Earlier this year, physicians in Ottawa and Calgary were pilloried in the media for refusing to prescribe the contraceptive pill, it being assumed that their refusal was based solely on religious and moral grounds. Last June, the College of Physicians and Surgeons of Ontario (CPSO) sought public input as part of a review of policy guidelines concerning the right of doctors to refuse to provide treatments based on religious or moral grounds.
One would have thought that those criticizing the doctors' refusal to prescribe the pill would have first checked whether there were any valid medical reasons for doing so. After all, most health professionals are aware that the World Health Organization in 2005 classified birth control pills as a Group 1 Carcinogen (the highest risk category of carcinogens), specifying that this classification, which also includes tobacco and asbestos, is used only "when there is sufficient evidence of carcinogenicity in humans." (In Canada, tobacco and asbestos have been declared major health hazards. Why not the pill?) Various websites such as that of the American Cancer Society and WebMD also warn against the health hazards of the pill, particularly in the case of women with a strong family history of breast cancer.
But, then, there are other legitimate reasons for opposing the pill, and this is most likely what the CPSO and the media have in mind when they approach the issue. These reasons have to do with questions of a philosophical and religious nature, questions such as: What is a human person? What is the purpose of human life? What is our true destiny?
These are not easy questions. However, as anyone who has ever been involved in a discussion on life issues has probably discovered, we can't avoid grappling with them because there is no longer any consensus about the proper answers. We are being forced to choose between the old, traditional answers rooted in our Greek-Judeo-Christian heritage and the apparently new but, in fact, old answers rooted in a tradition predating Christianity and even Judaism, and which now goes under the name of secularism, modernism, liberalism or moral relativism. These are different names for one attitude to religion: that of one seeking to convince us all that, for public policy purposes, we should act as if God did not exist.
At the most basic level, what separates the two sides in the debate about whether doctors should be allowed to refuse to provide treatments based on moral and religious grounds is the ultimate meaning of life.
On the one side, there are those who adopt a certain classical view of reality that, although it now represents a minority position, is solidly grounded in reason and requires no particular religious allegiance. It claims that everything that exists has a nature ordered to an end; that is, nothing exists that does not have some kind of built-in purpose. On the opposite side are those who share the prevailing postmodern view that things are nothing in themselves: they are whatever we want to make of them. In other words, we can transform anything, including ourselves, into whatever pleases us, subject to the availability of the necessary technical means. In effect, we, not nature, set the purpose of things.
The classical view says that our happiness requires that we act according to our human nature and that conscience is our guide in its pursuit. The postmodern view says that happiness results from the achievement of whatever desires we may have, that conscience is nothing but "personal subjectivity" and that all human desires are legitimate. The classical view (first formulated by Aristotle) assumes the primacy of reason over will and says that the lovesharing and life-giving ends of sexuality should not be separated. The postmodern view (elaborated by Nietzsche) assumes the primacy of will over reason and says that they should be separated if that accords with one's desire.
Today we are forced to choose between these two worldviews. Those who adopt the postmodern worldview generally assume that the choice in favour of the classical view is dictated by religious faith, which they understand as something entirely devoid of reason. Their assumption, however, is not shared by those who adopt a classical view. As they see it, their choice in favour of a classical understanding of reality, while it may be in accord with their religion, need not be so because it can be upheld on the basis of reason alone.
What makes any dialogue between these opposing views difficult, and perhaps impossible, is that they differ in their very understanding of the nature of reason itself. According to the classical view, reason can lead to knowing something to be true on the basis of either what our senses tell us or what our mind or intellect tells us. Knowledge acquired through our intellect is knowledge of abstract truths such as logic, mathematics and metaphysics (the latter referring to knowledge of reality taken as a whole). We can thus arrive at a real knowledge of the nature of man, including the ends of human life, and of the correct means to achieve those ends. Reason enables us to arrive at moral certitude.
According to the postmodern view, reason allows us to understand logic and mathematics, as well as propositions that can be experimentally tested, but nothing else. It denies the possibility of any kind of metaphysical knowledge such as that associated with the existence of God or the nature of man. This implies that any proposition outside the realm of logic, mathematics and empirical sciences is considered subjective – a matter of opinion. More specifically, it implies that there can never be any kind of absolute certitude regarding moral matters. Morality can never be anything more than a set of mutually agreed conventions: There is no such thing as moral absolutes. Moral relativism thus becomes the order of the day.
One major implication of the postmodern view is that reason is self-sufficient to explain everything about man and his world. It rejects Plato's view that "God is the measure of all things" and reaffirms the pre-Socratic view, held notably by the sophist Protagoras, that "man is the measure of all things." The only thing we know about the world is what reaches us through our senses and mental impressions. Since only an intellect can provide insights into the essence of things, there is no way for us to be absolutely sure that those impressions correspond to reality. We may accept certain ideas to the extent they can be said to "work," but we have no absolute certainty about how they actually fit with reality itself.
