Vasectomy, or Sterilization, by State Law
The State of Indiana in 1907 enacted a vasectomy law which obliges the superintendents of some prisons and asylums to appoint two surgeons whose office is to sterilize sexually criminals, idiots, imbeciles, and similar persons, if these surgeons, in consultation with the chief physician of the institution, deem the propagation of children by such so-called degenerates detrimental to society. The same law has been incorporated in the statutes by New York, New Jersey, Washington, Iowa, Nevada, Wisconsin, Connecticut, California, Utah, Kansas, Oregon, and Minnesota. The law has been proposed several times in the Legislature of Pennsylvania, but it was vetoed twice and held up once in the Assembly.
In New Jersey there was question of sterilizing an epileptic girl, and the Supreme Court of that State[216] decided in 1913 that the law is contrary to the State and Federal constitutions. In 1916 Probate Judge Lapeer of Michigan declared the law as passed in his State in 1913 unconstitutional, but the State appealed against this decision. The Supreme Court of Washington[217] decided in favor of the law in a case where a man convicted of rape was sentenced by the trial judge to life imprisonment and to vasectomy as a punishment. The constitutionality of the Iowa law is on appeal to the United States Supreme Court after a Federal judge had declared it unconstitutional. The law in Indiana was put into effect in hundreds of cases, but Governor Marshall set the law in abeyance. Two Federal judges in Kansas said the law is unconstitutional and granted an injunction against its application in a particular case. In 1808 the superintendent of a Kansan institution for the feeble-minded castrated forty-eight boys. Up to April, 1916, about twenty-five feeble-minded boys in the Wisconsin institution at Chippewa Falls were sterilized, and the authorities then said they intended to sterilize the girls. The law has been advocated by alienists in Switzerland, and French and English physicians have advocated it.
The reason given by the advocates of this law is the alarming prevalence of feeble-mindedness with its tendency to criminality; and as, they say, heredity accounts for 65 per cent. of feeble-mindedness, the feeble-minded should be prevented from propagating their kind. Sweden, with 5,500,000 inhabitants, has 18,000 insane, 14,000 idiots, 20,000 imbeciles, and 7,000 epileptics. Much of this degeneracy is due to the notorious alcoholism of the Swedes, which only lately has been brought under some control. Pennsylvania had about 17,000 feeble-minded in 1913. In a single county almshouse in that State were 105 women who had given birth to 101 defective children. One feeble-minded couple in the same State had 19 defective children; two other families had 9 imbeciles and 7 idiots. In New Jersey the history of 480 individuals of the famous "Kallikak" family (a pseudonym), descended from a feeble-minded woman who lived at the time of the Revolutionary War, has been traced out, and of these descendants only 40 were normal. New York State has 32,000 known feeble-minded persons. One State school for the feeble-minded in Indiana in 1908 had 1054 inmates. There are 6000 mentally defective children in the schools of Chicago. An investigation made in Illinois about 1907 brought out the conclusion that all the defectives and delinquents in that State at the time could be traced to 150 families. Poehlmann of Bonn traced the descendants of one female drunkard through six generations in 800 individuals, and of these 107 were illegitimate, 102 were beggars, 181 were prostitutes, 76 were criminals in a grave degree, 7 were murderers, and they had cost the State $1,206,000. The Jukes sisters, two illegitimate prostitutes in New York State, in five generations bred 709 criminals. Fifty-two per cent. of the women were prostitutes, whereas the ordinary ratio of prostitutes to other women is 1.66 per cent. Alcoholics engender degenerates. In three generations of 215 French alcoholic families, Legrand found that 60 per cent. of the children were degenerates. Bourneville found that 62 per cent. of 1000 idiotic, epileptic, and feeble-minded children in Paris had alcoholic parents.
Hereditary transmission is certainly a cause also of many diseases of the nervous system. Friedrich's ataxia is hereditary. It is an incurable progressive incoördination of the limbs, tongue, larynx, and eyes, which attacks commonly between the tenth and the twentieth year, and the patient dies from some intercurrent disease, usually an infection. Progressive muscular dystrophy is also hereditary and incurable. The legs and trunk atrophy, and death comes from an intercurrent disease. Related to this malady are hereditary progressive neurotic muscular atrophy, progressive spinal muscular atrophy in infants, and progressive spinal amyotrophy in adults. Amaurotic (amaurosis, blindness) family idiocy is hereditary, and the child dies at about two years of age. Huntington's chorea appears in every generation of an affected family. Its symptoms show between the ages of thirty and forty years, and it progresses from choreic and ataxic signs to dementia and death. The death is often by suicide. In eastern Long Island, southwestern Connecticut, and eastern Massachusetts 962 cases were all traced back to six persons, three of whom were probably brothers, who came to America in the seventeenth century. In the 3000 relatives of these choreics were 39 cases of epilepsy, 51 cases of cerebral inflammation, 41 cases of hydrocephaly, 73 feeble-minded children, and other evidences of neuroses. The heredity in this disease is apparently Mendelian. Besides the diseases enumerated here, there are several pathologic conditions of the eyes which are hereditary—presenile cataract, stationary night blindness, and retinitis pigmentosa. If the persons who have these diseases are sexually sterile, evidently the heredity so far as they are concerned will be cut across; hence the advocates of legal sterilization wish to have these patients sterilized to protect society.
