Ectopic Pregnancy Question

[acb]

Just thought I would share my experience, it was a little different than those discussed. I had a positive preganancy test, and then started staining in the 6th week. Severe cramps set in, and then the excruciating pain described by another poster. I went to the ER and was transported to my regular hospital. My OB started tracking my HCG levels and they were in the 100s, whereas they they should have doubled well into the 1000s by then. After a period of days, she concluded that I was miscarrying. She recommended a D&C - something I now regret, but I trusted my doctor since I didn’t know anything about miscarriage and how often they complete naturally. The D&C revealed there was nothing in the uterus. She advised Methotrexate because she thought I was having a miscarriage somewhere in my body that could not expel and might be toxic. I was very scared and in a lot of mental and physical pain, and not knowing how quickly I needed to act. I went ahead and took the drug. At the time, I wasn’t sure on the morality because I was convinced that I had already lost the baby and that there was no way for this to resolve naturally. I have since confessed, and I thank God every day for His great sacrament of mercy. My advice - find an orthodox Catholic OB/GYN (if you can) so they can guide you through these extremely difficult situations (when you are most vulnerable) in accord with Church teaching.

 

[AmISearching]

My question upon reading this is that one poster stated that the baby is likely already dead in the tube by the time the ectopic pregnancy is discovered… if they could verify this, then would that not make removing the baby legit as it is already dead?

 

[Seatuck]

The ectopic pregnancy is not supposed to be removed until its death is imminent. That is the moral teaching. We have ultra sounds and testing to verify this. Most women who go to the ER in severe pain are usually experiencing a rupture and the fetus is generally in the act of dying. In that situation it is ok to remove the part of fallopian tube which has the dying fetus .

It is not morally permissable to remove the ectopic pregnancy upon discovery if there is no fetal distress. Doctors are supposed to wait and see while providing emotional and spiritual support to the mother. That is the way I understand it.
Dr. May is one of the leading ethicists on this topic.He wrote a book I and others recommend -Catholic Bioethics and the Gift of Human Life

I’ve seen parts of this work in other forms on the web.

Here’s a brief discussion on the subject .

cuf.org/faithfacts/details_view.asp?ffID=57

 

[lifeisbeautiful]

AmISearching?:

My question upon reading this is that one poster stated that the baby is likely already dead in the tube by the time the ectopic pregnancy is discovered… if they could verify this, then would that not make removing the baby legit as it is already dead?

If they were 100% sure it was dead, then it is a totally different case. The problem with the two methods (methotrexate and removing tha baby) is that the action being taken is to kill an innocent child.

 

[vluvski]

lifeisbeautiful:

If they were 100% sure it was dead, then it is a totally different case. The problem with the two methods (methotrexate and removing tha baby) is that the action being taken is to kill an innocent child.

This is true of the methotrexate, but not true of removing the baby. How can you say the "action being taken is to kill an innocent child? The action is not “to kill an innocent child;” that is not the purpose, and the child’s death is not necessary for the operation to be successful. The means of methotrexate requires the child’s death to be successful. The means of removal of either the tube or the baby do not require the baby’s death, even though in both cases death will result. ANY option at this point in time will “kill” (result in the death of) the innocent child, including the removal of the tube, but you cannot say that killing the child is the purpose of removing it because it’s not. The action is to (meaning the purpose of the action) remove the child from the dangerous location.

Further, if I was the one who used the word “inconvenient,” I apologize sincerely if it sounded as if I was making light of this awful situation. The baby is not inconvenient, but the location, for lack of a better way to put it, is. Losing a child to miscarriage or ectopic pregnancy or stillbirth has to be the worst, most heartbreaking nightmare ever. That is why I think it is good to discuss this type of thing before it happens when you can be detached from the emotion of it, so you know how to react in a painful situation.

