Abortion and saving a woman's life

[Rence]

True, but pregnancy is not a disease or abnormal condition; fine line, perhaps, but nonetheless a line.

Of course pregnancy is not a disease. However, when a woman’s health has already declined due to an underlying condition, that line changes. When a woman’s health has already declined, the physiological changes that pregnancy causes can be a burden that she may or may not be able to tolerate. And that depends on the woman and her current health.

Yep, I can understand too. I’m not sure that there are not (medical) differences in the respective expected outcomes between surgery and medical treatment. If there were, that would be a considertion. Given that surgery and medical treatment were equal in terms of risks, chance of success, etc, from a moral standpoint it wouldn’t seem to matter.

Well of course there are differences in the outcomes between surgery and medical treatment. The surgery, of course, being more invasive. Being put under anesthesia has it’s own set of risks to consider as well. The woman has to weight taking a pill and dealing with the physical processes that take place vs. being put under anesthesia, being cut, and dealing with that healing process, and in addition, being short one tube. I wouldn’t say the outcome is the same. The outcome is different depending on which course is chosen.

 

[THP]

Not exactly. The intent is to restore the woman’s body to health, and the only way to do that is to remove the embryo. The unintended side effect is the termination of the embryo. If there was another way to save the embryo (implantation into the uterus, for example), and such were to be attempted, it would need to be at least tried in order for it to be a moral act.

An argument is likely to be made such as:

How is that different than removing an embryo from a uterus of a woman who has severe cardiac disease and isn’t likely to survive the pregnancy?

The answer is that removing the embryo in such a case will not cure the cardiac disease.

Subtle but important distinction.

I disagree. The intent is to remove the pregnancy, clearly I will not convince you and you will not convince me otherwise.

Of course removing an embryo from a tube is different from removing an embryo from the uterus. The embryo in the tube has ZERO chance of survival no matter what you do.

The use of Methotrexate will most certainly kill the embryo, but the “remains” of that embryo are more likely, it would seem, to cause inflammation and possible scarring and/or narrowing of the fallopian tube, possibly leading to a repeat condition. Of course, surgery could result in scarring as well. Perhaps a (human) surgeon could shed some light on it. That being said, the choice of medical procedure doesn’t always affect the morality of an action, given that choices are available.

You are in luck because I happen to be such a human. You are right that both salpingostomy and methotrexate both increase the scarring in the tube and increase the risk for recurrent ectopic. If you take the tube (assuming the other one is damaged as well or already gone) you eliminate any chance of future fertility. Plus you expose the mother to a surgery and the inherent risks. Of course the surgery is often necessary and may be the best, it all depends on the individual situation. I typically remove the entire tube for the reason you mentioned IF the other tube appears normal.

 

[Newbie2]

I disagree. The intent is to remove the pregnancy, clearly I will not convince you and you will not convince me otherwise.

Of course removing an embryo from a tube is different from removing an embryo from the uterus. The embryo in the tube has ZERO chance of survival no matter what you do.

.

Are you then equating abortion with removal of an embryo from a fallopian tube? If you see the intent as the same in both, and the action is the same, what is the moral difference in your opinion?

 

[THP]

Are you then equating abortion with removal of an embryo from a fallopian tube? If you see the intent as the same in both, and the action is the same, what is the moral difference in your opinion?

Absolutely not, and that is my point.

Apparently, the correct position to hold is that removing the tube is morally OK because of the principle of double effect whereas removing the embryo while leaving the tube intact is equivalent to abortion. I disagree with this. I think neither are equivalent to an abortion because the embryo has already implanted in the tube and there is zero chance of it surviving and because of its location the mother’s life is in danger.

 

[THP]

Are you then equating abortion with removal of an embryo from a fallopian tube? If you see the intent as the same in both, and the action is the same, what is the moral difference in your opinion?

Absolutely not and that is my point.

Apparently the correct position to hold is that removing the tube is morally OK because of the principle of double effect whereas removing the embryo but leaving the tube intact is equivalent to an abortion. I disagree with this. I don’t think either is equal to abortion because there is zero chance the embryo will complete gestation and the mother’s life is in danger because of where it implanted. I don’t think you are sacrificing the life of the embryo for the sake of the mother because the embryo’s life has already be sacrificed because of where it implanted.

 

[Newbie2]

Apparently, the correct position to hold is that removing the tube is morally OK because of the principle of double effect whereas removing the embryo while leaving the tube intact is equivalent to abortion. I disagree with this.

I think the confusion is coming in.