The surgical operation by which the man is sterilized according to the State laws mentioned above is an interruption of the continuity of the vasa deferentia near the testicles. This interruption may be a severing of each vas, a cutting out of a part of each vas, or a ligation of the vasa. The term vasectomy is now used loosely to cover all these methods. The vas deferens, or seminal duct, passes from the testicle up along the groin on each side, in through the belly-wall by the inguinal canal, down along the pelvis and under the bladder, where it opens into the bottom of the urethra a short distance in front of the bladder exit. Each vas is about two feet in length, and it has a diameter of one-tenth of an inch throughout the greater part of its length, but its lumen is extremely narrow.
There are two essential parts in the semen, the spermatozoa and the carrying liquid. The spermatozoa, which fructify the ovum, are formed in the testicle; the liquid, which is the essential vehicle of the spermatozoa, and without which the spermatozoa are inert and sterile, is secreted, except a few drops from the testicles, at the distal end of the vasa deferentia under the base of the bladder, in the seminal vesicles, the prostate gland, and Cowper's and Littré's glands. The semen is made up of 90 per cent. water and 10 per cent. solids, and in these solids is the nitrogenous base called spermin, which is produced by the interstitial cells of the testicles and the prostate gland. Ovarin, secreted from the ovaries, corresponds in the woman to spermin in the man. The ductless glands, and some that have ducts, produce secretions which sustain the tone of the blood-vessels and neutralize the toxins from waste substances while these are in the body before excretion. An excess of spermin or ovarin causes congestion of the cerebrum and cerebellum and the nerve centres there, with consequent sexual erethism. When there is a pathologic sexual erethism from an excess of spermin or ovarin, vasectomy, castration, spaying, or the menopause cuts off this excess and the erethism disappears. Sometimes the waste product toxins excite the patient when the spermin or ovarin has been eliminated, just as the excess of spermin or ovarin excites, and the neurotic disturbance or sexual erethism continues until compensation by other glands neutralizes the irritating substance.
The testicles in man are by no means the sole organ of generation. There are at least seventeen distinct organs in the male generative system. The seminal vesicles with the prostate gland are as necessary in generation as the testicles, as their removal sterilizes the spermatozoa and prevents the formation of the liquid vehicle. Castration effects an atrophy of several parts of the generative tract, and an irremediable degeneration; vasectomy cuts off the spermatozoa but causes no atrophy or degeneration, and the condition is remediable. Dr. Edward Martin of Philadelphia found active living spermatozoa in a testicle that had been ligated off for twenty years.
Running along the vasa deferentia, within the sheath of the two spermatic cords, are the spermatic arteries, the pampiniform plexus of veins, and the deferential arteries. These vessels, with the vas deferens and the sheath enveloping the bundle, make up the spermatic cord. In vasectomy, under local anesthesia, a slit is made through the skin of the scrotum behind, the sheath of the spermatic cord is opened, and the vas is isolated and tied or cut. The skin wound is left to heal. This operation is repeated on the second vas. If the blood-vessels in the cord are ligated or cut with the vas, the testicle will atrophy; if the vas alone is operated upon, the testicle is not injured. The person upon whom vasectomy has been done is conscious of no change. The semen is discharged as before the operation, but in a slightly less quantity, and it is, of course, sterile from the lack of spermatozoa.
Dr. Carrington of Virginia reported, in 1910,[218] twelve cases of vasectomy on convicts. He said ten of this dozen had been confirmed masturbators, and all were cured by vasectomy. One masturbating epileptic was cured of both conditions. Two dangerous homicides were rendered harmless and peaceable. One of these two homicides was a negro under a long sentence for murder. He grew insane in prison, and while insane killed a second person. A confirmed masturbator and sodomist, and a dangerous savage, he became lucid and relapsed into insanity several times. A year after vasectomy he was "a sleek, fat, docile, intelligent fellow, a trusty about the yard."
Dr. Sharp of Indianapolis, after ten years' experience with the operation, during which time he did 456 vasectomies, says:[219] "There is no atrophy of the testicle, no cystic degeneration, no disturbed mental or nervous condition following." He says, further, that 176 men in the Indiana Reformatory asked him to perform the operation on them. Vasectomy tends to check masturbation, and the minds of the masturbators frequently improve after the operation.
