Puberty Blockers and the Principle of Totality
Man does not have unlimited power to mutilate his body
The Vatican News website recently printed an interview with a member of the Pontifical Academy for Life discussing the current standard of care for pubescent age children suffering from gender dysphoria. During the course of the questioning, the member, Dr. Laura Palazzani, said that in order to “accompany” children battling the psychological condition it may be necessary to prescribe puberty blocking medication for “a short period of time” so that doctors could better treat the patient. Since this is also the standard of care here in the U.S., it is instructive for us to examine the proposal through the lens of Catholic moral theology.
In a world in which the technologically possible is equated with the morally permissible, we must make sure that we do not argue from a consequentialist perspective. Something is not wrong because it has bad consequences; it has bad consequences because it is wrong. All too often, especially where medical issues are concerned, people will examine consequences and make a moral determination based on that. In this case, the Academy member did precisely this. In order to bring about good consequences such as furthering psychological counseling, stopping suicidal thoughts and actions, etc., she concedes permission for a short period of time. But the moral permissibility of the action must be determined by looking at the action itself, and only once it is found to be morally permissible can we examine whether it is an effective means for carrying out the desired end. In this particular case, giving puberty blockers for the purpose of delaying puberty in a child suffering from gender dysphoria is always wrong.
During the pontificate of Pope Pius XII the Church began to think about and teach more clearly what has since come to be known as the Principle of Totality. The Holy Father articulates the principle by reminding us that man “is a user and not a proprietor [of his body], he does not have unlimited power to destroy or mutilate his body and its functions. Nevertheless, by virtue of the principle of totality, by virtue of his right to use the services of his organism as a whole, the patient can allow individual parts to be destroyed or mutilated when and to the extent necessary for the good of his being as a whole. He may do so to ensure his being’s existence and to avoid or, naturally, to repair serious and lasting damage which cannot otherwise be avoided or repaired” (Pius XII, Address to the First International Congress on the Histopathology of the Nervous System, Sept. 14, 1952).
In short, the Principle of Totality serves a limiting function on medical practice. For the sake of a physical whole, one may sacrifice a part of oneself, assuming the choice does not do harm to an authentic human good. What is often overlooked is that this principle applies to the physical whole and not a moral whole (the person). In other words, it is concerned with the physical well-being of the person. So while one may remove an organ that is contributing to some underlying physical pathology (even if that organ itself is not diseased), this does not mean one can halt the otherwise normal functioning of an organ when it is thought to be causing some psychic distress. Our Lord’s admonition to cut off your right hand if it causes you to sin would not pass the Principle of Totality. Nor would the case at hand, that is, stopping what is an otherwise normally healthy bodily function (like puberty) simply to relieve psychological distress. Any changes to one’s body, the Pope said, are always “limited by natural finality, of the faculties and powers of his human nature.” Whether or not for a short period of time (whatever that means), it remains a violation of the Principle of Totality to block puberty.
All that being said, we must also give another reason why the consequentialist can be wrong. By allowing puberty to proceed, it may just as likely lead the person to be more comfortable in who he or she is. Halting the growth of unsure persons and not allowing them to become more fully themselves could actually add to the confusion and not take it away. Given that is the natural way in which human beings develop, there ought to be a presumption of innocence upon Nature. This is compounded by the fact that it is impossible to put puberty “on hold” while figuring things out because these medications have lasting effects, such as permanent sterilization, that will only lead to further psychological issues later on.
In the end we must admit that these children are simply victims of ideology, consequences be damned. There are those who will do whatever it takes to erase any gender distinctions, no matter who gets hurt. And for this reason, the Church and those who speak on her behalf must always be clear and unequivocal in their protection of these children.
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