Contraception

Conservative and liberal approaches to the problem of abortion are oversimplified and deeply flawed. Accepting that the moral status of the conceptus changes during gestation, the author advances a more nuanced perspective. Through applying a form of rules in practice utilitarianism within the context of overall population policy, he provides a compelling ethical and legal framework for regulating contraception and abortion practices.

The ethics of abortion considers whether abortion is immoral. Pro-choice philosophers think that it is not immoral, while pro-life philosophers think that it is. The axiology of abortion considers whether world would be better if the pro-choice or pro-life position is right. While much attention has been given to the ethics of abortion, there has been no attention given to the axiology of abortion. In this article, I seek to change that. I consider various arguments for thinking our world would (...) be better if the pro-choice position or the pro-life position is correct, ultimately concluding that it would be better if the pro-choice position is right. This is unfortunate, however, since there is no good reason to think the pro-choice position is correct. (shrink)

In his ‘When conscientious objection runs amok: A physician refusing human immunodeficiency virus (HIV) preventative to a bisexual patient’, Brummett has argued that Catholic physicians (or indeed any other healthcare practitioner) should not be able to raise conscientious objections to HIV pre-exposure prophylaxis for bisexual patients, as this constitutes discrimination. Brummett argues that such a conscientious objection represents an instance of conscience creep, which he argues is undesirable. Here I re-analyse the case presented by Brummett using a teleological framework and (...) making reference to Catholic teaching on cooperation with evil. While I agree with Brummett that in this case the physician should not have had the right to conscientiously object, I argue that the teleological framework offers advantages over the argument Brummett has presented. I also comment on why only considering empirically measurable harm as a publicly defensible reason for one to hold a conscientious objection is problematic, as well as on the difficulties associated with cases of discrimination in a pluralistic society. (shrink)

This commentary defends 3 arguments for changing the label of levonorgestrel-based emergency contraception (LNG EC) so that it no longer supports the possibility of a mechanism of action after fertilization. First, there is no direct scientific evidence confirming any postfertilization mechanisms. Second, despite the weight of evidence, there is still widespread public misunderstanding over the mechanism of LNG EC. Third, this FDA label is not a value-free claim, but instead it has functioned like a political tool for reducing contraceptive access. (...) The label is laden with antiabortion values (even though EC is contraception, not abortion), and it imposes these values on potential users, resulting in barriers to access such as with Burwell v. Hobby Lobby. These 3 arguments together provide scientific, social, and ethical grounds for the FDA to take the initiate in changing Plan B's drug label. (shrink)

While the Value-Free Ideal of science has suffered compelling criticism, some advocates like Gregor Betz continue to argue that science policy advisors should avoid value judgments by hedging their hypotheses. This approach depends on a mistaken understanding of the relations between facts and values in regulatory science. My case study involves the morning-after pill Plan B and the “Drug Fact” that it “may” prevent implantation. I analyze the operative values, which I call zygote-centrism, responsible for this hedged drug label. Then, (...) I explain my twofold account of value-ladenness, involving the constitutive role of value judgments in science and the social function of facts as political tools. Because this drug fact is ineliminably value-laden in both senses, I conclude that hedged hypotheses are not necessarily value-free. (shrink)

Drucker's contribution succeeds as a handbook of contraceptive history, but I criticize her definition of contraception as too broad, and I argue that a narrower definition undermines her reproductive justice claims.

Historically, the Christian church was united in firm opposition to both homosexuality and contraception. Today most evangelical Christians continue to oppose the former but have embraced the latter. This paper argues that there is a clear tension between these views, especially when it comes to the evangelical use of natural law–type reasoning. The conclusion of this paper is that Christians who view homosexual activity as immoral must also view artificial contraception in the same light. They are wrong for the same (...) reason: they both misuse the sexual organs by directing sexual activity away from procreative unity. (shrink)

In Medical Sexism: Contraception Access, Reproductive Medicine, and Health Care, Jill B. Delston uses a feminist lens to examine the overwhelmingly common gynecological practice of declining to write prescriptions for oral contraceptives unless a woman agrees to an annual Pap smear, which is used to detect precancerous changes, as well as cancer of the cervix. Employing a comprehensive evaluation of the medical literature, Delston methodically builds a strong argument that these measures not only do not follow evidence-based medical guidelines, but (...) they also carry a significant potential of harm to the patient. Furthermore, cervical cancer prevention has absolutely nothing to do with... (shrink)

