Ectopic Pregnancy and Double Effect

[camerong]

Trying to better explain Catholic solution to this problem to a non-Catholic.

The principle of double effect with respect to ectopic pregnancy is that we are removing a damaged fallopian tube which is the intended, good consequence and which will unintentionally cause the baby to die. But what about situations where there is an ectopic pregnancy but the Fallopian tube is not damaged and is not the source of the problem itself (I believe such cases are possible)? In such a case then the removal of the tube is not a good consequence because it was not damaged and would not cause any harm to the mother, so it cannot be the intended “good” of the act, in order to justify the unintended harm of the baby dying. Am I misunderstanding the point here?

 

[1ke]

Trying to better explain Catholic solution to this problem to a non-Catholic.

The principle of double effect with respect to ectopic pregnancy is that we are removing a damaged fallopian tube which is the intended, good consequence and which will unintentionally cause the baby to die. But what about situations where there is an ectopic pregnancy but the Fallopian tube is not damaged and is not the source of the problem itself (I believe such cases are possible)? In such a case then the removal of the tube is not a good consequence because it was not damaged and would not cause any harm to the mother, so it cannot be the intended “good” of the act, in order to justify the unintended harm of the baby dying. Am I misunderstanding the point here?

I think you are misunderstanding the biology, not the principle.

 

[camerong]

I think you are misunderstanding the biology, not the principle.

So are you saying that ectopic pregnancies cannot occur in the absence of a damaged fallopian tube? Because even if there is one instance in which a healthy fallopian tube is involved in an ectopic pregnancy, the dilemma above applies. Am I correct that the double-effect application here requires a damaged fallopian tube?

 

[Just_Lurking]

Am I correct that the double-effect application here requires a damaged fallopian tube?

My recollection is that prior to the 1930’s it did require a severly damaged fallopian tube, and pregnant women often died before the damage to the fallopian tube reached the point necessary to justify the removal of the fallopian tube. Then T. Lincoln Bouscaren studied the issue in his 1933 canon law dissertation, and managed to justify the double-effect principle without trying to wait until the last minute to operate.

 

[Corki]

So are you saying that ectopic pregnancies cannot occur in the absence of a damaged fallopian tube?

It can happen but those cases are rarely diagnosed. Ectopic pregnancies are diagnosed when the symptoms occur - the symptoms being caused by the trauma to the fallopian tubes. I don’t remember the exact statistic but a large number of ectopic pregnancies resolve naturally with no one even realizing there was a problem.

Because even if there is one instance in which a healthy fallopian tube is involved in an ectopic pregnancy, the dilemma above applies. Am I correct that the double-effect application here requires a damaged fallopian tube?

No, it does not require a damaged tube but there has to be something wrong that requires intervention. If the tube is not damaged then what action would be taken that would require the application of the principle of double effect?

Even in the case where the baby lodges outside the uterous, the action is to treat the hemoraging. No damaged tube is present in these cases. The treatment causes the death of the child but is an unavoidable consequence of the treatment. The principle of double effect can be applied.

 

[runningdude]

So are you saying that ectopic pregnancies cannot occur in the absence of a damaged fallopian tube? Because even if there is one instance in which a healthy fallopian tube is involved in an ectopic pregnancy, the dilemma above applies. Am I correct that the double-effect application here requires a damaged fallopian tube?

Well, an by definition an ectopic pregnancy is damage to the fallopian tube, so the above dilemma wouldn’t apply.

However there are, related scenarios where the tube could be salvaged by removing just the fetal child, but I’ve read on the forum here that this constitutes an abortion and is therefore morally prohibited.

 

[sparrowhawk28]

I actually studied such a case in my theology course a few weeks ago, and I think I can be of some assistance.

So you understand that ectopic pregnancy occurs when the foetus is growing outside of the uterus. In such a circumstance, the child cannot survive and the mother’s life is also placed at significant risk. Such dangers occur regardless of whether or not the fallopian tube is healthy.

