Abortion - DOUBLE EFFECT questions

[GodHeals]

Hi,

It seems logical the mother would always want to save the child, but why wouldn’t it be a moral question if the mother has the cancer removed and thus indirectly saves the child?

Is there ever a situation where cancer would kill both the mother and the child and the mother has to choose to either have the uterus removed or not during a pregnancy or are there similar situations a mother might find her self involved in?

Or is it only in the 1960’s with less medical knowledge that a woman would have to choose life for a child and death for herself, knowing that both might die?

Any help would be great! Thanks!
Brian

"The clearest and surest example is the ectopic pregnancy. As everyone knows, should the fetus become lodged in the oviduct or fallopian tube, its continued growth will result in the death of both child and mother. A normal and proper procedure in this case is the removal of the fallopian tube, from which the death of the unborn child inevitably follows. In this case the death of the child is not sought, nor is the mother´s life saved by the child´s dying. …

A similar dilemma would arise in the case of an expectant mother diagnosed with uterine cancer. The death of the child obviously would result from the removal of the cancerous organ, but it is not the death of the child that is deliberately sought, nor is the mother´s life saved as a result of the child´s death. This is not an abortion in the sense used by moral theology; it is just a standard application of the ethical principle known as “double effect,” …

Unfortunately, however, given a chance to correct its earlier slip, the magazine compounded the difficulty by asserting that “the Church teaches that the mother must be saved.” No, strictly speaking, this is not true either; such a very tough medical decision is normally a matter of the mother´s choice, and I am familiar with no teaching of the Orthodox Church that would oblige a mother´s conscience to value her own life over her child´s. The mother´s life is not intrinsically of greater value than the child´s, and every mother known to me, if the choice were ineluctable, would value her child´s life above her own.

It is interesting to observe that the Roman Catholic Church recently honored with canonical beatification a woman who died in 1962 in consequence of choosing not to undergo the surgical procedure just mentioned. Even though she knew that it would result in her death, Gianna Molla carried her baby to term and then died a week later. Her little girl grew up and was on hand in St. Peter´s Square to see her mother raised to the dignity of the altar. "- catholic.net/index.php?option=dedestaca&id=177

 

[Reverie]

Hi,

It seems logical the mother would always want to save the child, but why wouldn’t it be a moral question if the mother has the cancer removed and thus indirectly saves the child?

I think in cases of uterine cancer, the only way to remove the cancer would be to remove the uterus. Not sure though.

Is there ever a situation where cancer would kill both the mother and the child and the mother has to choose to either have the uterus removed or not during a pregnancy or are there similar situations a mother might find her self involved in?
Brian

Some pro-choices will say that pre-eclampsia/eclampsia is a condition that risks the mother’s life, which is true, and suggest that the baby be aborted in order to save the mother’s life. This is not necessary since delivering the baby rectifies it, though the baby may be premature and not survive. It wouldn’t be willfully killing a baby to deliver it early.

A rare form of Gestational trophoblast disease is the only other reason I can think of where double effect would come into play in our world of modern medicine.

I’m not sure if that really answers your question. I’m not a medical practioner. I only know a little about gestational trophoblast disease because I had a form of it. Fortunately mine was not cancerous, and there was no baby.

 

[aux1]

In Catholicism, abortion cannot be justified under the double effect. The double effect requires that the action must be morally good or neutral, however, abortion is always evil by definition (CCC 2271). The implication is that even if you can save a woman by aborting the pregnancy, you’re not allowed to. See Margaret McBride.

You can, however, subject the patient to treatment which will have a side-effect of terminating the pregnancy. This is because CCC 2271 refers to direct abortion, while abortion as a result of unrelated treatment is indirect.

This results in a rather peculiar view on ectopic pregnancy. You are allowed to remove the fallopian tube with the embryo inside, however, you are not allowed to cut open the tube, remove the embryo, and suture it back. This is because Catholic Church believes (contrary to the common sense) that ectopic pregnancy is the disease of the fallopian tube itself, not a case of embryo anchoring itself in a perfectly healthy tube. So if you remove the tube, you are removing a threat to patient’s health from a diseased tube, but if you remove the embryo from a tube, you are performing an abortion.