 

[lifeisbeautiful]

vluvski:

This is true of the methotrexate, but not true of removing the baby. How can you say the "action being taken is to kill an innocent child? The action is not “to kill an innocent child;” that is not the purpose, and the child’s death is not necessary for the operation to be successful. The means of methotrexate requires the child’s death to be successful. The means of removal of either the tube or the baby do not require the baby’s death, even though in both cases death will result. ANY option at this point in time will “kill” (result in the death of) the innocent child, including the removal of the tube, but you cannot say that killing the child is the purpose of removing it because it’s not. The action is to (meaning the purpose of the action) remove the child from the dangerous location.

Further, if I was the one who used the word “inconvenient,” I apologize sincerely if it sounded as if I was making light of this awful situation. The baby is not inconvenient, but the location, for lack of a better way to put it, is. Losing a child to miscarriage or ectopic pregnancy or stillbirth has to be the worst, most heartbreaking nightmare ever. That is why I think it is good to discuss this type of thing before it happens when you can be detached from the emotion of it, so you know how to react in a painful situation.

Well, if the child does not die in the action of taking the child out, it will die of being taken out. There is a difference between treating a tube (which will result in the child’s death) and removing the child alone. In the former, the action is treating the mother, removing a section of the tube. In the latter the action is directed towards the baby, not treating the tube but treating the baby. In the case of removing the baby, the baby is killed by the means of removing the source it needs to live. If the doctors were planning on providing it with another source to live, it would be a different case (which is not what we are talking about). Since the doctors are not planning on doing anything, then it is killing the child.

BTW, here’s some info on how methotrexate can work:
“How does methotrexate work?
Methotrexate can cause an early abortion by stopping the ongoing implantation process that occurs during the first several weeks after conception. It may also** affect attachment of the embryo to the uterine wall**. Misoprostol is the second drug used in this regimen which causes uterine contractions that expel the embryo.”

" What methotrexate does is kill off the throphoblast cells which are the invading cells of the pregnancy and those that form the after birth or placenta. It is these that rupture the tube cause the pain and potential death of the mother. Once these die off, the pregnancy is lost and the whole pregnancy sac, including any baby that may be there, is reabsorbed by the mother. This is normal and happens in many cases of miscarriage. You may feel pain after being given methotrexate but this is due to the pregnancy sac swelling and not effects on the baby."

From what it says here methotrexate is doing the same thing the doctor’s would do by removing the baby. The baby dies of not being attached anymore. It is a different way of doing the same thing, yet it is wrong. There are different ways of killing the baby, but they are all killing the baby.

 

[Catholic2003]

vluvski:

This is true of the methotrexate, but not true of removing the baby. How can you say the "action being taken is to kill an innocent child? The action is not “to kill an innocent child;” that is not the purpose, and the child’s death is not necessary for the operation to be successful. The means of methotrexate requires the child’s death to be successful. The means of removal of either the tube or the baby do not require the baby’s death, even though in both cases death will result. ANY option at this point in time will “kill” (result in the death of) the innocent child, including the removal of the tube, but you cannot say that killing the child is the purpose of removing it because it’s not. The action is to (meaning the purpose of the action) remove the child from the dangerous location.

Based on my own personal reasoning, I agree with you. On another thread, we were discussing suicide, and had two examples to consider. The first example was where a soldier threw his body on an incoming grenade to save the lives of his fellow soldiers. The second example was where a spy took a poison tablet to avoid revealing information while being tortured. My conclusion was the first example was not suicide, but the second example was. The difference lies in the possibility of God performing a miracle to allow the person to live. In the first example, the soldier would thank God to be alive after having contained the grenade. In the second example, the spy would say that if he knew that God was going to miraculously save him, he wouldn’t have bothered to take the poison tablet in the first place. In other words, in the first example, the death was not intended as a means, but it was an unavoidable secondary effect. In the second example, the death was in fact the means by which the end of not revealing information during torture would be accomplished.

In this example, the same reasoning applies. If just the baby is removed, and the tube left intact, and God performed a miracle to allow the baby to survive, we would all be thanking God. If methotrexate is given, and God performed a miracle to allow the baby to survive, the doctors would just try giving more methotrexate until the baby dies.

However, I don’t think this how the Church reasons. Somehow, removal of a damaged fallopian tube is enough of a justification for the side effect of killing the baby. This is probably the same reason that treating severe menstrual cramps using birth control pills is enough of a justification for the possible side effect of causing spontaneous abortions.

