Fetus in Fetu

[Kevin12]

Lately, I happened to be reading a bit on the conjoined twin case of Jodie and Mary when I began to consider the situation of fetus in fetu, one theory for which is that it is the result of a twin being basically absorbed into another twin in the uterus. It remains “alive” in some sense, if it has blood flowing to it, but in all cases the fetus is undeveloped, though it may even have a partial brain and many other parts.

Now, in all cases, I’ve searched through bioethics sites and forums, and though it may just be because of how rare it is (less that 90 cases are known), I’ve never seen anyone sayings something like, the fetus in fetu has a right to life and shouldn’t be removed from the twin they are parasitizing even if the fetus doesn’t have a brain…well, except on this forum (of course). This post seems to express some concern that cutting the umbilical cord of a fetus in fetu may have been immoral, and this one seems to say outright that the fetus in fetu should not be removed unless it is a danger to the person (though whether this person means lowering their quality of life or actually endangering their live, I don’t know).

No one else has apparently ever even entertained the idea that a fetus in fetu should not be removed, and personally I think it is insane that anyone would, but I can understand why Catholics would be the only ones who would do so, because the Church demands an absolute understanding of life beginning at conception (something Aquinas, for example, didn’t believe).

Still, since I haven’t seen any actual bioethecists at all, let alone Catholic ones, try to say that a fetus in fetu should not be removed, I’m assuming that even the Church would not object to it were such situation to occur in their hospitals. I suppose if pressed, some theologian might bring in the double effect, saying that even if the fetus in fetu is a life, by cutting it out, we don’t intend its death, its death is just a foreseen but not not intended consequence of removing it from the host twin.

But this leads me to wonder, how is separating the fetus in fetu from the host different from a direct abortion when the mother’s life is endangered? Is it because the situation is unnatural? Is it because the fetus in fetu can never be “delivered” from the host body by any other means? Is it because the fetus ceased growing (though in some cases they do grow)? And, even though I doubt this is even possible, if such a fetus was simply causing health problems but not directly endangering the life of the person, would the double effect not apply, making it immoral to cut it out?

Note that I’m not talking about cases where the fetus was removed without the doctors knowing what it was before they removed it, I’m talking about a case where they were aware like this one.

 

[PaulfromIowa]

I think that most ethicists would argue that such a malformed fetus is not actually a human being.

 

[Kevin12]

I think that most ethicists would argue that such a malformed fetus is not actually a human being.

My point is, what makes these malformed fetuses different from malformed fetuses in the womb, that one is a person, but the other isn’t? Is it because they can’t be “born”? Is it because they can’t grow?

If we can’t be sure whether they are a person or not, doesn’t precedent suggest we should err on the side of caution and do so anyway? In that case, can they only be removed because of the double effect, in which case, can they not be rightly removed until they pose a direct threat to the life of the host, as happened with this woman in El Salvador who was forced to wait until her anencephalic child was large enough to “deliver” by C-Section, even though not removing it immediately put the woman at risk of death? The Church’s teachings on these matters seem to regularly defy common sense on other matters, so why not in this?

 

[Kevin12]

I thought I would give this thread one last lift, because this question has really been bothering me for the last several days. It seems that the Church’s position is that the life of a fetus is absolutely sacred, even if it doesn’t have a brain has no chance of living and is certain to kill the mother if not taken out, the mother has no choice but to die. But apparently, in a situation where there is a fetus inside of someone that in some cases has been known to have brain matter, its not considered a problem to cut it out.

In another thread on this topic that few people wanted to discuss as well, a poster made this point that definitely made sense:

Now, what to do? Well leaving the child inside his brother would certainly have long term harmful effects on the developed child. Eliminating the harmful effects wood be a moral good. Acheiving that moral good through the means of separating the two would be morally neutral. The death of the dependent child is morally negative. But the moral good desired is not acheived by directly killing the dependent brother, it is acheived by the separation. An undesired, but unavoidable consequence of the separation is the death of the dependent brother. We just don’t have the capability to save him. Since the dependent brother has no chance of further development, his tragic death as an undesired side effect of saving the healthy brother is acceptable under the principle of double effect.

