Reluctant sanction. A physician who is against premarital sex may feel that it is futile for him to take a positive stand in favor of chastity. Thus in reluctant sanction of what seems inevitable, he may say, “If I don’t prescribe the pills, she’ll get them anyway.”

This view seriously underestimates the physician’s moral influence and authority with his patients. In a way unique in human relationships, a patient turns himself over to the physician, revealing the most personal facts about himself and, at times, actually placing his life in the physician’s hands. His confidence is based primarily upon the scientific knowledge and skill he believes the doctor to have, but it also includes a strong component of faith in the doctor’s integrity and respect for his opinion.

The doctor who thinks his patient’s moral decision is beyond the reach of his influence disclaims responsibility for providing help in any but the physical or emotional dimension. And if he begins by trying to deter his patient but then grants her request, he is likely to vitiate any positive value his initial reluctance may have had. A strong position against premarital intercourse, buttressed by an unwillingness to compromise on grounds of expediency, may provide needed moral support to the patient.

In another form of the “reluctant” position, the physician may feel that premarital sex is bad but that an illegitimate pregnancy is worse. His dilemma may be compounded if the patient has already had an illegitimate pregnancy and comes seeking to avoid another. In granting the request for contraceptives, he may be convinced that he is choosing the lesser of two evils.

But the physician must realize that he is balancing a real decision against a contingency, an act that may or may not take place. By refusing, and by throwing the weight of his professional authority behind continence, he may help to avert illicit sexual relations. Granting the request, even though it may seem the lesser of two evils, implies sanction of the anticipated act.

Broad permissiveness. The physician who makes his decision from a broadly permissive attitude that accepts the new morality must weigh the time-honored medical maxim, “to do no harm.” The storm of responsible criticism that descended upon Kinsey, and the contemporary reaction of sober protest against the Playboy Philosophy, reflect not merely a residuum of moral conservatism but a substantial body of conviction that such an ethical code is damaging to human personality. Unlike the preceding positions, the new morality asserts that its roots lie securely in the classical tradition of Western Christianity, with agape—unselfish, self-giving love—as its sole criterion. However, since the system declares freedom from rules, laws, and principles, it has been described by one of its critics as a non-Christian non-system of non-ethics.

The physician endeavoring to practice his vocation as a Christian is under some constraint to evaluate the claims of situation ethics. The situationist asserts that rules and laws may be superseded by the claims of love in a particular situation and thus that premarital sex can at times be constructive and not wrong. The crucial elements for making a decision lie within the situation; “even the most revered principles may be thrown aside if they conflict in any concrete case with love,” says Joseph Fletcher.

Situationist ethicists tend to base their rejection of traditional morality upon one of three assertions:

1. Christian morality must be modified, because it is so widely rejected today. Bishop Robinson is undoubtedly partly correct in saying that “the sanctions of Sinai have lost their terrors, and people no longer accept the authority of Jesus even as a great moral teacher.” But it is something else to go on to imply that God’s laws, since they no longer have the support of the majority, should now be restated.

2. There is no such thing as a Christian ethic. Bishop Robinson deprecates the idea of a supranaturalistic ethic that stands for objective moral values and denies that Jesus’ commands were universal principles. In God, Sex and War, John Burnaby calls in question even the possibility of deriving norms from the teachings of Jesus: “An infallible Christ can be of no avail to us, unless we are sure both of what he said and of what he meant by it.…”

These comments, like much situationist quibbling, ignore the overarching fact of Christian ethics, that “the ultimate context of every moral situation is that of the divine will,” involving creation, judgment, and reconciliation. This provides the framework of meaning for all human decision-making. Even though man was created free, his autonomy is circumscribed by God’s sovereignty as Creator and Judge. God’s chastening is inescapable when man rebels in pride and self-centeredness.

Even Jesus’ ethic cannot be properly understood except in the light of the Old Testament conception of God, man, and the world. As E. Clinton Gardner has said, “Although Jesus summarized the whole duty of man in the twofold love commandment, he spoke of many other virtues even more frequently than he spoke of love: and he emphasized the abiding need for ‘the law and the prophets’ to safeguard morality from hypocrisy and sentimentality” (in Storm Over Ethics, Bethany Press, 1967, p. 58).

3. Christian standards of sexual morality are too restrictive. Acceptance of Niebuhr’s view that “the ethical demands made by Jesus are incapable of fulfillment in the present existence of man” surrenders not only the ideals relating to adultery and fornication but also the very capacity to confer unearned and undeserved love—that is, agapism in any form.

Freud examined the Christian ideal, “Thou shalt love thy neighbor as thyself,” and concluded that it is “unpsychological”: “If he is a stranger to me and if he cannot attract me by any worth of his own or any significance that he may already have acquired for my emotional life, it will be hard for me to love him. Indeed, I should be wrong to do so” (“Civilization and Its Discontents”). In regard to unregenerate man, he is right. Only by the intervention of divine grace can we become the channels by which love is bestowed upon the unlovable;

Situationists plead for an empirical ethic, “a morality of involvement and discovery,” but reject the safeguards provided by Scripture and the Church against subjectivism and rationalization. “The Word of the Lord is there—yet not as proposition,” says Bishop Robinson. The right is reserved to abandon entirely the guidance of the Church as “establishment-mindedness.” Love is pried out of its scriptural context and left alone to cope with the caprice of specious logic and self-deception.

The case for chastity is by no means argued solely on religious grounds. It is very apparent, particularly to university psychiatrists, that in our day of greater sexual freedom, sexual problems continue to abound; indeed, sexual inadequacy seems to be increasing. A symposium on premarital intercourse concludes:

Girls and boys of this generation need help in detecting and rejecting … the … subtly, persuasive, fraudulent national propaganda of the new sexual morality.… Four thousand years of Judeo-Christian wisdom cannot be dismissed lightly. There are still valid and urgent reasons for saving sex for the right time, place, and person, within the sanctions of a concerned society [Mervyn S. Sanders, in Medical Aspects of Human Sexuality, April, 1968.]

The historic Christian position. The Christian sexual tradition has its roots in the strict code of the Old Testament, which proscribed extramarital sexual activities on moral and religious grounds. This code was in effect ratified by Jesus as he upheld respect for the commandments. In presenting the new commandment emphasizing love, he did not withdraw the old. As he focused down upon the inner motive, he did not make light of the offense of adultery and fornication (see Mark 7:21).

Paul continued this teaching as he bracketed immorality and adultery with the basic sin of idolatry (1 Cor. 6:9, 10), and described sexual sins as opposed to the activity of the spirit (Gal. 5:19). The emphasis upon chastity that has characterized Christian sexual ethics is thus deeply rooted in biblical teaching.

It would be possible for an eager young physician to rebel against an “authoritarian” pharmacology, “liberate” himself from a “legalistic” Food and Drug code, and set out to administer medications to his patients without benefit of the accumulated wisdom of scientific medicine. Recent medical history makes it easy to imagine the consequences. The same danger of uncontrolled, capricious choice in moral and ethical matters ensues if the Christian heritage of divine and human wisdom is reduced to the level of an obsolescent appurtenance.

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