ROME—When 42-year-old Luisa Del Vecchio couldn’t take the debilitating pain caused by her endometriosis any longer, she was faced with a moral dilemma. As a staunch Catholic who teaches at a private Catholic school in Florence, she knew well that having a hysterectomy by choice over medical necessity would be a sin because it would cause permanent sterilization—in other words, irreversible birth control.
Del Vecchio, who has four children, has always believed in the Catholic Church’s indisputable teachings on birth control: Sex should only be between a man and a woman, and only under conditions that leave the woman “open to the possibility of conception.” That means elective hysterectomies on the basis of pain alone, not life-or-death situations, were a sin.
Del Vecchio had the hysterectomy anyway in 2015. “After consulting with my priest who tried to talk me out of it, I decided I just couldn’t deal with the pain any longer,” she told The Daily Beast. “I was missing work. I often couldn’t get out of bed. I wasn’t able to be a good mother to the children I had. I prayed and went through it even though I was defying God’s will.”
The decision to have her uterus removed turned out to be the easy part. She searched in vain for a physician in a Catholic hospital in Florence who would perform what was a voluntary procedure that defied church teaching. Del Vecchio felt it necessary to consult only devout Catholic doctors, but they all tried to talk her out of it. Finally, she found a female Catholic doctor in Milan who agreed to perform the surgery and who assured her that God would forgive her—eventually.
But Del Vecchio’s moral and physical quandary in getting a hysterectomy isn’t a factor any more. Last week, Cardinal Luis Ladaria, the Vatican's doctrine chief, confirmed in a letter that after studying several medical cases presented by Catholic doctors, it was no longer against church teaching to have a hysterectomy in most cases and that the procedure could be done in “extreme cases” that do not just hinge on life and death.
In his statement, Ladaria referred to a case the church’s doctrine arm studied: “The uterus is found to be irreversibly in such a state that it is no longer suitable for procreation and medical experts have reached the certainty that an eventual pregnancy will bring about a spontaneous abortion before the fetus is able to arrive at a viable state.”
In fact, not having a hysterectomy in cases like these could be considered “morally licit” because the purpose “does not regard sterilization,” the statement went on.
The new clarification, however, does not give carte blanche to Catholics. The Congregation for the Doctrine of the Faith studied a case in which:
In this case, according to the church, a hysterectomy is still considered “illicit” because even though the woman many not be able to safely carry a pregnancy to term, removal of the uterus is seen as direct sterilization; God could intervene to save the pregnancy.
“These fall into the moral category of direct sterilization which in the Congregation of the Doctrine of the Faith's document Quaecumque Sterilizatio is defined as an action ‘whose sole, immediate effect is to render the generative faculty incapable of procreation’,” the church letter goes on.
“It (direct sterilization) is absolutely forbidden... according to the teaching of the Church, even when it is motivated by a subjectively right intention of curing or preventing a physical or psychological ill-effect which is foreseen or feared as a result of pregnancy,” the letter states.
Pope John Paul II had the last word on elective hysterectomies in 1993 when he confirmed that only circumstances that actually put a woman's life in danger would be considered justifiable. According to strict Catholicism, a woman is never to use chemical or artificial birth control and to always be open to conception. Until now, the only other time a hysterectomy was possible was when a woman was postmenopausal and could no longer conceive.
The only acceptable form of birth control for Catholics is natural family planning, where fertile women count their body temperatures to track ovulation so they can avoid sex during fertile periods.
The debate over hysterectomies resurfaced as an increasing number of hysterectomies have been performed in Italy. Around 70,000 are performed every year, most in Catholic hospitals, and a recent study commissioned by Italy's health ministry showed that less than 18 percent are due to cancer, which would garner the church’s approval. The Congregation for the Doctrine of the Faith said it took on the matter to clarify church teaching.
Del Vecchio’s hysterectomy saved her life.
In what turned out to be a strange twist of fate, the surgeon found a small malignant tumor in Del Vecchio's uterus after it was removed that had evaded her gynecologist, likely due to the severity of her painful endometriosis. The fact that she actually had a potential life-threatening condition meant that church teaching did not, in fact, prohibit the procedure. “It was God's way of telling me that it was OK,” Del Vecchio says. “Defying the church sort of saved my life.”