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 Post subject: Moral question
PostPosted: Fri Oct 26, 2018 11:42 am 
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Alright, I’m posting these questions here as this forum gets a lot of traffic from some really solid thinkers. However, Admin’s move as is necessary....

Background: A married woman who believes in NFP and has practiced it for most of her marriage has some medical issues come up. She wants to make the best treatment decision in accordance with Church teaching so that she and her husband can continue normal marital relations.

The doctor advises three courses of action:

1) An “ablation” procedure whereby her uterus produces scar tissue and this solves the problem. However, she is never to get pregnant again for every child would miscarry, so they would then also “tie her tubes”.
2) The patient is prescribed a low-dosage of hormones, which would solve the problem. However, the patient is basically taking birth control.
3) A hysterectomy.

Now, I’m fairly confident that #1 is not an option. While the procedure’s intention is to not render the patient sterile, the intention of the 2nd part is (direct sterilization). Am I correct?

I’m also confident that #3 is an option, since the intention isn’t to render the patient sterile, but to solve a medical problem. Am I correct?

So it #2 an option since the intention isn’t to prevent pregnancy, but to solve the medical problem?

Lastly, while I appreciate everyone’s opinions here, I would prefer to hear responses only from those who consider their faith “robust”, are actively practicing, Fr. Kenobi, PED, etc.....I know this can be a sensitive subject for those outside our faith or for those who aren’t actively practicing and generally respect your opinions. However in this case, the thread could get derailed very quickly. :-)

Thanks!

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 Post subject: Re: Moral question
PostPosted: Fri Oct 26, 2018 12:20 pm 
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You are correct in your assessments of (1) and (3).

There is (IIRC) a debate over the liceity of taking medications whose primary purpose is something other than birth control but which have that as a secondary effect. Is there an NFP-friendly OB/GYN in your area? Mainstream OB/GYNs can be so accustomed to prescribing birth control that they aren't aware of other options for treatment.

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 Post subject: Re: Moral question
PostPosted: Fri Oct 26, 2018 3:46 pm 
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I think knowing the condition is important.

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 Post subject: Re: Moral question
PostPosted: Fri Oct 26, 2018 3:49 pm 
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Also, I concur with Fr. Obi's remarks about number 2. Docs are quick on number 2 when there are very effective alternatives depending on the condition.

FJ

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 Post subject: Re: Moral question
PostPosted: Fri Oct 26, 2018 4:13 pm 
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I think the condition is Menorrhagia.

Almost certainly has resulted in anemia (tests are confirming).

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 Post subject: Re: Moral question
PostPosted: Tue Oct 30, 2018 6:48 pm 
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I would be interested in understanding the objections to #2 (where birth control is a secondary effect).

It seems to me this is no different than an etopic pregnancy. The "treatment" kills the embryo, even if that's not the intention.

Not being argumentative at all, just want to fully understand the reasons for the objections.

So any links or other resources would really be appreciated.

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 Post subject: Re: Moral question
PostPosted: Tue Oct 30, 2018 7:27 pm 
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My understanding with (2) is that the patient would be on permanent birth control.

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 Post subject: Re: Moral question
PostPosted: Tue Oct 30, 2018 7:48 pm 
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Obi-Wan Kenobi wrote:
My understanding with (2) is that the patient would be on permanent birth control.


Most likely only temporary - 60 to 90 days.

Low dose progesterone. Based on what I’ve read, it can either be a hormone replacement or can act as a form of birth control. If its prescribed in combination with estrogen, it is defiantly contraceptive in nature. Alone it can be, but that’s not necessarily the primary intention - although there are progesterone-only forms of ABC.

A NFP doctor on EWTN agrees with the assessment of #1 and #3 (another person posted of a very similar situation - apparently this is more common a problem that I thought.) He too prescribed low-dosage progesterone for a short period of time.

Why can’t things just be easy?

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 Post subject: Re: Moral question
PostPosted: Tue Oct 30, 2018 8:50 pm 
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Then #2 is probably licit.

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 Post subject: Re: Moral question
PostPosted: Tue Oct 30, 2018 8:54 pm 
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Obi-Wan Kenobi wrote:
Then #2 is probably licit.


I’m leaning that way too, but am not certain.

Tough row to hoe when one can be a particularly overly scrupulous person. :fyi:

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 Post subject: Re: Moral question
PostPosted: Thu Nov 01, 2018 8:35 am 
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IIRC, low-dose progesterone is also used to maintain pregnancy under certain circumstances, if that helps. :fyi: So it's not merely a contraceptive.

