Double Effect, Methotrexate, and Ectopic Pregnancy

[fix]

I usually hate analogies but I want to ask folks about another scenario that has a moral similarity. Would it have been morally acceptable to shoot down the hijacked planes of 9/11? The similarity is that whether you shoot them down or not it isn’t going to change the fate of the people on the planes. However you if you do nothing you condemn 3000 more people to death. So I’m kind of curious, do you believe it is morally permissible to shoot the planes down?

I fail to see the analogy? In the case of ectopic pregnancy are you saying the baby is an unjust aggressor?

 

[rpp]

In this discussion, it is imperative for people to remember a few key facts.

• Ectopic pregnancies are 100% fatal for mothers.
• Medical treatment intended to save a patient’s life is a moral good.
• Abortion is always a grave evil.
• Refusing to treat a person with a life-threatening condition is not a moral good.
  The real question as I see it is are treatments for an ectopic pregnancy abortion or an attempt to save a life from certain death? The means of treatment do not seem to matter to me.

However, a treatment which preserves the mother’s fertility as well as her life seem appear, at least on the outset, to be preferable. Surgical procedures, I believe (though I may be wrong), generally involve the removal of the tube.

I say this from the perspective of a very good friend of mine whose first, and therefore, only, two pregnancies were ectopic.

 

[Seatuck]

In this discussion, it is imperative for people to remember a few key facts.

• Ectopic pregnancies are 100% fatal for mothers.
• Medical treatment intended to save a patient’s life is a moral good.
• Abortion is always a grave evil.
• Refusing to treat a person with a life-threatening condition is not a moral good.
  The real question as I see it is are treatments for an ectopic pregnancy abortion or an attempt to save a life from certain death? The means of treatment do not seem to matter to me.

However, a treatment which preserves the mother’s fertility as well as her life seem appear, at least on the outset, to be preferable. Surgical procedures, I believe (though I may be wrong), generally involve the removal of the tube.

I say this from the perspective of a very good friend of mine whose first, and therefore, only, two pregnancies were ectopic.

Ectopic pregnancies are not 100% fatal to the mother. They are a grave risk to her but do not result in maternal fatality 100% of the time when left untreated.

 

[TAS2000]

Sorry but your facts are merely opinions. Ectopics are NOT 100% fatal to the mother. In a high percentage of ectopic pregnancies, they will spontanesouly resolve themselves long before there is any real danger to the mother. However, most physicians are unwilling to let things resolve naturally as this takes time and lots of monitoring, and it is frankly more “safe” to do something now than wait for a potential problem to resolve.

SOME medical treatments are morally good, but some are not. So not all treatments for an ectopic are the same. Hence the issue. You can’t just say do anything because without it both will die. You can only say we can do what is morally good or at least neutral. What remains to be determined is if MTX fits that description.

Frankly, I put very little weight on the opinions of organizations that merely have Catholic in the name. There are plently of “Catholic” organizations I can come up with whose opinions are anythign BUT Catholic if you examine them. And plently of “Catholic” doctors prescribe ABC, perform abortions, etc. You must examine the policy in the light of church teaching. IF it holds true, then good. IF not, it must be discarded as a moral option.

 

[rpp]

Ectopic pregnancies are not 100% fatal to the mother. They are a grave risk to her but do not result in maternal fatality 100% of the time when left untreated.

Hmm.

That is not what I have heard. That does change things a bit doesn’t it.

In the case of my friend who had the ectopic pregnancies, her condition became suddenly acute and her life was in immediate peril. I suppose that may not be the case with all, but that is not what I have read.

This is utterly different than an “ectopic” pregnancy that “works itself out” via miscarriage.

It is often compared to appendicitis as the acute phase can present similar symptoms. The Mother’s death due to an ectopic pregnancy is caused by hemorrhaging and bleeding out, rather than infection, I believe (please continue to correct me if I am wrong.)

On the other hand, would it be correct to say that ectopic pregnancies are 100% fatal for the baby, treated or not.

 

[manualman]

Interesting. The OP claims that the drug specifically does not directly kill the embryo, but merely operates to detach the placenta from the fallopian tube wall. He further elaborates that the attachment to the tube wall does NOT provide any function (placenta can’t transfer food and waste to/from mom’s bloodstream). If, and that is a HUGE if, this is all true, then they might have a legitimate claim to double effect.

The supporting evidence is weak, however. An association has no teaching authority. I’m suspicious that no reference has yet been made to the National Catholic Bioethics Center, which DOES have a mandate from the USCCB at least to discern medical moral issues. The citation of a non-authoritative association and simultaneous lack of discussion on the NCBC position constitutes a red light on my spiritual dashboard.

The reason that the tube removal is permissible is that it celarly separates the treatment of the diseased tube from the death of the child. Presumably the child would be relocated if this were at all medically possible. If the drug directly kills the child, that is utterly different. You can’t cloak the killing in a deception of claiming to be targeting only the placenta if the drug has a direct lethal effect on the child.

If the drug merely detaches the placenta from an unproductive tube wall and does not change the ultimate cause of death for the child then this argument bears further investigation!

