ectopic pregnancy

[Gorgias]

Strictly speaking, 1ke is incorrect. The Church has no such teaching. But this particular case has circumstances that are widely held by Catholic health organizations to be licit.

Not true. It’s not just ‘Catholic health organizations’ that make this claim; Catholic moral theologians have advanced this argument. It’s true that it’s not a doctrinal claim, but then again, 1ke didn’t suggest that it was a doctrinal teaching. Nevertheless, it’s one that appears in the Catechism (cf CCC 2263).

 

[Reuben_J]

In medical term ectopic pregancy is not a pregnancy in a strict sense of the word as it does not satisfy the requirement of what a pregnancy should be, that is the embryo should be implanted in the uterus. The prognosis is obvious, it is not viable and only lead to one conclusion - the baby will not survive.

Logically this is a non-issue. It has to be terminated. Nature does blunder sometimes and this is one of them.

 

[Spider42]

Not true. It’s not just ‘Catholic health organizations’ that make this claim; Catholic moral theologians have advanced this argument. It’s true that it’s not a doctrinal claim, but then again, 1ke didn’t suggest that it was a doctrinal teaching. Nevertheless, it’s one that appears in the Catechism (cf CCC 2263).

Actually, 1ke said “the Church teaches”. The Church teaching is the Magisterium. Individual theologians offering opinions is a very different thing, and a critically important distinction for Catholics because we are an apostolic Church (authentic teaching has an obligation of religious submission of mind and will (Lumen Gentium #25)). That is why I pointed it out, even though I’m in broad agreement with the general sentiment.

In the case of the Catechism, I’m sorry, you are gravely mistaken. CCC 2263 talks about legitimate defense against an unjust aggressor.

The church does teach definitively about this particular theological argument. A fetus is innocent life, it can never be an unjust aggressor:

vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_19870222_respect-for-human-life_en.html

vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20081208_dignitas-personae_en.html

That said, the Church does teach the principle of double effect, and it can apply in healthcare:

usccb.org/about/doctrine/ethical-and-religious-directives/

But, as you note, the Church has not clearly taken a position on specific applicationsin the case of ectopic pregnancy. That is why you can find fairly extreme theological division and differences in treatment at different Catholic hospitals.

To reiterate, because it is a tragic situation and the Church does not teach definitively, we need to be careful speaking in absolute moral terms and we need to be generous with our love and prayers for all involved.

 

[Spider42]

Yes, my mother was already diagnosed with a mental illness but didn’t follow up with treatment, perhaps a trigger for the ectopic pregnancy? Also perhaps a reason why it was hush hush in my family, now she denies it ever happened.

Ectopic pregnancies happen frequently. The frequency appears to be increasing but research does not show a definitive connection to maternal habits and behaviors. I’m not sure that speculating on cause(s) in a specific case will be helpful to anyone.

Mental illness is a terrible burden, I frequently see it among the homeless we minister to. Your family has my prayers. But denial can have many reasons, including self guilt, which, in mental illness, might be irrational guilt. My suggestion would be nothing more than unconditional love and as much compassion as you can muster.

Pax Christi

 

[lynnehelen]

Thank you, my mother became a danger to all of us, and especially me, through her irrational inability to interpret and lack of a moral foundation to help her (any kind of religious formation). She does know Psalm 23 by heart. I loved her passionately and desperately as a child and young woman, but finally realized that she had pathological, negative feelings towards me and had learned to act on them in a pervasive, concerted, deceptive and devastating way. I thank you for your sentiments, presently in extremity for my own subsequent sins against my own children which i have to take responsibility for, as, I have finally come to, I AM an adult and blaming others will only get more institutional incarceration which I have been told to ABSOLUTELY stay away from, it is a difficult dance fraught with many dangers and NUISANCES, and my father has been complicit, presently working on the mess they made of my husband, other matters involved here but my best course with my mother, (as I have said, I am in extremity exactly now with all these issues working with a Catholic Project Rachel counselor on ALL of it), is to resist her intrusion and her use of others to intrude, to “GET” from me what she needs supplied; until she finally drops it and turns another way. She learned a long time ago that persistence always wins with me and I am learning to put up a wall. Just before I came back to this thread I had, after praying the Joyful Mysteries, made the determination that I need to let her make her own peace in this matter, she treats expressed compassion from me or any assertion of adulthood with insults and derision. Please don’t say “Nature just made a mistake”–that’s her line. Nature is a part of God and God doesn’t make mistakes. There IS an innocent life involved and peace of some sort DOES need to be made.

Thank you for nailing down the issues involved here, that helped a lot and I will also be talking to Sister about it next time.

(I have been posting in prayer intentions for the last year (2 years?) regarding my history/divorce/problems with my family, I won’t drag it up again here but I did come to the conclusion that a demon entered my mother at that point–the end of the ectopic pregnancy; certainly, she changed; nothing was ever the same again.)

Thank you for your prayers. I have an image of my mother coming to my mind recently, I don’t know where it comes from, of my mother lying cold and naked in a hospital bed, one cold tear rolling down her face. I was only exactly 5 years old. It could well relate to the event. Or maybe it was after she had me!

