Double Effect, Methotrexate, and Ectopic Pregnancy

[Doc_Keele]

Right - so this example revolves round what constitutes intention and what constitutes foresight, just like the issues of ectopic pregnancy.
With your premises of what constitutes intention, then your argument is valid. I disagree with the premises. If something is foreseen as almost certain, that is intended (what in criminal law is called oblique intention). Motivation could help distinguish what is morally licit both in the question of the exploding grenade and the treatment of ectopic pregnancy.

 

[o_mlly]

Right - so this example revolves round what constitutes intention and what constitutes foresight, just like the issues of ectopic pregnancy.
With your premises of what constitutes intention, then your argument is valid. I disagree with the premises. If something is foreseen as almost certain, that is intended (what in criminal law is called oblique intention). Motivation could help distinguish what is morally licit both in the question of the exploding grenade and the treatment of ectopic pregnancy.

We do disagree that what is foreseen is necessarily intended. If all that is foreseen is intended, one may never lethally defend themselves from an unjust aggressor.

2263 The legitimate defense of persons and societies is not an exception to the prohibition against the murder of the innocent that constitutes intentional killing. "The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not."65
Catechism of the Catholic Church

As to ectopic pregnancy, intention is central in determining the morality of the surgery.

1. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. …
   Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition
   usccb.org/bishops/directives.shtml

 

[o_mlly]

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?

Yes. If, and only if, he intends to save his own life.

 

[fix]

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.

Sure, I agree.

 

[fix]

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.

The child is not causing the problem. The problem is some pathology. A human being is not a pathology. The child is not directly, or indirectly, attacking the mother. This is not about legal ethics, but moral truth. The child is not an aggressor, just or unjust.

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.

Yes, one may subscribe to any erroneous idea they choose. That does not make them correct. The reality of the situation is that a baby is an innocent human being and intentionally killing an innocent human is murder.

 

[Doc_Keele]

We do disagree that what is foreseen is necessarily intended. If all that is foreseen is intended, one may never lethally defend themselves from an unjust aggressor.

2263 The legitimate defense of persons and societies is not an exception to the prohibition against the murder of the innocent that constitutes intentional killing. "The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not."65
Catechism of the Catholic Church

I’m not saying that all that is foreseen is intended, in fact. Just that if something is almost certain and that is foreseen, then that effect is intended. It is permissible to kill someone if that is what is required for your defence, because that is still not murder, legally or morally. You intend to kill them because that’s what’s necessary to defend yourself.

As to ectopic pregnancy, intention is central in determining the morality of the surgery.

1. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo. …
   Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition
   usccb.org/bishops/directives.shtml

OK, but you miss out the important information about how the Church defines intention and direct versus indirect abortion. They certainly don’t take a virtue ethics approach.

 

[Doc_Keele]

The child is not causing the problem

The medical reality is that the pregnancy IS causing the problem. This is medical fact.

The problem is some pathology

Any disease involves pathology, right.

A human being is not a pathology

Clearly not, it’s a definitonal matter. However that is begging the question, the fact is that the conceptus can CAUSE a pathological process

The child is not directly, or indirectly, attacking the mother

Yes, it is.

This is not about legal ethics, but moral truth

How about some respect for the medical facts.

The child is not an aggressor, just or unjust

Sorry,but it is.

Yes, one may subscribe to any erroneous idea they choose. That does not make them correct. The reality of the situation is that a baby is an innocent human being and intentionally killing an innocent human is murder.

You’re going back to this circular argument. I disagree with your premises and therefore your argument is unsound.

 

[fix]

The medical reality is that the pregnancy IS causing the problem. This is medical fact.

Yes, the pregnancy has a problem, not that the baby is a pathology. The child himself is not the etiology of the problem. Babies gestate in females. If a pathologic condition occurs that does not magically transform the baby from a person into a pathology.

Any disease involves pathology, right.
Clearly not, it’s a definitonal matter. However that is begging the question, the fact is that the conceptus can CAUSE a pathological process

The baby is not causing anything. The pathology associated with the baby is the issue.

Yes, it is.

No, the pathologic condition is causing problems.

How about some respect for the medical facts.

Indeed, how about some respect for medical facts and moral truth.

You’re going back to this circular argument. I disagree with your premises and therefore your argument is unsound.

It is not circular. You simply reject that a an unborn baby is a person that derserves the right not to be killed because people want to redefine words and by redefining reality.

 

[Doc_Keele]

Oh well, if you can’t accept certain uncontested medical facts then there’s no basis for a discussion.
I know the medical facts, you clearly don’t.

And don’t put words in my mouth please. I have at no stage rejected the notion that “an unborn baby is a person that derserves the right not to be killed”. I am assuming that this misrepresentation is not deliberate.

 

[Pug]

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.

Actually, it never would have occurred to me about moving a child except I heard somewhere that it was once done in 1915?, but it was moved to his/her own mother’s womb and lived to term. It was presented as some kind of medical fluke. But this brings up the idea to me that perhaps it is okay to move the baby, since it saved the child’s life. I see no immediate reason why people might not try to do such a thing in the far future again, or perhaps develop a way to move him to a synthetic environment. And if they do, our moral reasoning needs to be consistent with that state of affairs. In other words, I have no trouble envisioning this, and I want what I say to be consistent. If I can’t consistently apply a moral principle across the things to which it supposedly applies, well, I need to put in some more time in thought. In other words, it seems completely reasonable to me to wonder how whatever principles I use would apply to any case of ectopic pregnancy.

I could only turn up this reference from googling it. It is near the bottom.

