Ectopic pregnancy, methotrexate and pharmacists

[Canvas]

No. The former saves the life of the mother by the act of cutting out the fallopian tube. The latter kills the baby… and also has the side effect of preserving the fallopian tube. The distinction here is between act and side effect , by way of intent .

I appreciate that it’s a subtle distinction. I recognize that, in an age in which consequentialism is perceived as acceptable, that this appears to be ‘just semantics’. However, that’s not what Catholic moral theology teaches.

Canvas:

You seem to think I am completely ignorant of Catholic Moral Theology. I am no Alphonsus Ligouri, but I have studied it a bit and have read about this issue in particular. In this case, it really seems to be splitting hairs over this and like some other ethicists, I disagree with the position that there is only one moral way to deal with the situation.

In both cases, whether MXT or surgery is used, the intent is to save the only life that can be saved in this situation, that of the mother. The baby is doomed regardless of what happens.

And cutting out the tube with the unborn child is terminating the pregnancy, whether you want to say it is “operating on the tube with the forseen consequence of terminating the pregnancy.” Only in this case, terminating the pregnancy is not optional.

 

[Gorgias]

For me the semantics is pretending that directly cutting the tube out but somehow forgetting there is a live foetus inside and therefore we are not also directly cutting out the foetus

No, it’s not being forgotten. Rather, it’s being admitted, explicitly, that the death of the child is a side effect of the action taken.

Personally I believe the acceptability of doing so has never been adequately explained by the usual definition of the PODE.

Yes, it is a difficult concept to wrap one’s head around. Do you find Aquinas’ treatment of it an “inadequate explanation”, too?

 

[Gorgias]

In both cases, whether MXT or surgery is used, the intent is to save the only life that can be saved in this situation, that of the mother. The baby is doomed regardless of what happens.

You’ve got to ask what the intent of the action is. The intent of cutting the tube is “save the mother”. The intent of administering the drug is “abort the baby”. Different actions. Different intents.

I get what you’re saying: in the end, the same result occurs: mother lives, baby dies. However, since you’re not ignorant of Catholic moral theology, you know that the ends do not justify the means. One cannot directly kill the baby in order to save the mother.

 

[Pattylt]

You’ve got to ask what the intent of the action is. The intent of cutting the tube is “save the mother”. The intent of administering the drug is “abort the baby”. Different actions. Different intents.

Isn’t the point of MXT to save the Fallopian tube?

 

[Gorgias]

Isn’t the point of MXT to save the Fallopian tube?

That would be even more unacceptable! The evil (‘aborting the baby’) would far outweigh the good (‘saving the fallopian tube’)!

 

[Pattylt]

I understand the fine line distinction you are making, I really do! From my point of view the medical decision is than the embryo must be removed or the mother will die. One method removes a section of tube along with the embro while using MTX removes the embryo while saving the tube and allowing its future function to remain.

In the case of a woman who has already had one tube removed and now faces a second tubal pregnancy, removing the tube section will now leave her sterilized. Is this not also a moral dilemma? I’m just asking, I’m not Catholic, just so it’s clear.

 

[Gorgias]

From my point of view the medical decision is than the embryo must be removed or the mother will die.

I agree that, from the medical perspective, that’s how the decision appears. That doesn’t mean that this is how the situation is framed up purely from the perspective of the moral question.

In the case of a woman who has already had one tube removed and now faces a second tubal pregnancy, removing the tube section will now leave her sterilized. Is this not also a moral dilemma?

No. Sterilization is not an intrinsic moral evil. If there is sufficient cause (the usual canonical example is ‘cancer’), sterilization is morally permissible.

 

[Pattylt]

Thank you for the answers!

 

[ConfusedLucy]

Removal of a tube would be a very invasive procedure especially when there is a non surgical alternative. It’s not like the foetus comes off better from having the tube removed. It feels a bit like punishing the mother by leaving her unecessarily mutilated for having a life-threatening medical condition.

 

[ShrodingersCat]

I can see where the Pro-MXD ethicists are coming from, but I like to look at it this way: by operating, you are preserving the dignity of both mother and baby by treating both patients in so far as we can with modern medicine. In the future if we develop artificial wombs or transplant methods to save the foetus, the first step would be to remove it surgically.

With MXD, it’s not preserving the dignity of the foetus - it’s a more… hopeless approach, if you will. Sorry if I’m not articulating this very well.

This isn’t a direct response to the OP by the way. It’s just a slightly different perspective from someone on the “official Catholic POV” side.

 

[Sophie111]

Yes, it is a difficult concept to wrap one’s head around. Do you find Aquinas’ treatment of it an “inadequate explanation”, too

Wasnt aware either the current PODE definition (insofar as there actually is a consistent Catholic one) was what Aquinas originally asserted…nor that Galen described ectopic procedures .

 

[Canvas]

However, since you’re not ignorant of Catholic moral theology, you know that the ends do not justify the means.

I never said the ends justify the means. I was saying I see very little difference in the intent (to save the mother’s life) regardless of method used. I am saying in this particular instance, I don’t see a moral distinction between cutting the baby out or administering a drug. It seems merely to be a theoretical distinction because with one there is a fig leaf of being one step removed from termination. Hair splitting.

One could argue that by waiting until the situation is serious enough for surgery, in some situations, the doctor is placing the mother at an even higher risk.

Many doctors would not operate unless that is the only option, because surgery is very risky in and of itself.

 

[Gorgias]

Wasnt aware either the current PODE definition (insofar as there actually is a consistent Catholic one) was what Aquinas originally asserted

Wow. Just… wow.

Yes, there’s a consistent expression of the Catholic take on double effect. Others might provide other spins on it… but we’re talking Catholic moral theology here, right?

