Double Effect, Methotrexate, and Ectopic Pregnancy

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As I said I posted that to show the basic moral reasoning used. There will always be new procedures.
We are not talking about new procedures at all, we are saying that the medical facts relating to a single procedure (tube removal) have changed considerably, leaving the moral reasoning without one of its basic premises (diseased tube poses risk to mother’s life).
 
Eh, this?

Journal of Medicine & Philosophy; Feb2001, Vol. 26 Issue 1, p61-74, 14p

If so, I just pulled it off EBSCO. It’s by Christopher Kaczor. The precise title you gave was enough. I have work to do tonight (my work comes home with me), so I may not look at it until Wednesday (my day off). Of course, I may make a few goof off posts here at CAF, but this I would have to pay actual attention to.
 
We are not talking about new procedures at all, we are saying that the medical facts relating to a single procedure (tube removal) have changed considerably, leaving the moral reasoning without one of its basic premises (diseased tube poses risk to mother’s life).
Not sure of your point. The link refers to excising a diseased portion of the tube.
 
Not sure of your point. The link refers to excising a diseased portion of the tube.
We don’t seem to be understanding each other so let’s try this: Why does the “diseased portion of the tube” need to be removed?
 
Warning. If you are on dialup, these links are pdfs. They take a long time to download on dialup.

I found the article that Doc Keele mentioned on the web, for anyone who would like to read it.

myweb.lmu.edu/ckaczor/moralabsolutismectopic.pdf

Also, since I mentioned “iron wombs”, the same author wrote about if artificial wombs could be authorized by the Church in various situations. I’m not saying I agree with the author. I’m just supplying something that may be of interest to others. It is the second half of the article that talks about the Church teaching.

myweb.lmu.edu/ckaczor/artificialwombs.pdf
 
It’s certainly not a first principle that the ends do not justify the means.
Yes, I differentiate principal and principle. I do not act on my knowledge reliably. 😃 Also, it isn’t quite a first principle, but rather a specification of a first principle, but that is irrelevant to what concerns you, I’m guessing.

I don’t know why you say “the ends do not justify the means” (I’ll call this NEM for short) is circular. I am going to guess, though. Let’s say someone tells you the system of proportionalism (I’ll call this P) is wrong/useless/to be rejected, and they tell you the reason it is wrong is because of NEM. And then you ask them why NEM is true, and they tell you it is a principle of theirs that NEM is true. I can see why this might generate a complaint from you.

But I do not reject P on the grounds of NEM.
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
Kaczor is concerned with explaining a group of four characteristics to help determine if something is intended - is a means, and not merely a foreseen side effect. The ends are not mentioned, I assume, because everyone agrees that the ends are intended. I have indeed used some of the four characteristics he mentions, so I can’t see them as too far off base. He refers to a man, Gleeson, to motivate the action of providing the four characteristics. It seems from the paper that Gleeson believes that effects that march closely with the intended effect are also intended. Why, I do not know. It is extremely unintuitive to me. For example, I don’t feel like I intend to make air currents behind me as I walk, nor to wear down the carpet and generate static electricity with my shoes. I can distinguish the times that I do intend these things. Sometimes you want to zap someone with static electricity… :angel1: Unfortunately, I have no easy access to the thing for Gleeson that is given in the bibliography, so I can’t read what Gleeson actually says.

I agree with one of Kaczor’s conclusions. I think a moral absolutist might well be using a system that allows him to say that a woman can remove the baby while leaving the tube intact. Germain Grisez (a moral absolutist) appears to propose such a system, although he hems and haws around saying that his system says this, at least in his seminary texbook. (TWTLJ Vol 1 section 12F.6 and a footnote)
 
I think a moral absolutist might well be using a system that allows him to say that a woman can remove the baby while leaving the tube intact.
(emphasis mine)

Not to spoil your enlightening discussion, but would that happen to be the same ‘diseased’ tube that other moralists are certain poses the risk to the mother’s life?
 
(emphasis mine)

Not to spoil your enlightening discussion, but would that happen to be the same ‘diseased’ tube that other moralists are certain poses the risk to the mother’s life?
First, Grisez himself would be the first to say that you must follow magisterial guidance on this matter, and ignore whatever his theory suggests. I brought him up as an example of an absolutist with a certain type of moral system, not as a support to do any particular action.

But, yes, I think his hemming and hawing is indeed a reference to his theory not holding to the line of the proverbial “diseased tube”, since his context is that of, “the expulsion of a nonviable fetus otherwise than as a side effect of some other legitimate act”. But he refuses to say with precision what he means. He deliberately leaves the reader to draw a conclusion. So, I could misunderstand his silent implication.
 
First, Grisez himself would be the first to say that you must follow magisterial guidance on this matter, and ignore whatever his theory suggests. I brought him up as an example of an absolutist with a certain type of moral system, not as a support to do any particular action.

