PREMARITAL EXAMINATION. - A medical examination imposed or recommended, according to the various nations, on those intending to enter into marriage, and which entails the issuance of a "premarital medical certificate," mandatory in certain States, in order to proceed with the celebration of the marriage itself. The premarital visit is part of the complex eugenic provisions whose purpose is to improve the population, particularly those called "negative" because they tend to eliminate the birth of infirm beings or those otherwise unsuited to social life.
In comparison with other means far more damaging to liberty and personality, and more intrinsically illicit, the form under examination is susceptible to various criticism, from the moral point of view, according to the conclusions and practical sanctions to which it is connected.
The purpose of the premarital visit is to ascertain the state of health of the future spouses, in particular, the absence of contagious diseases or active morbid defects, of mental or physical infirmities transmissible by heredity. In America, this form of marriage control has had wide implementation, especially for syphilis; seventeen States require, of anyone wishing to contract marriage, a medical declaration attesting that he is free from this disease, while others require it for all venereal diseases; some impose the medical examination, while others require only a medical certificate. In many States the restriction is extended to tuberculosis and psychic defects, particularly in North America; in South America, owing to the prevalence of the Catholic element, the restrictions are far more limited.
Europe too has adopted such precautionary measures, although not to the same extent in the various nations. Among the first, Sweden must be remembered, which instituted, in 1915, the obligation of the premarital certificate with severe sanctions for violators, extending even to the annulment of the marriage. In 1907 in Germany the "Society for Racial Hygiene" began a campaign for the health control of marriages, starting from the concept that it is the duty of the State to limit the fecundity of the weakest, while requiring it instead of the strongest (along this path one arrived at the aberration of sterilization and State breeding). In 1920, again in Germany, the National Assembly established that the civil registry offices should require the exchange of health certificates between the spouses, with penalties for transgressors; this imposition was accentuated by the Hitlerian government. In 1919 Norway instituted a questionnaire which engaged couples had to answer in order to be admitted to marriage. In 1922 the first premarital counseling center arose in Austria and the Office of Hygiene undertook its propaganda with posters that had good results. Russia, with art. 131 of the law of 1934, prescribed the mandatory premarital certificate, with particular regard to venereal and mental diseases and tuberculosis, and severe sanctions for transgressors; Yugoslavia too in 1935 instituted the mandatory premarital certificate. France, which already in 1903 had opposed a second refusal to this institution, in 1942 established that engaged couples had to present to the civil registry office a certificate showing that each of them had undergone a medical examination; this not for prohibitive purposes, but with the aim of placing the contracting parties before their own responsibility, so that, while safeguarding liberty, the sense of responsibility would be stimulated. In 1946, owing to the repeated requests of the "French Society of Eugenics," the presentation of the reports of a radiological examination of the chest and of the Wassermann reaction was imposed on those aspiring to marriage. In Turkey, since 1930, marriage is prohibited to anyone lacking a certificate attesting the absence of venereal diseases. In Denmark, on one's word of honor, a declaration of the same condition is required.
In Italy, the question took shape in 1920 within the "Italian Society of Dermatology and Syphilography," which presented to the General Directorate of Public Health a draft regulation concerning the adoption of a premarital certificate barring marriage in the case of certain diseases. In June 1923 Prof. Cirisezione made in the Chamber the first proposal for a mandatory medical certificate for spouses, but with no result. Since that time the question has been variously debated on the legislative ground. In a bill presented to the Senate on 28 Sept. 1949, concerning measures in the fight against venereal diseases, on the initiative of Senator Monaldi, art. 7 speaks of the duty of a consultative premarital visit.
On 19 Dec. 1949 in the Chamber of Deputies a bill was announced, on the initiative of Mary Chiesa Tibaldi and others, for the institution of premarital counseling centers, which rests on three principal points: 1st recognition of the necessity of the premarital visit; 2nd recognition of the necessity of the premarital medical certificate; 3rd no determination to make the visit mandatory by law, but rather "the opportunity to create a conscience regarding the problems of marriage and offspring" and to carry out the greatest propaganda on the usefulness of premarital counseling centers.
At present there exists in Milan a premarital prophylaxis center; already advocated by E. Alfieri since 1924, founded at the Italian Red Cross, on the initiative of the latter, of L. Ronzoni and of P. Malcovati. Likewise in Milan there operates, with a juridical, medical and genetic section, a premarital counseling center at the Opera card. Ferrari, in connection with the Center of Human Genetics of the University, directed by Prof. L. Gianferrari. In Rome and in Verona, with the same organizational plan, one operates promoted by the "Fronte della famiglia."
As regards the question from the medical, medico-legal and moral point of view, the following considerations hold. From the medical point of view, without doubt, the premarital visit represents an effective means of fighting against the spread of serious diseases, transmissible to the other spouse or to the offspring, without violating the dignity of the human person, and it represents an act of legitimate intervention by public authority, in defense of superior interests of a social order (in the same way as the obligation of vaccinations and the reporting of infectious diseases) and of the right that every spouse has to know the real health conditions of the other. Therefore, even from the moral point of view, there is nothing to object to in a possible mandatory character of the premarital visit. To evaluate, however, within just limits the possible damages of certain morbid forms with regard to offspring, one must bear in mind the limitedness and relativity of our knowledge concerning the phenomena of heredity (v. EUGENICA).
The question appears different from the moral point of view in the case where the visit entails the obligation of compiling a medical certificate, where the exchange of it between the future spouses is mandatory, where the authority imposes sanctions or impediments for the existence of particular diseases. While the moral licitness of the legal obligation of the premarital certificate and of its exchange between the future spouses seems admissible, in accordance with the moral duty of each contracting party to disclose eventual hidden defects capable of compromising the validity of the marriage and family happiness, every sanction or temporary or permanent prohibition on the part of the State to celebrate marriage, in the case of a premarital visit not corresponding to determined requirements, must be considered morally illicit. Such an imposition would be damaging to the attributes of the human person and would strike "the natural right of man to to contract marriage" (Pius XI, Casti connubii). Moreover, this institution, being of divine and not human law, is governed by and recognizes impediments only from the former and from canon law, the civil authority having competence only over the civil effects of marriage (CIC, cann. 1016, 1038). Since it is a matter of marriage between non-baptized persons, it seems that the State may lawfully impose temporary impediments, prohibiting marriage as long as certain circumstances persist.