On this relativist view, all rules of human conduct are to be found not in some God-given law but from within man's own reason, unguided by any outside principle. We have no inner compass or standard that might direct our behaviour, no internal conscience telling us certain things are good and others bad. Thus, we are essentially "free" to do as we please. Since there is no objective standard for what is right, freedom is not only freedom to do what is right but also freedom to define what is right. Thus, human rights are no longer viewed as inherent in human nature but rather as emanating from and subject to human will.
These opposing views of reality are the root cause of the unrelenting struggle between two concepts of sex that arose out of the Sexual Revolution of the 1960s. The struggle is at the core of the current culture war as well as of the debate on whether doctors should be allowed to refuse certain treatments on moral or religious grounds.
What, then, are these two opposing concepts of sex? First, there is the traditional concept, rooted in the sexual revolution initiated 3,000 years ago by Judaism and later reinforced by Christianity. It asserts that sex is meant to bond man and woman and, under normal circumstances, to create new life. It views sex as being truly human only when it is integrated into a personal relationship based on a lifelong commitment open to life. Second, there is the recreational view of sex—perhaps best characterized as the Playboy-view. It postulates that sex is nothing more than a pleasure game, with orgasm as the goal and the partner as the means to achieve it. If the sexual instinct is not "liberated," it becomes "repressed" and unhealthy.
The fact that the recreational view of sex is now widely accepted in our culture explains a good deal of the sea change that has taken place over the past half century: the growing popularity of common-law partnerships over marriage, the high rate of divorce, the widespread practice of abortion and the legitimization of homosexual lifestyles. These various matters all flow from the recreational view of sex.
The question thus arises: How did our whole culture switch from the classical Greek-Judeo-Christian view of sex to the recreational view within a matter of a few decades? While the struggle between defenders and opponents of the classical view was, until about 50 years ago, largely limited to what might be called intellectuals and scholars, and fought mainly at the level of ideas, it has since moved to all classes of society and is being fought at the level of our general understanding of sex, turning what was merely a war of ideas into a war of cultures. What brought this about? The one factor that most contributed to changing people's understanding of sex is contraception. The switch from the classical to the recreational view of sex is a result of the general acceptance of contraception. If it were not for this change, moral relativism might still be fashionable as an intellectual movement, but there would be no culture war.
Although this might arouse emotional reactions in many people, it is a matter that calls for debate in terms of reason. It is based not on Christian dogmatic teaching but on the part of moral philosophy called the natural law, which, broadly speaking, says things function well to the extent they are used in accord with their nature.
From a natural law perspective, there are essentially two reasons why contraception is wrong. But before describing them, it may be useful to first dispel one major misconception. Although people often think that contraception is the same thing as natural family planning (NFP), there is a basic difference between the two.
With contraception, one engages in sexual intercourse but only after having placed a barrier to the natural consequence (i.e., procreation). In NFP, one simply does nothing at all during the fertile period of a woman. From the point of view of natural law, NFP is in accord with nature, while contraception prevents nature from following its course.
This points to the fundamental reason why contraception is wrong. Its exposition was developed by John Paul II as part of his theology of the body and can be argued on the basis of reason alone. John Paul II said that when husband and wife become "one flesh," they engage in an act of total self-giving. To someone we love, we want to give everything and not withhold anything.
Contraception entails the withholding of one's fertility, which is something that inherently belongs to the sexual act. To withhold is to not give entirely. When there is contraception, the spouses are saying to each other: I want you totally, except for that part of you that could result in procreation.
The natural language of the body in sexual intercourse is a language of total surrender. But contraception neutralizes the natural fertility of the body and this makes the language of the body unnatural. Furthermore, what makes contraception immoral is that it makes the language of the body untruthful. Contraception contradicts not only the procreative end of the one-flesh union but also its unitive end. It makes the act of sexual intercourse dishonest.
A consequent reason why contraception is wrong is that it cultivates a negative attitude towards children. It creates a sense that having more than a few children is in conflict with the true quality of life. This is an immense fraud that permeates the lives of many people in the postmodern West, a fraud that presents the begetting and nurturing of children as a sorry and dreary enterprise. It creates a culture that views raising a family not as a challenging adventure but as a life of unfulfilling tedium.
The truth is that to procreate and rear a child is the noblest enterprise conceivable, more so than being prime minister of Canada, founder of Microsoft or winner of a Nobel prize. Any prime minister is replaceable, and so is any great inventor or scientist, because anything they do can be done by someone else. But no father or mother is replaceable. They bring into the world a human being endowed with eternal life. And that person will most likely, in turn, help found a family and bring into the world children of his/her own, also endowed with eternal life. When a couple has a child, they assist in creating not only an eternal human person but potentially a whole chain of eternal beings. What in the world can compare to that?
