Double Effect, Methotrexate, and Ectopic Pregnancy

[seekerz]

When you are removing the container of the child for no reason other than to be able to say that you didn’t terminally separate the child from the only source of food, it seems hard to tell the difference. It seems like saying, “Oh, I didn’t pull the plug. I just turned off the electric main. See for yourself, the plug is still in the wall.”

The difference is intuitive to me if your goal is to move the child somewhere safe, somewhere other than where he is, and there is another goal, that of removing a location that is diseased. Then you can do one operation, that of moving the child while leaving the location untreated, or you can do a different operation, that of moving the child and that of treating the location. Those are two separate things, but clearly someone might like to do them at the same time, under one anesthesia. I am assuming the medical ability to move the child safely to somewhere safe (not currently a significant reality), and to do it independently of moving the location. I symbolized that assumption with the phrase “iron womb”.

With your phrase “oblique intention” you are using the word “intention” differently that I might. We agree more with your use of the word “effect”. What you call an oblique intention I call a foreseen likely side effect. I do not typically view these as “intended”.

I do not concede that the Church’s way of looking at ethics/morality (whatever that way is) is circular.

If your reason for moving the child is biologically impractical then how is it relevant at all? It’s like saying: I really jumped off the building to see if I could fly - not to kill myself…

For ethical/moral principles to be adhered to, they first have to be translatable into terms that make sense to the people expected to adhere to them. So far, from my perspective, separating (in that place in my mind where intentions are formed) treating the “diseased location” from treating the child, does not make sense because the abnormal attachment of the child’s placenta IS the disease.

 

[fix]

The child is not the cause of the illness? How do you reckon that?

How is the innocent child harming the mother? The pathology associated with the child is doing the harm. It is also a philosophical issue, not strictly medical.

 

[fix]

If the “innocent child is not the proximate cause of the mother’s illness”, then it seems reasonable that mother’s intention is not to end the child’s life. The child dies in the same circumstance innocent civilians die in a just war. Unintended “collateral damage” is the euphemism.

Yes, indirect abortion may be licit. The issue I was referring to is calling a child an unjust aggressor which is not possible in the context we speak of here.

The act is morally neutral - administering a drug. If the proximate cause of the threat to the mother’s life is the pathogen (not the on-going life of the child), and the mother intends to save her life, and if the drug attacks the pathogen, then the saving of the mother’s life (good effect) does not proceed directly from the child’s death (bad effect). The two lives are proportionate and the act is morally licit.

That is argued by some moral theologians and may licit with this drug. I do not think the Church has spoken directly to this specific use.

The contentions - the drug’s actual interaction with the mother/child and the prognosis of the probability of the child coming to term - are important in determining the morality of the drug’s use and is a highly technical determination. Since it is the mother’s act, the important judgement is hers - not her advisors - and, absent her own expertise, is a matter of her own prudence in as much as God must give her the grace to decide.

Well, the pope does not show up and stretch out his arms and yell now I will apply the principle of double effect here. The point is the principles used in moral theology apply.
There seems to be a debate among moralists on how licit the use of this particular treatment is for ectopic pregnancy. Again, my most recent point is that it is incorrect to claim the child is an aggressor.

 

[fix]

The pathology is what is punishing the child because it necessitates a treatment incompatible with the child’s life and because even declining treatment will not save the child’s life.

The child is not the cause of the problem nor is the child an unjust aggressor.

I don’t see how treating ectopics is so different from treating a woman with life-threatening bleeding from an inevitable abortion (baby still alive but cannot be saved).

The issue involves intent.

As far as I know, a D&C is completely licit in this case (I’ve seen it explained as removal of the bleeding uterus lining, with death of baby as an unavoidable side effect) and it is not required that the uterus be removed!

The reasoning behind requiring the removal of the whole tube, I can’t quite see when I consider the matter from this angle (why not removal of the bleeding segment of tube, with death of baby as unavoidable side effect?)…

BTW, if anyone has ever seen a D&C done, they will agree that there is nothing “indirect” about the action on the fetus. Gauging the “intent” of a patient or doctor is quite another story altogether. Ultimately, “intent” has to left to the individual conscience, I think.

It would help to have a Catholic doc who treats such patients weigh in on this type of discussion.

There are plenty of links in these fora that address your points specifically. Intent matters.

 

[seekerz]

How is the innocent child harming the mother? The pathology associated with the child is doing the harm. It is also a philosophical issue, not strictly medical.

The philosophy needs to relate to the practical reality: the child and its abnormally attached placenta are a unit. The question is not whether you SHOULD treat one separately from the other, the question is CAN you?

 

[seekerz]

The child is not the cause of the problem nor is the child an unjust aggressor.

The issue involves intent.

There are plenty of links in these fora that address your points specifically. Intent matters.

