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.