If a man has been sterilized by vasectomy, restoration of function and removal of the sterility seems practically always possible. If a ligature has been used, releasing the ligature restores function. Dr. William T. Belfield of Chicago[220] restored function fully by removing the ligature eight weeks after it had been applied. In a letter to me, Dr. Belfield said: "My observation accords with the general experimental and clinical experience that the restoration of the lumen after vasectomy or ligation, or both, is more certain than the lasting occlusion of the vasa by these measures. The perseverance of natural forces in restoring the lumen of the vas—and the success achieved over such obstacles as silk ligatures—is surprising until one reflects upon the natural factors favoring such restoration. In one case I tied a waxed (to avoid cutting through) silk ligature tightly around the sheath of each vas; a specimen examined a month later was devoid of sperms; one six months later contained plenty of them. I cut down upon the ligatures, found them in place and neatly encysted, and removed them. Evidently the pressure from behind had squeezed a passage on at least one side. The gynecologists have learned that ligatures around the Fallopian tubes are apt to cut through, whereupon the tubal lumen is restored, though pressure must be less than in the vas. Even when a piece of the vas has been excised cases of spontaneous restoration have been observed in men and dogs."[221]
When the ends of a cut vas are released from cicatricial tissue, these ends may be sutured together; but as the lumen of the vas is extremely small, there is sometimes obliteration by occlusion at the juncture. Christian and Sanderson[222] described a method of preventing this obliteration. A piece of No. 0 twenty-day catgut is inserted three-eighths of an inch into each end of the vas, and these ends are brought together by two catgut sutures, leaving the inserted catgut in the canal. The ends heal together and the catgut in the canal is absorbed. This method has been used successfully to join the cut end of a Fallopian tube.
Gemelli[223] did vasectomy on eleven dogs and seven cats; about six months later he reunited the cut ends, and on dissection found restoration perfect, anatomically and functionally, in the eighteen animals. The vas deferens in these animals is smaller than in man; and therefore offers greater difficulty in the suturing. He used no inserted catgut, but told me he employed the method Carrel applies in joining cut arteries. In one case, where the dissection was broad, he successfully inserted a piece of a vas taken from another animal. Whether there is occlusion or not after end-to-end suturing depends largely on the skill of the surgeon.
Dr. Edward Martin of the Pennsylvania University[224] and Delbet[225] have removed sterility by effecting a patulous anastomosis between the vas and the epididymis, and this method is applicable after vasectomy by cutting, but it is not successful, as a rule. It has been done effectively where the vas had no stricture. McKenna,[226] in five attempts on men, succeeded once. Fürbringer[227] said that in his experience with a thousand cases of double epididymis, the condition is incurable in 80 per cent. of the gonorrheal infections.
Apart from the so-called vasectomy law, gynecologists quite frequently sterilize women who have chronic heart disease, tuberculosis, nephritis, diabetes, or hereditary mental taints. Some men, like Spinelli, Cramer, Polak, and others, would sterilize also in chronic anemia, persistent albuminuria, epilepsy, syphilis, contracted pelvis, diseases of metabolism, infections, and cirrhosis of the liver. There are several methods of sterilizing women—removal of the ovaries, ligation of the Fallopian tubes, resection of portions of the tubes, resection of the whole tube on each side, cutting the tubes and burying the cut end in the tissues by various methods, and destruction of the lining of the uterus by vaporization or the thermocautery. De Tarnowsky[228] describes the various methods. Some ligations and short resections have failed to sterilize. When the ovaries or uterus are removed, or the major part of the tubes are resected, or the lining of the uterus has been destroyed, the sterilization is permanent. Almost certainly function could be restored where the resection of the tubes is not too destructive. Apart from the matter of mutilation, the effects of double oöphorectomy are very grave,[229] and removal of the uterus or the ovaries merely for sterilization is not only immoral, but altogether unjustifiable scientifically.
A phase of this subject which is important and has occasioned much discussion is whether vasectomy causes sexual impotence or not. From a medical point of view, there is no question of impotence; physicians would say it causes sterility only. Most canonists, however, hold that the condition after vasectomy is technically impotence in the canonical sense. Ferreres of Tortosa, a leading Spanish canonist, in several articles in the Ecclesiastical Review, in Razon y Fe (xxviii, 376; xxxi, 496), and in his book De Vasectomia Duplici (Madrid, 1913), opposed my opinion published in 1912 and 1913, which then was that vasectomy does not cause canonical impotence. De Smet of Bruges[230] holds that it causes impotence. So do Ojetti,[231] René Michaud,[232] Wouters,[233] Eschbach,[234] Capello,[235] Stucchi,[236] De Becker, Vermeersch, De Villers, and Salsmans of the University of Louvain, and others. Gemelli of Milan[237] agreed with me. The weight of authority is certainly in favor of the notion of impotence, but the arguments are by no means convincing, as virtually every canonist who has discussed the question has made gross misstatements of the physical facts in the case.
If a man or woman is impotent, the disability is an impedimentum juris naturalis, and as such it would nullify any marriage, no matter what the dispensation. There are two opinions among moralists as to the essence of canonical impotence.
I. Some hold that any permanent obstruction to fecundation, no matter in what stage of the physiological process or in what part of the genital tract it occurs, constitutes impotence. They maintain that a woman whose ovaries or uterus have been removed is impotent. Roman Congregations have promulgated several decrees in peculiar cases permitting the marriage of spayed women; but, these moralists say, it is not clear that in those special cases the entire ovary on each side of the whole uterus was taken out; they hold there is doubt as to the fact. And, since there is disagreement of moralists, the Holy Office or other congregations would give the same decision because of the dubium juris.