You are also not allowed to administer methotrexate which will inhibit the functions of the placenta (thus indirectly killing the embryo), because Catholic bioethicists believe that placenta is a part of the embryo – because is has the same DNA.

It’s also interesting to note that in other ethical systems (e.g. in Judaism) therapeutic abortion is allowed as a form of self-defense. Catholicism is the only ethical system I’m aware of which explicitly that rejects this common sense doctrine. Thus, despite the official claim that Catholicism views the woman and fetus as equally valuable, in practical sense, Catholicism views fetus as untouchable, and the woman as expendable.

If you think that doesn’t make sense, don’t worry, you’re not the only one.

Also, it should be noted that Catholic medical personnel is not allowed to perform therapeutic abortions under the threat of excommunication (Canon 1398). The woman has no say in the matter.

TL;DR D&C bad, ripping out uterus good.

 

[aux1]

Some pro-choices will say that pre-eclampsia/eclampsia is a condition that risks the mother’s life, which is true, and suggest that the baby be aborted in order to save the mother’s life. This is not necessary since delivering the baby rectifies it, though the baby may be premature and not survive. It wouldn’t be willfully killing a baby to deliver it early.

Inducing miscarriage (i.e. birth before viability) is the earliest known technique of performing an abortion.

 

[Christy_Beth]

When I was pregnant with my daughter, I ended up with pre-eclampsia and was put in the hospital on complete bed rest. This was within a month of her due date. Being in the hospital also made it possible to watch the situation to see if it would get worse. I was told that if it did, they would either induce labor or do a C-section. Well, it did get worse, so they induced labor 13 days before her due date. She came out just fine. Other than being a natural born screamer. So, the situation doesn’t necessarily mean that the baby would have to die to save the mother’s life. They can take care of babies that are premature. In fact, there have been many stories of babies born very early and surviving.

 

[Reverie]

Inducing miscarriage (i.e. birth before viability) is the earliest known technique of performing an abortion.

Yes, it would be wrong to induce labor to terminate a pregnancy. I was referring to induction as it relates to pre-eclampsia and eclampsia. This can develop around 20 weeks gestation, and as the poster before me can attest, the mother, in a hospital situation is monitored. I believe the goal is to hang on until viability. But if the condition worsens, they induce or perform a c-section. They should not willfully kill the baby, though this probably does happen. As Catholics, we need to be aware of that in order to protect the baby

 

[Gorgias]

Catholic Church believes (contrary to the common sense) that ectopic pregnancy is the disease of the fallopian tube itself, not a case of embryo anchoring itself in a perfectly healthy tube. So if you remove the tube, you are removing a threat to patient’s health from a diseased tube, but if you remove the embryo from a tube, you are performing an abortion.

I’m not certain I’ve ever heard it spun exactly like that. It’s not that an ectopic pregnancy is a ‘disease of the fallopian tube’; rather, the mother is expected to experience a medical condition at that location, and therefore, that is the proper location at which to focus attention. For example, the condition that would threaten the life of the mother is a ruptured tube; therefore, any therapies should be focussed there, right?

You are also not allowed to administer methotrexate which will inhibit the functions of the placenta (thus indirectly killing the embryo), because Catholic bioethicists believe that placenta is a part of the embryo – because is has the same DNA.

I think this analysis is ‘off’ a little: you’re not allowed to administer methotrexate, because that would be directly targeting the baby. The placenta is a different matter entirely, and hasn’t really been addressed by Catholic bioethicists (the McBride case notwithstanding).

It’s also interesting to note that in other ethical systems (e.g. in Judaism) therapeutic abortion is allowed as a form of self-defense. Catholicism is the only ethical system I’m aware of which explicitly that rejects this common sense doctrine. Thus, despite the official claim that Catholicism views the woman and fetus as equally valuable, in practical sense, Catholicism views fetus as untouchable, and the woman as expendable.

