Ectopic pregnancy, methotrexate and pharmacists

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gingersensei

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I’ve done a lot of reading on methotrexate and ectopic pregnancy. I feel I understand both sides of the argument. My problem is not knowing where I stand.

I am a pharmacist in a hospital and we do occasionally treat ectopic pregnancy with methotrexate. In my little hospital I am the only pharmacist on staff. We don’t make the dose in our hospital because we don’t have the proper IV hood, but the big sister hospital draws up the proper dose and sends it over. My job is mostly to verify the dose is properly calculated and ensure that it arrives in time for its scheduled administration. However, I expect that some time in the future we will have the proper equipment, and I will be more directly involved. Until we grow, I expect that I will remain the only available pharmacist and unable to ask a colleague to cover this duty for me in most instances.

My parish priest has said that he doesn’t think I am doing anything wrong, as I am neither prescribing nor using this drug for this purpose, rather safeguarding the mother’s health by calculating the proper dose and seeing to its proper preparation. I emailed the catholic bioethics people and I am morally proximate in some degree that I can’t repeat because it was complicated and I don’t remember it word for word, but basically I was told that I need to examine my conscience and go from there.

I wonder what opinions are on this topic. Some might say quit and work somewhere else, but there are no catholic hospitals near me. I would have to work retail, which would involve filling a ton of birth control prescriptions, and likely prescriptions from PP as well, which I could not refuse without losing my job.

When I chose this career, the thought that this might be an issue never once occurred to me, and I am 25 years in, just learning more about my faith and realizing that I have been deficient in a few areas.

Apologies if this has been covered already. I did search and found a lot about ectopics, but nothing that directly discusses pharmacists.
 
gingersensei said:
My parish priest has said that he doesn’t think I am doing anything wrong, as I am neither prescribing nor using this drug for this purpose, rather safeguarding the mother’s health by calculating the proper dose and seeing to its proper preparation.
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This would be enough for me since this product is being used to treat ectopic pregnancy.
 
Does your hospital confirm that the small embryo has died before they administrate the drug? If they do, then there is nothing morally wrong with using the drug to dissolve the tissue.

If, on the other hand, the embryo is alive, the medication is a direct abortion.

The National Catholic Bioethics Center would be my suggestion to you.

Thank God many states have conscience protection for pharmacists. http://www.ncsl.org/research/health/pharmacist-conscience-clauses-laws-and-information.aspx
 
gingersensei said:
My parish priest has said that he doesn’t think I am doing anything wrong, as I am neither prescribing nor using this drug for this purpose, rather safeguarding the mother’s health by calculating the proper dose and seeing to its proper preparation.
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As someone else said, this should have been the end of the matter.

If you are still concerned about whatever the “catholic bioethics people” said, please go back to your priest, who knows you, the situation, and is I presume your confessor, and discuss it with him.

God bless
 
I can offer you no advice, but I can say I sympathize. I thought at one point last year that I was being asked to design an abortion clinic. I looked up the facility I was designing and learned that it was no such thing, but until I did so I was terrified that I could potentially lose my job by refusing to design it. I still worry that I’ll someday be asked to do so, and I don’t think my current employer (a major and very progressive international engineering firm) will be sympathetic to my objections (I think my employer before probably would have been just fine with my objecting). Praying for you.
 
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Just to add on: Ectopic pregnancy is a serious life-threatening condition to the mother. One of my college roommates, who was married, had one which was only discovered after she hemorrhaged for several days (she thought it was a heavy period) and ended up needing emergency surgery and hospitalization.

I would presume the drug in this case has the primary purpose of treating the mother’s serious health condition.
 
I also had a ectopic that ruptured.

The direct abortive nature of the metho is what renders it immoral.

Surgery where the ruptured portion of the tube is removed is the moral choice when the death of the embryo cannot be confirmed. This surgery is what saved my life.
 
You are not giving the drug, you are not prescribing the drug, I think your parish priest is right. You are just making sure your patients are getting a safe dose of a medication. Methotrexate can, I believe, be used to treat a variety of things.
 
