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Question 33: Should NFP be taught to a couple whose marital intercourse might transmit HIV?

My husband and I teach natural family planning (NFP) at our parish as part of the pre-Cana program for engaged couples. We like to take the couples in groups, not privately, both to save time and because we believe it works better. Our pastor is asking us to make an exception and take one couple separately. Two years ago, while in Africa working on famine relief, the man, whom I’ll call John, received unscreened blood transfusions when he had emergency surgery and he has now tested positive for HIV. Though the woman, whom I’ll call Felicity, knows this, she still wishes to marry him. The couple want to try to have a child as soon as they can after they marry, and, in the hope that Felicity and the baby will not become infected, to do this with the fewest possible number of acts of marital intercourse. John and Felicity hope NFP will help them accomplish this. The pastor told me he asked the chancery office about their plan, and the bishop told him to treat them the same as any other couple.

My husband and I have talked this over, and we do not think this couple should be getting married. They are risking Felicity’s life and taking a chance on having a child afflicted with AIDS. Moreover, they are risking imposing a huge monetary burden on everyone in their health insurance group and, if their insurance runs out, on the public. We wonder whether we should teach them at all and, if we do, whether we should take them separately as the pastor wishes.

Since the bishop has approved their plan to marry, and the pastor is going to go ahead with the wedding, I realize you might say: “Who are you to argue?” But this is not a question of Church teaching, so we feel we must make our own judgment. To us, it just does not seem right to help John and Felicity do what we think they should not be doing.

Of course, we have talked this over with the pastor. He seems to agree with our view, and, though he did not say so, we have the impression he had hoped the bishop would forbid the marriage. He wants us to do as he asked, but says he will understand if we refuse. That leaves it up to us.


The questioner explicitly asks about her and her husband’s teaching responsibilities, but implicitly asks whether John and Felicity should marry. The Church’s law does not forbid a man infected with HIV and the woman who wishes to marry him from exercising their natural right to marry. The possible moral permissibility of their taking the risks to themselves and their offspring follows from the inherent goodness of marriage and marital intercourse, the dignity and heavenly calling of any child or children they might have, and the moral acceptability of taking risks in pursuing goods. Yet the couple could have a moral obligation not to exercise their right to marry. But even if the questioner and her husband believe it is wrong for John and Felicity to marry, they may, and I think should, instruct them in NFP with the intention of facilitating their chastity, perhaps leading them to reconsider marrying, and, if they marry, reducing the risks they will be taking.

The reply could be along the following lines:

It would be wrong for you to help John and Felicity unless you come to see either that what they are doing probably is not wrong or that you may help them even if it is. First I shall consider whether they can rightly marry and then whether you may help them even if they should not.

Even though the bishop told the pastor to treat John and Felicity like any other couple, it is possible that, morally speaking, they should not marry.

Consider why the bishop responded as he did. Since marriage is a fundamental human good (see LCL, 555–69), people have a natural right to marry, so that couples free to marry and capable of doing so generally should not be impeded by the wider society. Accordingly, the Church’s law provides: “All persons who are not prohibited by law can contract marriage” (CIC, c. 1058). Church law identifies various impediments to marriage, but nowhere says couples may not marry when afflicted with a deadly, communicable disease and faced with the prospects of John and Felicity. At the same time, Church law provides that a sacrament cannot be denied those who are properly disposed and ask for it at an appropriate time unless the law prohibits its reception (see CIC, c. 843, §1), and also specifies that Catholics’ marriages ordinarily must be witnessed by the bishop or pastor, or a priest or deacon delegated by either of them (see CIC, c. 1108, §1). So, when nothing mentioned in the law would prevent a couple from marrying validly and no other condition specified by the Church’s law provides a basis for refusing their request to be married in the Church, the couple have the legal right to the pastoral service required to celebrate their marriage in the Church. That, no doubt, is why the bishop told the pastor to treat John and Felicity like any other couple.

Nevertheless, the marriage of a particular couple, though permitted by Church law, can be imprudent or unfair to others—for example, due to their poor health, poverty, or prior obligations to others, such as aged parents. The Church’s law leaves judgment on such matters to the consciences of the couple themselves. So, the moral question about this marriage is not settled by the bishop’s directive to the pastor.

Does sacred Scripture, tradition, or the authoritative teaching of the magisterium settle it? I find nothing in those sources to indicate that this couple cannot rightly marry and engage in marital intercourse. It might be thought that the issue had not been addressed until now because infection with HIV has occurred only recently. But Christians throughout history have been afflicted with various deadly, communicable diseases, or have foreseen the likelihood that a woman might die in giving birth, yet some chose to accept the risks of marrying and having children.