The problem, as another poster has alluded to, is that once you allow ‘therapeutic’ abortions, you’ve opened Pandora’s box. Besides which, a ‘self-defense’ approach places you in the untenable position of needing to explain how an innocent baby can be considered – from a moral point of view – as an unjust aggressor.

The Church sees the fetus as innocent life, and therefore, the stakes are raised on any rationalization for abortion. ‘The woman [is] expendable’? Really? That’s just plain wrong, on so many levels. If you want to reduce your argument to hysterics, then go ahead; but that’s certainly not what the Church teaches…!

 

[Peter12rb]

While I believe the ‘abortion is ok if the woman’s life is in danger’ argument is massively overused, I do believe it is justifiable in some situations.

Take the recent example of Savita Halappanavar, and Indian woman visiting Ireland in 2012. She was pregnant and went to the hospital complaining of back pain. The doctors told her she was miscarriaging and that there was nothing to do to save the child. There were complications, and everyone knew her life was at risk and that the child would die no matter what, but no abortion was permitted. She died (pointlessly in my opinion) of septicemia. You can google her name if you want to know more.

This example (and others similar to it) don’t prove in any way every argument made by the pro-choice movement. But it does show a need in extreme cases for abortion, when everyone knows the child will not be able to make it and the mother’s life is in danger.

 

[Reverie]

Savita’s death is a tragidy that could have likely been prevented with better care. But an abortion would not cure septecimia. To say it could have prevented it is speculation because an abortion could just as likely cause septecimia. What we don’t know is how neglectful the hospital was by not aggressively treating or preventing infection or looking for other things that may have been wrong besides, “you’re miscarrying”.

 

[vames]

This results in a rather peculiar view on ectopic pregnancy. You are allowed to remove the fallopian tube with the embryo inside, however, you are not allowed to cut open the tube, remove the embryo, and suture it back. This is because Catholic Church believes (contrary to the common sense) that ectopic pregnancy is the disease of the fallopian tube itself, not a case of embryo anchoring itself in a perfectly healthy tube. So if you remove the tube, you are removing a threat to patient’s health from a diseased tube, but if you remove the embryo from a tube, you are performing an abortion.

The real reason is that they consider the fetus totally untouchable, regardless of its chances of surviving outside the womb. That’s why they always promote the most invasive surgical procedures regarding the woman’s body (removing the whole fallopian tube, removing the whole uterus, choosing a C-section in order to extract the fetus intact - even if the fetus is unviable - instead of performing a therapeutical abortion that would allow the woman’s body to remain intact).

And the real logic is the one expressed above by Gorgias: the simple fear of creating a precedent. So it’s better to mutilate a woman or to leave her die now, ONLY because they fear that sometimes in the future other people will use the availability of therapeutical abortion as a first step towards the full liberalization of abortion laws.

 

[devoutchristian]

While I believe the ‘abortion is ok if the woman’s life is in danger’ argument is massively overused, I do believe it is justifiable in some situations.

Take the recent example of Savita Halappanavar, and Indian woman visiting Ireland in 2012. She was pregnant and went to the hospital complaining of back pain. The doctors told her she was miscarriaging and that there was nothing to do to save the child. There were complications, and everyone knew her life was at risk and that the child would die no matter what, but no abortion was permitted. She died (pointlessly in my opinion) of septicemia. You can google her name if you want to know more.

This example (and others similar to it) don’t prove in any way every argument made by the pro-choice movement. But it does show a need in extreme cases for abortion, when everyone knows the child will not be able to make it and the mother’s life is in danger.

Murder is a sin. Do you really think that Jesus would condone abortion?