 

[vluvski]

Catholic2003:

Based on my own personal reasoning, I agree with you.
…This is probably the same reason that treating severe menstrual cramps using birth control pills is enough of a justification for the possible side effect of causing spontaneous abortions.

Thanks for your support. I just hope one day the distinction won’t be necessary when the baby can be saved as well.
The two instances of suicide are perfect parallels for my (and your) logic.
As for treating cramps with pills… those must be some severely dehabilitating cramps to justify abortion! That’s kind of alarming!

 

[Catholic2003]

vluvski:

As for treating cramps with pills… those must be some severely dehabilitating cramps to justify abortion! That’s kind of alarming!

I’m a man, so I can’t really say, but I assume they are.

The reason that I bring it up is because when I first learned that severe but non-life threatening medical problems could justify the use of treatments with abortive side effects, it didn’t make sense to me that this would be enough justification, but the Church seems to teach that it is. Later, when I learned that removal of damaged fallopian tube justifies the “accidental” removal of the baby, even though it is precisely the part of the fallopian tube containing the baby that must be removed, I can’t say that it made more sense, but at least the Church’s teachings seemed more consistent.

 

[lifeisbeautiful]

Catholic2003:

Based on my own personal reasoning, I agree with you. On another thread, we were discussing suicide, and had two examples to consider. The first example was where a soldier threw his body on an incoming grenade to save the lives of his fellow soldiers. The second example was where a spy took a poison tablet to avoid revealing information while being tortured. My conclusion was the first example was not suicide, but the second example was. The difference lies in the possibility of God performing a miracle to allow the person to live. In the first example, the soldier would thank God to be alive after having contained the grenade. In the second example, the spy would say that if he knew that God was going to miraculously save him, he wouldn’t have bothered to take the poison tablet in the first place. In other words, in the first example, the death was not intended as a means, but it was an unavoidable secondary effect. In the second example, the death was in fact the means by which the end of not revealing information during torture would be accomplished.

In this example, the same reasoning applies. If just the baby is removed, and the tube left intact, and God performed a miracle to allow the baby to survive, we would all be thanking God. If methotrexate is given, and God performed a miracle to allow the baby to survive, the doctors would just try giving more methotrexate until the baby dies.

However, I don’t think this how the Church reasons. Somehow, removal of a damaged fallopian tube is enough of a justification for the side effect of killing the baby. This is probably the same reason that treating severe menstrual cramps using birth control pills is enough of a justification for the possible side effect of causing spontaneous abortions.

Unless nature is defied, taking a baby that is only weeks old out of her mothers tube and discarding of him/her (however they do that) is killing the child. God can perform miracles, but that would not be a justification for going thru all the motions of killing someone.

BTW, I too am looking into the birth control/abortion thing, as I don’t seem to understand it either (maybe I never will ). I am trying to find out exactly what the Church says on that topic, as there may be misunderstandings about what it really says. Are you sure it is ok’d for severe cramps?

 

[Catholic2003]

lifeisbeautiful:

BTW, I too am looking into the birth control/abortion thing, as I don’t seem to understand it either (maybe I never will ). I am trying to find out exactly what the Church says on that topic, as there may be misunderstandings about what it really says. Are you sure it is ok’d for severe cramps?

I’m glad you are looking into it too. I’m not 100% sure, but it does seem to me that is what the Church teaches.

A related question would be the case where an ectopic pregnancy is caught early. Is it allowable to remove the baby and tube at that point, or must the ectopic pregnancy be allowed to progress to the point where the damage to the fallopian tube is actually life-threatening by itself?

