More on AIDS and Condoms

Providing Oxygen to a Dying Patient

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WASHINGTON, D.C., MAY 19, 2010 ( Here are two questions on bioethics asked by ZENIT readers and answered by the fellows of the Culture of Life Foundation.

The March 31 column «AIDS and the Spousal Use of Condoms» elicited this response from a reader:

Q: My question relates to the situation where one of a married couple has AIDS. The person with AIDS wishes to have sexual intercourse with his/her spouse. Is it licit for the spouse without AIDS to refuse the marriage act?

I have had had two answers to this from educated Catholics — one is «no» and one is «yes.» It is not a question of using condoms or anything pertaining to this. Simply for the sake of the spouse saving his/her life, is it morally licit to refuse the conjugal act even if the other wants it? Best wishes, W. L.; Sydney, Australia

William E. May and E. Christian Brugger offer the following response.

A: In our opinion an uninfected spouse is not required to have intercourse with his or her infected spouse if there is good reason to avoid intercourse. Allow us to explain.

In 1 Corinthians 7:3, St. Paul speaks about the «conjugal rights» of spouses when he says: «the husband should give to his wife her conjugal rights, and likewise the wife to her husband.» Catholic moral tradition has consistently affirmed the importance of spouses generously rendering to one another the «conjugal debt.» Why is willingness to have intercourse with one’s spouse a duty? St. Paul says that it is because the bodies of the spouses are in a sense not their own; they belong to each other (cf. 1 Corinthians 7:4).

He does not mean, of course, that a husband possesses his wife’s body and a wife her husband’s body in the way we possess a thing; that would be tantamount to chattel slavery. His teaching is more profound. It derives from the very nature of marriage. Scripture teaches that marriage is a «one-flesh» communion of persons (Genesis 2:24; Matthew 19:5). This «one-fleshness» is paradigmatically actualized in and through marital intercourse. Intercourse allows spouses to enjoy the two defining goods of marriage: their relational union and the procreation of children — both realized uniquely in and through the marital act.

Spouses who choose for a time or indefinitely to refrain from marital intercourse, refrain also from this important expression of their one-flesh relationship, with its two goods. Because, as St. Paul notes, this can be the cause of temptation for the spouses (cf. 1 Corinthians 7:5), it is only justified for serious reasons. But Catholic moral tradition has never interpreted St. Paul’s teaching as a requirement to consent to intercourse whenever a spouse requests it. When, then, is it legitimate to refuse one’s spouse? We think it is reasonable to conclude that it is legitimate to refuse intercourse when there are «good reasons» to refuse.

This is not explicitly taught to our knowledge in any authoritative Church teaching. But there is a parallel teaching that we think implies this conclusion. There are multiple texts teaching that refraining from procreating is only justified if there are «good reasons.» Paul VI, for example, taught in «Humanae Vitae» that recourse to natural fertility cycles is legitimate only if «there are iustae causae (just causes/good reasons) for spacing births» (No. 16); John Paul II taught at an audience at Castel Gandolfo in 1994 that «when there is a reason not to procreate, this choice is permissible and may even be necessary;» and Benedict XVI spoke about «grave circumstances which make it prudent to delay the birth of children or even suspend it» (Papal Message to «Humanae Vitae» Congress, Oct. 2, 2008).

These passages teach the norm that refraining from procreating is legitimate only for good reasons. We think it follows that refraining from the type of behavior through which procreation is realized is only justified for good reasons. In other words, because marriage is a one-flesh procreative relationship, there must be justifying reasons (iustae causae) to refrain from actualizing that one-fleshness with its procreativity.

We said above that an uninfected spouse is not required to have intercourse with his or her infected spouse if there is a good reason to avoid intercourse. We think that avoiding a gravely harmful disease is a good reason to avoid intercourse. Although we do not think it necessarily would be wrong for an uninfected spouse to consent to intercourse with his or her infected spouse; in such a case the uninfected spouse accepts as an unintended side-effect the risk of contracting HIV in order to share the great goods of their one-flesh unity; nevertheless, since the harm one risks in choosing intercourse under such circumstances is very grave, we also do not think an uninfected spouse is under any obligation to consent to intercourse and accept these risks.

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Extraordinary Measures

The May 5 column «Are Food and Water Extraordinary Measures?» elicited this response from a reader:

Q: Is it all right in the eyes of the Church to withdraw oxygen from an extremely ill patient (COPD) who requires it, if the family requests it? Let’s say, the patient’s life is coming to an end, but the family is busy and needs to return home. They need to solidify matters of the money and belongings of the patient and move on with their lives, and the doctor says, «Okay, she is going to die soon, anyway.» Is this okay?» — M.A.; Omaha, NE

William E. May offers the following response.

COPD (Chronic Obstructive Pulmonary Disease) is a serious lung disease that makes it harder and harder for a person to breathe. It includes chronic bronchitis, emphysema, or both. The leading cause is cigarette smoke (see Oxygen therapy is a treatment that has been shown to help people with COPD live longer.

Today, oxygen can be delivered in many ways, from small machines that concentrate oxygen from the air, to liquid and compressed gas systems that are light and portable (see

Many of my friends suffering from COPD have lived for more than a decade because of the oxygen they receive in the way described. One died last week as a result of heart failure in his sleep (not caused by COPD) who had been receiving oxygen in this way for more than five years during which he led a happy, full life, driving his car in order to visit family members, etc.

In my judgment, provision of oxygen to such persons is morally required by the teaching of the Church insofar as the therapy (treatment) is neither futile (useless) nor excessively burdensome, and hence must be regarded as «ordinary» or «proportionate» treatment.

Deliberately to withdraw this therapy as a means of ending the person’s life is an act of euthanasia that is morally condemned by the Church.

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E. Christian Brugger is a Senior Fellow of Ethics at the Culture of Life Foundation and is an associate professor of moral theology at St. John Vianney Theological Seminary in Denver, Colorado. He received his Doctorate in Philosophy from Oxford in 2000.

William E. May, is a Senior Fellow at the Culture of Life Foundation and retired Michael J. McGivney Professor of Moral Theology at the John Paul II Institute for Studies on Marriage and Family at The Catholic University of America in Washington, D.C.

[Readers may send questions regarding bioethics to The text should include your initials, your city and your state, province
or country. The fellows at the Culture of Life Foundation will answer a select number of the questions that arrive.]
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