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 Post subject: Re: Moral question
PostPosted: Thu Nov 01, 2018 11:12 am 
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It's also used to balance hormones in relation to estrogen. I think it is available over the counter as a lotion.

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 Post subject: Re: Moral question
PostPosted: Thu Nov 01, 2018 3:52 pm 
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Bombadil wrote:
It's also used to balance hormones in relation to estrogen. I think it is available over the counter as a lotion.

Yes, there are OTC progesterone creams.

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 Post subject: Re: Moral question
PostPosted: Thu Nov 01, 2018 3:55 pm 
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By the way, I don't think that a procedure that caused sterilization indirectly (that is, treated an issue with the foreseen but intended result that any future pregnancy would probably miscarry) is necessarily immoral. Having marital relations, even with the knowledge that a resultant pregnancy would probably miscarry, is not wrong.

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 Post subject: Re: Moral question
PostPosted: Fri Nov 02, 2018 7:17 am 
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Peregrinator wrote:
By the way, I don't think that a procedure that caused sterilization indirectly (that is, treated an issue with the foreseen but intended result that any future pregnancy would probably miscarry) is necessarily immoral. Having marital relations, even with the knowledge that a resultant pregnancy would probably miscarry, is not wrong.


Yes, but they won't perform the ablation procedure without the tubal ligation unless one of the couple has already been sterilized.

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 Post subject: Re: Moral question
PostPosted: Fri Nov 02, 2018 7:56 pm 
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Peetem wrote:
Yes, but they won't perform the ablation procedure without the tubal ligation unless one of the couple has already been sterilized.

*** SIGH ***

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 Post subject: Re: Moral question
PostPosted: Sat Nov 03, 2018 3:43 am 
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Hmm. My sister is an ob/gyn

Your friend needs to talk to another doctor.

An endometrial ablation does not guarantee a miscarriage, but it does render the pregnancy very dangerous (for both mother and child). That said, it is not standard policy to require sterilization in order to perform the procedure. It is standard to discuss birth control as "necessary" until after menopause , but sterilization? Indeed, pregnancies after endometrial ablation are not that rare, all things considered.

So option one is to have the ablation and not get sterilized. Her doctor might refuse, but that is abnormal. The procedure itself renders pregnancy significantly less likely (or more accurately, implantation. So I suppose miscarriages are far more common than doctors reckon here).

2 would be supported by most moralists, but I second the advice to find an NFP friendly doctor. The difficulty has to do with the causal proximity of the evil effect

3. Would be justifiable in principle, at least with regard to a supracervical hysterectomy.


Now, at the risk of overreach, I would ask if they have an idea as to the underlying cause. Temporary treatment and relief (NSAIDs and transxemic acid efc) could suffice, if the underlying cause can be treated or managed. E.g fibroids, medication, diabetes, or even thyroid imbalances can cause it. Of course it may not have a known or separately treatable cause.

Now I presume her doctor considered the cause, and what, if any other options are available, but a 2nd opinion might be called for. My sister tells me that much of the choice in procedure is guided by future plans for children, with ablations or hysterectomy only recommended when there are no plans to ever have children or other treatments insufficient and the condition is more serious.

But I am not a doctor!

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 Post subject: Re: Moral question
PostPosted: Sat Nov 03, 2018 3:51 am 
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One note, I specified supracervical hysterectomy for two reasons... One, it is increasingly favored here, being less invasive and with less risks (and offers very minimally invasive surgery with current methods) and because it does not render any issue of impotency, whereas total hysterectomy does

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 Post subject: Re: Moral question
PostPosted: Sun Nov 04, 2018 10:34 pm 
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The doctor has found no physiological abnormalities which would typically, but not always, cause the problem.

So the thought is there are some hormonal imbalances. However, blood tests came back normal. The patient is 49, so almost certainly premenopausal.

Complicated situation....

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 Post subject: Re: Moral question
PostPosted: Sun Nov 04, 2018 11:07 pm 
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Peetem wrote:
The doctor has found no physiological abnormalities which would typically, but not always, cause the problem.

So the thought is there are some hormonal imbalances. However, blood tests came back normal. The patient is 49, so almost certainly premenopausal.

Complicated situation....

49? Isn't that smack in the middle of the average age for menopause?

Not sure how that factors. In anycase, I think 2 and 3 can be moral, 1 if without sterilization, but as you say the doctor is refusing that. The fourth option of managing the symptoms, NSAIDs, transxemic acid and iron supplements may not be sufficient in her case, but is usually an option,

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