And, as one hopes you already know, Aquinas was the first to express the salient notions present in double effect in his treatment of the moral permissibility of self-defense in the Summa (ST II-II.64.7, if you need to refresh your memory).

On the other hand, if you really weren’t aware that this is the case… well, I’m glad I could help you learn something new!

 

[KathleenT]

The question isn’t really about removal of the tube vs. methotrexate. It is does the pharmacist have an obligation to confirm the baby has passed prior to filling the prescription?

Can the pharmacist even demand that information? What standard do we hold that info? How much time do we take to do those tests…time which may cause the mother to bleed out? At what point are we allowed to trust the doctor, the doctors who often work very hard to save all the babies they can? So how do you confirm death? Lack of heartbeat (that likely won’t be visible anyways), dropped HCG levels?

For me, we saw the sonogram and my HCG levels continued to drop to the point of nothing. At the time, my doc was unwilling to say for sure it was an ectopic because it could have been a cyst which also raises HCG levels.

I get the importance of working out the moral thinking but we should keep in mind there is not always 100% clear information.

To my mind the pharmacist either has to refuse to fill all prescriptions or he has to trust the doctor did everything possible, because he can’t really rifle through people’s medical records to have enough information to make an independent decision.

 

[Gorgias]

I never said the ends justify the means.

Not explicitly. However, here’s what you wrote: " In both cases, whether MXT or surgery is used, the intent is to save the only life that can be saved in this situation, that of the mother. The baby is doomed regardless of what happens." That sounds a lot like the consequentialist / utilitarianist way of framing up the question (which, in the end, really is an assertion of the ends justifying the means!), so that’s the way I took your assertion there.

I was saying I see very little difference in the intent (to save the mother’s life) regardless of method used

I understand. How would you characterize the two (very distinct) acts in question? That’s where you find the assessment of intention!

It seems merely to be a theoretical distinction because with one there is a fig leaf of being one step removed from termination. Hair splitting.

Umm… isn’t moral theology, by and large, the practice of making such fine distinctions?

 

[TheLittleLady]

Removal of the damaged portion of the tube is just that. There is nothing done directly to the embryo.

Metho targets the embryo and to put it bluntly “dissolves” the embryo. If the embryo has already died, this is an acceptable means of removing the dead tissue. If the embryo is alive, it is a grisly way to kill that embryo. It is a direct attack on that small life.

Look at it like this, grandma is dying. She is hooked up to a machine that breathes for her.

You have two options, you can remove the intubation and make her comfortable, she will die in a short time. This is a moral option.

You could also pour a medication on her that inhibits her body’s cells from functioning and kills her. This would be a direct killing of your grandmother and you would stand there and prevent anyone from trying to pour that substance on her.

Go read the medical publications, they do not pull any punches: mechanism of action , competitive inhibition of folate-dependent steps in nucleic acid synthesis, effectively kills the rapidly dividing ectopic trophoblast. Methotrexate: the pharmacology behind medical treatment for ectopic pregnancy - PubMed

 

[TheLittleLady]

It is does the pharmacist have an obligation to confirm the baby has passed prior to filling the prescription?

This comes down to the conscience protection laws in the pharmacist’s state.

 

[EnglishTeacher]

The question isn’t really about removal of the tube vs. methotrexate. It is does the pharmacist have an obligation to confirm the baby has passed prior to filling the prescription?

I say no. Especially since Catholic ethicists are divided over whether taking methotrexate in the case of an ectopic pregnancy is morally permissible. It’s not a cut and dried situation.

Also, does a pharmacist normally take time to find out exactly what the prescriptions he fills are being used for? He probably fills tons of prescriptions every day for oral contraceptive pills, for example, many of which are being used for contraception, while others are being used to treat female hormonal issues. He doesn’t know, and I don’t think he has an obligation to research each case to find out. Just my opinion.

To my mind the pharmacist either has to refuse to fill all prescriptions or he has to trust the doctor did everything possible, because he can’t really rifle through people’s medical records to have enough information to make an independent decision.

This.

 

[Canvas]

Grandma on life support is different from a medical emergency that could cause a life threatening situation for a mother. How long Grandma stays on life support isn’t increasing the risk to another.

Using hospice or letting nature take it’s course is a moral option rather than assisted suicide or euthanasia. I agree. I am pro-life myself. I want to see medicine advance to where we can save the baby in an ectopic situation.

But a better comparison using the “grandma” example for the ectopic pregnancy “is which life support machine do you unplug when you realize grandma is beyond recovery”, assuming she has several forms of life support keeping her alive.

Because both surgery and the pill are terminating the child, it is as simple as that. There is no other choice but to end the pregnancy. One gets to say “it is only indirect”, but it is essentially cutting an unborn child out of the mother. How is that morally superior to giving the mother chemicals?

BTW— the trophoblast isn’t actually part of the unborn child—it is the placenta in it’s early stages.

 

[Gorgias]

Because both surgery and the pill are terminating the child, it is as simple as that. There is no other choice but to end the pregnancy. One gets to say “it is only indirect”, but it is essentially cutting an unborn child out of the mother. How is that morally superior to giving the mother chemicals?

It’s “morally superior” because it’s not a direct termination of life. And, in fact, the word you’re looking for is “licit”, not superior, because the other option isn’t “inferior”, it’s “illicit”.

If you’re looking at it through a consequentialist lens (i.e., “what is the end effect?”), then I get how you’d frame it up in the way you have. However, the Church rejects consequentialist moral ethics. In all charity, I think I should point out that it appears that that viewpoint is where you’re coming from, when you say “it’s all the same”. Maybe I’m mistaken, but… “if it quacks like a duck”…