Elective Sterilization: Does the Bible Have Anything to Say?

The following article by Toni Saad appeared in the May 2025 issue of the Banner of Truth magazine (no. 741). You can purchase a copy of the relevant issue, or subscribe in print or digital formats.

It is a truism that even the more sophisticated strains of contemporary Reformed theology lack a developed theology of the body and matters adjacent to it (bioethics, we might say). This has proven a challenge to me and like-minded colleagues who wish to serve the Lord faithfully in medicine, while having relatively little home-grown theology to feed on when it comes to bioethics—though, more broadly, the Reformed tradition is a feast for the heart and mind. If those of us seeking guidance for the specialized sort of ethics related to our work are disappointed, how much worse is the situation for the rest of the church.

Many, even learned believers, take such matters to be matters of indifference, subject to the principles of Christian liberty. I humbly propose that we rethink this line of thought.

Some matters are perceived very clearly by most evangelicals, and it is not uncommon for them to be touched upon from the pulpit. I am thinking of abortion and euthanasia. But I fear that when it comes to issues which are far more likely to directly affect a church member, very little teaching is available. Contraception and sterilization are two examples. My perception is that even well-informed believers do not know where to find moral guidance in these areas; indeed, I know that the question of moral guidance often does not enter the discussion. Many, even learned believers, take such matters to be matters of indifference, subject to the principles of Christian liberty. I humbly propose that we rethink this line of thought, drawing on Scripture and the Reformed tradition.

While I am an appreciative reader of Professor David VanDrunen’s work on natural law, and believe he is to be commended for writing one of the rare books on bioethics from a Reformed point of view¹Bioethics and the Christian Life, Crossway, 2009, I believe his comments on contraception and sterilization example the problem I am drawing attention to. Having very briefly touched upon and rejected (in my view, unfairly) certain arguments against contraception, he touches upon sterilization: ‘If, as concluded above, there is no theoretical difference between so-called natural and artificial methods [of contraception], then there seems to be no theoretical problem with sterilization either. The moral questions are again practical rather than theoretical’ (p. 117). With the greatest of respect for the author, I think there is a lot more that needs to be said about sterilization.

Direct sterilization is in no way therapeutic. It is effectively a form of mutilation, which is defined as damage to a tissue or organ leading to its dysfunction or failure.

The morally relevant sort of sterilization I am addressing is sometimes termed ‘direct sterilization,’ which is to say sterilization for its own sake, not merely sterilization as a consequence of an otherwise therapeutic intervention. Patients sometimes become sterile after systemic chemotherapy; however, the aim of the chemotherapy is not sterilization, but the treatment of cancer. Likewise, a man may be effectively sterilized following surgical removal of testicular cancer. Again, the procedure is only accidentally a sterilization. We can term it indirect sterilization, and this is considered acceptable either as a side effect (if it is proportionate) or as a-part-for-the-whole argument (principal of totality), which is the same reason it is right to amputate a gangrenous leg but not a healthy one (more on this below for anyone sceptical of this claim). Direct sterilization characterizes an act whereby a man or woman intends to become sterile by having a procedure such as a vasectomy or tubal ligation (to name two common options I know faithful believers have undergone). Direct sterilization is in no way therapeutic. It is effectively a form of mutilation, which is defined as damage to a tissue or organ leading to its dysfunction or failure.

The relevant biblical background to this matter begins in Genesis, where God created man and woman to be one flesh, to fill the earth and multiply by the process of natural generation. Descendants and offspring were marks of covenant blessing, and sterility a sign of covenant curse. Thus, we see the function of procreation being connected to creation and redemption. It is worth reflecting on why ‘no one whose testicles have been crushed or whose male member has been cut off shall enter the assembly of the Lord’ (Deut. 23:1). Clearly, in the age of the new covenant no such restrictions apply— indeed, the example of the Ethiopian eunuch whom Philip evangelized makes this clear, if the theological principles needed confirmation. Yet, the prohibition against castrates from entering the assembly indicates, like much of the ceremonial law, that holiness requires wholeness, and wholeness comprehends bodily integrity. This is a clear endorsement of the goodness of the body, including of the organs of reproduction.

It seems that such clear teaching on care for the body excludes mutilation of any kind, be it the removal of healthy limbs, or the temporary or permanent disruption or destruction of healthy sexual organs.

