Is it ethically permissible for spouses, either of whom has been exposed to the human immunodeficiency virus (HIV) or tested seropositive for HIV, to use condoms (of the male or female type) in order to prevent a possible HIV infection resulting from their sexual intercourse?1 The use of a condom under these circumstances is, in my opinion, contrary to Catholic moral teaching and tradition. A brief comparison between four types of cases is directly relevant to showing why such condom use is illicit. The four cases to be considered are: (1) the use of an anovulant by the wife to treat a pathology, concurrent with spousal sexual intercourse during the time of treatment; (2) the use of anovulants to prevent pregnancy; (3) the use of a condom in marriage to prevent HIV infection; and (4) the use of a condom in marriage to prevent pregnancy.2
In the therapeutic anovulant case (1), the act in question is taking an anovulant which suppresses the hormone production that is the cause of the pathology. This act sterilizes the wife but does not constitute contraception because the direct effect of the act is the cure or alleviation of a present pathology, and this is what the wife and husband intend even though there is the foreseen but unintended effect of sterilization. In the case of the therapeutic use of an anovulant, a present pathology is treated concurrent with sexual intercourse. Treatment of the pathology, independent of any acts of sexual intercourse, causes the sterility. The proximate end of the act of taking the anovulant, which determines the moral species of their act, is the cure or alleviation of a pathology in the wife. Even though the act of taking an anovulant to cure or alleviate a pathology is the same in its natural species as the act of taking an anovulant for the purpose of preventing pregnancy [(2) above], what differentiates them morally are their respective proximate ends.
St. Thomas Aquinas showed that a real human act may be abstracted into its natural species and the several different proximate ends to which the same act in its natural species may be ordered by the will. This demonstrates that human acts which are the same in their natural species may be different in their moral species. He states that:
It is possible, however, that an act which is one in respect of its natural species is ordered to several ends of the will; thus this act, to kill a man, which is but one act in respect of its natural species, can be ordered, as to an end, to the safeguarding of justice, and to the satisfying of anger.3
It is important to note that prior to arguing how acts which are the same in their natural species may be diverse morally, Aquinas states that for any single, real human act, its moral species is determined by its proximate end, even though it may also be ordered to remote ends:
One and the same act, in so far as it proceeds once from the agent, is ordered but to one proximate end, from which it has its species, but it can be ordered to several remote ends, of which one is the end of the other.4
Thus, in reply to an objection, Aquinas shows that the same human act may be ordered to multiple ends and remain in a single moral species in two senses: first, with respect to an ordering to proximate and remote ends; and second, with respect to the potential ordering of different acts, which have the same natural species, to several different moral species. In both types of ordering, the moral species of an act is determined by its proximate end. Given this account of the ordering of an act to its ends, even though the act of taking an anovulant is the same in its natural species whether it is ordered to therapy or to the prevention of pregnancy, the fact remains that the diversity of moral species here is determined by the difference in proximate ends, not by a difference in remote ends.
In the anovulant cases above [(1) and (2)], there is a difference in the proximate ends which results in the moral acceptability of one case and the moral unacceptability of the other. If the HIV case (3) is compared with the therapeutic anovulant case (1), we find that the proximate ends of the acts are different, though their remote ends may be the same. Moreover, if the HIV case is compared to the case of using a condom in marriage to prevent pregnancy (4), we find that the proximate ends are the same, though the remote ends are different. The act for moral evaluation in the HIV case is ejaculation into a condom during spousal sexual intercourse. The proximate end of this act is the prevention of both insemination into the reproductive tract of the wife and direct genital contact, and may only be characterized as a direct thwarting of the procreative ordination of the conjugal act; as such this end is intrinsically disordered with respect to the procreative and unitive goods of the conjugal act. In the HIV case, the fact that the conjugal act is being attempted without ejaculation into the reproductive tract of the wife is what causes the sterility. This sterilization is inextricably bound up with the act of sexual intercourse. The sex act does not just happen to be sterile because of some condition independent of the act, as in the therapeutic anovulant case. Rather, the sex act is undertaken because it is disordered (by virtue of the absence of ejaculation into the reproductive tract of the wife).
