Ectopic Pregnancy Question

[Catholic2003]

lifeisbeautiful:

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.

This is complicated stuff, and I certainly don’t know the answers. But the way I try to figure out this kind of thing is by coming up with different scenarios, and making sure that our moral rule gets the right answers in all those different scenarios.

Take the situation where a pregnant woman has some condition (I don’t have much medical knowledge, but I’m thinking of things like preeclampsia or diabetis, or even both) where carrying the pregnancy to term will overtax the woman’s body so much that it will result in the death of both mother and child. In this case, the Church teaches that removing the pre-viability fetus is a direct abortion, and consequently immoral. The only moral solution is to pray for a miracle while watching both mother and child die. (Note that this is another example where the Church teaching goes against vluvski’s & my “superior” logic.)

Thus, the “life threatening” condition that you mention can’t be the baby itself. It must be that the damaged fallopian tube is life threatening in and of itself, and that even if the baby alone were removed by some means, the doctors would still go back and remove that section of the fallopian tube. Otherwise, the procedure to remove the damage tube is a pretext, and the removal of the baby is not a “side effect” but the actual intended effect.

Thus, I would have to conclude that in the case of an ectopic pregnancy detected early, the only moral choice is to wait until the damage to the fallopian tube becomes so severe as to be life-threatening in and of itself. And if the ectopic pregnancy isn’t within the fallopian tube, then no medical intervention would be moral.

 

[PCR99]

A couple of things you may not know - my ultrasound tech said that in the 5 years she has been working she has only actually seen a beating heart in an ectopic pregnancy about 3 times. It is rare.

At 6 weeks, (certainly by 8 weeks) you should be able to see a sac, a fetal pole and a heartbeat in a healthy baby, but when you have an ectopic, many times appears as a cyst or a “mass.” Nothing is recognizable. It took 4 ultrasounds for the doctors to be able to GUESS that I had ectopic and even then they could not be sure.

To me, this is similar to a woman having a D&C when diagnosed with a missed abortion. (Which I also experienced). This is when the baby dies, but does not expel from the uterus. I had a natural miscarraige instead of the D&C which was quite horrible because I carried around my dead baby for 4 days before I started labor which lasted for 5 painful days. I was lucky because some women wait 2 weeks for their body to start labor. Many women have a D&C because the emotional pain, let alone the physical is just too difficult. I totally understand this.

So, in the case where the ectopic has no beating heart and no sac or fetal pole can be identified on ultrasound and the HCG levels have significantly declined, I think Methotrexate can be an option in addition to the surgery.

What we probably need to distinguish is what to do if there is an ectopic pregnancy with a beating heart on ultrasound. I would like more direction on this in case it does happen to me.

I hope this makes sense.
PCR

 

[lifeisbeautiful]

Catholic2003:

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.

What if there is another option other than directly killing himself, with which the soldier can save the others? (Like in this case, removing the tube). Also, in that example the soldier is killing himself. In the pregnancy example it is a third party (the doctor) killing the baby.

Also, with the spy guy, he does not have to die for his objective to be accomplished. If he were to become completely paralized (not able to feel or control any movement in his body, the secret would still be safe and he would still be alive.

 

[lifeisbeautiful]

vluvski:

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).

lol (the joke at the end)

Actually, if you reread the explanations of how methotrexate can work it is not necessary for the baby to die in order for it to work. The methotrexate could just act to stop implantation, killing the placenta which is outside of the amniotic sac. In one explanation it said that it did not hurt the baby (directly, we know it will hurt itby cutting off the baby’s connection to the mom). In the other it said “Misoprostol is the second drug used in this regimen which causes uterine contractions that expel the embryo.” It is an abortion that works by separating the baby from its source of nutrition etc (just the same as what the doctor would do). Sure the baby might die in the mother if not taken out before it dies due to not being attached to the mother, but this is the same way the baby will die if the doctor stops implantation manually and disposes of the child.

 

[Catholic2003]

lifeisbeautiful:

What if there is another option other than directly killing himself, with which the soldier can save the others?

I don’t see anything in the four criteria for double effect, or in CCC 1749-1761, that base the morality of a given act on the existence of other options. An act is either moral or immoral.