In the New Testament, Paul expresses his desire that those preaching a false gospel requiring circumcision would go all the way and emasculate themselves (Gal. 5:12)—we should consider this remark in the context of Paul’s double anathematizing of those who preach this false gospel (Gal. 1:8, 9). Paul’s statement in Ephesians 5 is perhaps the most helpful positive biblical statement in relation to our question: ‘In the same way husbands should love their wives as their own bodies. He who loves his wife loves himself. For no one ever hated his own flesh, but nourishes and cherishes it, just has Christ has done the church, because we are members of his body’ (Eph. 5:28-30). That we should love our neighbour as ourselves conveys a similar truth. Husbands must love their own wives by nourishing and cherishing them as their own flesh. It seems that such clear teaching on care for the body excludes mutilation of any kind, be it the removal of healthy limbs, or the temporary or permanent disruption or destruction of healthy sexual organs.

The Westminster Larger Catechism supports this claim. Question 135 asks about the duties required of the sixth commandment: ‘The duties required in the sixth commandment are all careful studies, and lawful endeavours, to preserve the life of ourselves and others …’ Unsurprisingly, the proof-text cited after ‘ourselves’ is Ephesians 5:28, 29. Then, Question 136 sets out the sins forbidden by the sixth commandment: ‘… all taking away the life of ourselves, or of others, except in case of public justice, lawful war, or necessary defence; … striking, wounding, and whatsoever else tends to the destruction of the life of any.’ Based on this and what has been argued above, it is not a stretch to conclude that mutilation, which is by definition an injury to the body which God has made good, is not one of moral indifference. We have a duty to ourselves to preserve our life, to nourish and cherish our flesh, not only because we are creatures, but because we have been purchased with a price and belong to the Lord, and because we belong to others whom we are called to serve. ‘You are not your own, for you were bought with a price. So, glorify God in your body’ (1 Cor. 6:19, 20). I propose, therefore, that our duties to ourselves preclude sterilization.

The conventional response to my argument goes like this: we should look beyond the biological facts and acts, and consider the more important personal and inter-personal ethics; what is more important that the rightness or wrongness of a sterilizing act is the broader context of the marriage in which it occurs and the intentions of the spouses; so, if husband and wife are making the very reasonable decision that they should have no more children, so long as they are not doing so selfishly, they are free to exercise their Christian liberty in sterilization.

There are some major flaws to this argument, however. It abstracts godly ends such as stewardship and wisdom from means, which are also governed by the moral law. It abstracts what is done in the body from what is done in the soul, and so does violence to the person made in the image of God. We are not permitted to do evil so that good may abound, so how can it be right to perform an act which Scripture forbids for the sake of a higher end which it encourages? This line of reasoning is not compatible with Christian ethics. And Christian ethics does not recognize that acts done to the body are neutral, whereas mental or spiritual acts truly determine the moral character of an action. Some ‘bodily’ matters are clearly indifferent—what we eat for breakfast, for example. But, as I have shown above, some things done to the body, including mutilation, are not morally neutral, and so cannot be glossed. Wisdom in family building is certainly to be commended, and there is no obligation to have as many children as possible, but this does not mean we are sovereign over our bodies. We are stewards, not owners. We have been made and redeemed by God, body and soul, and we are not our own.

I hope I have shown that acts of direct sterilization are not morally indifferent. The word of God is not silent on the matter. Moreover, there is a whole tradition of natural law argumentation which, in my view, supports and develops what Scripture teaches (by good and necessary consequence)—this is for another day. Suffice it to say that we all need to examine our lives and our doctrine in all areas and submit to God’s revealed will, lest we deprive ourselves of his fatherly smile of blessing on our lives. I would like to urge preachers and teachers to search the Scriptures and the Reformed tradition to remedy what is lacking in our ethics, to better serve our Triune God who has bought us with a price.

Toni Saad is a doctor specialising in neurology, and an ordained elder at Whaddon Road Evangelical Presbyterian Church, Cheltenham, part of EPCEW (The Evangelical Presbyterian Church in England and Wales). Dr Saad has a degree in bioethics and medical law from St Mary’s University.

Featured Photo (visible when the article is shared on social media) by Jonathan Borba on Unsplash