April 2, 1909, the Congregation on the Discipline of the Sacraments decreed that the marriage of a Spanish woman, from whom, according to the physician in charge of the case, the uterus and both ovaries had certainly been removed, should not be prevented.
February 3, 1887, the Holy Office made the same decree in the case of a woman from whom the uterus and both ovaries had been removed.
July 23, 1890, the Holy Office made the like decree under the same conditions.
July 31, 1895, the Holy Office permitted the marriage of a woman from whom both ovaries had been removed.
Another case, in 1902, in which the physician was not certain that the whole ovary on each side had been removed, was decided in the same manner.
There have been, then, four decisions so far permitting the marriage of women who lacked both ovaries, and three of these women lacked the uterus also. The Congregation of the Council has made four decisions in recent time forbidding the marriage of women because of impotence; March 21, 1863, a case in which there was neither vagina nor uterus; January 24, 1871, a case in which the vagina was only two inches in depth; September 7, 1895, a case in which the vagina was obliterated in greater part; December 16, 1899, a case in which the vagina was only five centimetres in depth.
That a woman who certainly lacks both ovaries is canonically impotent is the opinion of Antonelli,[238] Lehmkuhl,[239] Rosset,[240] Alberti,[241] Bucceroni,[242] and others. These men meet the decisions of the congregations concerning the spayed women by saying it is not certain the whole ovarian tissue or the entire uterus was removed, although as a matter of fact the physician in one case testified explicitly that both ovaries and the whole uterus were undoubtedly removed. That a woman lacking both ovaries is not impotent is the opinion of Gasparri, D'Annibale, Génicot, Berardi, Aertnys, Tanquerey, Ojetti, De Smet, and others.[243]
II. The second opinion on impotence is that this condition is caused exclusively by those permanent disabilities which exist in the copula itself. If the sexual act contains in itself all that is essential to generation, if the copula is de se apta ad generationem, prescinding from all antecedent and subsequent, temporary or permanent, obstructions to generation, there is no impotence. In this opinion the woman without ovaries is not impotent, but the vasectomized man is; in the first opinion both the mulier excisa and the vasectomized man are impotent. The second group says the vasectomized man is incapable of performing an act de se apta ad generationem because his semen lacks the essential spermatozoa. If one objects that the spayed woman, who is not impotent according to some moralists that so interpret the decisions of the congregations, lacks the essential ovum, so that she cannot perform an act de se apta ad generationem because she has nothing to generate with, they answer that her copula is per se apta, that there happens in it everything which takes place in a copula from which generation actually follows. The vasectomized man cannot go through the form of the act with all the elements which, so far as the act is concerned, are required and sufficient for generation because he lacks the spermatozoa, but the mulier excisa can. His inability is intrinsic to the act, it vitiates the very substance of the act; her inability to present ova is not intrinsic to the act, they say. All that is necessary in her case is that she be capable of receiving the semen.
Marriage was instituted to beget children; that is the proper end of the contract, its basic justification. Whenever the debitum is used it must be with the intention of generating children. Even the use of marriage as a remedy of concupiscence is so secondary an end that it alone is not enough to legitimize marriage. Because a woman does not always have ova present in the tubes,—and there is no means of knowing just when the ova are present,—it is justifiable to repeat the conjugal act until the woman is impregnated; secondarily and dependently, the repetition may be a remedy of concupiscence. The sexual act does not form either the spermatozoa or the ova; these pre-exist. The spermatozoa are always released in a normal sexual act; the ova are not always present when the spermatozoa are released. A copula which is perfectly de se apta ad generationem supposes not at the time the presence of both sperm and ovum, but it does suppose the possibility of the ovum, otherwise generation is utterly impossible; and every copula becomes justifiable solely because there is a hope that it may be present. It is a mere quibble to say that an act is de se apta ad generationem if by no possibility generation ever can take place; nevertheless the congregations in four cases have apparently judged to the contrary. In these special decisions, however, Rosset, Antonelli, Bucceroni, and Palmieri hold there was a doubt in the minds of the members of the congregation as to the complete removal of the ovaries or uterus. Bucceroni expressly states[244] that the Cardinal Secretary of the Holy Office told him personally the members of the congregation supposed in the particular cases that generation could follow. Therefore these decisions do not say that the mulier excisa in general is not impotent or potent; they merely gave the women of these cases the benefit of the doubt. Tho question is entirely open so far as these decisions are concerned.
Those who hold that vasectomy causes canonical impotence say also the constitution of Sixtus V. forbidding the marriage of eunuchs is applicable necessarily to the vasectomized man, because the semen from the vasectomized man, inasmuch as it lacks spermatozoa, is not genuine semen, and Sixtus V. said eunuchs cannot produce true semen. The relevant passage in the constitution is: "Cum frequenter in istis regionibus eunuchi et spadones, qui utroque teste carent, et ideo certum ac manifestum est eos verum semen emittere non posse; quia impura carnis tentigine atque immundis complexibus cum mulieribus se comiscent, et humorem forsan quemdam similem semini, licet ad generationem et ad matrimonii causam minime aptam, effundunt, matrimonium ... contrahere praesumant ... mandamus ut conjugia per dictos et alios quoscumque eunuchos ... contrahi prohibeas."