The principle of double effect has nothing to do with whether or not the (portion or entire) tube is removed; that is immaterial.

Let’s change the scenario slightly to a moral equivalent: a normal pregnancy with a cancerous uterus. Removing the uterus with the attempt to save the life of the mother has two forseen effects:

1. Saving the life of the mother, which is the intended effect.
2. The death of the embryo, which is the unintended but forseen second effect.

Two effects from one action, one intended and forseen, the second resultant action, unintended and forseen.

In the tubal pregnancy scenario, the principle of double effect also applies:

1. 1st intended effect is the saving of the life of the mother by removing the embryo from its abnormal and life-threatening location (regardless of whether the tube needs to be removed or not)
2. 2nd unintended but forseen effect is the death of the embryo.

I think neither are equivalent to an abortion because the embryo has already implanted in the tube and there is zero chance of it surviving and because of its location the mother’s life is in danger .

This part is correct.

 

[THP]

I think the confusion is coming in.

The principle of double effect has nothing to do with whether or not the (portion or entire) tube is removed; that is immaterial.

Let’s change the scenario slightly to a moral equivalent: a normal pregnancy with a cancerous uterus. Removing the uterus with the attempt to save the life of the mother has two forseen effects:

1. Saving the life of the mother, which is the intended effect.
2. The death of the embryo, which is the unintended but forseen second effect.

Two effects from one action, one intended and forseen, the second resultant action, unintended and forseen.

In the tubal pregnancy scenario, the principle of double effect also applies:

1. 1st intended effect is the saving of the life of the mother by removing the embryo from its abnormal and life-threatening location (regardless of whether the tube needs to be removed or not)
2. 2nd unintended but forseen effect is the death of the embryo.

This I can agree with but I don’t think that is what Underacloud and Thistle were saying. To be clear, are you saying its OK to give methotrexate (a medication) for a known ectopic pregnancy to avoid surgery?

 

[underacloud]

In the tubal pregnancy scenario, the principle of double effect also applies:

1. 1st intended effect is the saving of the life of the mother by removing the embryo from its abnormal and life-threatening location (regardless of whether the tube needs to be removed or not)
2. 2nd unintended but forseen effect is the death of the embryo.

This isn’t quite correct. I’ll try to lay it out, according to Catholic moral understanding of this problem.

Scenario one – tubal pregnancy is dealt with by removal of the tube.
Intended effect: preserving the woman’s health.
Means: removing the damaged (or soon to be damaged) tube, which is morally neutral.
Unintended effect: unavoidable (by current medical practices) death of the embryo.

Scenario two – tubal pregnancy is dealt with by aborting the embryo.
Intended effect: preserving the woman’s health, as above. Also, the preservation of the tube; thus, the good effects seem to be better in this scenario.
Means: direct abortion (which is not morally allowable).
Unintended effect: none – the death of the embryo is intended – it is the means by which the good effects are gained.

Double effect makes scenario one allowable, but not scenario two. We can debate whether or not this is a good thing, or whether we should employ a consequentialist approach to morality, but I’m just trying to make the specifics clear with regard to Catholic moral understanding.

I can completely understand why some people think scenario two is preferable. But we have a clear, established principle in Catholic morality that we may not do evil (in this case direct abortion) that good (preservation of woman’s health, including tube) may come of it.

 

[Michael_Mayo]

Now this surprised me:

Hence, if some Catholic hospitals have
policies that prohibit salpingostomy and
the use of methotrexate, this is not
because these procedures are forbidden by
Church teaching or by the ERDs. Rather,
it is because an individual or individuals
decided either to take the safer course or
personally believed that salpingostomy
and the use of methotrexate constitute
direct abortions and are, therefore, in
conflict with Directives 48 and 45.
**However, given the on-going debate, it is
permissible for Catholic hospitals to
employ both the third and fourth
approaches. **As the editors of the National
Catholic Bioethics Center’s Catholic
Health Care Ethics note: “Resolution of
this debate will depend on further
specification of the exact nature of these
medical procedures and further
refinement of the arguments about the
moral object of each act. Generally, if
there are two competing but contrary
bodies of theological opinion about a
moral issue, each held by experts whose
work is in accordance with the
magisterium of the Church, and if there is
no specific magisterial teaching on the
issue that would resolve the matter, then
the decision makers may licitly act on
either opinion until such time that the
magisterium has resolved the question.”5
R.H.