But the thing is, what makes this situation different from an abortion? It’s not like the “separation” in these cases is always comparable to a C-section where the fetus dies afterwards. This poster tells about this situation:

The one that was hard for me was the fetus in fetu that showed on an ultra-sound. The mom got an ultra-sound and it showed the the fetus-in-fetu right there. Within a few days after birth the baby (boy) was operated on and they removed the fetus from inside him. They knew this baby was alive and had a heartbeat because they saw it on an ultra-sound. This one was hard for me since it was similar to the direct act being to separate the twins, but in this case the separation involved severing the umbilical cord. One child was “born” and the other was not. I still believe a little person died in each case. I just don’t know if this one was morally handled or not.

That sounds pretty similar to an abortion, but is this persons discomfort correct: would the moral choice be to leave the fetus inside the child? If not, what is the difference? Is it because the fetus shouldn’t have been there in the first place, i.e. it’s unnatural?

I just want someone to give me some kind of answer so I can get this disgusting feeling out of my stomach that the Church’s absolutist teachings would require someone to die for for the sake of something that may well be a cancerous growth (one theory is that they are teratomas, not embryos at all) if they are to be consistent.

 

[carn]

This poster tells about this situation:

"The one that was hard for me was the fetus in fetu that showed on an ultra-sound. The mom got an ultra-sound and it showed the the fetus-in-fetu right there. Within a few days after birth the baby (boy) was operated on and they removed the fetus from inside him. They knew this baby was alive and had a heartbeat because they saw it on an ultra-sound. This one was hard for me since it was similar to the direct act being to separate the twins, but in this case the separation involved severing the umbilical cord. One child was “born” and the other was not. I still believe a little person died in each case. I just don’t know if this one was morally handled or not. "

That sounds pretty similar to an abortion, but is this persons discomfort correct:

Similar is not enough, the details are important. Many abortions are suction abortions, meaning the unborn human is literally shredded to pieces by a sort of vacuuming device; that is very different from cutting a fetus in fetu out, as this usually does not include directly killing the fetus, e.g. en.wikipedia.org/wiki/Fetus_in_fetu
second picture on the right, its actually not shredded to pieces and was not directly killed.

Practically all the rest of the early abortions (which are the majority of abortions) are done via mifepristone usually in combination with misoprostol.

en.wikipedia.org/wiki/Medical_abortion#Methods
“The World Health Organization (WHO) recommends an evidence-based mifepristone-misoprostol combination regimen for medical abortion; where mifepristone is not available it recommends a misoprostol-only regimen.”

en.wikipedia.org/wiki/Mifepristone#Pharmacology
“In medical abortion regimens, mifepristone blockade of progesterone receptors directly causes endometrial decidual degeneration, cervical softening and dilatation, release of endogenous prostaglandins, and an increase in the sensitivity of the myometrium to the contractile effects of prostaglandins. Mifepristone-induced decidual breakdown indirectly leads to trophoblast detachment, resulting in decreased syncytiotrophoblast production of hCG, which in turn causes decreased production of progesterone by the corpus luteum (pregnancy is dependent on progesterone production by the corpus luteum through the first 9 weeks of gestation—until placental progesterone production has increased enough to take the place of corpus luteum progesterone production). When followed sequentially by a prostaglandin, mifepristone 200 mg is (100 mg may be, but 50 mg is not) as effective as 600 mg in producing a medical abortion.”

en.wikipedia.org/wiki/Misoprostol#Pharmacology
“Misoprostol, a prostaglandin, binds to myometrial cells to cause strong myometrial contractions leading to expulsion of tissue. This agent also causes cervical ripening with softening and dilation of the cervix.”

If i understand correctly, the usual medical abortion via first mifepristone and then misoprostol first “starves” the unborn human by reducing/stopping placenta attachment to uterus and blood flow, then the misoprostol expels the usually dead body.
That would be equivalent in some sense to first cutting into a fetus in fetu to kill it by slowly bleeding it to death and only then removing it; this would be immoral, cause directly killing innocent humans is immoral; hence, the usual medical abortion is different from what is done in fetus in fetu cases.