The question is not really about intent, if you hold that salpingostomy or methotrexate are not licit treatments for ectopic pregnancy. If we assume, for the purposes of this discussion, that the intent is the same (that of saving the mother) in all cases, (often assumed to be the case in the real world as well), what is the difference in the methods considered licit?

Salpingostomy, for example, allows for removal of the baby (usually intact) while repairing and saving the tube and is generally regarded as illicit, but D&C (considered licit in treating inevitable abortions from the forum sources you cite) involves suctioning out baby, placenta and uterine lining in tiny bits! I believe the difference here relates more to what is considered direct attack (versus indirect attack) but how can a D&C be indirect and a salpingostomy direct? As one who has witnessed both, that’s what I simply don’t get.

In both cases the mother’s life is at risk from a complication of pregnancy, in both cases treatment will end the child’s life, in both cases nothing can be done to save the child regardless of what is done to save the mother…how does one treatment get to be classified as direct attack and another indirect attack? Is this simply a philosophical decision unhinged from what actually happens to the child?

 

[o_mlly]

It looks like a case of false alternatives to me…

Which case is false or what case is excluded?

It’s not necessary to argue that the conceptus is not a person to argue thatabortion is permissible. The unconscious violinist thought experiment is an illustration.

Kreeft does not argue for or against the personhood of the fetus. Rather he allows for all possible states of reality and knowledge. One of the four cases must be true and the others false. Kreeft argures that independent of the personhood of the fetus, abortion is at a minimum reprehensible and at a maximum damnable.

The old saw (and strawman to Kreeft’s argument) about the unconscious violinist does not stand up to examination as a parallel because the attached- woman has no voluntary act contributing to her perdicament. If the attached- woman had first run the violinist over with her car, the gap between the thought experiment and the pregnant woman would be closer but still not equivocal.

Relieving the above statement of the ambiguities of multiple negatives:
“The personhood of the fetus is irrelevant to the morality of abortion.”

If I have correctly restated your claim, I think one who claims “I am interested in formal philosophical arguments” would give us one.

 

[Doc_Keele]

How is the innocent child harming the mother? The pathology associated with the child is doing the harm. It is also a philosophical issue, not strictly medical.

I know it’s a philosophical issue, that’s precisely my point.
I am puzzled as to how you agree that the pathology associated with the child is doing the harm, yet exclude the harm being related to the child. Could you explain that?

False alternatives means that the alternatives set out do not cover all the possibilities. I may be wrong in that analysis. My objection is as already stated, I don’t find the argument valid even if the premises are correct because you can accept that the foetus is a person but believe that autonomy makes abortion permissible.

 

[Doc_Keele]

o milly - the unconscious violonist thought experiment is not a straw man argument. Kreeft does not in fact argue that under all four cases abortion must be wrong - he cannot.
You have not correctly restated my claim. At all.
Stating that the argument for abortion does not have to rely on assuming that the foetus is NOT a person is not remotely the same as saying that the personhood of the foetus is irrelevant.

 

[o_mlly]

…

Well, the pope does not show up and stretch out his arms and yell now I will apply the principle of double effect here. The point is the principles used in moral theology apply.
There seems to be a debate among moralists on how licit the use of this particular treatment is for ectopic pregnancy. Again, my most recent point is that it is incorrect to claim the child is an aggressor.

Of course, I agree the child is incapable of being a just or unjust aggressor.

I’ve never heard the pope yell??? Still, the pope does not make the decision and his prudential judgements are fallible. So, as I posted, “Since it is the mother’s act, the important judgement is hers - not her advisors - and, absent her own expertise, is a **matter of her own prudence **in as much as God must give her the grace to decide.”

 

[fix]

Of course, I agree the child is incapable of being a just or unjust aggressor.

I’ve never heard the pope yell??? Still, the pope does not make the decision and his prudential judgements are fallible. So, as I posted, “Since it is the mother’s act, the important judgement is hers - not her advisors - and, absent her own expertise, is a **matter of her own prudence **in as much as God must give her the grace to decide.”

Not sure I am following yoir point here? Direct abortion is not a prudential matter. If it is direct abortion it would be wrong to agree to such an act. If you are saying the use of MTX as a therapy for ectopic pregnancy is a prudential decision, then I guess I would agree with you as the magisterium as not said it is wrong in such cases and plenty of orthodox moral theologians claim it is licit.

 

[fix]

I know it’s a philosophical issue, that’s precisely my point.
I am puzzled as to how you agree that the pathology associated with the child is doing the harm, yet exclude the harm being related to the child. Could you explain that?

False alternatives means that the alternatives set out do not cover all the possibilities. I may be wrong in that analysis. My objection is as already stated, I don’t find the argument valid even if the premises are correct because you can accept that the foetus is a person but believe that autonomy makes abortion permissible.