My father fled in terror from her and the whole situation and made his work his life, then had a stroke at 61 and retreated into cagey helplessness. Your prayers and compassion for them would certainly help at this exact juncture–like I said, I am in extremity with this. They need to find their own peace. generally, and quit using me. It is simply evil how they have worked me for what they needed, because I do still love them; and they want to take advantage of my practical vulnerability right now, post-divorce, to do it more. To no avail. They need to understand that they can’t beat death. YOUR compassion for them would be a comfort to me. It would comfort me to know somebody was thinking of them, particularly, their age, lack of faith, lack of help with practical issues of old age and confronting the inevitability of death.

 

[lynnehelen]

My father attended Catholic school and was a believer but earned a scientific PhD and went into high-tech and became a “scienteer” and a confused but outspoken apologetic for atheism, still reading and rereading the Bible in his later years to bolster his arguments while, I think, receiving comfort from it but he suffers from extreme intellectual narcissism and is at a point where he is going to have to swallow his many words.

It is never clear with them, now to an insane degree, who is in control; they desperately work together to continue to pretend; and to conspire; it is a constant worry to me, I do prefer to talk to my father but understand that when I talk to him I am also talking to my mother (he had mild brain damage from the stroke); likewise, I realized at a certain point that if I was talking to my mother my father was for sure in the background

for sure they need to rework their thinking but don’t want to

so if you happen to think of them or pray for them with compassion, know these things

for sure they need help and they have lost mine

 

[TheWarriorMonk]

In medical term ectopic pregancy is not a pregnancy in a strict sense of the word as it does not satisfy the requirement of what a pregnancy should be, that is the embryo should be implanted in the uterus. The prognosis is obvious, it is not viable and only lead to one conclusion - the baby will not survive.

This is not quite true. Non-uterine pregnancy survival rates are very low, but it not 0%. You can easily google such cases.

 

[Gorgias]

In the case of the Catechism, I’m sorry, you are gravely mistaken. CCC 2263 talks about legitimate defense against an unjust aggressor.

And in that paragraph, mentions ‘double effect’, which is the context of our discussion. Note the footnote at this point: it cites Aquinas, who writes:

Nothing hinders one act from having two effects, only one of which is intended, while the other is beside the intention. Now moral acts take their species according to what is intended, and not according to what is beside the intention, since this is accidental

Although the particular question is ‘self-defense’, the general principle that Aquinas asserts is ‘double effect’. In other words, the principle of double effect is being held up by the Church in the Catechism. No ‘grave mistake’ here…

That said, the Church does teach the principle of double effect

And that’s what I was attempting to point out. To remind you of how we got here:

Spider42:

Gorgias:

As 1ke mentioned, the Church teaching on moral theology (“double effect”) covers this circumstance

Strictly speaking, 1ke is incorrect. The Church has no such teaching.

If you are suggesting that double effect does not apply in this situation, I would encourage you to make your case…

 

[Spider42]

This is not quite true. Non-uterine pregnancy survival rates are very low, but it not 0%. You can easily google such cases.

That is correct. That is why Catholic hospitals that use MTX for ectopic pregnancies require imaging first. They use a criteria much like licit organ donor situations. The fetus must truly be “dead or dying” (see the NCBC articles catalog for details).

The argument still raises moral concerns, since it resembles euthenasia, but, as the theologists supporting it have noted, it is hard to understand how a salpingectomy would alter the situation morally. The principle difference is that, with one, the mother undergoes medically unnecessary surgery with the associated risks and ends up partially or wholly sterilized.

As I noted above, a very difficult situation for all involved, including the caregivers.

 

[Spider42]

If you are suggesting that double effect does not apply in this situation, I would encourage you to make your case…

First, to stress again, theologians have made the argument you are presenting, that CCC 2263 is relevant, but the Church has expressly rejected that argument. See the *doctrinal notes *I provided. It doesn’t matter if you invoke St. Augustine. Just War does not occur in the womb!

This is critically important because if we accept that a fetus can, in fact, be an unjust aggressor, then direct abortion would be licit. Some people believe that it is, but I am a Catholic, under an Oath of Fealty no less. For me, direct abortion is ALWAYS a grave moral disorder. This teaching is not only supported by the Patoral Constiution of the Church, it is held to be infallible by the universal agreement of the Magisterium.

You can certainly disagree with Rome. No one can disregard the certainty of his or her moral conscience (CCC 1790). But in this matter, I can only give the Mother Church my complete obedience and support.

As to the question above, to understand why some theologians argue against common applications of double effect, you have to understand that medicine has changed. When the salpingectomy/saplingostomy distinction was first argued, the woman was in a hospital, suffering from internal bleeding, and diagnosis started with exploratory surgery.

The women was clearly in mortal peril and there was at least the possibility that the section of tube being removed might not contain a fetus (even though the surgeon might suspect it was there).