For double effect to occur, doctors need to remove the fallopian tube with the intention to save the mother, while acknowledging the unfortunate side effect of this decision (the death of the baby). There does not need to be damage to the fallopian tube for the principle of double effect to be initiated.

Hope this helps.

 

[SonCatcher]

according to the wikipedia entry, only 2% of all ectopic pregnancies are not tubal pregnancies. That is approximately 1 in 5000 overall using the provided statistics. Of those, a small portion are located elsewhere in the abdomen and may have attached to some organ with adequate bloodflow to support the child without unduly injuring the mother. If it is possible to support both the physical needs of mother and child until such a time as the child can be delivered safely (obviously via cesarian), we have an obligation to do so. In the other cases, it is legitimate to treat the mother with the unfortunate effect of the loss of the child.

 

[Boulder257]

Double effect really confuses me. I have tried to understand the concept, but I think if a person like myself would lead to using such an argument as a rationalization, which is what I fear with these types of things. I am sure some things have been done in the spirit of double effect when they really didn’t apply to that principle.

That doesn’t take away from it’s validity, it just scares me for this reason.

 

[Bookcat]

ncbcenter.org/Page.aspx?pid=940

 

[yablabo]

Trying to better explain Catholic solution to this problem to a non-Catholic.

The principle of double effect with respect to ectopic pregnancy is that we are removing a damaged fallopian tube which is the intended, good consequence and which will unintentionally cause the baby to die. But what about situations where there is an ectopic pregnancy but the Fallopian tube is not damaged and is not the source of the problem itself (I believe such cases are possible)? In such a case then the removal of the tube is not a good consequence because it was not damaged and would not cause any harm to the mother, so it cannot be the intended “good” of the act, in order to justify the unintended harm of the baby dying. Am I misunderstanding the point here?

There are four means of treating an ectopic pregnancy:

• expectant management (allowing nature to take its course under close medical supervision in the hopes that the developing child can be saved; most of these cases, 40-64% spontaneously abort removing any need for chemical or surgical intervention)
• salpingectomy (removal of fallopian tube and embryo)
• salpingostomy (removal of embryo from fallopian tube, leaving the tube in place)
• administration of methotrexate (in tissues such as cancers which are rapidly growing, this drug inhibits cellular reproduction; in ectopic pregnancies, this drug has a very high success rate at ending the pregnancy and allowing fast recovery and retained fertility due to the fact that it is non-invasive).

However, the thing that everyone is so ready to shoo out the door when discussing the principle of double effect is “certainty.” When the effects of an action are reduced to “likelies” or “may bes” one has entered the realm of probability and cannot render a precise judgment of an action with the principle of double effect. The moral agent would then have to use the basic moral tenet that one may not do evil that good may come of it.

Until there is a certain (not probable) pathology presented either by a deceased embryo with a continually growing placenta attached or actual proportional reason for allowing the evil of the death of the embryo, it seems to me that the only moral route is expectant management.

I also would buy that salpingostomy may possibly be a moral option when a certain dangerous pathology presents as long as there is the attempt at least to transplant the embryo in the womb. There is an article which was published in 1990 outlining such a procedure which was performed on a 27-year-old patient who presented with a tubal pregnancy, the transplant resulting in the delivery of a healthy infant. (L. Shettles, “Tubal Embryo Successfully Transplanted in Utero,” American Journal
of Obstetrics and Gynecology 163 (1990): 2026.)

I would buy the use of methotrexate when dealing with a certainly deceased embryo, but not otherwise.

– Nicole

 

[Leegal]

So are you saying that ectopic pregnancies cannot occur in the absence of a damaged fallopian tube? Because even if there is one instance in which a healthy fallopian tube is involved in an ectopic pregnancy, the dilemma above applies. Am I correct that the double-effect application here requires a damaged fallopian tube?

You need to look it up ectopic. You don’t understand the biology. You cannot use “healthy” tube with ectopic.