 

[vluvski]

Sorry, it just doesn’t hold water for me. If you can’t justify removing the child, then in my mind you can’t justify removing the tube either. It would require an equally shocking miracle to save the baby inside the broken piece of fallopian tube. We’re removing the piece of fallopian tube that contains the baby (perhaps because the baby’s presence in this location is the cause for the problem?), and it just so happens that the baby can’t survive there once the tube is removed. I don’t think I’ll ever understand why that is so different from directly removing a baby that just so happens to be unable to survive. And the irony of it all is that the baby isn’t going to survive even if left alone.
It seems like we’re mutilating the woman’s body just so the action is performed on the woman and not on the baby, and somehow (as I see it) two wrongs are making a right. It just doesn’t make sense!
I also think couples who must use birth control for other means (which there is evidence it isn’t really as useful as some say) should be compelled to abstain during fertile periods to minimize the chance of an abortive effect.

 

[Catholic2003]

lifeisbeautiful:

Unless nature is defied, taking a baby that is only weeks old out of her mothers tube and discarding of him/her (however they do that) is killing the child. God can perform miracles, but that would not be a justification for going thru all the motions of killing someone.

Unless nature is defied, jumping on a grenade is killing yourself. But the possibility of God performing a miracle is not the justification for killing yourself; the possibility of God performing a miracle is merely what proves that the death is not intended as a means, but is truly an unintended side-effect. What actually justifies this lethal side-effect is the directly intended good effect.

 

[Catholic2003]

vluvski:

Sorry, it just doesn’t hold water for me.

It doesn’t make a whole lot of sense to me either. But I guess we just have to keep on trying to conform our conscience to what the Church teaches.

vluvski:

I also think couples who must use birth control for other means (which there is evidence it isn’t really as useful as some say) should be compelled to abstain during fertile periods to minimize the chance of an abortive effect.

This is consistent with the view that killing a baby can’t really be justified by less important objectives, including the removal of a damaged fallopian tube.

 

[vluvski]

Catholic2003:

This is consistent with the view that killing a baby can’t really be justified by less important objectives, including the removal of a damaged fallopian tube.

Not exactly, I don’t think. In the case of the fallopian tube, the baby’s death is unavoidable no matter how the tube is treated.
In the case of the birth control, it IS avoidable… by not having intercourse when a pregnancy is likely to occur.

 

[lifeisbeautiful]

vluvski:

Sorry, it just doesn’t hold water for me. If you can’t justify removing the child, then in my mind you can’t justify removing the tube either. It would require an equally shocking miracle to save the baby inside the broken piece of fallopian tube. We’re removing the piece of fallopian tube that contains the baby (perhaps because the baby’s presence in this location is the cause for the problem?), and it just so happens that the baby can’t survive there once the tube is removed. I don’t think I’ll ever understand why that is so different from directly removing a baby that just so happens to be unable to survive. And the irony of it all is that the baby isn’t going to survive even if left alone.
It seems like we’re mutilating the woman’s body just so the action is performed on the woman and not on the baby, and somehow (as I see it) two wrongs are making a right. It just doesn’t make sense!
I also think couples who must use birth control for other means (which there is evidence it isn’t really as useful as some say) should be compelled to abstain during fertile periods to minimize the chance of an abortive effect.

Ok, we agree that in both cases (with or without tube) the baby will die, or at least has the same chance of survival. The difference is in one, the action is removing the tube (or section) and in the other it is removing the baby. As it is right now, the baby will die in either case, but the action being taken is different. The Church says its ok to remove a persons organ if it will save his/her life but it does not say its ok to remove a live child that will die due to this removal from his mother (abortion). The results are the same, but the means do matter.

 

[Catholic2003]

vluvski:

Not exactly, I don’t think. In the case of the fallopian tube, the baby’s death is unavoidable no matter how the tube is treated.
In the case of the birth control, it IS avoidable… by not having intercourse when a pregnancy is likely to occur.

I see your point, but I’m thinking from the perspective of Church reasoning, not our reasoning. The question of whether a lesser objective, such as removing a damaged tube or treating severe cramps, can possibly justify an unintended side-effect of killing a baby, has a Yes or No answer.

If the answer is No, then removal of the damaged tube would not justify killing the child, so it makes just as much (if not more) sense to remove only the child and repair the fallopian tube. Also if the answer is No, then the couple would be required to abstain from relations during fertile periods, because the medical treatment of severe cramps would not justify the possible spontaneous abortions that might occur.