(Like in this case, removing the tube).

This is an example where looking at alternatives makes the moral option seem wrong. Removing the tube not only kills the baby, but it damages the fertility of the woman. Removing only the baby isn’t any different as far as the baby is concerned, but preserves the fertility of the woman, which is clearly a good. So comparing possible options seems to lead to the wrong choice.

Only by looking at each possible act in isolation can we see that removing the tube is moral, while removing only the baby is immoral.

lifeisbeautiful:

Also, in that example the soldier is killing himself. In the pregnancy example it is a third party (the doctor) killing the baby.

I don’t see how this matters. Murder and suicide are immoral for exactly the same reason - they don’t recognize the sanctity of human life.

lifeisbeautiful:

Also, with the spy guy, he does not have to die for his objective to be accomplished. If he were to become completely paralized (not able to feel or control any movement in his body, the secret would still be safe and he would still be alive.

Again, I don’t think alternative possible actions enters into the evaluation of morality. However, the paralysis option doesn’t really seem like an actual practical possibility in the spy scenario.

 

[lifeisbeautiful]

Catholic2003:

I don’t see anything in the four criteria for double effect, or in CCC 1749-1761, that base the morality of a given act on the existence of other options. An act is either moral or immoral.

1. There must be a proportionately grave reason for permitting the evil effect to occur.
   If there are other equally accessible options, do you think it would still be as proportionately grave a reason?
   I wasn’t talking about the morality of the act perse, but the allowing to do the act.

Catholic2003:

This is an example where looking at alternatives makes the moral option seem wrong. Removing the tube not only kills the baby, but it damages the fertility of the woman. Removing only the baby isn’t any different as far as the baby is concerned, but preserves the fertility of the woman, which is clearly a good. So comparing possible options seems to lead to the wrong choice.

Only by looking at each possible act in isolation can we see that removing the tube is moral, while removing only the baby is immoral.

There is a difference. In one act you are killing the baby, and in the other you are removing a tube. Even if in both cases the baby ends up dying.
Removing only the baby is different because it is an evil act and does not comply with B.

Catholic2003:

I don’t see how this matters. Murder and suicide are immoral for exactly the same reason - they don’t recognize the sanctity of human life.

My point is that these are two different scenarios, not parallel. To be honest with you, I don’t know the logic that allows for the soldier to kill himself unless it is not an action of suicide but an action of stopping the grenade and death is a side effect. In the baby’s case the action itself is of killing the baby, that is the difference.

Catholic2003:

Again, I don’t think alternative possible actions enters into the evaluation of morality.

When evaluating the gravity of the case it does. If there are two equally accessible options, one where a person will die and one where a person won’t die, do you think there is a proportionately grave reason to let the person die? (and this is just an example of how other options affects, I know the baby dies in both cases).

Nevertheless, the reason the baby cannot be killed is not because there are other options, but because killing the child itself is an evil act, and the ends cannot justify the means.

Catholic2003:

However, the paralysis option doesn’t really seem like an actual practical possibility in the spy scenario.

Paralysis doesn’t seem practical, neither does the idea of a baby surviving being separated from his mother without any help, see what I am saying? This was in reference to what you said with your analogy:

Catholic2003:

…The difference lies in the possibility of God performing a miracle to allow the person to live…

 

[acb]

I think it is interesting that most of the posts on this thread have glossed over the points PCR99 and I (both of whom have had ectopic pregnancies) have made - that in the vast majority of ectopic pregnancies, the their is no heartbeat and the HCG levels are of such a dimished degree that there is no possibility (short of a direct miraculous intervention) that the child is alive at the time medical action is taken. The discussion has been interesting in a philosophical way, but it actually pretty hurtfully (direct killing of a baby) to those of us who have gone through the trauma of a typical ectopic (miscarriage outside the uterus).

 

[lifeisbeautiful]

acb:

I think it is interesting that most of the posts on this thread have glossed over the points PCR99 and I (both of whom have had ectopic pregnancies) have made - that in the vast majority of ectopic pregnancies, the their is no heartbeat and the HCG levels are of such a dimished degree that there is no possibility (short of a direct miraculous intervention) that the child is alive at the time medical action is taken. The discussion has been interesting in a philosophical way, but it actually pretty hurtfully (direct killing of a baby) to those of us who have gone through the trauma of a typical ectopic (miscarriage outside the uterus).

