Ectopic Pregnancy Question

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Nurses, doctors, and other medical personnel:

Should we not seek timely guidance from a knowledgeable pastor or another wise and knowledgeable source before refusing to care for a patient. We are seldom adequately trained to deal with the moral issues to the extent that we should refuse a patient care solely on our own opinion. The patient has a right to care. All of us have taken on some form of obligation to provide the needed care. If a type of care is allowable and we refuse it on out own moral standards, when they are not those of the church, we wrong the patient. We are refusing the patient Christian charity. Now, when we refuse to participate in an abortion, we know such participation is not allowed and do not need to seek additional guidance. It is not fair to the patient (and her spouse) to say other procedures, treatments and medications are abortions so we can apply the easy answer.

We can look for a miracle. They happen. I have seen them in the operating room or delivery room. But we should not enjoin a patient to wait an unreasonable time for a miracle to occur. Medical, and moral decisions are not made based on the possibility of a miracle, but on the facts as they are known. God can provide a miracle instantly. Should we then expect to wait for threatened death to quit waiting.

The mother with the difficult decisions to make usually has a spouse for whom she bears a responsibility. Allowing herself to die when God has not assigned the death could leave the spouse to despair because of the actions of the wife. Perhaps she is meant to be a major influence, example and comfort to her spouse in Gods plan for his salvation. She may also have other children who would be left without a mother. I do not mean that she should commit grave sin to remain alive for them, but neither, I think should she be required by anyone to go for some higher ideal just to be on the safe side.

Retired Physician
 
ProlifeMD said:
Nurses, doctors, and other medical personnel:

Should we not seek timely guidance from a knowledgeable pastor or another wise and knowledgeable source before refusing to care for a patient. We are seldom adequately trained to deal with the moral issues to the extent that we should refuse a patient care solely on our own opinion. The patient has a right to care. All of us have taken on some form of obligation to provide the needed care. If a type of care is allowable and we refuse it on out own moral standards, when they are not those of the church, we wrong the patient. We are refusing the patient Christian charity. Now, when we refuse to participate in an abortion, we know such participation is not allowed and do not need to seek additional guidance. It is not fair to the patient (and her spouse) to say other procedures, treatments and medications are abortions so we can apply the easy answer.

We can look for a miracle. They happen. I have seen them in the operating room or delivery room. But we should not enjoin a patient to wait an unreasonable time for a miracle to occur. Medical, and moral decisions are not made based on the possibility of a miracle, but on the facts as they are known. God can provide a miracle instantly. Should we then expect to wait for threatened death to quit waiting.

The mother with the difficult decisions to make usually has a spouse for whom she bears a responsibility. Allowing herself to die when God has not assigned the death could leave the spouse to despair because of the actions of the wife. Perhaps she is meant to be a major influence, example and comfort to her spouse in Gods plan for his salvation. She may also have other children who would be left without a mother. I do not mean that she should commit grave sin to remain alive for them, but neither, I think should she be required by anyone to go for some higher ideal just to be on the safe side.

Retired Physician
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Thank you so much for your post.
 
SHEMP said:
I don’t think that is currently possible.

Just so people understand the principle of double effect, I will list the criteria. The principle is that you MUST satisfy ALL four conditions.
  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.
Removing only the unborn child does not satisfy criteria #1.
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I’m sorry if this question was already answered, I didn’t read all 7 pages of this thread.

How is war justifiable, then? Wouldn’t the direct act of killing others be wrong?

Or, if the direct of the war is to free a people, or some other morally indifferent or morally good act- how is the ectopic pregnancy any different? Could the direct act be saving the mother’s life?

:confused:

**
 
It is not correct to say that only ‘intended miscarriages’ are immoral.

Direct abortion is intrinsically evil and always immoral, regardless of whether the abortion is the means or the end. In the case of chemical contraceptives, the early abortion is one of the means used to prevent the implantation and development of the prenatal. The abortion is direct and so always immoral.

If a man repeatedly drives drunk, knowing that there is a good chance that his actions will kill someone, he is guilty of sin even though he does not intend to kill anyone.

If a surgeon continues to operate even though a decline in health has caused his hands to become shakey, he is guilty of sin even though he does not intend to kill anyone.

If a woman uses chemical contraceptives, knowing that they sometimes work by causing an abortion, she is guilty of sin even though she does not intend to kill her prenatal. This is not properly a miscarriage because the death of the prenatal was a foreseeable consequence of the act of taking the contraceptives. Neither is this an indirect abortion because the abortion is one of the means by which the chemical contraceptives achieve their end of preventing (or in this case interrupting) pregnancy.

As for the use of chemical contraceptives to treat a medical disorder, the abortion in such cases is indirect, but it is not thereby justified. Indirect abortion is only justified when the death of the prenatal is not intended AND the medical treatment does not use abortion as either a means or an end (it is an unintended consequence) AND the good consequences outweigh the bad consequences.

Unless the chemical contraceptives are necessary to save the life of the mother, their use would not be moral because the death of an innocent human being outweighs the good done by treating a medical disorder.