 

[VARC]

On the other hand, would it be correct to say that ectopic pregnancies are 100% fatal for the baby, treated or not.

Yes, unfortunately it is absolutely true that an embryo has a 0% chance of survival of ectopic pregnancy. Anyone who suggests otherwise is mistaken or misleading you. It may be possible for the fetus of another type of extrauterine pregnancy(abdominal) to survive but highly unlikely. It is impossible that the embryo can survive a tubal implantation. Embryos are too delicate to survive being ripped from the tube and I’ve never heard of survival from any credible medical source.

 

[TAS2000]

I don’t have a source at hand but I have read that at least 2 medical procedures were done YEARS ago to implant the embryo in the uterous and both children survived to the age of a few years. Since that time no one wants to experiment with it. I personally think that medical procedures have improved greatly since then and it is worth a second shot, but it is so much easier to prescribe a pill to just eliminate the problem and try again.

 

[Seatuck]

Yes, unfortunately it is absolutely true that an embryo has a 0% chance of survival of ectopic pregnancy. Anyone who suggests otherwise is mistaken or misleading you. It may be possible for the fetus of another type of extrauterine pregnancy(abdominal) to survive but highly unlikely. It is impossible that the embryo can survive a tubal implantation. Embryos are too delicate to survive being ripped from the tube and I’ve never heard of survival from any credible medical source.

No this is not true. There have been rare, miraculous cases of ectopic babies who have survived.Tubal pregnancy is not the only type of ectopic .

 

[Joan_M]

Father O’Rourke, Father Clark, Dr. Shannon and I have finely tuned consciences as well. I really don’t see why the other side thinks they have the pro life position. By insisting that a useless trophoplast that has implanted in the tube must be given the moral status of an embryo instead of a tumor, you are actually pro death.

It is NOT a useless anything that has implanted in the tube. It is an embryo. A baby. Why are you so blind?

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Because until the time does come where it is possible to do what you described, you are not protecting life.

If the time comes where it is possible to do what I described, what would be moved to the uterus? A trophoplast, that you say is useless, or an embryo? Make up your mind. Either it is a baby in the tube or it is not. If it was a “useless trophoplast” (your words) and not a baby, why bother? It is a baby, right from the moment of fertilization, and must not be aborted.
You are protecting your assumed moral high ground at the expense of innocent lives.

You are the one who is prepared to expend innocent lives. The surgical removal of the tube does, unfortunately, result in the death of the baby, but it is not endangering the mother any more than any other surgery would - yes, I do understand that all surgery carries with it some risk.

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I understand your zeal to protect the unborn and I respect your opinion but I take offence that the reasonable explanation of the other side is"twaddle" and that our opinion is “from the devil”.Happy New Year.

**Well, the pseudo scientific rationalization of aborting the baby is twaddle and from the devil. **Your “reasonable explanation” is not at all reasonable. MTX, used in ectopic pregnancy has only one result - abortion.

Further, the only way a woman’s fertility is affected to any extent by the surgery is if the other tube is blocked, or, if like one poster said, if she has a second ectopic pregnancy.

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**When I had surgery for ectopic pregnancy I was warned that I might be “less fertile than I might have been”. Well, I can guarantee that that was not so! The woman remains with two ovaries and one tube. An ova from either ovary can find that one tube very easily. **

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[Seatuck]

Hmm.

That is not what I have heard. That does change things a bit doesn’t it.

In the case of my friend who had the ectopic pregnancies, her condition became suddenly acute and her life was in immediate peril. I suppose that may not be the case with all, but that is not what I have read.

This is utterly different than an “ectopic” pregnancy that “works itself out” via miscarriage.

It is often compared to appendicitis as the acute phase can present similar symptoms. The Mother’s death due to an ectopic pregnancy is caused by hemorrhaging and bleeding out, rather than infection, I believe (please continue to correct me if I am wrong.)

On the other hand, would it be correct to say that ectopic pregnancies are 100% fatal for the baby, treated or not.

No it wouldn’t be. There have been cases of ectopics that have been delivered. Very rare but it has happend. When I was in Nursing school many years back there was a case in ( I think it was )South America where an abdominal ectopic baby was delivered by surgical intervention.

I think you should do a little research instead of going by what you’ve heard.

Start with this-

cuf.org/faithfacts/details_view.asp?ffID=57

 

[VARC]

I heard that it was successful two times as well but I didn’t trust the source. It stated that the embryos were successfully transfered in 1914. Ultrasound wasn’t in medical use until the1960’s so it would have been impossible to see there was ectopic pregnancy before the hemmoraging began and it’s certainly too late at that point. In any event, no credible doctor is going to tell you that it is even an option. At least until the technology is available.

 

[Seatuck]

I don’t have a source at hand but I have read that at least 2 medical procedures were done YEARS ago to implant the embryo in the uterous and both children survived to the age of a few years. Since that time no one wants to experiment with it. I personally think that medical procedures have improved greatly since then and it is worth a second shot, but it is so much easier to prescribe a pill to just eliminate the problem and try again.