If the answer is Yes, which is what I think the Church teaches, then removal of the damaged tube does justify killing the child. Also if the answer is Yes, then treating the severe cramps is enough to justify the possible spontaneous abortion that might occur. Certainly the couple can nonetheless choose to abstain from relations during fertile periods, but seeing how marital relations are a natural good, they would not be required to, because the possible spontaneous abortions would be already justified by the medical treatment of severe cramps.

It does not seem at all consistent to me to answer Yes to the damaged tube case, but No to the severe cramps case.

 

[lifeisbeautiful]

Catholic2003:

I see your point, but I’m thinking from the perspective of Church reasoning, not our reasoning. The question of whether a lesser objective, such as removing a damaged tube or treating severe cramps, can possibly justify an unintended side-effect of killing a baby, has a Yes or No answer.

If the answer is No, then removal of the damaged tube would not justify killing the child, so it makes just as much (if not more) sense to remove only the child and repair the fallopian tube. Also if the answer is No, then the couple would be required to abstain from relations during fertile periods, because the medical treatment of severe cramps would not justify the possible spontaneous abortions that might occur.

If the answer is Yes, which is what I think the Church teaches, then removal of the damaged tube does justify killing the child. Also if the answer is Yes, then treating the severe cramps is enough to justify the possible spontaneous abortion that might occur. Certainly the couple can nonetheless choose to abstain from relations during fertile periods, but seeing how marital relations are a natural good, they would not be required to, because the possible spontaneous abortions would be already justified by the medical treatment of severe cramps.

It does not seem at all consistent to me to answer Yes to the damaged tube case, but No to the severe cramps case.

1. In the ectopic pregnancy case the child will die in or out of the tube (unless a new procedure is developed) and it will also die if left as is. The justification is not due to the fact that a body part is being removed, it is due to the fact that it comes as a side effect to an acceptable procedure to help solve a life threatening case, in those specific circumstances.
2. In the cramp case the child would probably not die if the abortifacient wasn’t being used and it is not being done for a life threatening cause (unless the cramps you were talking about are life threatening)
   They are two different situations, I don’t know enough about the Church’s standings on the second case to comment any further on it, but I think it is clear that the cases are different.

Also, about the example above about the suicide/grenade, if it is justified, it is only because it meets the criteria:

1. The act must be good or indifferent in itself.
2. The good the agent intends must not be obtained by means of evil.
3. The evil effect must not be intended for itself but only permitted.
4. There must be a proportionately grave reason for permitting the evil effect to occur.

Not just because the end was good. Also, things change if there is an alternative. For example, in this case they can remove the tube (which is an action that is acceptable) rather than kill the child (which is not an acceptable action). What is the difference between a doctor removing the child from the wall (and discarding of it) and an abortive pill that removes the child from the wall?

 

[mvinca]

This is a very tough issue. What we need is some very bright people to find a way (via drug, surgery, whatever) to allow the baby to replant where it should be. This would be awesome, and would make this issue go away. What an amazing calling if someone devoted their life studies to making this a reality.

 

[vluvski]

lifeisbeautiful:

For example, in this case they can remove the tube (which is an action that is acceptable) rather than kill the child (which is not an acceptable action). What is the difference between a doctor removing the child from the wall (and discarding of it) and an abortive pill that removes the child from the wall?

Hmm, now that one has made me think a little, but I have an answer for it. I am guessing that the pill acts by removal, and the child dies because of the removal. If the pill is ingested for the purpose of aborting the child, the act is not good, which dissatisfies criteria 1. If the pill is ingested for the purpose of non-surgical removal of the child from the tube wall, the means becomes not good because if the child does not die, the procedure has been unsuccessful, dissatisfying 2.

This seems to me the clearest litmus test of whether an effect is really a “side-effect” or part of the “means:”
If it is truly an unavoidable side effect, a miracle that rendered the side effect avoidable *would not * make the act unsuccessful. If this so-called side-effect is in fact part of the means, then a miracle that prevented the adverse reaction from coming about would render the act unsuccessful.
Unfortunately, the church has not yet recognized my superior logic (I’m being totally sarcastic here).