Sixtus V. says here: (1) that eunuchs "who lack both testicles certainly and evidently cannot emit true semen"; (2) that "although eunuchs may perhaps produce a kind of liquid resembling semen, this is by no means fit for generation or marriage"; (3) therefore eunuchs are forbidden to marry. The effects of castration in the eunuch are: (a) that all spermatozoa are absent; (b) that, as a consequence of the absence of the testicles, the power of penetration is lost; (c) that, as another consequence, the liquor seminis, which normally is formed in the seminal vesicles, the prostate and other glands, is no longer secreted. The eunuch, then, is completely impotent, in the full sense of the term. Ferreres is of the opinion, erroneously, that eunuchs, as a rule, have the power of penetration and of emitting a humor semini similis, and that amputation of the penis is requisite to cause impotence in eunuchs. There are only five authentic cases of temporary apparent potence in eunuchs in modern medical records, and these are explicable as cases of erethism from waste-product intoxication.
The canonists who hold that the vasectomized man is impotent interpret the words of Sixtus V. to fit their opinion, although the vasectomized man has all the sexual potency of the normal man except that his spermatozoa are occluded. The potestas coeundi is not lost in any degree; neither he nor the woman is conscious of any change whatever. Only the microscope can tell that the spermatozoa are absent if the fact that he has been vasectomized is not told. Moreover, if vasectomy has been done by mere cutting without considerable resection, and especially if the vasa have been shut by ligation alone, no one can be certain that the occlusion is either certain or permanent. There is always doubt that the spermatozoa are present if the microscope is not used, and these canonists all disclaim the use of the microscope in such circumstances. The argument Ferreres uses, to the effect that the absence of spermatozoa is seriously injurious to the woman, is a supposition of his own arising from an erroneous notion of potency in the vasectomized. This absence is not injurious to her, but it is probably injurious to the vasectomized man because of the partial ejaculation. Onanism, which is different, is decidedly injurious to both the man and the woman.
Onanism, coitus interruptus, or withdrawal before ejaculation, which takes place extra vas, is intended to prevent impregnation. In the normal sexual act the male genital tract suddenly becomes congested with blood through nervous action of centres in the lumbar cord and the cerebrum. Cowper's and Littré's glands secret an alkaline fluid which neutralizes the acid urine in the urethra and thus prevents killing of the spermatozoa. Muscular peristaltic action presses out the spermatozoa and the secretions of the seminal vesicles and the prostate. When the act is normal there is a complete emptying of the tract of semen and of the blood engorgement; in coitus interruptus there is incomplete ejaculation and only partial deplethorization. The seminal vesicles remain distended, and this distention, with the congestion of the prostate, causes continual excitation of the sexual centres without relief. There is irritability and exhaustion of the centres, and this state brings on premature ejaculation and final impotentia coeundi. Other common effects are tenesmus of the urinary bladder, incontinence of urine, nocturnal pollutions, sexual neurasthenia, pain in the legs, over the eyes, and in almost any part of the body, general weakness, headache, vertigo, cardiac palpitation, neurotic dyspepsia, and a train of psychic symptoms which not seldom end in suicide.
In the woman there is the like blood engorgement and a pouring out of the secretions of Bartholin's and the other glands, but deplethorization takes place later in the woman than in the man, and for this reason the woman suffers more from coitus interruptus than the man does. In onanism, as in masturbation, after the diseased conditions have been established it is extremely difficult to induce the patient to resist the almost overwhelming irritation.
The canonists have interpreted the text of Sixtus V. to the effect that the eunuch is impotent precisely and solely because he cannot produce semen "elaboratum in testibus." No man produces semen elaboratum in testibus—more than 93 per cent. of the semen is produced entirely outside the testicle; nothing but the spermatozoa and two or three drops of a lubricating fluid are produced in the testicles. The eunuch really is impotent because the removal of the testicles and their nervous system so breaks the genital circuit, which consists of at least seventeen distinct parts, that erection is prevented, the formation of spermatozoa is impossible, the secretion of the essential vehicle of the sperm and of the fluids which render it fertile is cut off. The eunuch cannot penetrate and he cannot form any semen; he is impotent; the vasectomized man can penetrate, and he forms a semen which is sterile.
I think now the vasectomized man is really impotent for the reason that I think the mulier excisa is impotent, but he is not impotent because of the constitution of Sixtus V., which is not relevant at all to his case.
If the vasectomized man is impotent, the following cases are also impotent:
1. A man whose germ-cells have been destroyed by the action of the X-ray.
2. A man with double permanent occluding epididymitis.
3. A man whose vasa deferentia open into the ureters and not into the urethra.
4. A man whose vasa are shut by surgical operations for stone, or cysts of the prostate, or seminal vesicles.
5. A man whose seminal vesicles are shut by concretions, cysts, or tumors.
6. A man with bilateral cryptorchidism.
7. A man with a tuberculous condition of the testicles.
8. A man with absolute neurotic aspermia.
9. A man with congenital lack of development of the testicles or vasa.
Sterility in the male would exist only in advanced diabetes, general tuberculosis, senility, or in cases of absent or diseased prostate gland or seminal vesicles.