Not following you here. If you mean the mother has a right to kill the baby to save herself based on the notion of autonomy the Church would reject such reasoning. The mother and child should have any authentic medical care needed. What is illicit is intending to kill an innocent person to save another. IOW, the ends never justify the means.

 

[Doc_Keele]

Well being an unjust aggressor doesn’t require intent or wickedness. Innocence does not preclude being an unjust aggressor. The right to private defence does not depend on criminal culpability on the part of the unjust aggressor.
As for the issue of autonomy, I realise the Church rejects such reasoning. That doesn’t change the fact that many believe that autonomy is a justification for abortion. Saying the end doesn’t justify the means is a deontological argument. Not every accepts that approach. If you subscribe to consequentialism, virtue ethics or proportionalism (an off-shoot of consequentialism) then you reject that paradigm.

 

[seekerz]

Doc Keele;6313921:

I know it’s a philosophical issue, that’s precisely my point.
I am puzzled as to how you agree that the pathology associated with the child is doing the harm, yet exclude the harm being related to the child. Could you explain that?

There is no authentic medical care for ectopic pregnancy that does not involve actions that result in the child’s death, so the relevance of intent is mainly theoretical/philosopical. I don’t know that doctors (even pro-choice ones) approach a patient with an ectopic pregnancy intending to end the baby’s life. In common practice, the child’s life is usually not even an issue under consideration (since it is considered doomed, save for a miracle), but how best to safeguard the mother’s.

 

[seekerz]

Not sure I am following yoir point here? Direct abortion is not a prudential matter. If it is direct abortion it would be wrong to agree to such an act. If you are saying the use of MTX as a therapy for ectopic pregnancy is a prudential decision, then I guess I would agree with you as the magisterium as not said it is wrong in such cases and plenty of orthodox moral theologians claim it is licit.

My question to you would be, in the case of ectopic pregnancy, what treatment method/methods constitute a direct abortion? Is that a prudential matter?

 

[o_mlly]

Not sure I am following yoir point here? Direct abortion is not a prudential matter. If it is direct abortion it would be wrong to agree to such an act. If you are saying the use of MTX as a therapy for ectopic pregnancy is a prudential decision, then I guess I would agree with you as the magisterium as not said it is wrong in such cases and plenty of orthodox moral theologians claim it is licit.

Affirmative to the fomer (direct abortion is illicit). Affirmative to the latter (prudential decision is licit).

 

[Doc_Keele]

I have come up with two arguments by analogy/thought experiments for the issue of ectopic pregnancy or other pregnancies where the mother’s life is seriously endangered.

Here’s the first:

Suppose you have two mountaineers, roped together. One slips, through no fault of his own. His weight will pull both of the mountaineers to their death.

Is the top mountaineer justified in cutting the rope?

 

[o_mlly]

Not sure I am following yoir point here? Direct abortion is not a prudential matter. …

I think it is important when applying the double effect principle to clearly distinguish the act separate from the actor’s intention or the foreseen (and unforeseen) consequences. Because the object of the act must be morally good or neutral in itself, we ought not to phrase the act to incorporate intent or consequence into its meaning for that burdens or elevates the act. Intent and consequences are analyzed in the three other principles of the double effect.

So, if by the phrase “direct abortion,” we mean any and all acts that intend an attack on the life of the child such acts are clearly immoral and do not need the principle of the double effect to establish that immorality. The double effect can only be applied to “indirect abortions” as the unintended although foreseen consequence of some act.

Take, for instance, the standard example for explaining the double effect principles in determining the morality of an act: a soldier throws himself on a live grenade intending to shield others from its blast and clearly foresees his own death.

The act must be morally neutral or good. The act is “throwing himself on a live grenade” and is morally neutral in itself (per se).

The good end must be intended and is specified in the example.

The good end may not proceed from the evil end. The lives of his comrades are not saved because of the soldier dies but because his body shields them from the shrapnel.

The good and evil ends must be proportionate: one life for the sake of many.

Does the exploding grenade “directly kill” the soldier? Yes. But that unintended consequence is not a consideration in defining the act. It is only a consideration in determining proportionality.

 

[Doc_Keele]

How does proportionality come into a deontological approach like the church takes?
If throwing oneself on a llive grenade is a morall neutral act, then committing suicide by throwing oneself on a live grenade must be morally neutral surely?

 

[o_mlly]

How does proportionality come into a deontological approach like the church takes?
If throwing oneself on a llive grenade is a morall neutral act, then committing suicide by throwing oneself on a live grenade must be morally neutral surely?

Yes, the act in both cases is morally neutral. But the act alone (other than intrinsically evil acts) does not determine the morality of the act. In morally neutral acts, the circumstances and the intention determine the actor’s morality. Suicide, a disorderd intention, is immoral.