Today, things are significantly different. Ectopic pregnancies can be easily detected prior to any tubal rupture or internal hermoraging (this isn’t always the case, but it often occurs). At this point internal bleeding is not even a certain outcome. Should internal bleeding occur, we also now have plasma and antibiotics, so the mortal peril is greatly diminished for the mother.

To be clear, I’m not specifically advising anyone to endure hemoraging for their faith! Speaking as someone who has experienced massive internal bleeding in war and lived to tell the tale, there are dire health effects, like organ damage, as a consequence.

But we have to consider the criteria for double effect.

• That we do not wish the evil effects, but make all reasonable efforts to avoid them;
• That the immediate effect be good in itself;
• That the evil is not made a means to obtain the good effect; for this would be to do evil that good might come of it — a procedure never allowed;
• That the good effect be as important at least as the evil effect.

Because of earlier detection and better prognosis for hemoraging, many theologians question the 2nd and 4th criteria with regards to the salpingectomy application. Removing the fetus before rupture improves long term health outcomes for the mother, but it is pre-emptive to *possible *mortal peril, for a health effect that might not occur. Likewise, it is no longer clear that the choice is maternal life or death, it has become possible death, higher probability of serious disability, and some possibility of no adverse effect at all.

Also, because of modern imaging, no one can pretend that the section of tube being removed might not contain a fetus, we can see it is there. This raises concerns over the 3rd criteria. Physicians had asked the Vatican at the end of the 19th century if they could remove an ectopic fetus, unharmed, and let nature take it’s course. The answer in 1902 was, for the Vatican, suprisingly terse. Effectively is said “No”, and cited the papal decree of 4 May 1898.

To be clear,** I myself am making no case **(other than giving 100% agreement to the Congregation of the Doctrine of the Faith’s repeated rejection of the argument that destroying fetal life can be licit self defense). I have repeatedly referred to it as a tragic situation and opined only that everyone involved needs our prayers.

But I am pointing out that some very well regarded Catholic theologians have rejected this as double effect and their arguments are far from baseless. If you study articles in places like the NCBC you will find that modern theological arguments about ending ectopic pregnancies have become a lot more nuanced. More akin to not ending ectopic pregnancies, but intervening once they have become interrupted miscarriages.

Pax Christi

 

[Gorgias]

First, to stress again, theologians have made the argument you are presenting, that CCC 2263 is relevant, but the Church has expressly rejected that argument. See the *doctrinal notes *I provided. It doesn’t matter if you invoke St. Augustine. Just War does not occur in the womb!

I am neither appealing to Augustine nor to the concept of just war; rather, I am simply pointing out that double effect applies here. Your appeal to the Ethical and Religious Directives escapes me – it addresses neither the search terms ‘ectopic’, nor ‘double effect’. Since I’m missing the force of your argument, perhaps you might consider showing me the citation that dismisses the claim that ‘double effect’ can be used in this case?

This is critically important because if we accept that a fetus can, in fact, be an unjust aggressor, then direct abortion would be licit.

I am not attempting to make this case. Step back, take a deep breath, and repeat after me: “double effect does not require an unjust aggressor.”

Some people believe that it is, but I am a Catholic, under an Oath of Fealty no less. For me, direct abortion is ALWAYS a grave moral disorder.

There are therapies that address ectopic pregnancy that are direct abortion. I am not attempting to justify them. However, there are also therapies that address ectopic pregnancy that do not constitute direct abortion – these fall under the realm of ‘double effect’. This is the only claim that I am making. If you can refute it, I invite you to do so.

Likewise, it is no longer clear that the choice is maternal life or death, it has become possible death, higher probability of serious disability, and some possibility of no adverse effect at all.

Can you provide some citations?

If you study articles in places like the NCBC you will find that modern theological arguments about ending ectopic pregnancies have become a lot more nuanced.

Cool… citations, please?

 

[lynnehelen]

There was a woman in a 3rd world country (medical mysteries show on t.v.) whose baby “went to sleep.” There was a tradition of the sleeping baby in her culture, so she carried on, never giving birth. In her forties she experienced abdominal pain, and, at the hospital, the doctors found a calcified fetus behind her stomach (or something like that).
I don’t know how this relates to the argument but it is an interesting case of how God took care of one woman’s predicament, through her faith although not Christian.

 

[lynnehelen]

As far as “double effect” I have a question.

At university in a course on the literature of Christian reflection I wrote a paper (still harboring atheism even while holding on to the Lord without understanding, which was more or less what I had learned in my life)

on Dietrich Bonhoeffer’s participation in an attempt to assassinate Hitler, how this could be justified vs. “Thou shalt not kill” which, as my teaching assistant pointed out, put me up against the position of the Holy Fool as taken by Dorothy Day, a pacificist.

My T.A. found the paper brilliant but I knew I was just cranking it out in ignorance and darkness and finally destroyed it about a year ago. I wrote that “because it is a fallen world”, there is always “a motion to the good and a motion to the evil in every action…”

I am corrected. I understand that through “living the presence” and with the help of the Holy Spirit a person can be in the Truth and free of such co-mixture.

I always feared that through the future activities of that teaching assistant my ill-conceived logic got around and led to confusion.