 

[gardenswithkids]

…This results in a rather peculiar view on ectopic pregnancy. You are allowed to remove the fallopian tube with the embryo inside, however, you are not allowed to cut open the tube, remove the embryo, and suture it back. This is because Catholic Church believes (contrary to the common sense) that ectopic pregnancy is the disease of the fallopian tube itself, not a case of embryo anchoring itself in a perfectly healthy tube. So if you remove the tube, you are removing a threat to patient’s health from a diseased tube, but if you remove the embryo from a tube, you are performing an abortion. …

I want to address what you wrote here about ectopic pregnancy because the Church’s teachings make perfect sense to me from a medical point of view and not just moral point of view. According to medical sources, in most cases there was something going wrong before the embryo implants in the wrong spot. The fallopian tube may not have been perfectly healthy before an ectopic pregnancy occurs—and even if it was, having had an ectopic pregnancy and/or surgery on her fallopian tubes places a woman at higher risk for ectopic pregnancy in the future.

ovulation-calculator.com/pregnancy/endometriosis.htm?page=1
In most cases, ectopic pregnancies occur when the fertilized egg faces obstructions in the fallopian tube that prevent the egg from moving freely into the womb. Instead of implantation in the uterus, obstructions or tubal abnormalities cause the egg to implant outside of the womb. There is no way to prevent or predict an ectopic pregnancy, though there are a number of risk factor that may predispose a woman for ectopic pregnancy - from advanced age to previous pelvic inflammatory diseases or prior surgery in the region.

 

[aux1]

I’m not certain I’ve ever heard it spun exactly like that. It’s not that an ectopic pregnancy is a ‘disease of the fallopian tube’;

According to the National Catholic Bioethics Center…

the section of tube around the growing child has clearly become pathological, and constitutes a mounting threat with time. This threat is addressed by removal of the tube, with the secondary, and unintended, effect that the child within will then die.

(emphasis mine)

I think this analysis is ‘off’ a little: you’re not allowed to administer methotrexate, because that would be directly targeting the baby. The placenta is a different matter entirely, and hasn’t really been addressed by Catholic bioethicists (the McBride case notwithstanding).

From the same source as above…

The first procedure involves a drug called methotrexate, which targets the most rapidly growing cells of the embryo, especially the placenta-like cells which attach the early embryo to the wall of the tube. Some have suggested that methotrexate might preferentially target these placenta-like cells, distinct from the rest of the embryo, so that it could be seen as “indirectly” ending the life of the embryo. Others, however, have noted that these placenta-like cells are in fact a part of the embryo itself (being produced by the embryo, not by the mother), so that the use of methotrexate actually targets a vital organ of the embryo, resulting in his or her death. A significant number of Catholic moralists hold that the use of methotrexate is not morally permissible, because it constitutes a direct attack on the growing child in the tube, and involves a form of direct abortion.

The problem, as another poster has alluded to, is that once you allow ‘therapeutic’ abortions, you’ve opened Pandora’s box.

Not really, if you write the law correctly. Poland allows therapeutic abortion and this exception is not overused. The current practice is that hospitals have commitees which judge that on a case-by-case basis.

Besides which, a ‘self-defense’ approach places you in the untenable position of needing to explain how an innocent baby can be considered – from a moral point of view – as an unjust aggressor.

In the same way an insane person attacking you with a knife is an unjust agressor while being innocent.

The Church sees the fetus as innocent life, and therefore, the stakes are raised on any rationalization for abortion. ‘The woman [is] expendable’? Really? That’s just plain wrong, on so many levels. If you want to reduce your argument to hysterics, then go ahead; but that’s certainly not what the Church teaches…!

I think I wrote correctly what the Church teaches before this part, the part you quote now is my opinion of this. As for treating women as expendable, this is my characterization of an ethical system which:

1. Requires you to mutilate the woman in order to remove an ectopic pregnancy, while such mutilation is avoidable;
2. Requires you to let a woman die, because you cannot directly kill a child who is going to die with her anyway.

 

[aux1]

The fallopian tube may not have been perfectly healthy before an ectopic pregnancy occurs—and even if it was, having had an ectopic pregnancy and/or surgery on her fallopian tubes places a woman at higher risk for ectopic pregnancy in the future.

That would be a good argument… if it was used by itself.

The issue at hand, however, is that you have two procedures which will kill the embryo and save the mother. Somehow, one is permitted under the double effect while the other one is not…

 

[aux1]

Murder is a sin. Do you really think that Jesus would condone abortion?