Of course, during recent centuries many Catholic moral theologians, in considering spouses’ responsibilities with regard to marital intercourse, held that they should abstain from it if necessary to avoid taking serious health risks. These theologians no doubt would have said that John and Felicity should not carry out their plan. But theological opinion by itself does not demand religious assent. Moreover, the theologians’ opinion on this matter, in my judgment, should be regarded with suspicion, because they failed to grasp the inherent value of marriage and marital intercourse, which they regarded as merely instrumental goods. Therefore, the question of whether the couple may marry can be dealt with only by rational reflection in the light of relevant moral principles.115

One reason why AIDS seems to many people more horrible than other deadly diseases is that HIV infection generally is transmitted irresponsibly, by conduct that is, at least objectively, gravely evil. That thought and the negative feelings it appropriately evokes must be excluded carefully from the following reflection. The issue is whether the couple’s plan is morally acceptable. Letting horror related to immorality come into play would prejudice judgment.

Your argument for the view that John and Felicity should not marry is that in doing so they would risk her life, risk having a baby afflicted with AIDS, and risk imposing a huge monetary burden on everyone in their health insurance group and on the public at large.

Heterosexual behavior seldom results in HIV infection.116 Each act of marital intercourse would involve some risk that John would transmit the infection to Felicity, but she might well escape infection if the couple take care to avoid lacerating her genital tissues, abstain from intercourse if the tissues already are lacerated or sore, and limit the number of times they engage in intercourse, as they are planning to do. Moreover, if she does become infected, she might not die of the disease; something else might cause her death, or a lifesaving treatment for AIDS might become available. So, in marrying, she would accept, not death, but only some risk of it.

If Felicity may accept this risk to her own life and freely chooses to accept it, I see no reason why John will do wrong by joining her in taking the risk. May she? Risks to one’s own life and health are accepted rightly or wrongly depending on whether they are accepted for a good reason, that is, as incidental to the pursuit of an intelligible human good by appropriate means. Now, even though John is HIV positive, marriage and its fulfillment in parenthood remain intelligible goods, and the couple can pursue them only by consenting to marriage and engaging in marital intercourse. Thus, if Felicity intends to marry for the good of marriage—and she will intend that good if she validly consents to marry—she need not violate any mode of responsibility in accepting the risk to her own life.

Someone might object that Felicity almost certainly is motivated primarily by feelings of affection and erotic attraction, for she hardly would be prepared to risk her life so heroically on the basis of a calm and cool grasp upon the intelligible goodness of marriage. That may be so, but very few couples today marry unless they have those emotional motives—unless they are “in love.” But being in love harmonizes with good reasons to marry, so the emotional motives do not vitiate anyone’s consent to marry. Therefore, if Felicity really consents to marriage, she will intend the intelligible goods that can make it reasonable for her to accept the risk to her own life.

Again, someone might argue that, if John does not truly love Felicity, he should not marry her, and if he did truly love her, he would not wish to marry her. I answer: To accept risks to others by cooperating with them in doing something inherently good is entirely compatible with loving them and willing their true human fulfillment. Indeed, just as loving oneself regularly requires that one take various risks in pursuing goods, so loving others regularly requires that one accept various risks to them as well as to oneself in cooperating with them. What is peculiar about the present case is the kind and, perhaps, the magnitude of the risk. But if there is no injustice in taking this risk, John and Felicity themselves must discover whether taking it pertains to their vocations. If they are convinced that they are called to marry and have a child, it would be presumptuous for others to judge that the magnitude of the risk shows their choice to marry to be incompatible with authentic, mutual love.

May John and Felicity risk having a baby who will die of AIDS? This risk, too, should not be exaggerated; it is considerably less than the risk some couples take of passing on a very serious hereditary disease. Unless a woman is infected with HIV, she will not infect her baby, and even if a woman becomes HIV positive before the baby is born, her child may not be infected.117 Moreover, even if the baby is infected with HIV, he or she may not die of AIDS; something else might be fatal, and more effective treatment for HIV infection might become available.

More important, parenthood and the very being of a new person are goods, and it is not inherently wrong for a couple to accept the risk that a baby will be afflicted with some congenital defect or disease. Indeed, every couple who expect to have children accept some such risk, so one must ask why accepting the risk of HIV infection would be wrong. The plausible answer is that in this case the prospect is worse than it generally is, namely, that the baby will have only a short and sickly life. If a person’s fulfillment were in this world only, that prospect might seem to preclude taking such a risk. But the baby’s sufferings in this life will be insignificant by comparison with the joy of everlasting life (see Rom 8.18). With that prospect, why should it be sinful for John and Felicity to accept some risk of having a child who will die of AIDS or for other couples to take even greater risks of having a child die of certain genetic diseases?