More complicated it gets with an abortion just using misoprostol, as in this case the unborn human is just removed from the body of the mother and dies only because it is not yet able to survive outside; actually if taken later than 24 th week or so, purely taking misoprostol is often not an abortion, as its just what is done, when early induction of labor is necessary (which is certainly permissable).

Therefore, taking misoprostol alone is from a pure perspective what physically happens - removing the fetus from the body of the host - closest to fetus in fetu removal; in both cases if the removed fetus can live on its own, it will live on its own; medically misoprostol is actually only ending the pregnancy, with the childs survival mostly/only depending upon gestation.

Now comes the complicated stuff of intent; if a pregennt woman takes misoprostol with the sole intent of ending the life of her unborn child, its always immoral whether early or late in pregnancy (late her plan will just fail, but the intent will still be immoral).

Just like it would be immoral to cut out a fetus in fetu with the sole intent of getting it/her/him killed.

With fetus in fetu it would potentially not immoral, if the actual intent is survival of the host, with the death of the fetus in feto an unintended but unavoidable side effect.

Which leads to the hopefully core issues of this thread:

Is taking misoprostol prior ~24th week with the intent to ensure the survival of the pregnant woman immoral?
Are there actually situations in which ending the pregnancy via misoprostol (or any other method identical to methods used for abortions) prior to 24th week is actually medically the only option for ensuring the survival of the pregnant woman?
If such a case happened, could it actually be called an abortion?

 

[carn]

In case you wonder, why its relevant whether such situations arise, if read lots and lots and lots of stories about abortions and reasons for abortions; never - except for ectopic pregnancies - i have come across one in which ending the pregnancy prior 24th week was the only option to safeguarding the life of the mother; usually, there would be other solutions like “take the medication even if it has side effects for the unborn”, “clench your teeth, kick the doctors hard, so they do their best to help you and try to hang on till viability”, “suicide is avoidable by voluntary entering a closed institution for psychological problems”, “what about killing the one threatening her life instead of killing the unborn as the aggressors wants?”, …; not perfect solutions, but a lot better than killing innocent and defenseless humans.
Which is relevant, because the teaching of the Church is not about extraterestial aliens, invisible flying unicorns or other stuff which presumably does not exist; if such medically necessary early ending of pregnancies via methods which are identical to abortion methods do not exist, then one cannot expect Church teaching to offer anyhing about it.

Regarding, whether it can be called abortion, abortion is - as far as i understand - within Church teaching only the intentional killing of unborn humans; actions that as a side effect unintentioally or accidentally kill unborn humans are not abortion; e.g. ending an ectopic pregnancy is not called abortion, although it includes removing an unborn human prior viability.

Hence, my guess (and i emphasize its a GUESS) to resolving your issue is:

If ever the invisible flying unicorn of a medically necessary ending of a pregnancy prior viability via a method usually used for abortions comes along, the issue would be stared long and hard at by moral theologist and then it would probably be resolved that although a method for ending a pregnancy was used that usually is used for abortions, which are always immoral, it was not an abortion but a medically necessarily premature endind of the pregnancy, which the unborn unfortunately could not survive, and therefore not immoral, though to be handled with great care to avoid both being careless in such cases and the impression that abortion is ok.

I just want someone to give me some kind of answer so I can get this disgusting feeling out of my stomach that the Church’s absolutist teachings would require someone to die for for the sake of something that may well be a cancerous growth (one theory is that they are teratomas, not embryos at all) if they are to be consistent.

In case of doubt, whether “something” is a human, better save than sorry, so presumption is, if it is living, has a beating heart, human DNA, then its a human. But of course, if it would be shown that fetus in feto is actually not a human, the similarities would be gone immediately.