But, yes, I think his hemming and hawing is indeed a reference to his theory not holding to the line of the proverbial “diseased tube”, since his context is that of, “the expulsion of a nonviable fetus otherwise than as a side effect of some other legitimate act”. But he refuses to say with precision what he means. He deliberately leaves the reader to draw a conclusion. So, I could misunderstand his silent implication.
Thank you. Maybe you can help me with one more thing I’m genuinely curious about. How is the medical information used in these theories obtained? I would love to see these issues discussed by a moralist with professional training in women’s health, i.e. someone with experience in treating ectopic pregnancy.

Not that you have to perform an action to be able to determine its morality, but experience dealing with a situation would give a unique perspective and perhaps even a better ability to communicate moral truths in terms that make sense to the practitioner.
 
Pug, I haven’t said that NEM is a circular argument as such - NEM is an expression of taking the deontological approach. I don’t believe there is any way of formally proving by argument that the deontological approach has to be taken rather than the consequentialist approach - with pure deontologicalism and pure consequentialism you can show absurd results in particular scenarios, and it’s also true for all the offshoots to a lesser extent. Can one set of principles decide every dilemma? Possibly not.
 
… First, it is never morally licit to choose
an intrinsic evil, such as abortion. The classic case is “Sophie’s choice,”
where the mother is asked to choose which child she will spare from death, or
both will be killed. The correct choice (though some ethicists disagree on this
point) is to refuse to choose even if both children will be killed, and even
if one could be saved, for if she chooses, she is cooperating in the evil.

“Sophie’s choice” should be differentiated from “the case of the runaway train.”
Here, you are driving a runaway train (that is, with no brakes) which reaches
a split in the tracks. On the one side is one person; on the other side are
two people. In this case, your responsibility is to choose the “lesser evil,”
which is the track with only one person. This case differs from the first in
that it does not involve cooperation with moral evil (you are not willing or
causing the driving force of the train), and that necessity therefore demands
a choice.

Both of the these types of cases, in turn, should be distinguished from “the
principle of double effect” in which, under certain circumstances, one must
choose a good even with the knowledge that an evil will result. The conditions
are: 1) the moral object must not be evil; 2) the evil result is tolerated,
not intended; 3) the good effect doesn’t result directly from the evil effect;
and 4) there must be a proportionate reason for doing the act. The classic case
here is ectopic pregnancy, in which the fallopian tube must be removed, even
when the result will be the death of the child. Here the moral object is to
save the life of the mother, and the action to achieve that object is removal
of the fallopian tube, not the direct killing of the unborn child. The death
of the child (a great material evil) is tolerated (not directly intended
or caused) because the moral object (the life of the mother) is sufficiently
proportionate to it. …

Drawing Pro-Life Lines
Nathan Schlueter
First Things
October 2001
firstthings.com/article/2007/01/drawing-pro-life-lines-18
 
The principle of double effect never justifies an intrinsic evil act. The use of Methotrexate to kill the developing ectopic prenatal is direct abortion, which is intrinsically evil. It is absurd to claim that this use of the drug is somehow indirect, or is somewho justified by the principle of double effect.

It is very disconcerting how many Catholics do not understand or do not accept the most basic teachings of the Catholic Faith on the basic principles of ethics.

“It is no longer a matter of limited and occasional dissent, but of an overall and systematic calling into question of traditional moral doctrine… the traditional doctrine regarding the natural law, and the universality and the permanent validity of its precepts, is rejected… In particular, note should be taken of the lack of harmony between the traditional response of the Church and certain theological positions, encountered even in Seminaries and in Faculties of Theology, with regard to questions of the greatest importance for the Church and for the life of faith of Christians, as well as for the life of society itself.” – Pope John Paul II, Veritatis Splendor.
 
Ron, have you been following the discussion? Because you’ve just posted the stuff that has been posted several times before.
 
Thank you. Maybe you can help me with one more thing I’m genuinely curious about. How is the medical information used in these theories obtained? I would love to see these issues discussed by a moralist with professional training in women’s health, i.e. someone with experience in treating ectopic pregnancy.

Not that you have to perform an action to be able to determine its morality, but experience dealing with a situation would give a unique perspective and perhaps even a better ability to communicate moral truths in terms that make sense to the practitioner.
Being a mere CAF junkie, I can’t say that I know. Sometimes you must advise someone immediately based upon the information at hand, of course, but clearly you would like to obtain sufficient detail from someone qualified to explain the salient features. You can’t evaluate those features unless you know what they are.

Part of what a moral advisor has to do is support the person appropriately, not just feed them an answer. A colleague might be well-received in that role. A priest is good, too. They seem to be overall excellent at spiritual matters.
 
Pug, I haven’t said that NEM is a circular argument as such - NEM is an expression of taking the deontological approach. I don’t believe there is any way of formally proving by argument that the deontological approach has to be taken rather than the consequentialist approach - with pure deontologicalism and pure consequentialism you can show absurd results in particular scenarios, and it’s also true for all the offshoots to a lesser extent. Can one set of principles decide every dilemma? Possibly not.
I read an article recently that tried to tie our psychological inner workings to systems of morality, basically the two you mention. The authors felt that different/conflicting systems within us give rise to moral dilemmas, thus they see them as inevitable. It is this:
The Psychology of Dilemmas and the Philosophy of Morality.Authors:Cushman, Fiery;Young, Liane;Source:Ethical Theory & Moral Practice; Jan2009, Vol. 12 Issue 1, p9-24, 16p
I do know that I find it difficult to understand how to apply P, so it is of no use to me. If I can’t figure out how to weigh goods, then I can’t use it for anything.
 
