We have to be careful. A major issue is when the use of salpingectomy as a means of ‘preventative’ treatment is said to be ‘justified’ on principle of double effect. It is an action which surely results in death with justification being that the fallopian ‘might’ rupture. Surgery to ‘correct’ and ectopic pregnancy on the sole basis that it is ectopic can be thought of as ‘preventative’ surgery. It would not seem justifiable to kill another living human being on the basis of prevention.
Double effect has serious conditions attached to it, which cannot be reduced to simply doing one thing while not intending an unavoidable outcome of grave significance.
So we have the possibility of tubal rupture, which, in turn, has the possibility of death (but a relatively low probability outcome with medical treatment). So the old ‘treating the tube isn’t direct abortion’ argument has migrated into ‘preventively treating the tube isn’t direct abortion’ (we can’t say ‘pre-emptive’ because we don’t know if the tube will actually rupture). It is all too easy to take a thin distinction and make it thinner still.
The justifications typically used in support of salpingectomy on the principle of double effect are very weak and it is quite difficult to differentiate between that and Methotrexate treatment in ectopic pregnancy. In fact it can be said that salpingectomy is even worse because it is both a direct attack on the unborn and an attack on the mother’s fertility. It is a difficult argument to say that removal of the tube with the baby inside is not a direct attack. In many Latin American countries which hold a strong Catholic presence, health care providers usually cannot intercede until an ectopic pregnancy results in an actual tubal rupture. Treatment of the internal bleeding is then deemed a more licit application of double effect (since the condition threatens the life of both patients).
In recent times medical advances have progressed over the years. For example, ectopic pregnancies are able to be detected much earlier. As well we have antibiotics, blood transfusions, and many developed surgical techniques. Although a tubal rupture under certain circumstances may very well, under certain circumstances, present a significant health risk, maternal death is highly unlikely.
There used to be not much distinction between salpingectomy and salpingostomy. The pregnancy itself was not usually detected until internal bleeding became evident or other severe symptoms manifested. Nowadays we have early detection, and managed health care at our disposal. It is much more difficult to justify salpingectomy over something such as Methotrexate for instance.
The outcome of both procedures results in a medical abortion with the dispute lying between what constitues direct rather than indirect abortion per Church teaching. One requires surgery and results in partial sterility, the other generally does not effect fertility and is less intrussive.
Many theological arguments have developed in the wake of this issue. Some groups simply contend that all three treatments could be construed as falling under “double effect”. However, given that the original distinction was ‘thin’, many theologians disagree.
The Church has not formally declared the legitimacy or lack thereof of any of these applications of theology and specific medical procedures and is being prudent in doing so. But it has unquestionably, always and everywhere, asserted that life is something that is to be respected from fertilization to natural death. Both the zygote and the mother are loved infininately by God, so, as the Church has stated, both must be treated equally. However, the absolute ban on abortions, even to the extent of saving the life of the mother dates back to 1884 and 1889. In of itself, it is an incredibly hard teaching for many to accept, let alone live.
The only clear statements we have from the Church all lean towards our ban on abortion being absolute. Abortion to save the life of the mother is not licit. The Church stated this expressly in ccc 1884, 1889, and 1902 (the last regarding the question of ectopic gestations).
So clearly any assertation with certainty that Catholic teaching is ‘salpingectomy yes, everything else no’ is incorrect. That is the opinion of some theologians, but the belief is hardly the universal teaching of the Church.