Scroll down to:
Catholic Hospitals and Ectopic Pregnancies

chausa.org/Content.aspx?pageid=4294969960&terms=ectopic#Ectopic

 

[Newbie2]

This I can agree with but I don’t think that is what Underacloud and Thistle were saying. To be clear, are you saying its OK to give methotrexate (a medication) for a known ectopic pregnancy to avoid surgery?

Morally speaking, removing the embryo surgically and chemically are the same, but there is something that just doesn’t seem right about chemical removal. And that is assuming that the embryo is at a stage where it will be removed without complications (scarring, etc.) by the woman’s body.

This isn’t quite correct. I’ll try to lay it out, according to Catholic moral understanding of this problem.

Scenario one – tubal pregnancy is dealt with by removal of the tube.
Intended effect: preserving the woman’s health.
Means: removing the damaged (or soon to be damaged) tube, which is morally neutral.
Unintended effect: unavoidable (by current medical practices) death of the embryo.

Scenario two – tubal pregnancy is dealt with by aborting the embryo.
Intended effect: preserving the woman’s health, as above. Also, the preservation of the tube; thus, the good effects seem to be better in this scenario.
Means: direct abortion (which is not morally allowable).
Unintended effect: none – the death of the embryo is intended – it is the means by which the good effects are gained.

Double effect makes scenario one allowable, but not scenario two. We can debate whether or not this is a good thing, or whether we should employ a consequentialist approach to morality, but I’m just trying to make the specifics clear with regard to Catholic moral understanding.

I can completely understand why some people think scenario two is preferable. But we have a clear, established principle in Catholic morality that we may not do evil (in this case direct abortion) that good (preservation of woman’s health, including tube) may come of it.

I’m not sure this interpretation is correct, as it reduced the question of whether it is considered an abortion or not to whether or not the tube is removed. Perhaps I’m thinking of this more from a surgical angle; I don’t know the extent of damage that normally occurs to a fallopian tube from an ectopic pregnancy if it is not treated.

Yes, agreed that direct intended abortion is not morally acceptable.

But in scenario 1, it seems that if the surgery is done before there is any tubal damage, what is the difference between scenarios 1 and 2? The only thing I can see is the effort to preserve the integrity and function of the tube. Take that away, methinks, and the scenarios are identical; the intent is to preserve the life of the mother.

Waddya think?

 

[underacloud]

I’m not sure this interpretation is correct, as it reduced the question of whether it is considered an abortion or not to whether or not the tube is removed.

That’s exactly the point.

You remove the tube to prevent the (soon to be) damaged tube from threatening the woman’s health/life. The death of the embryo is unintended, even though unavoidable. This is not considered abortion.

The other option is to perform an abortion…which is, regardless of one’s view of the consequences, a direct abortion and morally illicit.

But in scenario 1, it seems that if the surgery is done before there is any tubal damage, what is the difference between scenarios 1 and 2? The only thing I can see is the effort to preserve the integrity and function of the tube. Take that away, methinks, and the scenarios are identical; the intent is to preserve the life of the mother.

It is not the intent or the consequences that determine moral licitness of these scenarios, it is the means by which they are achieved.

 

[THP]

That’s exactly the point.

You remove the tube to prevent the (soon to be) damaged tube from threatening the woman’s health/life. The death of the embryo is unintended, even though unavoidable. This is not considered abortion.
.

How do you square this with the quote Michael Mayo posted? I didn’t read the link.

 

[underacloud]

How do you square this with the quote Michael Mayo posted? I didn’t read the link.

Sorry, I missed that; I have now read it. Yes, that certainly presents a different perspective to the one I have been presenting! Like Michael Mayo, I am surprised.

While it is true that the magesterium has not given a direct ruling on this matter, the vast weight of moral theologians come down on the side that salpingostomy and methotrexate constitute direct abortion, and this needs to be given very careful consideration before this weight of opinion is ignored. I’m very surprised by the position of the CHA on this and will be keen to see how this evolves.

A relevant response can be read here: johnpaulbioethics.org/FinalProofs.pdf

It is long and detailed and a good article for those wishing to explore this issue further. Their recommendations:

“Because of the increasing numbers of ectopic pregnancies, Catholic moralists,
counselors, and confessors need to know what medical and moral issues are involved.
Until recent years, the Catholic consensus has been that only expectant therapy or
salpingectomy would qualify as moral means for treating tubal or other forms of
ectopic pregnancy. Recent attempts to justify salpingostomy and methotrexate by
Kaczor and Rhonheimer might seem appealing, because these methods do not ordinarily
result in the loss of a fallopian tube. But neither Kaczor nor Rhonheimer has
provided sound arguments for believing that these two methods do not, in themselves,
constitute the direct and immediate killing of an innocent human being, an action
that is forbidden by the divine and natural law and the magisterium of the Church.”