Tis_Bearself said:
I would presume the drug in this case has the primary purpose of treating the mother’s serious health condition.
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No. This drug is intended to kill the embryo. That’s why there’s a potential moral dilemma.
1ke said:
I would agree with your priest in this case.
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To be fair, I would think that the NCBC is a bit more well-versed in these issues than the average parish priest.
Delphinus said:
You are not giving the drug, you are not prescribing the drug
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That’s why he’s not the agent performing the act or a formal cooperator in the act. The case that the OP says that the NCBC is making is that he is contributing to the act. My guess is that they told him that he is an immediate material cooperator in the act. See this chart for a simplified breakdown of the ways in which one may cooperate with immoral acts.
Delphinus said:
Methotrexate can, I believe, be used to treat a variety of things.
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That would be relevant if it were being prescribed to treat “a variety of things”, rather than being prescribed to abort an ectopic pregnancy.
 
Tis_Bearself said:
I would presume the drug in this case has the primary purpose of treating the mother’s serious health condition.
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Actually no, methotrexate is a medical abortion. The only licit method of treating an ectopic pregnancy per the Catholic Church is removal of the tube.
 
that is debatable, although in 1994 the USCCB guidelines on medical ethics were revised and tend to favor tubular removal over other methods. There are moral theologians and ethicists who have debated that in the case of ectopic pregnancy it is morally licit to use other means than removal of the tube.

I mean, the whole “double-effect” argument is a nice way to say “I didn’t terminate a pregnancy, I just removed a length of Fallopian tube” when in fact, you removed a tube to terminate a non-viable, life threatening ectopic pregnancy. The parties just “indirectly” terminated a pregnancy. The end result is the same for the non-viable pregnancy as MXT: termination of the pregnancy. MXT just acts differently but doesn’t require invasive surgery. Still same end result for the baby.

But I and some ethicists would argue, a doctor using MXT is acting in this case to protect the mother from a horrible complication that rendered her pregnancy non-viable and is a potentially a grave risk, so he is acting to save the mother, not to kill a baby. Double -effect.

I have also seen an argument saying that MXT doesn’t kill the embryonic baby directly either, it kills the connection between the baby and the wall of the tube, which cuts the life support off. But then again, what does tube removal do?

Anyway to me, it seems to be a medically necessary procedure to protect the mother in a possible life threatening situation with a non viable pregnancy. Splitting hairs over the exact method seems silly when no matter what method is used, the non-viable pregnancy is terminated and the mother is saved (saving the mother being the goal here.)

I don’t see any moral equivalence here to an elective abortion.
 
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In an ectopic pregnancy, methotrexate causes the sloughing off of cells in the Fallopian tube resulting in the death and expulsion of the embryo. The NCBC has several articles addressing ectopic pregnancies and the treatment, and most Catholic hospitals have also worked with their own ethics committees to render an opinion. I suggest you read and investigate this. The use of methotrexate in this setting is a direct abortifacient. I do sympathize with your situation in a small or rural hospital setting.
 
1ke said:
I would agree with your priest in this case.
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I would too.

As always, I also don’t really like it when posters seem to be wanting strangers on a lay person forum to second guess their priest on a moral issue that they have already discussed with the priest.

If you absolutely need a “second opinion”, which should be rare if you trust your priest, then the correct thing to do is to talk to another priest. Not to CAF.
 
Canvas said:
so he is acting to save the mother, not to kill a baby. Double -effect.
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With MXT he is acting directly against the child. You cannot couch it in terms of the end, but always must include the means. The end, to save the mother, is certainly the goal. But we may not use an immoral means to achieve it.

Removing the tube is not immoral, even though the foreseen but unintended result is that the child dies.

Giving MXT has only one purpose and one outcome: killing a child. This is direct abortion and can never be done.
 
I don’t see it that way—the way I see it is that both methods terminate a non-viable pregnancy to save the mother. I just fail to see a huge difference here. I would rather we had a way to prevent this or save the child, but argument over how to terminate the pregnancy seems to me like splitting hairs while a woman’s life is on the line.

Only with one, you can say “i was removing an organ and only indirectly caused an abortion”.

The Doctor is killing the child regardless of how he treats it. It is either cutting the baby out inside the tube or giving it poison that will destroy the embryonic placenta.
 
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