 

[seekerz]

Actually, it never would have occurred to me about moving a child except I heard somewhere that it was once done in 1915?, but it was moved to his/her own mother’s womb and lived to term. It was presented as some kind of medical fluke. But this brings up the idea to me that perhaps it is okay to move the baby, since it saved the child’s life. I see no immediate reason why people might not try to do such a thing in the far future again, or perhaps develop a way to move him to a synthetic environment. And if they do, our moral reasoning needs to be consistent with that state of affairs. In other words, I have no trouble envisioning this, and I want what I say to be consistent. If I can’t consistently apply a moral principle across the things to which it supposedly applies, well, I need to put in some more time in thought. In other words, it seems completely reasonable to me to wonder how whatever principles I use would apply to any case of ectopic pregnancy.

I could only turn up this reference from googling it. It is near the bottom.

I see what you were referring to. It would be great if means could be developed to save the baby’s life as well…and given the advances in technology it’s not unreasonable to hope that we will have such options one day. The practical reality for now is that the baby’s life is not even a consideration in most of these medical decisions because it is assumed that it cannot be saved.

On another note, I have serious difficulty with the infected, deranged tube explanation simply because it does not reflect the present day medical options. Nowadays, we give antibiotics for an infected tube and repair (if feasible) a damaged one, so the tube itself may present no pathology that necessitates its removal. The only medical reason for surgery then, is the presence of the pregnancy in the enclosed space.

Consideration of other locations (cervix, abdominal organs) makes the matter even more difficult because in some of these cases the risks of life-threatening bleeding if surgery is attempted are high and MTX is the safer option.

 

[Pug]

I phrased that loosely. A deontological approach is not of itself a circular argument, since it’s not an argument.
The church’s argument that an intrinsic evil can never be used to achieve a good end is however a circular argument.

Intention certainly means different things to different people. This is one of the bones of contention, as to what is intention. The paper I am looking at about moral absolutism at the moment examines that in depth.

I’ve never seen a carefully presented argument attempting to prove that you may not do an intrinsic evil to try and accomplish some good, not that I paid much attention to, anyway. It seems more of a first principal to me that the ends do not justify the means, and not something that is proven. Either that, or it would be directly derivable from one’s first principles. A first principal is not circular.

But who knows, maybe the Church actually has a proof out there that we are supposed to believe (required by faith to believe). I don’t know of it, though.

Please note, I am someone who learns and thinks, not someone who wishes to win. I want to KNOW (and talk to people, of course).

Your paper, it is from the side of a consequentialist, no? Do you have some reasonable length link to tell me to read about the view of intention that you are talking about? As you can tell, I have a Catholic view of intention. I don’t have the knowledge yet to suitably address some other form of morally significant intention.

 

[Doc_Keele]

It’s certainly not a first principle that the ends do not justify the means.
The paper I’m writing is actually a review of another paper called “Moral Absolutism and Ectopic Pregnancy”, but I’ve barely started - I am marshalling my arguments at the moment.
This discusses the issues of intention in some depth, but unfortunately I have access via Athens so a link would be useless for you.
No, I won’t be arguing from a consequentialist standpoint - the positions I intuitively feel are most sensible are proportionalism, which states that rules can be broken for a proportionate reason, and rule utilitarianism, which states that moral actions conform to the rules that produce the greatest good. I favour the former at the moment.

 

[fix]

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?

Not sure what decade this was written, but the moral theology it presents is true today as it always has been:

The claim that the fetus can ever be, under any
circumstances, an unjust aggressor cannot be accepted as correct. The
fetus is a living human being. It has been placed by nature where it
now resides. It had no voice in the decision. It cannot be called an
unjust aggressor, for it is engaged in a purely natural process…

This judgment is confirmed by the words of Pius XI: “What
could ever be a sufficient reason for excusing in any way the direct
murder of the innocent? . . . Who would call an innocent child an
unjust aggressor?”

 

[seekerz]

Not sure what decade this was written, but the moral theology it presents is true today as it always has been:

The problem is see with this explanation, which otherwise makes perfect sense, is the premise that the “diseased” tube has to be removed to save the mother’s life. With the medical resources presently available (availability of blood transfusions, antibiotics, microsurgical techniques), a bleeding, damaged or infected tube by itself, rarely if ever poses serious risk to the mother’s life. So our moral reason for removing the tube is…?

 

[Doc_Keele]

These ideas about the tube arise from the work of a Jesuit in the 40s, as if medical science has not moved on since then? Incredible!

 

[seekerz]

These ideas about the tube arise from the work of a Jesuit in the 40s, as if medical science has not moved on since then? Incredible!

Exactly my point. The theology has not kept pace with the science. If there were no pregnancy in it, there rarely be the medical necessity of removing the tube given our present medical technology.

 

[fix]

The problem is see with this explanation, which otherwise makes perfect sense, is the premise that the “diseased” tube has to be removed to save the mother’s life. With the medical resources presently available (availability of blood transfusions, antibiotics, microsurgical techniques), a bleeding, damaged or infected tube by itself, rarely if ever poses serious risk to the mother’s life. So our moral reason for removing the tube is…?

There will always be new procedures and the Church uses the principles we have been talking about to evaluate them. The bottom line is that direct abortion, the intentional killing of the baby, is always wrong.

 

[fix]

These ideas about the tube arise from the work of a Jesuit in the 40s, as if medical science has not moved on since then? Incredible!

As I said I posted that to show the basic moral reasoning used. There will always be new procedures.

 

[Doc_Keele]

The issue isn’t new procedures fix.