I have also found this link to the answer given in “ask an apologist”: forum.catholic.com/showthread.php?t=55211

Perhaps the moral debate will evolve in another direction, as per the CHA’s statement. But these links above address the traditional perspective on this matter and there’s not much more I can add now.

 

[Newbie2]

That’s exactly the point.

You remove the tube to prevent the (soon to be) damaged tube from threatening the woman’s health/life. The death of the embryo is unintended, even though unavoidable. This is not considered abortion.

The other option is to perform an abortion…which is, regardless of one’s view of the consequences, a direct abortion and morally illicit.

It is not the intent or the consequences that determine moral licitness of these scenarios, it is the means by which they are achieved.

We cannot ignore the intent; it must be considered along with the action itself.

So, we’ve got an ectopic pregnancy. Surgery in this particular instance, let’s say, if done at a certain time, can save both the mother’s life…and preserve the tube. To be a morally licit procedure, must the tube be removed, salvagable or not? ( Obvioiusly, it’s damaged beyond repair, it should be revoved.) Or it it a matter of waiting until the tube is beyond saving to perform the procedure?

 

[Michael_Mayo]

A relevant response can be read here: johnpaulbioethics.org/FinalProofs.pdf

.

I dbont’ know. That moral line between salpingectomy and salpingostomy seems pretty thin. The response states:

Kaczor’s argument fails to take into account the totality of the moral object
chosen in salpingostomy, however. The embryo is not being removed to transfer it
to a place, such as the uterus, where it can continue living. Rather, the embryo is
being removed from the tube with the knowledge that no attempt will be made to
move the embryo to “a safe haven.” This changes the moral object completely, in
spite of Kaczor’s claim that the killing is not intentional.

Well, the same can be said in salpingectomy but with the tube included.

 

[underacloud]

We cannot ignore the intent; it must be considered along with the action itself.

I’m not ignoring the intent. It’s just that in this case…comparing the two scenarios…it is the means that is important in the consideration of morality. The intent is arguably better in the case of preserving the tube, but it’s the means - a direct abortion* - that is not allowable. If the means of both scenarios is considered OK, then of course preseving the tube is the better option.

• noting that there is obviously some debate on this point, as per Michael Mayo’s post.

 

[underacloud]

I dbont’ know. That moral line between salpingectomy and salpingostomy seems pretty thin.

It does seem pretty thin. Arguably, the line is a mere technicality, which is why this issue is difficult to work through.

In one case, you perform what is (arguably) a direct abortion, be directly removing the embryo.

In the other, you remove the tube, with the death of the embryo unintended but unavoidable. This is not considered a direct abortion, even if the outcome seems the same or worse.

Of course, as you point out, there is some debate as to whether salpingostomy constitues a direct abortion, but the John Paul Bioethics group argue that it does and this has been the classic understanding of the issue.

 

[THP]

It is a thin line and I don’t think it is enough to change the way I practice. I feel I have to do what is best for my patient who is, in this case, clearly the mom.

 

[underacloud]

It is a thin line and I don’t think it is enough to change the way I practice. I feel I have to do what is best for my patient who is, in this case, clearly the mom.

It’s one thing to discuss these issues abstractly, and another thing to put them into practice. I hope your opinion is not based on discussion of deep theological issues on an internet forum. I’m not a moral theologian so probably don’t present the issues as well as they ought to be. Given that this issue affects you directly in your profession, you really ought to look deeper into it and perhaps consult with a relevant association that informs Catholic ethics in your area.

All the best.

 

[SparkleFly]

I believe that abortions can be deemed acceptable if it is to save the mom’s life, although I wish she’d go for checkups to make sure she is healthy enough to get pregnant before going about it, but I do understand things pop up.

I also think it’s the more moral decision to abort the baby if they are are thought to have an inevitable genetic disease. While I’d wish parents would go for genetic testing before conceiving to rule this out, if the kid is going to die anyways, let them die peacefully NOT in suffering. I don’t think it is ever okay to let someone live a life of suffering in a hospital bed. I’ve had to have the vet put one of my dogs to sleep after she was diagnosed with an inevitable disease and was in such unbearable pain I couldn’t watch her suffer. I think the same ideology should apply to humans. This is why I also support physician assisted suicide.