Any ordering of the act in the HIV case to the end of preventing HIV infection is an ordering to a remote, not a proximate end, and therefore is not determinative of the act's moral species. The end of preventing HIV infection is a remote end because it is only as a consequence of having disordered sex that HIV infection is prevented. The only means by which the spouses may prevent HIV infection in their acts of sexual intercourse is to ensure that unitive and procreative meanings of those acts are severed. Even if the end of preventing HIV infection is characterized as a therapeutic end because it prevents disease, this is a remote therapeutic end not a proximate therapeutic end, as in the therapeutic anovulant case.
The proximate end of the act in the HIV case as the prevention of insemination and direct genital contact is the same proximate end (with respect to insemination) in the case of spouses using a condom to prevent pregnancy. In both cases, the proximate ends of the acts directly thwart the procreative ordination of their acts and are contrary to the inseparable procreative and unitive goods of the conjugal act. The fact that in the HIV case, the act of ejaculating into a condom is also ordered to the remote end of preventing HIV infection does not make the moral species of the act any different from the moral species in the case of preventing pregnancy.
To conclude that the proximate end in the HIV case directly thwarts the procreative ordination of the act is fully consistent with the recognition in Catholic teaching that the conjugal acts of infertile spouses are morally licit. It can be objected that to claim that the act in the HIV case is intrinsically evil would be to conclude that any sexual intercourse between infertile spouses is illicit, because by definition these acts cannot be open to procreation. This objection assumes that the openness to procreation in the conjugal act according to Catholic teaching presumes physiological fertility - it does not. What the teaching presumes is that each and every conjugal act has a procreative ordination, which is an ontological aspect of the act that is not dependent upon the particular physiological capacity for fertility. This is why infertility, whether temporary or permanent, does not affect the procreative ordination of the conjugal act, and why the Church teaches without qualification, "it is necessary that each conjugal act [matrimonii usus] remain ordained in itself [per se destinatus] to the procreating of human life."5
Because the procreative ordination of the conjugal act is directly thwarted by the proximate end of the act in the HIV case, there is no fulfillment of the unitive good that should be present in the spouse's sexual intercourse. The inseparability of the procreative and unitive meanings of the conjugal act means that the absence of one necessarily entails the absence of the other. Each meaning of the conjugal act is fulfilled in and through the other. As tragic as the circumstances are which HIV-infected spouses face, they accomplish neither the procreative nor the unitive meanings inherent to the conjugal act by engaging in sexual intercourse with a condom.
1 The original version of this arhcle was an unpublished essay by me used for consultations. Benedict Guevin, O.S.B., in his "On the Use of Condoms to Prevent Acquired Immune Deficiency Syndrome," The National Bioethics Quarterly 5.1 (Spring 2005): 39, uses part of the original essay. [Back]
2 This analysis prescinds from the queshon of the possible abortifacient effect of anovulants. [Back]
3 Summa theologiae I-II, Q. 1. 3, reply 3, trans. Fathers of the English Dominican Province, in Great Books of the Western World, vol. 19, ed. Robert Maynard Hutchins (Chicago, IL: Encyclopedia Britannica, 1952). See Mardn Rhonheimer, "On the Use of Condoms to Prevent Acquired Immune Deficiency Syndrome," The National Bioethics Quarterly 5.1 (Spring 2005): 40 48, for an argument that uses this text from Aquinas to show that the use of condoms in marriage to prevent HIV infechon is not intrinsically evil. [Back]
4 Summa theologiae, I-II, Q. 1. 3, reply 3. [Back]
5 Pope Paul VI, Humanae vitae, n. 11, translahon by Janet E. Smith, in her book Humanae Vitae: A Generation Later (Washington, D.C.: The Catholic University of America Press, 1991): 281. See also my "The Conjugal Act: 'Open' to Procreahon?" Ethics & Medics 16.12 (December 1991): 3-4. [Back]