Someone might object that, while nobody is excluded from the hope of heaven by the circumstances of his or her conception, parents surely can wrong children in the very act of procreating them—for example, people wrong prospective children when they try to have them produced in a laboratory or risk having them outside marriage (see LCL, 267–68, 643–44, 655, 684). True, but in these cases the wrong is inherent in the acts of producing babies in a laboratory and of extramarital intercourse. Deliberately conceiving or risking conception in acts wrong in themselves unjustly deprives a baby of something due each new human person: to be received as the God-given fruit of authentic marital love. Since babies are not due good health, however, except insofar as their parents and others can and should protect and promote it, risking having a baby afflicted with some defect or disease does not wrong that child unless it is wrong to take the risk. But since that is the precise point the objection was meant to prove, it begs the question.

Again, someone might object that, just as other couples should regulate births by morally acceptable means so that they will not have more children than they can reasonably expect to raise properly, so John and Felicity should avoid having a baby they may not be alive and able to care for. My reply is twofold. First, when a couple already have children, fairness to those children often precludes having more. But the question concerns John and Felicity having their first, and perhaps their only, child. Second, John and Felicity should consider the prospects that their child will not be cared for properly, but only they are in a position to judge whether those prospects make carrying out their plan unreasonable.

May the couple risk imposing a huge monetary burden on everyone in their health insurance group and on the public at large? Whether they marry or not, the man almost certainly will require extensive health care. So, the question is: Will they act unfairly in risking the additional burden on others if the woman and one or more children also are infected with HIV and contract AIDS?

Perhaps they will act unfairly, especially since the burden here is not only monetary, but extends to the difficulties and risks for caregivers and others in dealing with people afflicted with this disease. The couple could argue, however, that many women who learn that they are HIV positive do not alter their sexual activity or make special efforts to avoid pregnancy.118 Moreover, government officials, the medical profession, and the public at large have been quite tolerant not only of infected women’s behavior but of men who persistently engage in sodomy, which is even more likely to transmit HIV infection. If such people are doing others a grave injustice, they might say, why has nothing been done except to urge them to practice so-called safe sex, which by no means eliminates the risk but only reduces it in particular sodomitical acts? Those who engage in sodomy are not punished even for disregarding that advice; those who take such risks are not tested for HIV and isolated from society if they test positive; those who lose their gamble and develop AIDS are not limited to palliative care and denied expensive, life-prolonging treatment. How, then, John and Felicity might ask, can it be a great injustice for them to risk imposing similar burdens on others by entering marriage and engaging in marital intercourse, which are actions good in themselves?

That argument would deserve respect, but it would not be cogent. In a nation that has legalized abortion and that condones and even facilitates sexual irresponsibility despite the huge burdens it unjustly imposes on society, the attitudes of government officials, the medical profession, and the majority of the people cannot be considered a reliable index of the demands of justice.

In sum, it seems to me that, while the case against the couple’s marrying is inconclusive, their doing so might well be unfair to others. Perhaps they have not thought about the grave burdens they might impose on others by marrying and having a baby, or have not applied the Golden Rule and put themselves in the place of those others. Surely, they should not marry without considering this aspect of the matter and reaching a confident judgment that doing as they propose will not be unfair to others.

Besides the moral questions you raised, at least two others ought to be considered by the young couple.

First, John and Felicity plan to try to have a child with the fewest possible acts of marital intercourse. Perhaps they do not realize that they might not be very fertile—they might even be sterile—and so they may not have considered how many acts of marital intercourse might be required to bring about conception or to discover their infertility. Then too, perhaps they have not considered what they will do to express affection apart from those acts of marital intercourse. They may think it will not be wrong to attempt intercourse while using a condom or to engage in sexual acts leading to orgasm apart from intercourse. But “intercourse” with a condom is not truly intercourse, and so cannot be marital intercourse, even if the intention is, not to prevent conception, but to prevent the transmission of disease.119 Moreover, so-called safe sex, practiced repeatedly, eventually will have the result it is meant to prevent (see q. 22, above). And any sexual stimulation to orgasm apart from marital intercourse is gravely sinful. Perhaps, however, they plan to practice perfect continence apart from the acts of marital intercourse required to have a baby. If that is their plan, they may be tempted to set it aside and either wrongly engage in marital intercourse when they have grave reasons for abstaining or to commit other sexual sins. But unless they are committed to a chaste marriage and can reasonably hope to fulfill that commitment, they should not marry.