Concerning ectopic pregnancy, the medical disorder is that the prenatal is growing in the wrong location (this is the definition of ectopic pregnancy). Removing the prenatal directly treats the disorder and the death of the prenatal is an unintended consequence. This type of indirect abortion is justified because there is no way to save the prenatal (with current medical technology) and there is a substantial risk of death to the mother.

The risk of death to the mother is not nearly 100%, since in about 25% of cases the ectopic pregnancy is not even discovered until the prenatal has died on its own. But the risk of death to the mother is of sufficient moral weight, given that the prenatal has very little chance of survival, to permit indirect abortion in such cases.
 
My doctorate is not in medicine, but in molecular and medical microbiology. However, I’ll give this a stab.

Ectopic pregnancy results from a partially blocked fallopian tube. The egg cannot pass by the blockage, but the much smaller sperm can. They fertilize the egg on the ovarian side of the blockage and that is where the embryo develops.

If it were possible to open the fallopian and remove the baby, the resulting scar tissue would probably completely block the fallopian tube.

Beyond that, in not removing the diseased organ, you would then be performing an abortion to save the life of the mother, no?
:sad_yes: :sad_yes: :sad_yes: :bigyikes: :bigyikes: :bigyikes: :newidea: :newidea:
 
Gerard_Nadal said:
Ectopic pregnancy results from a partially blocked fallopian tube. The egg cannot pass by the blockage, but the much smaller sperm can. They fertilize the egg on the ovarian side of the blockage and that is where the embryo develops.

If it were possible to open the fallopian and remove the baby, the resulting scar tissue would probably completely block the fallopian tube.

Beyond that, in not removing the diseased organ, you would then be performing an abortion to save the life of the mother, no?
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The above quote is not at all correct. Ectopic pregnancy can occur in the fallopian tube, in cornua (where the tube meets the uterus), in the cervix, or in the abdomen. It is not due to a ‘partial blockage’.

It is a fact that some hospitals remove the prenatal but leave the tube intact, in order to allow further use of the tube, so your guess about scar tissue is not correct.

The tube is not diseased.

When the ectopic pregnancy occurs in the abdomen, do you claim that the abdomen is diseased and suggest removing it?

The medical disorder of an ectopic pregnancy is the growth of the prenatal in the wrong location.
 
Fertilization normally occurs outside the uterus, in the fallopian tube or at the opening of the fallopian tube near the ovary. The fertilized ovum then moves down the fallopian tube to implant on the uterine wall. That is the normal course of events.

One cause of ectopic pregnancy is indeed a partially blocked fallopiian tube, often but not always from previous infection and inflamation. Pelvic inflamatory disease associated with Chlamydia and gonorrhea infection can be one cause. That is not to say that all ectopic pregancies are related to venereal diseases, but they do increase the risk of ectopic pregancy.
 
ProlifeMD said:
Fertilization normally occurs outside the uterus, in the fallopian tube or at the opening of the fallopian tube near the ovary. The fertilized ovum then moves down the fallopian tube to implant on the uterine wall. That is the normal course of events.

One cause of ectopic pregnancy is indeed a partially blocked fallopiian tube, often but not always from previous infection and inflamation. Pelvic inflamatory disease associated with Chlamydia and gonorrhea infection can be one cause. That is not to say that all ectopic pregancies are related to venereal diseases, but they do increase the risk of ectopic pregancy.
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Thanks for the lesson. From now on. I shall confine myself to microbiology!!

Building on what you have said, where does double effect come into play for these other loci of attachment?
 
Apologies in advance for this long and somewhat rambling post, I hope the forum moderators don’t jump on me too hard…

I am not Catholic, but was raised in a conservative Christian tradition, and I’m here seeking clarity on the Catholic Church’s position on the termination of pregnancy. I have been researching and writing (to improve my own understanding really) about the moral theories of different cultures and faiths and what is common and what is fundamentally different. My motivation is to understand why the standard of political debate is so lacking in charity and seems to leave no hope of reconciling viewpoints.

I’m currently studying attitudes to abortion because it is such a major moral and social issue – and so divisive.

The teaching of the Catholic Church on abortion seems – at first glance – prescriptive and clear, but as this forum and several others show, there are particular cases that leave people uncertain, and worse, leave them wondering if their actions are gravely sinful. My fourth son was born (healthy, kicking and screaming:)) in a Catholic hospital here in Sydney (Australia), and it never occurred to me to wonder, if the pregnancy had encountered difficulties, that my wife and unborn son would not have received the optimal treatment – based on the best clinical judgment of the doctors and nurses. My wife is Jewish, and in their tradition, if the mother’s life is threatened during pregnancy, then, having done everything to try to save both mother and unborn child, the physician is obliged to save the mother’s life, even if that means directly aborting the foetus (note that Orthodox Judaism does not generally permit abortion, although there is a range of opinion). I now know this to be at odds with the Catholic view. I would have been greatly concerned if I had thought that any of those attending my wife would have been inhibited from the optimal clinical approach because they felt it was in conflict with their faith.