Here it is worth noting that since the copula must be natural, fit for generation in the natural manner, artificial impregnation by the use of instruments is immoral, and forbidden by a decree of the Holy Office, promulgated March 24, 1897. Artificial impregnation does not effect a copula which is by its nature proper to generation, but is an act contrary to nature, one from which generation does not follow in a natural manner, secundum communem speciem actus. It supposes deliberate pollution and semination outside the vagina, both of which actions are intrinsically evil.
In discussing the morality of vasectomy the following points must be considered:
1. In what degree of mutilation is vasectomy?
2. Vasectomy may be done either at the request or by the permission of the vasectomized person; or by order of the State.
(a) If done by the request or permission of the vasectomized person, it may be either (1) as a means to use the debitum without the inconvenience of having children; or (2) as a therapeutic measure to cure some malady.
(b) If done by order of the State, it may be (1) a punishment; or (2) a prophylactic measure to avert physical or moral evil in society.
If vasectomy causes canonical impotence, that fact adds a special moral quality. The weight of authority is on the side that it does cause canonical impotence, as has already been mentioned.
A slight mutilation, in the sense of the term as commonly used, can be any permanent effect of a wound, bruise, or similar cause, from a mere scar to an amputation or other injury whereby any member of the body is rendered unfit for normal action. That the causal wound or injury is trivial in itself, apart from its effect, as in vasectomy, has little or no direct bearing on the morality of the mutilation. It is possible to have a very gross mutilation without extensive wounding. We can blind a man permanently by putting the point of a fine cambric needle one-twentieth of an inch within the pupil.
Vasectomy is a grave mutilation because (1) it removes from the man the power of generation; (2) it inhibits the function of the testicle, which is an important organ of the body. Although they are not the entire organ of generation, the testicles are together a complete organ in themselves, the function of which is to produce the spermatozoa essential to the procreation of the human species. If by a wound one inhibits the function of the testicles, he gravely mutilates the human body, for a grave mutilation is nothing but an inhibition of the function of a distinct organ through a wound.
A mutilation of this kind, since it frustrates the production and action of the human generative semen and prevents generation, is what is technically called a mortal sin against nature, unless there is sufficient cause to necessitate the frustration, such as to save life, to restore as a sole means the health of the whole body, to protect society, or a similar reason. What is said here of vasectomy is true for fallectomy or other methods of sterilizing the woman. Fallectomy, however, is in itself a dangerous operation, and oöphorectomy is never justifiable as a mere method of sterilization because of its very injurious effects on the whole body and mind of the woman.
Among the decretals of Gregory in Corpus Juris (lib. v, tit. xii, c. 5) is the following canon: "If any one, for the sake of indulging lust, or through revenge, does anything to a man or woman, or gives them anything to drink, whereby they cannot generate, or conceive, or bear children, he is to be treated as a homicide." Any one who sterilizes a man by vasectomy or a woman by fallectomy or oöphorectomy, for an improper motive, ipso facto falls under this decree, and is before the canon law classed in the same category as a murderer; that is, the agent is deemed guilty of a grave crime against nature.
If a man has vasectomy done upon himself, his intention may be (1) to use the debitum without the inconvenience of having children; or (2) to avert from a wife with a narrow pelvis the dangers of the cesarean section or other obstetrical operation to herself and the child; or (3) to avoid the transmission to possible offspring of a hereditary disease like Huntington's chorea or one of the others mentioned at the beginning of this chapter; or (4) to cure himself of some malady.
1. If vasectomy is done merely to be able to use the debitum without the inconvenience of having children, it is evidently illicit. It is in that condition the same as onanism; it is contrary to the basic justification of marriage; it is a frustration of nature; and so on.
2. If it is done to safeguard a wife with a narrow pelvis it is a means, evil in itself, used directly to effect a good end; and a good end, or any end or effect, never justifies a direct evil means or cause. There is in reality no such thing as a good effect from an evil means or cause; the evil means or cause essentially and substantially vitiates the effect. There is no question here of a double effect, one good and one evil, wherein the good effect is intended and the evil permitted, both coming with equal directness from the single causal act. On the contrary, from the vasectomy here there is the single direct effect that the man is sterilized, and then directly from this sterility comes the desired effect, the protection of the wife. For exactly the same reason, vasectomy done to prevent the transmission of a hereditary disease is illicit; it is an evil means used directly to effect an end intended. In artificial abortion when the fetus is inviable the act done is to empty the uterus, and this act itself kills the fetus, which is not an unjust aggressor, and is murder. This murder may save the mother's life, but the end does not justify the means. The vasectomy to protect the mother's life or to avert an evil heredity is a parallel case.[245]
The fourth case supposes that the vasectomy was done to cure the man of some malady. If there were a malady that endangered the patient's life, or destroyed the health of the body and it could be cured by vasectomy, the operation would of course be licit for the reasons given in the chapter on General Principles concerning Mutilation. Dr. Carrington tells us[246] that he did vasectomy on an epileptic convict and cured him. Such a cure is doubtful as to permanence. He describes two dangerous insane negro homicides who were rendered harmless by vasectomy. In cases like those of the homicides any one responsible for them would probably be justified in having the operation done, although these two cases are the only direct ones on record. Epileptics sometimes show a homicidal tendency, but it is doubtful that vasectomy would help them. The operation of vasectomy as a cure for bodily ill has a very limited field. There are very many conditions in women where it is necessary to remove the ovaries or the tubes to save life, or to cure chronic invalidism of an unbearable nature. These conditions are discussed in the chapter on Gonorrhea. There is no objection to the removal of a tube or an ovary when such removal is absolutely necessary, but the necessity must be clearly evident. There is a tendency in some surgeons to mutilate women in this manner without sufficient reason or to follow out a therapeutic theory.