Second, though John and Felicity no doubt intend intelligible goods, they may be being moved too much by feelings and too little by insight into how to pursue those goods. Have they thought carefully and in detail about the prospective course of their entire lives and considered all the risks they will be accepting? Loving each other, Felicity should ask how best to serve John, and he should ask whether it is best that he accept the sort of self-sacrifice Felicity is offering. Before long, he may need a healthy, motherly nurse more than a wife. And despite Felicity’s present heroism, she eventually may be overwhelmed by the extraordinary responsibilities she will have accepted, especially if, after John dies, she finds herself and her child afflicted with AIDS. Surely, this couple should examine their feelings very carefully. Like every other couple preparing to marry, they should not proceed unless both are convinced that the marriage is, not simply what they want for themselves, but what they want for one another and, even more important, what is God’s will, his vocation, for them.

All these things considered, should you and your husband help John and Felicity carry out their plan?

You do not have a strict duty, analogous to the pastor’s, to help the couple carry out what you may still regard as a bad plan. Nevertheless, you may cooperate with them in the same way the pastor must, not intending that they marry or do anything they should not. If you do not teach them, they might proceed with even greater risks. So, you can teach them NFP intending nothing other than to provide sound counseling and instruction that will promote their chastity and mitigate the bad consequences of what they are planning to do.

Moreover, it seems to me you not only may but should teach John and Felicity, for in this way you will have the opportunity to raise questions about their plan. In preparing them for marriage, the pastor should and probably will deal with some of these questions, namely, the ones regarding marital chastity. But he may consider it prudent to focus exclusively on matters he must discuss with them, so as not to distract them from the essentials or render them unreceptive by challenging them unnecessarily. You will have greater latitude. Proposed gently and discussed with sympathetic understanding, the various questions sketched out above, and others that may occur to you, might well lead John and Felicity to reconsider and decide not to marry. And if they do marry, you will be in a position to continue to advise and encourage them to fulfill their marital responsibilities in their unusual situation.

In view of this possibility of getting them to reconsider, you probably should make an exception to your usual practice and take them privately, despite the extra work that will involve. If you included them in a group, you could not give them the special attention they need without more or less neglecting the other couples—while that special attention itself probably would cause them embarrassment. I assume they therefore desire to be taught separately, and, by doing them this favor, you probably will render them more receptive to the questions you raise. Finally, having this couple in the group might make the other couples anxious and distract them, which would detract from the effectiveness of your teaching.

Still, while meeting John and Felicity separately insofar as necessary, it might be advantageous to encourage them to meet with the group as well. If they agree, you could consider with them whether and how to share their secret with the other couples—perhaps not at the beginning of the course but near its end. The communication, while perhaps difficult, could benefit both them and the other couples, for it might lead everyone to reflect more deeply on the significance of what they are doing in marrying and the grave responsibilities they are assuming. Moreover, having become acquainted with John and Felicity, the other couples perhaps may keep in touch with them and offer appropriate support.

115. John M. Haas, “HIV and Marriage—I,” Ethics and Medics, 16:2 (Feb. 1991), 1–3; “HIV and Marriage—II,” Ethics and Medics, 16:3 (Mar. 1991), 3–4, argues that marital intercourse is morally excluded in cases like that discussed here. But though he appeals to certain teachings of the magisterium, none of them logically require the conclusion he draws. In my judgment, he also overestimates the risks and inadequately appreciates the benefits of marital intercourse in such circumstances.

116. See Michael B. Flanagan, “A Study of AIDS,” Linacre Quarterly, 63:1 (Feb. 1996): 61–74.

117. Edward M. Connor et al., “Reduction of Maternal–Infant Transmission of Human Immunodeficiency Virus Type 1 with Zidovudine Treatment,” New England Journal of Medicine, 331:18 (1994): 1173–80, report the results of a study of the use of zidovudine (AZT) during pregnancy, delivery, and the first six weeks after birth to impede the transmission to infants of HIV infection from mothers already mildly symptomatic with AIDS. Without AZT, 25.5% (one out of four) infants were HIV infected at eighteen months; using it, only 8.3% (one out of twelve) were. The European Collaborative Study, “Caesarean Section and Risk of Vertical Transmission of HIV–1 Infection,” Lancet, 343 (11 June 1994): 1164–67, report that in women with advanced AIDs, caesarean delivery reduced transmission by about half.

118. See Anna Kline, Jennifer Strickler, and Judith Kempf, “Factors Associated with Pregnancy and Pregnancy Resolution in HIV Seropositive Women,” Social Science and Medicine, 40 (1995): 1539–47.

119. See LCL, 634–36; cf. William E. May, “AIDS, Marriage and Condoms,” Ethics and Medics, 13:9 (Sept. 1988): 3–4.