Several influential organisations have attempted to quantify the costs and benefits of expanding access to interventions-like contraceptives-that are expected to decrease the number of pregnancies. Such health economic evaluations can be invaluable to those making decisions about how to allocate scarce resources for health. Yet how the benefits should be measured depends on controversial value judgments. One such value judgment is found in recent analyses from the Disease Control Priority Network (DCPN) and the Study Group for the Global Investment Framework (...) for Women's and Children's Health. Noting the decrease in the number of pregnancies expected to result from providing access to family planning, DCPN and the Study Group claim that a substantial benefit of such interventions is averting the stillbirths and child deaths that would have resulted from those pregnancies. We argue that health economic analyses should not count such averted deaths as benefits in the same way as saved lives. First, by counting averted stillbirths and child deaths as a benefit but not counting as a cost the lives of babies who survive, DCPN and the Study Group implicitly commit themselves to antinatalism. Second, this method for calculating the benefits of family planning interventions implies that infertility treatments are harmful. Determining how potential people should be treated in health economic analyses will require grappling with population ethics. (shrink)

Many women identify sterilisation as their preferred form of contraception. However, their requests to be sterilised are frequently denied by doctors. Given a commitment to ensuring women’s reproductive autonomy, can these denials be justified? To answer this question, I assess the most commonly reported reasons for a denied sterilisation request: that the woman is too young, that she is child-free, that she will later regret her decision, and that it will lower her well-being. I argue that these worries are misplaced (...) and hence insufficient reasons for denying a request. I also argue that even if concern for patient welfare provides doctors with a valid reason to withhold sterilisation, this is overriden by respect for patient autonomy and the importance of enabling women’s reproductive control. Consequently, I suggest that adequately informed, decision-competent women should have their requests for sterilisation agreed to, even if they are young and/or child-free. In addition, I examine the impact of pronatalism on how women’s requests are understood and responded to by doctors. I show that the equation of women with motherhood can make it unjustifiably hard for them to access sterilisation, especially if they are child-free. Consequently, part of ensuring women’s access to sterilisation involves challenging pronatalist beliefs and practices. (shrink)

Philosophers of science and medicine now aspire to provide useful, socially relevant accounts of mechanism. Existing accounts have forged the path by attending to mechanisms in historical context, scientific practice, the special sciences, and policy. Yet, their primary focus has been on more proximate issues related to therapeutic effectiveness. To take the next step toward social relevance, we must investigate the challenges facing researchers, clinicians, and policy makers involving values and social context. Accordingly, we learn valuable lessons about the connections (...) between mechanistic processes and more fundamental reasons for medical interventions, particularly moral, ethical, religious, and political concerns about health, agency, and power. This paper uses debates over the controversial morning-after pill to gain insight into the deeper reasons for the production and use of mechanistic knowledge throughout biomedical research, clinical practice, and governmental regulation. To practice socially relevant philosophy of science, I argue that we need to account for mechanistic knowledge beyond immediate effectiveness, such as how it can also provide moral guidance, aid ethical categorization in the clinic, and function as a political instrument. Such insights have implications for medical epistemology, including the value-laden dimensions of mechanistic reasoning and the “epistemic friction” of values. Furthermore, there are broader impacts for teaching research ethics and understanding the role of science advisors as political advocates. (shrink)

The National Catholic Bioethics Center’s commentary on the Congregation for the Doctrine of the Faith’s 2018 responsum concerning hysterectomy fails to address the explicit reasoning that the CDF offers to justify its response. The CDF does not condone the hysterectomies in question as indirect sterilizations, justified by double effect. Rather, it defines procreation—and consequently sterilization—such that the moral categories of direct and indirect sterilization are not applicable in such cases. The CDF responsum is far more radical and consequential than the (...) NCBC commentary acknowledges. The responsum provides Catholic ethicists with an occasion for a necessary conversation that can be had only once the reasoning of the 2018 responsum is taken seriously in its own right. (shrink)