Men, like Sharp, who have done hundreds of vasectomies, say the operation commonly removes the inclination to masturbation. Masturbation is, as a rule, a moral condition, but it can, like alcoholism, come to have a large physical element. Idiots almost unexceptionally have this vice, and in them there is no morality possible. If by vasectomy they can be cured of this vice, which injures their health and is a social indecency and a source of sin in observers, the operation would be licit in their case. When the patient is morally responsible vasectomy would not be licit, as there is no adequation between a physical evil like sterilization and a moral vice. There are cases of pathological sexual erethism which are so violent that the patients must be put into strait-jackets to prevent constant masturbation. The semen of such patients is usually devoid of spermatozoa. If the patient is confined in a strait-jacket he will die, and vasectomy, according to Sharp, will quiet such a man. Vasectomy would be permissible in these circumstances.
The question has arisen in the case of a sane masturbator who is neurotic, weak-willed, and a confirmed addict to his vice, whether or not his vasa might be tied off by ligatures, temporarily, with the intention of removing the ligature later and restoring function. I think not. Even temporary sterilization is sterilization, a grave mutilation, while it lasts, and the condition is really moral fundamentally, and therefore not a fitting object for physical remedies.
When vasectomy is done by the State, it is done either as a penal or as a prophylactic measure. As a general statement we can say the State in certain conditions has the right to kill or mutilate a criminal in defence of the social order; but even then any punishment, to be justifiable, must be effective and necessary, and it has to be either reformative, exemplary, or reparative in regard to the crime for which it is inflicted. Capital punishment and mutilation are effective usually, and are necessary for the preservation of society. The natural law permits the State to preserve itself against the unjust encroachments of individuals by curtailing their rights in so far as that curtailment is effective and necessary: since the natural law requires the existence of civil society, it must allow what is necessary for the preservation of that society. There is no question here of a good end justifying evil means; the means which otherwise would be evil in these conditions become good. Homicide and mutilation are not mere killing or mere maiming, but unjust killing or unjust maiming. Killing or maiming is not intrinsically wrong under all circumstances, as lying, blasphemy, and some other crimes are; nevertheless, as a punishment by maiming, vasectomy is ordinarily wrong, and therefore a law making it an ordinary mode of punishment for certain whole classes of criminals, or all criminals, is unjust.
It is wrong because as a punishment it is neither effective nor necessary nor reformatory nor exemplary nor reparative—it lacks every quality of a justifiable punishment. In Dr. Sharp's list of vasectomies done in Indiana prisons, 176 operations were done on men who voluntarily asked for vasectomy. There is no pain, no inconvenience caused by the operation, no sexual change perceptible, but a fitting of the criminal to indulge his lust without the various inconveniences of impregnation. Instead of being reformatory, it is conducive to crime. I find only one man who objected to vasectomy.[247] In this man vasectomy was added to life imprisonment as a punishment for rape.
The legislators in the States which have passed the vasectomy law all seem to have been influenced by the pseudoscientific notion that criminality is a hereditary condition, a physical disease, and not a matter of volition. This Lombrosan absurdity is now held by no physical scientist, and from an ethical point of view it is nonsense. Moreover, if the State vasectomized all the criminals in the jails, this method would not appreciably affect the supply of criminals, nor reach an appreciable minority of the criminal class, as the most dangerous criminals are not in jails.
The operation is not a punishment to the men upon whom it is done, but it is an unnecessary deprivation of an essential right of these men, an excessive, ill-ordered attack on a primary right of man, and an act of violence against human nature and its Author without adequate reason. The law is against the natural order because it directly deprives a man, and that against his will, of functions which are at times a moral necessity to him, and puts him into the occasion of sin. Vasectomy does not remove his venereal desires, but gives opportunity to lust; it turns the conjugal relation into mere onanism and degrades marriage into a crime. Other conditions, like military service, in which necessity obliges the State to place its citizens and thus prevent the conjugal relation, cause an indirect temporary prevention, reluctantly permitted, not directly intended. Vasectomy is an evil directly intended.
It is to the interest of the State to prevent the transmission of hereditary disease, and in doing so it may to a certain degree curtail the natural liberty of its citizens. When the peril is great, as in a plague, the State may isolate infected individuals, and thus indirectly, but temporarily, prevent a natural right—namely, the conjugal relation. It may even perpetually isolate, as in leprosy. Vasectomy, however, is a direct prevention without reason, and it is done as a direct evil means to effect a so-called end which it never attains.