 

[robbie20]

This deep kind of Philosphical talk is for theologians and doctors to work out… No layman here is qualified to judge this matter…

 

[runningdude]

This deep kind of Philosphical talk is for theologians and doctors to work out… No layman here is qualified to judge this matter…

That would be a cop out. The laity need to understand and discuss these issues so that we can demand morally responsible medical treatment from our doctors and hospitals.

 

[Leegal]

That would be a cop out. The laity need to understand and discuss these issues so that we can demand morally responsible medical treatment from our doctors and hospitals.

Healthy fallopian tube and ectopic pregnancy is a contradiction in terms.

 

[Benadam]

You know the two methods found objectionable because they targeted the child so as to preserve the tube? The preferred method is cutting out the tuble with the baby inside not a target of removal.

It seems the preferred method might cause a longer painfull death:shrug:

 

[runningdude]

runningdude;8668665:

That would be a cop out. The laity need to understand and discuss these issues so that we can demand morally responsible medical treatment from our doctors and hospitals.

Healthy fallopian tube and ectopic pregnancy is a contradiction in terms.

I was addressing a comment saying this conversation was over the heads of laymen…

 

[robbie20]

Really this is stuff for doctors and theologians to worry about… If you have an etopic pregnancy consult a Catholic physician and priest…

This is too complicated for the laity the vast majority of whom don’t understand a thing about biology and science… Therefore we have no business debating something that is reserved for the professionals…

It’s kind of like abortion… We are to accept it is wrong in all circumstances and not quustion it or find ways around it… We are not to understand the science of any of it…

It is wrong and that’s all we need to know…

It is not for us find out how or why… Just to accept what is told to us…

I know I sound medieval but its the way things are meant to be…

 

[yablabo]

Really this is stuff for doctors and theologians to worry about… If you have an etopic pregnancy consult a Catholic physician and priest…

This is too complicated for the laity the vast majority of whom don’t understand a thing about biology and science… Therefore we have no business debating something that is reserved for the professionals…

It’s kind of like abortion… We are to accept it is wrong in all circumstances and not quustion it or find ways around it… We are not to understand the science of any of it…

It is wrong and that’s all we need to know…

It is not for us find out how or why… Just to accept what is told to us…

I know I sound medieval but its the way things are meant to be…

Except this is a very simple moral issue which should take no more than 10 minutes to bring any mature mind to the ability to discern it.

It’s not complicated in the least.

Mature adult human beings ARE morally responsible and accountable for every action they choose to do…which means they are capable to comprehend both cause and effect in this case, basic moral tenets and the principle of double effect.

– Nicole

 

[Corki]

Really this is stuff for doctors and theologians to worry about… If you have an etopic pregnancy consult a Catholic physician and priest…

This is too complicated for the laity the vast majority of whom don’t understand a thing about biology and science… Therefore we have no business debating something that is reserved for the professionals…

First of all, there are many theologians who post on CAF - clergy and lay.

Secondly, if you are facing an ectopic pregnancy, it is unlikely that your doctor will be ab expert in moral theology or that you will have time to consult a theologian. You need to be aware of the implications of your possible decisions. Understanding the principle of double effect in general and how it relates to various situations such as this one helps people make moral decisions when faced with other variables.

It’s kind of like abortion… We are to accept it is wrong in all circumstances and not quustion it or find ways around it… We are not to understand the science of any of it…

It is wrong and that’s all we need to know…

It is not for us find out how or why… Just to accept what is told to us…

That’s not correct. As Catholics we are called to learn the reasoning behind the Church’s teachings. When it comes to abortion, the key reason is scientific - the point at which a new life is created. Without understanding that key scientific point, being anti-abortion comes down to “because the Church told me so” and that’s not a good reason for any moral position.

I know I sound medieval but its the way things are meant to be.

It doesn’t sound medieval and it’s not the way things are meant to be.