 

[Kevin12]

In case of doubt, whether “something” is a human, better save than sorry, so presumption is, if it is living, has a beating heart, human DNA, then its a human. But of course, if it would be shown that fetus in feto is actually not a human, the similarities would be gone immediately.

First, if the fetus has no head even it would be brain dead in a way that went beyond anencephaly, and according to the Vatican, it would be dead even if it had a heartbeat:

The conclusion that infants with anencephaly are not brain-dead, however, should not be argued by claiming, as is done by some, that the brain-death definition of death now standard in medical practice is erroneous. Such arguments are based on the well-known fact that the human body can continue to function physiologically with little actual (name removed by moderator)ut from the brain. It is contended that the unity of a living human organism is not dependent on the action of any primary organ, such as the brain, but on the interaction of other essential parts of the human body. It is not at all clear, however, how a system of many organs can regulate itself so as to act in a unified way without some primary organ that is the principal regulator. The clinical data are much better explained by noting that a complex organism has many levels of organization. Thus in sleep the brain ceases to play so great a role in regulating physiological function as in the waking state, while the lower levels continue to function in relative independence. What is decisive, however, is that without the brain, the higher specifically human functions of thought and will and of voluntary bodily actions cannot take place. Thus total brain-death, with its absolute elimination of even the possibility of specifically human function is the best criterion of human death.

Second, there is literally no way to determine whether its human or not. Otherwise there wouldn’t be a medical controversy about whether it is just a cancer or not.

But anyway, if I understand you, you’re saying that the parasitic fetus has to be treated like a fetus in pregnancy. So by the rational that we can only remove pregnancies beyond the point when they are certain to be a danger to the live of the mother (24-weeks), we cannot remove a fetus in fetu that had any brain material until the point that it was directly endangering the life of the host, and people have been known to carry them for decades, suffering through endless health problems because of them. So if you found out you can a fetus in fetu in you right now, you wouldn’t be able to do a thing about it until it was directly endangering your life.

If I’ve interpreted rightly…that is insane. If this is really what the Church teaches, it is insane and I don’t know how I can remain a Catholic.

 

[Mary_Gail_36]

I thought I would give this thread one last lift, because this question has really been bothering me for the last several days. It seems that the Church’s position is that the life of a fetus is absolutely sacred, even if it doesn’t have a brain has no chance of living and is certain to kill the mother if not taken out, the mother has no choice but to die. But apparently, in a situation where there is a fetus inside of someone that in some cases has been known to have brain matter, its not considered a problem to cut it out.

In another thread on this topic that few people wanted to discuss as well, a poster made this point that definitely made sense:

But the thing is, what makes this situation different from an abortion? It’s not like the “separation” in these cases is always comparable to a C-section where the fetus dies afterwards. This poster tells about this situation:

That sounds pretty similar to an abortion, but is this persons discomfort correct: would the moral choice be to leave the fetus inside the child? If not, what is the difference? Is it because the fetus shouldn’t have been there in the first place, i.e. it’s unnatural?

I just want someone to give me some kind of answer so I can get this disgusting feeling out of my stomach that the Church’s absolutist teachings would require someone to die for for the sake of something that may well be a cancerous growth (one theory is that they are teratomas, not embryos at all) if they are to be consistent.

Hi. There isn’t a link with the poster you quoted, so we are just going with her understanding of what she read.

What I understand about fetal development is that at conception all the genes and chromosomes are in place for the new baby. Some genes control embryonic and fetal development.

I think what happens with a fetus is fetu is that that baby did not receive whatever genetic material it needed to survive, so instead of surviving and growing as his twin, some incomplete tissues grow within the twin.

So in a sense the fetus in fetu is alive in the same way an organ ready for transplant is alive.

I see it similarly to a molar pregnancy. A molar pregnancy occurs when there is an embryo that is fertilized where there is a significant genetic defect. The cells then start dividing, but don’t differentiate, so instead of normal embryonic growth and development, the cells just keep multiplying causing a mass within the mother. It would be legitimate and moral to remove this pregnancy. The baby stopped developing very early on, and instead the molar pregnancy developed.