Much of the discussion surrounding the ethics of abortion has centered around the notion of personhood. This is because many philosophers hold that the morality of abortion is contingent on whether the fetus is a person - though, of course, some famous philosophers have rejected this thesis (e.g. Judith Thomson and Don Marquis). In this article, I construct a novel argument for the immorality of abortion based on the notion of impairment. This argument does not assume that the fetus is (...) a person - indeed, I concede (for the sake of argument) that the fetus is not a person - and hence the morality of abortion is not contingent on whether the fetus is a person. I finish by answering a plethora of objections to my argument, concluding that none of them are successful. (shrink)

This volume comprises various viewpoints representing a Catholic perspective on contemporary practices in medicine and biomedical research. The Roman Catholic Church has had a significant impact upon the formulation and application of moral values and principles to a wide range of controversial issues in bioethics. Catholic leaders, theologians, and bioethicists have elucidated and marshaled arguments to support the Church’s definitive positions on several bioethical issues, such as abortion, euthanasia, and reproductive cloning. Not all bioethical issues, however, have been definitively addressed (...) by Catholic authorities, and some Church teachings allow for differing applications in diverse circumstances. Moreover, as new biomedical technologies emerge, Church authorities rely on experts in science, medicine, philosophy, theology, law, and other disciplines to advise them. Such experts continue to debate issues related to reproduction, genetics, end-of-life care, and health care policy. This volume will be a valuable resource for scholars in bioethics or Catholic studies, who will benefit from the nuanced arguments offered based on the latest research. This volume is also instructive for students entering the field to become aware of the founding philosophical and theological principles informing the Catholic bioethical worldview. (shrink)

In this article, I address what kinds of claims are of the right kind to ground conscientious refusals. Specifically, I investigate what conceptions of moral responsibility and moral wrongness can be permissibly presumed by conscientious objectors. I argue that we must permit HCPs to come to their own subjective conclusions about what they take to be morally wrong and what they take themselves to be morally responsible for. However, these subjective assessments of wrongness and responsibility must be constrained in several (...) important ways: they cannot involve empirical falsehoods, objectionably discriminatory attitudes, or unreasonable normative beliefs. I argue that the sources of these constraints are the basic epistemic, relational, and normative competencies needed to function as a minimally decent health-care professional. Finally, I consider practical implications for my framework, and argue that it shows us that the objection raised by the plaintiffs in Zubik v. Burwell is of the wrong sort. (shrink)

Sterilisation requests made by young, childfree adults are frequently denied by doctors, despite sterilisation being legally available to individuals over the age of 18. A commonly given reason for denied requests is that the patient will later regret their decision. In this paper I examine whether the possibility of future regret is a good reason for denying a sterilisation request. I argue that it is not and hence that decision-competent adults who have no desire to have children should have their (...) requests approved. It is a condition of being recognised as autonomous that a person ought to be permitted to make decisions that they might later regret, provided that their decision is justified at the time that it is made. There is also evidence to suggest that sterilisation requests made by men are more likely to be approved than requests made by women, even when age and number of children are factored in. This may indicate that attitudes toward sterilisation are influenced by gender discourses that define women in terms of reproduction and mothering. If this is the case, then it is unjustified and should be addressed. There is no good reason to judge people’s sterilisation requests differently in virtue of their gender. (shrink)

I will argue that physicians have an ethical obligation to justify their conscientious objection and the most reliable interpretation of the Polish legal framework claims that conscientious objection is permissible only when the justification shows the genuineness of the judgment of conscience that is not based on false beliefs and arises from a moral norm that has a high rank. I will demonstrate that the dogma accepted in the Polish doctrine that the reasons that lie behind conscientious objection in medicine (...) cannot be evaluated or controlled by anyone is based either on a mistaken interpretation of the Constitution or on the unreliable concept of conscience. I will refer to the legal regulations concerning military refusals that require from objectors to reveal and justify their views. Finally, I will demonstrate why conscientious objection under uncertainty does not deserve acceptance, because it is based on a specific version of the precautionary principle. (shrink)

Niektórzy twierdzą, że nawet jeśli ktoś nie wierzy, że embriony lub płody ludzkie mają jakiś szczególnie wyróżniony status moralny, to z ostrożności powinien traktować je tak, jak gdyby miały pełny status moralny. Pokażę, dlaczego takie rozumowanie jest niepoprawne.

