Surgeon General's report on sexual health: The public effects of private behavior

On June 28, 2001, then Surgeon General David Satcher issued a report entitled "A Call to Action to Promote Sexual Health and Responsible Sexual Behavior". An editor at the Philadelphia Inquirer editorial page asked for my impressions, and they appeared in their opinion page on July 8, 2001 next to those of Susan Wilson, a sex educator at Rutgers University. Soon after, it also appeared alongside "counterpoint" articles by Bill O'Reilly of Fox News in the Miami Herald (July 11, 2001) and by Pastor Madison Shockley of the Religious Coalition for Reproductive Choice in the Houston Chronicle (July 16, 2001). The Sacramento Bee (July 13, 2001) and the News-Gazette of Champaign, Illinois (July 15, 2001) and the Holland (Michigan) Sentinel (July 12, 2001) ran the piece as well. The terms "self-possession" and "self-donation" do not appear in Satcher's report. They are my way of classifying categories of social pathology that Satcher describes. The references to freedom of indifference and freedom for excellence are taken from the thought of Servais Pinckaers as published in his book, The Sources of Christian Ethics. A helpful review of this approach to understanding human freedom was published by George Weigel in a paper entitled "A better concept of freedom" in March, 2002.

The “Call to Action”, recently issued by Surgeon General David Satcher, is an effort to identify sound strategies for promoting responsible sexual behavior in the United States. Meant to serve as a starting point for a national dialogue on this important issue, the document offers in broad brush strokes a clear portrait of sexual health -– or perhaps more accurately, sexual pathology -- in America today. At first blush, one might be tempted to ask why is more discussion about sex necessary? We already talk about it quite a bit. Ours is a culture saturated with sexual information and imagery. If Dr. Satcher feels even more dialogue is needed, perhaps it is because the conversation thus far has been neither helpful nor healthful.

Three broad themes run through this document. The first points to what may be called a “crisis of self-possession”. The epidemic of sexually transmitted diseases, including AIDS, and teen pregnancy lamented in the report are often the result of sexual promiscuity. If some persons choose to be promiscuous -- and by Satcher’s account, many do -- it is usually not because they always enjoy what they are doing, but because they want to be truly loved by another person, and believe that sex is a way to achieve this. They seek to placate their loneliness by giving themselves away, but more often than not are sorely disappointed, frequently infected and inevitably embittered by their experiences. Promiscuity occurs because, all too often, persons have not been helped to discern their authentic dignity and the true value of their sexuality. They choose intimacy with anyone and end up trusting no one.

A second trend within the document suggests a “crisis of self-donation”. Satcher suggests that abortion and unwanted pregnancies are bad for society, and their incidence should be reduced. But fixing the numbers will never fix the cause of these tragedies. When a man and woman conclude that their pregnancy is unwanted, they are saying that the life they have helped to bring about is not worthy of being. It’s too much trouble. They fail to understand that the demands that children impose upon parents are actually a great blessing. Nothing can shake us out of our complacency and selfishness faster than the arrival of a child. They offer us countless opportunities to forget about ourselves. Rising to the occasion, rather than shrugging it off can be among the most salutary experiences known.

The third theme implicit in “A Call to Action” is simply this: private behavior has public consequences. For years now, a new right to privacy -- conceived in the so-called “penumbra” of the U.S. Constitution by Roe v. Wade -- has served to protect the personal reproductive choices of Americans from external interference. Yet the unrelenting emphasis on “privacy” and “freedom of choice” advocated for three decades by many of our fellow citizens has not led to demonstrable improvements in sexual health. Why not? Perhaps it is because the brand of freedom they advocate leads only to indifference: it’s OK to abort and it’s OK to keep your baby; it’s OK to have sex before marriage and it’s OK to wait; it’s OK to be promiscuous and OK to be monogamous, and for that matter it’s OK to not play the game at all. So what’s the difference? Who cares! The only thing that matters is the “freedom to choose”. And we all watch dumbfounded as America’s families – husbands, wives and children -- despair of trusting one another, victims of the apathetic chill brought on by freedom misused.

Dr. Satcher would like his “Call to Action” to serve as a point of departure, “common ground upon which the nation could work to promote sexual health and responsible sexual behavior”. This might be a good thing, but only if we acknowledge that true freedom has limits. Those limits are defined not by arbitrary rules and individual choices, but by a law inscribed in human nature. This law binds all of us equally, and guides the behavior that leads to health and happiness. Freedom may then be understood as the struggle for excellence, the effort to achieve a desirable ideal despite obstacles and adversity. With this view of freedom, surrender to indifference is failure. What is needed to restore health to American family life is not more sex education, but education in the proper use of personal freedom.

The use of freedom leads to personal fulfillment only if we give ourselves to others in ways that are appropriate to our nature: self-possession for self-donation. Normally, we enjoy the company of colleagues and neighbors. We relish the companionship of friends and family. We desire intimacy with those closest to us, our spouse and our children. Each relationship fulfills in its own way a basic human need for others. When freedom is used to justify the gratification of our personal whims, we end up avoiding our spouse and children, caring little about family and friends and having sex with our colleagues and neighbors: self surrender for self-indulgence. Which life would you choose for yourself?