What you can do is contact the National Catholic Bioethic Center, an ethicist could probably answer your question better than I can.

 

[carn]

First, if the fetus has no head even it would be brain dead in a way that went beyond anencephaly, and according to the Vatican, it would be dead even if it had a heartbeat:

My list of criteria was not exhaustive.

Second, there is literally no way to determine whether its human or not. Otherwise there wouldn’t be a medical controversy about whether it is just a cancer or not.

Whether something is a living member of species homo sapiens can often be determined.

But anyway, if I understand you, you’re saying that the parasitic fetus has to be treated like a fetus in pregnancy.

If we conclude that its a human, then yes; if not, then not.

So by the rational that we can only remove pregnancies beyond the point when they are certain to be a danger to the live of the mother (24-weeks),

I left out the issue of a not immediately life endangering condition, cause then things get even more complicated.

we cannot remove a fetus in fetu that had any brain material until the point that it was directly endangering the life of the host, and people have been known to carry them for decades, suffering through endless health problems because of them. So if you found out you can a fetus in fetu in you right now, you wouldn’t be able to do a thing about it until it was directly endangering your life.

The main difference is, that with a pregnancy there is hope that both affected humans can survive the problematic situation with acceptable health results.

In case of fetus in fetu, presuming the fetus is a human, there is usually zero chance for a good outcome for the fetus. So the choice is only damaging the health of the host more, by useless waiting, and damaging the health less by immediate removal.

If I’ve interpreted rightly…that is insane. If this is really what the Church teaches, it is insane and I don’t know how I can remain a Catholic.

Don’t drop out of the church due to some guesswork of a random internet stranger; that would be insane. Besides, as i tried to describe above, you did not interpret my opinion correctly.

I implied that the situation of a pregnancy with zero chance to reach 24th week is more or less similar to a fetus in fetu situation with the fetus being a human and hence just like in the later situation in the former situation removal though not killing of the human ‘without hope for survival’ might be found to be permissable by the church, if ever the former question arises.

Similar, if reaching viability is not possible, but only the health of the mother is endangered, not her life, removing the unborn from her womb could be permissable.

You just have to remember, that such cases are either rare or non-existent; usually there is either a decent chance for 24th week or removing the unborn is actually not the only treatment option.

If I’ve interpreted rightly…that is insane. If this is really what the Church teaches, it is insane and I don’t know how I can remain a Catholic.

Furthermore, the approach alternative to Church is the actual insane or maybe even more insane one; in the US every year about 1.300.000 unborn humans are killed, because the mother or the one pressuring her has decided its the best way to proceed. And vast part of society and politics simply do not care.

That is incompatible with a society based on “that all men” (humans) “are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”.

Two solutions are effectively only avaible:

-declare unborn humans to be non-humans; then there is no longer reason to care about those 1.3 Million non-humans killed per year

-accept that unborn humans are humans and thereby have a right to life and enter the complicated considerations how then these unborn humans are to be treated correctly in light of also treating the pregnant women correctly; then one also has to accept, that unborn humans developing in absolute wrong places - e.g. ectopic pregnancies or fetus in fetu with fetus being a human or embryo in lab dish - also must be treated correctly also in light of the consequences on other humans directly effected (which for example directly leads to the conclusion that embryos in labs is highly questionable, as there is little justifing such use of humans as experimentation material for labs)

why do you think the latter approach to be more insane?

I agree, that its complicated (i have my own problems, e.g.: forums.catholic-questions.org/showthread.php?p=13248158) and i would not guarentee that the medical knowledge upon which the teaching of the Church in this regard is based is always complete and accurate, but just because its complicated does not justify to take the easy road and proclaim in full knowledge a lie, that the unborn “something” inside the womb of a pregnant woman is a non-human.

edit:
To stress again, i presume in this and the other posts, that a specific fetus in fetu is actually a human in the same way that an unborn human developing the usual way is a human; if like for example the above poster suggest, fetus in fetu are not humans, then all similarities completely fall apart and there is no complicated moral issue regarding fetus in fetu.