Each of the 13 articles in this collection wrestles with intricate metaphysical and moral aspects of the widespread belief that a thing’s potential—what it could, would, might, or will be, but isn’t yet—matters for how we should treat that thing. As John Lizza explains in his lucid introduction, the articles are grouped into three parts according to their aims and theoretical constraints. In this review, I briefly summarize and offer some critical discussion of each part.

An overview of the philosophical and bioethics literature on conscientious refusals by health care professionals to provide abortion and contraceptive services.

„Skoro powszechnie przyjmuje się, że sumienie jest suwerenne, to nie wiadomo, po co lekarz miałby uzasadniać pisemnie swój światopogląd” – napisała Naczelna Izba Lekarska w skardze do Trybunału Konstytucyjnego. Trybunał tę część skargi oddalił w wyroku z 7 października 2015 r., ale stwierdził, że „Celem prowadzenia dokumentacji medycznej nie jest (…) utrwalanie na piśmie poglądów filozoficzno-prawnych lekarza”. Uznał też, że uzasadnienie „powinno mieć charakter medyczny, a nie służyć wyjaśnieniu światopoglądu lekarza, czy też wskazaniu zasady moralnej leżącej u podstaw jego zachowania”. (...) Podobną interpretację akceptuje wielu polskich prawników, twierdząc, że skoro sumienie czy światopogląd lekarza są „indywidualne”, „autonomiczne”, „suwerenne”, to merytoryczne powody odmowy wykonania świadczenia medycznego nie mogą podlegać jakiejkolwiek ocenie i kontroli. (shrink)

Some philosophers have argued for what I call the reason-giving requirement for conscientious refusal in reproductive healthcare. According to this requirement, healthcare practitioners who conscientiously object to administering standard forms of treatment must have arguments to back up their conscience, arguments that are purely public in character. I argue that such a requirement, though attractive in some ways, faces an overlooked epistemic problem: it is either too easy or too difficult to satisfy in standard cases. I close by briefly considering (...) whether a version of the reason-giving requirement can be salvaged despite this important difficulty. (shrink)

On the basis of three empirical assumptions about the rhythm method and the viability of embryos, Bovens concludes that the pro-life position regarding empbryos implies that it is prima facie wrong to use the rhythm method. Pruss objects to Bovens's philosophical presuppositions and Kennedy to his empirical premises. This essay defends two revised versions of Bovens's argument. These arguments revise Bovens's empirical assumptions in response to Kennedy and, in response to Pruss, supplement Bovens's argument with what I call ‘the principle (...) of parental care’. (shrink)

Pharmacists who refuse to provide certain services or treatment for reasons of conscience have been criticized for failing to fulfil their professional obligations. Currently, individual pharmacists in Great Britain can withhold services or treatment for moral or religious reasons, provided they refer the patient to an alternative source. The most high-profile cases have concerned the refusal to supply emergency hormonal contraception, which will serve as an example in this article.I propose that the pharmacy profession's policy on conscientious objections should be (...) altered slightly. Building on the work of Brock and Wicclair, I argue that conscientious refusals should be acceptable provided that the patient is informed of the service, the patient is redirected to an alternative source, the refusal does not cause an unreasonable burden to the patient, and the reasons for the refusal are based on the core values of the profession. Finally, I argue that a principled categorical refusal by an individual pharmacist is not morally permissible. I claim that, contrary to current practice, a pharmacist cannot legitimately claim universal exemption from providing a standard service, even if that service is available elsewhere. (shrink)

A Catholic physician practices in a world that condones the use of contraception. In the effort to be morally consistent, Catholic physicians are faced with questions about the extent to which their participation in providing contraceptives constitutes immoral cooperation in evil. Particular challenges face resident physicians, who practice under attending physicians and within the constraints of local and specialty-wide training requirements. The author examines the nature of the moral act of referring for contraception and argues that, in limited cases, there (...) is a moral distinction between a referral and an intra-residency patient transfer, and the latter may be morally licit according to the principle of material cooperation. National Catholic Bioethics Quarterly 12.2 : 283–309. (shrink)