A man with Huntington's chorea, if married and if he has children, will surely transmit the disease to some of these children, and they to their children. Vasectomy on him will prevent a propagation of his kind but will cure no disease. Moreover, he is not a criminal and not amenable to punishment. The bad effect, sterilization, must be perpetual in his case or it is foolish, but the sterilization is not a punishment, nor a means of saving the health of the patient. Whatever good comes of the act comes out of an evil cause. If such a man persists in marrying, his marriage might be prevented, but that is different from mutilating him.
The State has no direct dominion over the lives or members of its citizens, nor are citizens naturally mere instruments for the good of the government; on the contrary, the government exists solely for the good and utility of the citizen. The State may not take the life of an innocent person, nor mutilate him, unless these acts are necessary either (1) to protect the life or rights of individuals; or (2) to preserve the social life of the commonwealth. Now, neither of these two requisites is present when there is question of vasectomizing a man.
The right or life of no individual is at stake. The rights of the possible children, yet unborn, are not injured, because, as these children are not in existence, they have no rights. Should they come into being, it is always better to be, even though diseased, than not to be. The methods of cattle-breeders in dealing with human beings is not a virtue in the State, but an outrage and a degradation of human nature.
The rights of the wife are not injured, because she personally receives no injury; and if her possible children have chorea, for example, she either voluntarily took that risk when she married, or if she did not, through ignorance, there are other means to avoid the trouble than the evil of sterilization, which in itself would render the use of marriage onanistic. If the husband has syphilis, gonorrhea, leprosy, tuberculosis, or any other infectious disease, vasectomy is no protection for the wife.
May a physician employed by the State in a prison, an institution for the feeble-minded, or a like place, do vasectomy at the command of the law? Certainly he may not, except in those rare cases where vasectomy is permissible as described above.
The advocates of freakish legislation harp on the assertion that insanity and imbecility are increasing alarmingly, and as a consequence the entire nation is degenerating. To cure this evil we are to mutilate certain criminals and the mentally defective. It is not true that insanity and mental imbecility are increasing in a very marked degree in the United States. The number of inhabitants in this country is increasing rapidly, and as there are more people here than there were a few years ago, the number of the insane and the mentally defective has increased pari passu, but the percentage does not increase to any degree that calls for immoral and ineffective legislation. Only of late years have the State governments begun to classify, diagnose, and gather up the insane and the imbecile, whom we always have had with us, and these processes have brought the defectives into the light.
Our late immigrants are not equal in race, in mental and moral strength, to the old northern European immigrants. In Philadelphia the foreign-born population is 24.7 per cent. of the whole, but that foreign-born population gives us 44 per cent. of the indigent insane. In New York State 27 per cent. of the registered insane are not American citizens. What we need here is not sterilization, but a better control of the immigrant, a keeping out of the unfit. Again, our insanity percentage is increased avoidably by the undoubted increase of insanity among negroes. We are accountable for this because we do not care for our helpless negroes. These people are prevented by trades-unions from learning and working at elevating trades, and they are thus forced unjustly into a poverty and degradation which lead to vice and mental deterioration. The cure is not a jail surgeon's scalpel, evidently.
A system of education that ignores the will, upon which morality and virtue are based, and substitutes a sham intellectuality as elaborated by ignorant boards of education and administered by emotional, half-educated women, together with a lack of genuine religion, is a prolific source of mental and moral deterioration and consequent degeneracy in the physical and moral orders. Our American public-school system is such, and its deity is the unwashed and crassly depraved god Demos, whose bible is the evening newspaper. If we could civilize our schools, we should have no mention of legislation by vagary.
BIBLIOGRAPHY
Ecclesiastical Review, vols, xlii, xliii, xliv, xlvi, xlvii, xlviii, passim. Philadelphia.
Gemelli. La Scuola Cattolica, November, 1911. Milan.
Stucchi. Ibid.
Eschbach. Ibid., February, 1912; Analecta Ecclesiastica, September and October, 1911.
Capello. La Scuola Cattolica, February, 1912.
Michaud. Nouvelle Revue Théologique. Paris, 1914.
Schmidt. Zeitschrift für katholische Theologie, nn. 1 and 4, 1911.
Ferreres. De Vasectomia Duplici necnon de Matrimonio Mulieris Excisae. Madrid, 1913.
De Smet. Collationes Brugenses, December, 1910.
Wouters. Nederlandische kathol. Stemmen, January 15, 1911.
Waffelaert. De Virtutibus Cardinalibus, vol. ii. Bruges, 1889.
Sharp. Journal of the American Medical Association, December 4, 1909. This is the article which started the entire vasectomy controversy.
Barker. Maryland Medical Journal, April, 1910.
Bell. Hereditary Criminality. Medico-Legal Journal, vol. xvii. New York.
Desfosses. Presse Méd., vol. xviii.
Rentoul. St. Thomas Hospital Gazette, vol. xx. London.
Swift. Maine Medical Association Journal, December, 1914.
Lydston. Medical Record, November 8, 1913. New York.