Is Tubal Ligation Indicated

Question

I am 28 years old and pregnant with my 4th child. I have chronic kidney stones and currently have one 1 cm in my right kidney. I also have hydronephrosis in both kidneys, but my right is much worse than my left. My last two pregnancies have put my kidneys at risk. My husband thinks I should have a tubal ligation for the sake of my kidneys. My last two pregnancies we have just prayed our way through.
Do you think future pregnancies will continue to be risky for my kidneys and would I qualify for a tubal ligation under the principle of double effect?

Janelle

Answer

Dear Janelle;

I’m very sorry that you are put in this difficult circumstance, but rest assured that difficult circumstances are often occasions to practice heroic virtue.

I understand that your intention here is good and noble. You are trying to avoid placing your health or life at risk in order to be able to fulfill your responsibilities to your family for years to come.

I will not comment in detail about whether a future pregnance will place your kidneys at risk. I do not have a clear understanding from your E-mail of what is causing your hydronephrosis, or why your kidney stones can’t be treated if they are the source of the problem. I would recommend you confer with your urologist and OB about correcting the problem; and if it cannot be corrected, then a detailed discussion should be had about the risk posed by future pregnancies. Don’t be afraid to request a second opinion.

I will assume for the sake of addressing the moral question you pose that a pregnancy would pose a significant risk to your health or life.

The principle we use to answer this question is this: a good end, no matter how noble, cannot be used to justify a means to that end that is in itself bad. The principle of cause and double effect is used only if the means used (in this case, the tubal ligation) is not in itself bad. Thus, a means that is itself good, or at least morally neutral, can be used to obtain a good end, even if something bad also happens as a result (that’s the double effect), as long as certain criteria are met.

The problem in your situation is that the action you are considering (the “means”) is not good (or morally neutral) in itself–tubal ligation (as with all sterilization procedures) is always morally evil, so the principle of cause and double effect does not apply.

I would encourage you to educate yourself and your husband about modern Natural Family Planning. It is easy to learn and very effective for preventing pregnancy when such is necessary.

May God bless and reward your faithfulness in these difficult circumstances.

John Gisla, MD

Answered By:

John Gisla, MD
Dr. John Gisla, Board Certified by the American Academy of Family Physicians, pracitces in the Sacramento Region.

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