I argue that Malthus’s Essay on Population is more a treatise in applied ethics than the first treatise in demography. I argue also that, as an ethical work, it is a highly innovative one. The substitution of procreation for sex as the focus makes for a drastic change in the agenda. what had been basically lacking in the discussion up to Malthus’s time was a consideration of human beings’ own responsibility in the decision of procreating. This makes for a remarkable (...) change also in the approach, namely, the discussion becomes an examination of a well-identified issue, taking cause-effect relationships into account in order to assess possible lines of conduct in the light of some, widely shared and comparatively minimal, value judgements. This is more or less the approach of what is now called applied ethics, at least according to one of its accounts, or perhaps to the account shared by a vast majority of its practitioners. In a sense, both the subject matter, sexuality, was substituted with a more restricted issue, namely reproduction, and the traditional approach, moral doctrine, was substituted with a more modest approach, in Malthus’s own words, the “moral and political science”. Such a drastic transformation brought about a viable framework, for a discussion of ethical issues that were still unforeseen by Malthus, namely those having to do first with the technical feasibility of eugenics programs and secondly with the scientific discovery of genetics as a field of study but also of possible intervention. Malthus’s ethics had obviously enough nothing to say on those unforeseen issues in so far as it was meant to treat just the ‘quantitative’ dimension of procreation, that is, ‘how many’. Later discussions and controversies will arise around different dimensions, that is, not just ‘how many’ but also ‘how healthy, how strong, hoe empowered’, but what Malthus’s lesson could have taught and still can teach to partners defending opposite views in these controversies is that such issues may be framed in a way that possibly avoids unending controversy on incompatible ultimate principles once the strategy is turned upside down and a principle of responsibility becomes the overriding rule in the treatment of such ethical issues. -/- . (shrink)

Benatar’s central argument for antinatalism develops an asymmetry between the pain and pleasure in a potential life. I am going to present an alternative route to the antinatalist conclusion. I argue that duties require victims and that as a result there is no duty to create the pleasures contained within a prospective life but a duty not to create any of its sufferings. My argument can supplement Benatar’s, but it also enjoys some advantages: it achieves a better fit with our (...) intuitions; it does not require us to acknowledge that life is a harm, or that a world devoid of life is a good thing; and it is easy to see why it does not have any pro-mortalist implications. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 40-41, July 2012.

In his recent writings, Sir Michael Dummett has reflected twice on the Catholic position on the morality of contraception, focusing his attention especially on Humanae Vitae’s prohibition of the contraceptive use of the birth control pill. On examination, Dummett finds this prohibition ‘incoherent’, arguing that its promulgation ‘greatly damaged the respect of the faithful for the Catholic Church’s moral teaching in general’, as well as ‘the integrity of Catholic moral theology’. Given Dummett’s earlier defense of Paul VI’s reaffirmation of the (...) Church’s traditional position on contraception in Humanae Vitae, as well as his forceful criticisms of certain liberalizing tendencies among Catholic theologians and biblical scholars, these arguments deserve to be taken seriously, and regarded as coming from a spirit of serious philosophical reflection rather than casual dissent. Nevertheless, this paper argues that they are based on a misapprehension of what is really behind the position Dummett means to be criticizing, and that when the essentials of that position are clarified the rationale behind it is safe from his objections. (shrink)

The American Journal of Bioethics, Volume 12, Issue 7, Page 42-43, July 2012.

Defenders of medical professionals’ rights to conscientious objection (CO) regarding emergency contraception (EC) draw an analogy to CO in the military. Such professionals object to EC since it has the possibility of harming zygotic life, yet if we accept this analogy and utilize jurisprudence to frame the associated public policy, those who refuse to dispense EC would not have their objection honored. Legal precedent holds that one must consistently object to all forms of the relevant activity. In the case at (...) hand, then, I argue that these professionals must also oppose morally innocuous practices that may prevent pregnancy after fertilization. These results reveal that such objectors cannot offer a plausible and consistent objection to harming zygotic life. Additionally, there are good reasons to reject the analogy itself. In either case, these findings call into question the case supporting refusals of EC based on scruples. (shrink)

Most people take it for granted that it's morally permissible to have children. They may raise questions about the number of children it's responsible to have or whether it's permissible to reproduce when there's a strong risk of serious disability. But in general, having children is considered a good thing to do, something that's morally permissible in most cases (perhaps even obligatory).