I’m so very sorry if our discussion has been hurtful. I was not addressing cases when the baby had passed away already, even if the majority of the cases were like that. I was specifically addressing if the baby is still alive: See post 63

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.

I am sorry for the pain you and the others have gone through. Please understand that in our discussion we were not trying to judge anyone nor suggest anything about anyone. We are simply trying to understand what the Church teaches on this subject. I personally would like to be equipped with this information just in case I am faced with such situation.

 

[Catholic2003]

lifeisbeautiful:

Paralysis doesn’t seem practical, neither does the idea of a baby surviving being separated from his mother without any help, see what I am saying?

I was using the possibility of a miracle as a thought experiment to distinguish between means versus unintended side-effect. But this doesn’t seem to be what you are doing here?

 

[lifeisbeautiful]

Catholic2003:

I was using the possibility of a miracle as a thought experiment to distinguish between means versus unintended side-effect. But this doesn’t seem to be what you are doing here?

Correct me if I am wrong. I thought the objective of the poison man was not to divulge the secret.

 

[Seatuck]

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.

They are working on it.

**

If Only

There is a case that took place in 1915 in which a doctor, in the process of removing a tumor from a uterus, discovered an early tubal pregnancy. The operation on the tumor had left an incision in the uterus. The doctor transferred the embryo to the uterus through the incision. The embryo implanted, and the mother eventually gave birth to a healthy baby. The same hospital allowed further attempts at embryo transferal. Only a very small percentage were successfully implanted and born. Of those, the majority did not live very long. Most died between the ages of six and 12 years. With such low odds of the birth of a healthy baby, it is rare nowadays for medical professionals to consider embryo transferal. Recently a doctor at a Catholic fertility institute attempted three embryo transferals with none surviving to birth.

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

 

[Seatuck]

Catholic2003:

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.

The church does not uniformly teach that the abortive side effects are justified. Most moralists state that the married couple must do thier best to prevent an abortion by practicing a modified application of NFP. In other words abstaining for part of the woman’s cycle where a break through ovulation might occur. I know I have seen some Priests not mention the last part .But they are in the minority.
Fr. Hogan states-

If a woman is taking the pill for MEDICAL REASONS, i.e., non-contraceptive reasons, and THERE IS NO ALTERNATIVE, then she is not sinning. However, since while on the pill, she can ovulate (break-through ovulation), she can conceive if there is sperm present around the time of ovulation. If there is a conception, a new child, then the baby will travel down the fallopian tube and try to lodge in the womb, but will be unable to do so because the pill prevents the build-up of soft lining in the womb. So the baby is “flushed out” of her body. This is the killing of a child, a very early abortion.
If there is absolutely no medical choice (and competent physicians have assured me over and over that there are alternatives for almost all conditions), then a woman MAY take the pill for medical reasons, but if she is married, she MUST abstain from the marital embrace for about ten days every month (the time when she would be normally fertile), otherwise there is the possibility of an abortion and a very grave sin.

Richard Hogan NFP Outreach

 

[Catholic2003]

lifeisbeautiful:

Correct me if I am wrong. I thought the objective of the poison man was not to divulge the secret.

Correct. The “end” of the spy is not to divulge the secret. The purpose of considering the miracle was to show that his death was in fact the means to that end, and not an unintended side effect.

 

[Pug]

Catholic2003,

Have you posted these questions to the ask an apologist forum? I remember we talked about this, oh, six months ago with similar results. I have a certain level of frustration that clarity cannot be achieved. This issue bugs me.

So, is there some apologist (name removed by moderator)ut on this? (I mean more than the pat answer…take out the tube with the baby in it…line).

 

[Seatuck]

I’ll give the link to the CUF article again. I found it helpful.Maybe you are looking for something deeper. There is not direct magesterial teaching on this at this time.