Jesus was a Jew who observed Jewish law. Since He did not speak on abortion, it’s logical to assume that he agreed with Jewish law on the matter… which allows you to perform abortion to save the woman (and only to save the woman):

vbm-torah.org/halakha/abortion.htm

 

[Reverie]

1. Requires you to mutilate the woman in order to remove an ectopic pregnancy, while such mutilation is avoidable;
2. Requires you to let a woman die, because you cannot directly kill a child who is going to die with her anyway.

1. I feel your term “mutilate” is meant to be inflammatory. You probably wouldn’t say that a woman is mutilated if her appendix were removed because it was about to burst. Are you saying then it is okay to mutilate a baby in order to save a woman from being infertile? You could just as easily save her life by removing the defective tube and the baby. By the time an ectopic pregnancy is discovered, the tube has been stretched and possibly scarred. If I had an ectopic pregnancy, I wouldn’t want that tube in me any more anyway. The intent here would be to remove the tube because if it ruptures or has ruptured the woman could die. The effect of removing the tube is the unintended death of the baby. If the baby could be transplanted to the uterus to save it too, doctors would do that.
2. There are very few problems that could occur in pregnancy that would warrant the need for the removal of the uterus with a baby in it. Uterine Cancer, complete molar pregnancy, and probably abruption. Again, if any of these things happened to me, I wouldn’t want to have that defective uterus. Removing a uterus does not equal requiring a woman to die. Removing the uterus would save her life. Aborting the baby in any of these circumstances would not cure the problem with the uterus. The effect of removing the uterus with a baby inside would be to save the life of the woman with the unintended effect of the baby’s death.

Woman are not expendable. Fertility is.

 

[gardenswithkids]

…Is there ever a situation where cancer would kill both the mother and the child and the mother has to choose to either have the uterus removed or not during a pregnancy or are there similar situations a mother might find her self involved in?

Or is it only in the 1960’s with less medical knowledge that a woman would have to choose life for a child and death for herself, knowing that both might die?

Any help would be great! Thanks!
Brian

Hi Brian-
You might be interested in reading some of these stories of pregnant women with cancer who refused abortions. These choices didn’t just happen in the 1960’s. Women with cancer are often heavily pressured by the medical community to abort their pregnancies before undergoing cancer treatment.
lifesitenews.com/news/cancer-mom-refuses-abortion-nominated-walmarts-mom-of-the-year/ Mother underwent mastectomy when 20 weeks pregnant with her seventh child. Mom and baby fine.
lifesitenews.com/news/woman-dies-of-cancer-after-refusing-treatment-to-save-unborn-child/ This woman had head and neck cancer. She refused chemo since she was pregnant. The child was born by emergency c section at 2 pounds after the mother collapsed. She died but her child lived.
lifesitenews.com/news/a-thanksgiving-gift-mother-with-aggressive-cancer-gives-birth-to-healthy-ba/ Woman discoved aggressive breast cancer when 20 weeks pregnant. She’d had four prior miscarriages and refused an abortion. She chose to both fight the cancer and keep her baby. Mother beat the cancer and baby born healthy.
lifesitenews.com/news/im-going-to-heaven-you-stay-here-with-dad-italian-mom-sacrifices-life-for-u/ Mother, whose first two children had died shortly after birth, postponed cancer treatment until she had her baby. Her baby was born healthy and lived. The mother later died of cancer.
lifesitenews.com/news/exclusive-young-mother-with-cancer-sacrifices-life-for-unborn-child/ Mother postponed cancer treatment fro throat cancer because of risk to her baby. She refused an abortion. Mother very ill when baby born by emergency c-section at 1 pound 3 ounces.

As you can see, in the stories above, these women didn’t have uterine cancer or ectopic pregnancies. They are pregnant and have cancer in other areas of their bodies and being advised by medical professionals to abort so that they can undergo cancer treatment. In some cases, the women died and in some cases they lived. In all the stories above, the babies lived, even though some were born very tiny and premature. Some of these stories are very sad, yet they are also very beautiful.