If one were to commit abortion by destroying the placenta, and then letting the prenatal die as a result, this would be still a direct abortion.
Following this argument, surgical removal of the tube that contains the unborn child would also be a direct abortion.

After all, it is not the tube itself that endangers the woman’s life, but it is the pathological pregnancy. The female body does not support pregnancies outside of the uterus. Thus, any causal treatment of ectopic pregnancy must always prevent the unborn child from further growing outside the uterus.

Even if the tube is removed, the primary reason is to terminate the pathological pregnancy.

The only exception would be when the surgeon waits until the tube ruptures, but that means risking the woman’s life.
Methotrexate has the direct effect of killing the growing cells of the prenatal. It also has the direct effect of destroying the placenta, without which the prenatal cannot life. Killing the prenatal by destroying the placenta is still direct abortion.
Removing the tube has the direct effect of cutting the unborn child off from blood supply. So how does that differ from destroying the placenta?

Best regards,
Buntspecht
 
To my way of thinking, when you take a drug to fix an ectopic pregnancy, you are doing exactly the same thing as you’re doing when you remove the woman’s tube. You are removing a “dangerous growth” in a part of the woman’s body that isn’t supposed to be growing. If you use the drug, you have preserved the woman’s tube so she will be able to get pregnant again.

Yes, the “dangerous growth” has a baby inside of it. The baby isn’t going to live, no matter what.

The Church teaches that it can be moral to kill a person in self defense. If a person breaks into your house and attacks you physically, my understanding is that you have a right to kill that person if that is the only way you can save yourself from being killed by the intruder.

Some might argue that the person breaking into your house is guilty, but an unborn baby growing in your tube is innocent. I disagree with that type of thinking. It seems to me that the intruder who breaks into your house and tries to kill you could be innocent because he has the mental ability of a three-year-old and is not really responsible for his actions.

In a tubal pregnancy, an innocent intruder has broken into a place where it shouldn’t be. Sometimes the mother has to take its life in self defense to save herself from getting killed.

That’s how I see it, but I’m sure glad I have never been in that situation myself. I’m sure it would be very upsetting.

The other thing I was thinking is that if you’re in that situation, you may have to act fast. If the doctor you go to wants to give you a drug, would you have time to shop for a doctor who wants to remove your tube?
 
Hello,

I perhaps unfortunately happened upon this forum website whilst looking for information regarding the unforseen, heart-renching and personally horrific experience I am now facing (together with my husband). I never post on internet sites but I feel there is an unquestionable need for a higher level of respect, understanding and sharing of real human experience on this thread - a thread I trust will stop if this need is not met.

Let me share my very real and very recent and very human experience with you.

After doing 2 pregnancy tests which were positive, I decided to share the news with my husband by writing ‘I am pregnant’ in the snow in our back garden. Being our first pregnancy, I wanted to share this amazing news in a memorable way for him. I sneaked out early in the morning to write the news in the deep snow before he woke up. When I requested he look out the kitchen window at some animals in the snow and he (eventually) made out the words, his delight can only be described as truly beautiful and only mirrored my own - something very special between us. We then attended a small mass which our family friend and priest happened to be celebrating that morning at my parents’ home. We felt fortunate and blessed to have the opportunity to attend an intimate mass, whilst holding in such joyful news. Over the next few days we planned how we would tell our parents our good news at Christmas time. In the interim, we ept everything to ourselves.

A week and a half later, we attended our first ever scan (now 3 days ago). We were hopeful, excited, thankful but not presumptous. We are practising Catholics and I am a church reader and eucharistic minister and our faith - as well as respectful dispositions - informed our approach to this new experience and whole new stage in our marital journey. So with hope and respectful trepidation, we walked to the early pregnancy ward.

At this scan, (3 days ago) I was told that no pregnancy was visible in my womb. Being an educated woman, the loss and horror of what we faced hit me simultaneously. Unless you have experienced the elation of first pregnancy, followed by the news that your pregnancy is ectopic, you truly have no human understanding of the loss, confusion and physical heartache this causes. If you are humane, you might empathise, even sympathise, but going from some of these posts, I - regretfully - doubt some of you would have that capacity.

This is the most unexpected, distressing and challenging situation which I have ever had to face. Please do not forget that those who experience ectopic pregnancy deserve the utmost care and respect. Intellectual reason and dogma should really be stopped as a mark of respect for all people who have experienced this. I for one, do not wish to be the subject of ivory tower debate and speculation.

Remember that Christ told us that this should always comes well behind the importance of compassion and caring for our fellow humans. I am truly hurt by many of the posts here. Please search your consciences.

From someone going through a very profound, heartbreaking experience - only made many times worse by the lack of respect shown in some of these posts.
 
True Compassion,

What a trial you and your husband are in right now! May God bear you up on his wings. 🙂

I usually neglect night prayer (from the office), but I’ll pray it tonight and offer it for all three of you.

:gopray:
 
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