While the Church has not spoken officially about the morality of specific treatment options, she does provide several principles rooted in the natural law concerning human life. In applying these principles, the great majority of moral theologians agree that the salpingectomy does not constitute a direct attack on the life of the baby and is morally licit. A couple may serenely choose this option in good faith without fear that they are violating Church teaching.

Because the salpingectomy is considered by most theologians to be morally acceptable, the issue becomes how long to wait before proceeding with this invasive treatment, given the grave health risk posed by the ectopic pregnancy. This will vary from case to case. Sometimes the immediate risk is low and allowing the miscarriage to occur naturally preserves the mother’s fallopian tube. Conversely, there are also cases in which the fallopian tube itself is so compromised that it must be immediately removed to preserve the life of the mother.

The course of treatment the woman chooses should be determined by her informed conscience. This means that she must strive to understand the natural law regarding the value of life—her own and the baby’s—and choose a course of action that will respect both. She must also become informed about alternative treatment and the facts related to her own condition. She can then prayerfully discern the course of action she will take.

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

 

[Pug]

Seatuck,

I have read the article before. It is one of the best options that I know of on the web to have someone read. A certain percentage of ectopic pregnancies are located in places other than the fallopian tube, so the salpingectomy is not a helpful analysis for that issue.

I struggle with wondering, is the woman just supposed to die along with her child if the child is located somewhere like the abdominal wall? In conversations with pro-abortion folks, this would run me up against an unbreachable wall to say the Church says the mom can do nothing in that case (of course pray). I do not want to have to tell the pro-abort person that unless I absolutely must. With one person I know, I am avoiding discussing the issue for precisely this reason. It would be a deal-breaker.

 

[lifeisbeautiful]

Seatuck:

I’ll give the link to the CUF article again. I found it helpful.Maybe you are looking for something deeper. There is not direct magesterial teaching on this at this time.

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

Excellent Article

 

[Catholic2003]

Here is an Ask an Apologist reply to the issue of using the pill for medical reasons:

The use of the pill for medical reasons may cause an UNintended miscarriage. Women often have unintended miscarriages—sometimes without even knowing it. It is only miscarriages that are INTENDED that the Church considers immoral. The Church never allows the pill to be used as an abortifacient. But it does allow the use of the pill for medical reasons with the possiblity of producing an unintended miscarriage—without obliging the couple to abstain from sexual relations during that time.

Fr. Vincent Serpa, O.P.

I just found an ectopic pregnancy reply.

 

[candicecheyenne]

I have just recently had an ectopic pregnancy. If there was any way to save my unborn child, I would have done everything I could! In this situation, the only thing that can be done is to be strong and let the little one go back into the peacful arms of the Savior. About deeming this as an abortion if the baby is removed from the tube, NO! I am sooo against abortion and I strongly believe that I did not have an abortion! I have watched ‘The Silent Scream’ on youtube just weeks before I knew about my ectopic and I cried for hours! I would never intentionally decide to kill my baby. It was necessary to save my life, and the life of the child would have inevitable have been lost either way. Now, It is hard for me to see another young baby without fighting my tears. In the name of morality and the name of Jesus Christ, I am alive today! I am here to mother the child that I have, who needs me, and I am here to stand by my husband and serve the Lord; That is a miracle!

 

[ProlifeMD]

An Abdominal Pregnancy is considered nearly 100 percent fatal for the mother. The rare case where it is not should not create an obligation to act differently.

An Tubal Pregnancy is always considered a nonviable pregnancy. It is the mass that is the problem. In this case the pregnancy amounts to an expanding mass in the tube, which will either rupture it or become an abdominal pregnancy.

A pregnancy in the uterus is the natural and expected place for an embryo, fetus. When the pregnancy is outside its natural environment, the uterus, why should it not be treated as invasive. The intent is not kill the fetus, but to remove it from where it does not belong.

A better analogy than those given so far might be an older child attempting to kill his mother by violence. Would she not be allowed to defend herself by even by killing the child if necessary? Not that a mother would actually act in such a way. It may not be the ideal, but the question being dealt with is what is permissible, not what is ideal.

Even if there were a possibility of implanting an ectopic pregnancy in the uterus, it would be experimental and extraordinary and therefore should not be considered a requirement. There would be risks, which the woman should not be obliged to undertake.

Retired Physician