I have the following from CUF -

**

If Only

There is a case that took place in 1915 in which a doctor, in the process of removing a tumor from a uterus, discovered an early tubal pregnancy. The operation on the tumor had left an incision in the uterus. The doctor transferred the embryo to the uterus through the incision. The embryo implanted, and the mother eventually gave birth to a healthy baby. The same hospital allowed further attempts at embryo transferal. Only a very small percentage were successfully implanted and born. Of those, the majority did not live very long. Most died between the ages of six and 12 years. With such low odds of the birth of a healthy baby, it is rare nowadays for medical professionals to consider embryo transferal. Recently a doctor at a Catholic fertility institute attempted three embryo transferals with none surviving to birth.

I know I read some of this in one of my Maternal/Child Nursing texts but I don’t have acess to them right now. Too many Christmas boxes in the way.**

 

[Seatuck]

Here’s an ectopic survival story from 2000. Probably the only reason this child lived was because they didn’t find her. Surely the doctors would have pursuaded this mother to abort. The medical community is loath to take the wait and see approach due to malpractice suits.

news.bbc.co.uk/2/hi/health/671390.stm

 

[rpp]

No it wouldn’t be. There have been cases of ectopics that have been delivered. Very rare but it has happend. When I was in Nursing school many years back there was a case in ( I think it was )South America where an abdominal ectopic baby was delivered by surgical intervention.

I think you should do a little research instead of going by what you’ve heard.

Start with this-

cuf.org/faithfacts/details_view.asp?ffID=57

Thank you for the link. I read it. Did you?

While there are anecdotal accounts of fetuses living to six months without the tube rupturing, postponing surgery indefinitely is dangerous, given the virtual certainty of rupture long before viability. So, it’s one thing to wait a short period of time for miscarriage to occur spontaneously. It’s quite another to forego intervention altogether in anticipation of a life-threatening tubal rupture. Such a high-risk course of action is rightly discouraged and can even be indicative of a reckless disregard for the life of the mother.

We cannot forget that it can be a serious moral problem to recklessly risk your life.

 

[VARC]

Here’s an ectopic survival story from 2000. Probably the only reason this child lived was because they didn’t find her. Surely the doctors would have pursuaded this mother to abort. The medical community is loath to take the wait and see approach due to malpractice suits.

news.bbc.co.uk/2/hi/health/671390.stm

I don’t believe that you actually read the article. It describes an abdominal pregnancy not a tubal pregnancy. It is grossly misleading to post this link as proof that an embryo can survive a tubal implantation. MTX is not used to treat abdominal ectopic preganancy only tubal ectopic preganancy.

 

[rpp]

I don’t believe that you actually read the article. It describes an abdominal pregnancy not a tubal pregnancy. It is grossly misleading to post this link as proof that an embryo can survive a tubal implantation.

Correct. It is clear from the article that the child implanted in the bowel and it very nearly killed the mother.

 

[VARC]

I just wanted to mention that I have been "google"ing the possibilty of embryonic survival for tubal implantations. I have found absolutely nothing to support that idea. On the contrary, many of the sites I have viewed state the opposite; that it is impossible and has never been done. I simply don’t believe that some anonymous doctor in an unnamed hospital pulled it off, many times apparently, almost a hundred years ago and catholic hospitals can’t do it today. I can’t verify that any of this actually happened. The only sources I have on this scenario are from catholic apologetics websites like the one cited.

All of these incredible scenarios are not reality for the poor women that actually suffer this tragedy. In real life a woman is told that she has an ectopic pregnancy. The doctors remedy is MTX if it is not too late. If a woman refuses it then that’s it. The doctor will tell her to come back when her tube ruptures and she is in agonizing pain. Hopefully she can be admitted to surgery on time before the hemmoraging kills her. Surgery to take out the tube is not an option because her insurance views it as unnecessary surgery. So unless she has thousands of dollars in cash, it isn’t even an option.

This is the real world. While many people will cite unsubstantiated events from 100 years ago and give other “what if” possibilities that are not realistic, those who actually suffer this condition are given no such luxary. They make the best decision they can based on their conscience and since Rome hasn’t ruled on the specific treatment options available, they are free to do so while remaining in good standing with the church.The vast majority of women who go through this condition would have done anything to save their children and mourn the loss of thier child. But there remains those who, under the guise of being pro-life, will call these women excommunicated baby killers. How very heroic of them.

 

[Seatuck]

I don’t believe that you actually read the article. It describes an abdominal pregnancy not a tubal pregnancy. It is grossly misleading to post this link as proof that an embryo can survive a tubal implantation. MTX is not used to treat abdominal ectopic preganancy only tubal ectopic preganancy.

Yes I read it. I was responding to the statement that all ectopics are 100% fatal to the Mother. Just because you didn’t make that statement in your OP doesn’t mean it wasn’t raised in the thread.

 

[Seatuck]

Correct. It is clear from the article that the child implanted in the bowel and it very nearly killed the mother.

The child had a 95% chance of dying before delivery and the mother had a 10% chance of death.

Not quite very nearly killed the mother.This is not to say that I don’t think that ectopic pregnancy is an not an extremely high risk and life threatening situation. It just doesn’t mean 100% death to mother and child. It clearly depends upon the situation.