 

[Kevin12]

I’m sorry if I was rude before, and I’m not trying to support abortion.

I’m just going to try to put it out of my mind for now.

 

[Mary_Gail_36]

edit:
To stress again, i presume in this and the other posts, that a specific fetus in fetu is actually a human in the same way that an unborn human developing the usual way is a human; if like for example the above poster suggest, fetus in fetu are not humans, then all similarities completely fall apart and there is no complicated moral issue regarding fetus in fetu.

I just wanted to touch on this part. I agree. I’m assuming that the fetus in fetu is actually not a distinct human, but the remains of a human who has passed away, and whose tissues survive.

I was able to find this scientific article:

ncbi.nlm.nih.gov/pmc/articles/PMC2810823/

Apparently this condition is very extremely rare with only about 100 or so recorded examples.

They give an example of a 10 day old baby girl who presented with a mass in her abdomen. The “fetus in fetu” was only diagnosed after the surgery to remove the mass.

The second example is a little 3 week boy with a mass in his buttocks. Again the fetus in fetu was diagnosed during the surgery to remove the mass.

I think the goal in these two cases specifically was to remove a mass from a young baby. The diagnosis came afterward with closer examination of the mass.

I would think ethically, it would be similar to a D and C following a miscarriage to remove any tissues that were not expelled.

 

[Ph0enix]

I read in alot of cases with Fetus in Fetu the baby is dead.

but in the event of the baby being alive… well better to leave that to some one who knows the answer(I am very pro life i just would now know what to do in this case)

 

[carn]

I’m sorry if I was rude before,

You weren’t rude.

As billions of humans lived and died in horrible, cruel and/or unjust circumstances and actually still live and die and probably will live and die, the notion that every single one of these humans had/has a right to life and that thereby what has/is happening to him/her might be truly wrong, the question, whether the whole approach of “every human has rights! realy every single one!”, is not just a sign of insanity, is valid. I asked that question myself and could not refute it completly, just that the other options are at least more insane.

I’m just going to try to put it out of my mind for now.

Nothing wrong with asking questions and poking issues, i do that myself extensively and often i end up with “They can’t be serious, this doesn’t add up.”; but i lessen this attitude rather effictively by reminding myself, what i actually believe as christian/Catholic:

That Jesus was tortured and died for our sins.

Why does this help?

Because that was/is God’s plan for our salvation. Since God is perfect, it was/is not only His plan, its actually the best plan (or best among equal plans) for our salvation.

Why does that help?

Because, if i ponder into somewhat hypothetical and hopefully not blasphemous thoughts, what i would do, if i would be in the situation to being unsatisfied about some lesser creatures getting lost and in need of my help to be saved from eternal damnation and i would devise a plan to that end and someone would come up with the plan “Hey boss, what about bringing one of your three personas down to earth, let him preach the truth to this ungrateful humans, let him provide them with direct evidence via wonders, watch as they reject and abandon him so that in the end he or actually you gets arrested, beaten, tortured, declared guilty although innocent and then brutally, painfully murdered via crucification lasting several hours, only then to rise from the dead? Sounds like the best plan, doesn’t it?”, both my instincts and reasoning would not yield a “Yeah, great plan, lets do it.” but more like “Best plan? Are you nuts? At least suggest one without that crucification, cause that will not be fun, there must be one, e.g. why not just decapitation, that at least doesn’t take hours and makes the resurection far more believable cause people might mistakenly be taken for dead hanging at a cross, while a severed head leaves nobody in doubt.” or in words above “They can’t be serious, this doesn’t add up.”; but as it must be the best plan, the only conclusion is that either i lack information and/or both my instincts and reasoning are just plain wrong.

But if i must accept such a “This doesn’t add up.” problem at the core of Catholic teaching, i can certainly tolerate it at some at least for practical purposes rather marginal or side issue, which has not been throughfully inspected anyway and upon which information is obviously limited and with many holes and unknowns.

(And yes, i have to be careful with such hypothetical thoughts, though i am realy curious, why that is/was the best plan.)