 

[Gorgias]

the section of tube around the growing child has clearly become pathological

Context, context, context! What Fr Tad is talking about here is that the Catholic approach is to closely monitor the status of the pregnancy. If the body naturally aborts the fetus, then there’s no need for medical intervention. If, however, the pregnancy continues – to the point that the tube becomes compromised – then surgical intervention becomes necessary. At that point, and not before, there is a ‘pathology’ that needs to be addressed. It’s a subtle point, but let me state it clearly: the Church doesn’t define ‘ectopic pregnancy’ as a ‘disease of the fallopian tube’, as you claim. Rather, the Church simply notes a medical fact – if the pregnancy advances to the point that the tube is compromised, then the need for a (morally acceptable) medical procedure exists. Big difference, there…

From the same source as above…

Your source notes that there isn’t a settled answer here (“some have suggested… others, however, have noted that these placenta-like cells are in fact a part of the embryo itself”). Moreover, the next sentence – which you quote – makes the point that I suggested: “the use of methotrexate is not morally permissible, because it constitutes a direct attack on the growing child in the tube.”

aux1:

Gorgias:

Besides which, a ‘self-defense’ approach places you in the untenable position of needing to explain how an innocent baby can be considered – from a moral point of view – as an unjust aggressor.

In the same way an insane person attacking you with a knife is an unjust agressor while being innocent.

Apples and oranges. Fetuses do not ‘attack’ their mothers. By definition, they are incapable of being an ‘aggressor’. On the other hand, a person who is not in control of their faculties may not be held accountable for a knife attack, but clearly they may be physically capable of an attack. One may act in self-defense – by disarming or disabling the aggressor – without killing him; if excessive force (or deadly force) is used without sufficient cause, then this would be an immoral use of force against that person. On both counts, then, your example fails to hold.

I think I wrote correctly what the Church teaches before this part, the part you quote now is my opinion of this.

OK, then: your opinion of the situation is not an accurate portrayal of what the Church teaches…!

As for treating women as expendable, this is my characterization of an ethical system which:

1. Requires you to mutilate the woman in order to remove an ectopic pregnancy, while such mutilation is avoidable;

No: it requires you to not kill an innocent, while such killing is avoidable. Your reasoning borders on the horrific: “meh, the child’s gonna die anyway, so let’s just kill it.” Remind me never to give you power of attorney over me, if I’m ever hospitalized…

1. Requires you to let a woman die, because you cannot directly kill a child who is going to die with her anyway.

Whoa! Pardon? Where’d you get that? That’s not part of this discussion at all! (Instead, it seems that you’ve come into this discussion with preconceived notions, and these notions are what are informing your opinion.) Perhaps I’ve missed where you draw this conclusion, based on what’s been said here?

 

[Gorgias]

And the real logic is the one expressed above by Gorgias: the simple fear of creating a precedent. So it’s better to mutilate a woman or to leave her die now, ONLY because they fear that sometimes in the future other people will use the availability of therapeutical abortion as a first step towards the full liberalization of abortion laws.

That’s not at all what I was suggesting! Rather, the attempt to define “therapeutic abortion” is one that attempts to say “I’m not allowed to directly kill in this case, but I am in that one.” That’s just plain immoral (in the case of an innocent life).

It’s not at all a question of letting women die today so that other fetuses might live. That, too, would be highly immoral.

 

[CopticChristian]

Hi,

It seems logical the mother would always want to save the child, but why wouldn’t it be a moral question if the mother has the cancer removed and thus indirectly saves the child?

Is there ever a situation where cancer would kill both the mother and the child and the mother has to choose to either have the uterus removed or not during a pregnancy or are there similar situations a mother might find her self involved in?

Or is it only in the 1960’s with less medical knowledge that a woman would have to choose life for a child and death for herself, knowing that both might die?

Any help would be great! Thanks!
Brian

Brian,

You are asking a very vague question.

What cancer are you speaking of?

How old is the mother?

This question should not be answered without specifics.