As I understand it, this comes about because Catholicism views human lives as sacred and incommensurable – one cannot be valued, measured against another – and holds that human life begins at conception. The practical consequence of this view is some real difficulty with some complications of pregnancy – ectopic pregnancy for example – and the need for some fancy intellectual footwork based on double effect to justify actions that, on their face, are illicit. I’m speaking here of the often quoted tubal ectopic pregnancy, which it is legitimate to treat by excising the fallopian tube (with the foetus inside it), even though the foetus will die. The application of the double effect principle says that the intention is to save the mother’s life by removing a ‘diseased’ fallopian tube, and the death of the foetus is an unintended and regrettable side effect.

But what of non-tubal ectopic pregnancies? Here is a real example of such a situation: A hepatic ectopic pregnancy treated with direct methotrexate injection.

Here the embryo had implanted on the liver and, I imagine, left untreated, the outcome would be certain death for the embryo and death or severe liver damage for the mother – I’m not a doctor so I cannot say this for certain. Here there is no chance of using the double effect principle because there is no way that I can see that you can claim the liver or a part of it is diseased (and in any case according to the case report, surgery was deemed dangerous to the mother). The choice seems stark: do nothing and hope the pregnancy spontaneously aborts (before too much damage is done to the liver and the mother’s life is severely threatened or she dies), or directly remove (and so kill) the embryo, surgically or chemically. The latter seems at odds with the established Catholic position, leaving the former. But surely this cannot be? There must be some way morally to distinguish this situation from the removal of an embryo in utero. For example, the Jewish view in this case is to regard the embryo – because it is in the wrong place – as a potential, albeit inadvertent, murderer of the woman, and so permit its direct removal – but this seems utterly remote from the Catholic position.

I know other posters on this forum have asked similar questions about non-tubal ectopic pregnancies and been frustrated with the lack of authoritative response. This type of ectopic pregnancy is rare – but that is surely no excuse for leaving the position formally unresolved and leaving the mother and Catholic staff on the ground to decide, with all the resulting moral anguish for them that may result.

For anyone who has stayed with me through this, my sincere thanks for your patience; if anyone can offer clarity on these issues, I would be very grateful.

Regards

John
 
Certainly this is an extreme case of abdominal ectopic pregnancy. The liver is the most vascular organ in the body. The untreated outcome would be that the mother and the baby would die. I would be surprised if there had ever been a case in which the baby survived. Certainly when the placenta (afterbirth) released from the liver, the result would be massive hemmorhage and death for the mother within minutes. You would be talking about the whole surface of the liver bleeding. It would be possible to loose the entire blood volume of the mother in just a few minutes, faster than it could be transfused.

The baby is clearly out of its proper place and a direct threat to the mother. Though the baby does not mean to, she becomes the attacker. I don’t believe it would be necessary to invoke double effect to remove a misplaced embryo, fetus, baby that is DIRECTLY attacking the mother by trying to draw sustainance from the wrong area of the mother’s
anatomy. The proper place for a new life is in the uterus, or on the way to implant in the uterus. Any other place of implantation is a disease condition in itself and nonviable.

I think we need to hear from a conservative Catholic physician, who is qualified by trainig to speake on the ethics (and morality) involved. I say conservative, because it is the conservative side that we may tend to err on in our thinking here, and I suspect that some opinions here are more restricting than Catholic teaching on the subject. We run the risk of having someone act on opinions given here which are incomplete. I, for one, would not like to be the cause of either death or sin by my opinions.
 
candicecheyenne said:
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!
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I completely agree with you ^ sorry for your loss. It’s not abortion because we don’t want the baby to die, it doesn’t please us in any way (actually quite the opposite). It’s a loss, a miscarriage, and even with a beating heart not a viable pregnancy. There is no chance of unborn baby survival, all we can do is ask ourselves…Who can we help? Who is left that we can save? What life are we able to protect? Save as many lives as possible and then pray for the ones you couldn’t save. God does not blame us for a death we could not have prevented in the first place.
 
Viki59 said:
This is a very difficult situation and more clarity would doubtless be helpful, as Lorarose says.
You could argue: that the unborn child must be removed from the tube to avoid the mother’s death. The child’s death is not intended, but with our present technical abilities is unavoidable (that may change).
Removing the fallopian tube just to avoid the accusation of abortion seems hypocritical.
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Yes, it is extremely dubious philosophically. I am going to examine this issue as part of philosophical medical ethics but my initial analysis is that the position lacks coherence.
 
His basic premise in that treatise that the way that the conceptus is killed makes a difference is pretty dubious.
 
Personally, I cannot see why allowing the woman to keep her fallopian tube and therefore her fertility would be murder any more than if the fallopian tube was removed. The goal in removing the baby is not the death of the baby anyway: it is still for the purpose of saving the woman’s life.
Whenever a woman loses a baby, it is a tragic loss for all concerned. But the sheer cruelty of calling her a murderer unless she gives up her future fertility is despicable.
 
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