To summarize, from the point of view of natural law, there are two reasons why contraception is wrong. First, it introduces a wedge in the mutual self-giving of husband and wife. Second, it devalues procreation and the rearing of children. These considerations do not presuppose any particular Christian belief, but they do presuppose a law of nature – a law that brings all manner of misery when we violate it.
Consider what have been the major social consequences of the widespread use of contraception. There are at least five: the destruction of marriage as a cultural institution, same-sex marriage, abortion, a general decline in population, and deep changes in the character of men and women. The first consequence of contraception is the destruction of the culture of marriage that has prevailed over the past 1,500 years, as attested by several indicators, notably a major increase in divorce rates. In North America, the divorce rate doubled between 1965 and 1975, which is exactly the period when contraception became widespread, and has remained at about 50 per cent ever since. (By contrast, the rate of divorce among couples who do not practice contraception is virtually nil.) Today, young adults live together and have babies before getting married. In the U.S., 48 per cent of first births today are to unmarried women. According to several studies, the poor no longer get married. And middle-income and rich people postpone marriage to the end of their 20s.
Contraception is also the root cause of the promotion and acceptance of same-sex marriage. We cannot uncouple the love-sharing and life-giving ends of the one-flesh union without also uncoupling marriage and procreation. Married people who use contraception embrace the view that sex is primarily recreational and thus have no grounds for objecting to two homosexuals marrying and having recreational sex.
A third consequence of contraception is that, in addition to preventing births, it results in the killing of millions of human lives through a greater number of abortions. It has been estimated that 50 per cent of women who go to abortion clinics do so because of contraceptive failure. If one does not find that conclusive evidence of the link between contraception and abortion, then one might perhaps want to rely on the judgment of the U.S. Supreme Court. In a famous case, known as Planned Parenthood v. Casey, the Court stated the following: "For two decades, couples have based their intimate relationships on the availability of abortion should contraceptives fail." So you have it on the authority of the U.S. Supreme Court that couples view abortion as a safety net for contraceptive failure.
A fourth consequence of contraception is a drop in birth rates so drastic that the future of Western civilization seems imperiled. Indeed, population data indicate that our current secularist model of civilization is not viable. The total fertility rate (the number of children born to women aged 15 to 49) in Organisation for Economic Co-operation and Development countries stood at 1.7 in 2012, well below the replacement rate of 2.1 (that's the rate required for a stable population). In 2011, total fertility rates were well below the replacement level in most countries. Only six countries had a rate of at least 2 children per woman. And only two of those had rates over 2.1: Mexico and Israel.
This is not without precedent in human history. Lamenting his civilization's decline, the Greek historian Polybius wrote in 140 BC: "In our time, all Greece was visited by a dearth of children and general decay of population. This evil grew upon us rapidly, and without attracting attention, by our men becoming perverted to the passion for show and money and the pleasures of an idle life." A fifth consequence of contraception is the loss of our defining characteristics as male and female. Before the advent of contraception, to be male was, as a general rule, to be a husband and family protector; to be a woman was to be a child-bearer and nurturer. Man and woman, husband and wife relied on the unique differences of the other to create a cohesive family – an environment of love in which children could grow and become real men and women who in turn marry and raise families.
Contraception removes the family from a man. His virile powers no longer produce a family. Without a family, there is nothing that requires his protection. He becomes unnecessary because there are no children who need him. His wife, who bears no children, is working somewhere. She doesn't need his protection either. She can make as much money as he can, perhaps even more. The family was what gave meaning to the man. Having no occasion to exercise the strength of a husband or father, then man loses that strength. Instead of being called on to protect the family and bring home the food, he is called upon to be in touch with his feelings. The woman, having no children to raise, does not require the strength and virility of the man. Gallantry vanishes.
Modern culture is increasingly rebellious against the fundamental distinction between male and female, illustrating modernism's ambition to re-engineer our humanity. Man ceases to be a child of God and sets himself up as God. This is what stands behind all the evils just referred to. When a society decides to transgress the natural law, it does so at its own peril. Contraception is just such a transgression. It changes our identity as men and women, undermines the welfare of children and puts the future of Western civilization at risk.
The upshot of all this is that if a professional or public entity/organization were ever to require doctors to not refuse certain treatments, and in particular contraceptive means, such an entity would in effect be forcing them to act against their conscience and to abide by the rules of a secular religion to which they do not adhere. This would be wrong on two counts. First, from a strictly utilitarian perspective, it would not be an optimal solution: not letting doctors act freely would burden their conscience, while letting them act freely would burden no one (since their patients could get a prescription from a multitude of other doctors). Second, from a human rights point of view, a requirement to violate one's conscience would be a fatal blow to personal freedom and the development of a free society: a majority would be coercing a minority to adopt its own worldview, thus contradicting the very essence of an open society.