The author uses the central insight of the principle of double effect—that the distinction between intended effects and foreseen side effects is morally significant—to distinguish contraception from natural family planning. After summarizing the contralife argument against contraception, the author identifies limitations of arguments presented by Pope John Paul II and by Martin Rhonheimer. To show that the contralife argument does not apply to NFP, the author argues that agents do not intend every effect that motivates their actions. This argument supplements (...) the action theory of Germain Grisez, Joseph Boyle, John Finnis, and other proponents of new natural law theory. National Catholic Bioethics Quarterly 11.1 : 83–97. (shrink)

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right (...) of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)

The author argues that an action is morally wrong if any of its steps serves no purpose apart from preventing the existence of a human being. This principle entails that contraception and some proposed techniques for altered nuclear transfer are morally wrong, but it does not preclude producing stem cells through parthenogenesis. His argument depends on the premise that human life always is a good, including human life produced through immoral actions. The immoral action, not the life caused by the (...) action, is the evil that should be prevented. National Catholic Bioethics Quarterly 10.2 : 257–264. (shrink)

This paper addresses the likely impact on women of being denied emergency contraception (EC) by pharmacists who conscientiously refuse to provide it. A common view—defended by Elizabeth Fenton and Loren Lomasky, among others—is that these refusals inconvenience rather than harm women so long as the women can easily get EC somewhere else nearby. I argue from a feminist perspective that the refusals harm women even when they can easily get EC somewhere else nearby.

Concerning abortion and infanticide, ethics has always seen to each one as quite puzzling an issue. The dilemma expectedly goes like this: “Are they morally good, permissible or acceptable, or are they not?” All three major approaches in ethics, viz. virtue ethics, deontology and consequentialism, have fervently exerted themselves in order to settle both. A virtue ethicist is expected to approach the issue wondering: “Is performing abortion and infanticide indicative of virtues, to wit of character traits that the virtuous agent (...) possesses?” A deontologist would bring the dilemma up for discussion asking: “Is conducting abortion and infanticide in accordance with some moral rule or principle?” To an act utilitarian, on the other hand, the same question would strike as: “Do abortion and infanticide promote the best consequences, to wit those in which happiness is maximized?” All three approaches have been applied to the subject matter ever since the classic era, sadly with no remarkable success and, most of the times, even without the slightest suspicion of the promised rigor. (shrink)

Introduction -- Rational anthropology and the difference between persons and animals -- Human freedom and conscience -- The three moral determinants and doubts of conscience -- The principle of double effect and consequentialism -- Cooperation and scandal -- Virtues--natural and supernatural -- Sin and grace -- Revelation -- Reproductive technologies -- Homosexuality and same-sex marriage -- Contraception -- Abortion -- Marriage and family -- End of life issues -- Appendix A : Summary of Evangelium Vitae -- Appendix B : Summary (...) of Savifici Doloris. (shrink)

In this paper we argue that society should make available reliable information about parenting to everybody from an early age. The reason why parental education is important (when offered in a comprehensive and systematic way) is that it can help young people understand better the responsibilities associated with reproduction, and the skills required for parenting. This would allow them to make more informed life-choices about reproduction and parenting, and exercise their autonomy with respect to these choices. We do not believe (...) that parental education would constitute a limitation of individual freedom. Rather, the acquisition of relevant information about reproduction and parenting and the acquisition of self-knowledge with respect to reproductive and parenting choices can help give shape to individual life plans. We make a case for compulsory parental education on the basis of the need to respect and enhance individual reproductive and parental autonomy within a culture that presents contradictory attitudes towards reproduction and where decisions about whether to become a parent are subject to significant pressure and scrutiny. (shrink)

Does the position of the Roman Catholic Church on contraception also imply that the usage of condoms by HIV-discordant couples is illicit? A standard argument is to appeal to the doctrine of double effect to condone such usage, but this meets with the objection that there exists an alternative action that brings about the good effect—namely, abstinence. I argue against this objection, because an HIV-discordant couple does not bring about any bad outcome through condom usage—there is no disrespect displayed for (...) the generative function of sex. One might retort that the badness of condom usage consists in thwarting the unitive function of sex. I argue that also this objection cannot be upheld. In conclusion, if there are no in-principle objections against condom usage for HIV-discordant couples, then policies that deny access to condoms to such couples are indefensible. HIV-discordant couples have a right to continue consummating their marriage in a manner that is minimally risky and this right cannot be trumped by utilitarian concerns that the distribution of condoms might increase promiscuity and along with it the HIV infection rate. (shrink)