Patients with ectopic pregnancies

[Millie123]

If you are a nurse, you should know that an ectopic pregnancy is not a viable pregnancy and it is a life threatening situation to the woman. Removing it and the fallopian tube is not an abortion.
So OF COURSE you should arrange transport or do whatever you need to do to facilitate treatment. Emergently.

Yes I do know that an ectopic pregnancy is emergent, and non-viable. I’ve already received my response from the ethicist, who has given me a very good clear and theological response that yes I can give my assistance in these situations, but not for the reasons you stated (the baby not viable).

(I’ve read it twice now in the responses that I have received in this thread, that yes I can act and the explanation that I’m given is because the baby will never reach viability)…I’m really left unsatisfied with this reasoning…the viability argument just makes me cringe. I do want to point out that viability of the fetus, is not a measuring stick in which we are given a free pass by the church to make an aggressive act (abortion) against a baby.

-For example, an anencephalic baby is not viable, however it would be illicit for us to abort it.
-Recently it was revealed that a Texas lawmaker Wendy Davis, performed an act of abortion on her child because her baby was not viable. “the brain of the fetus had developed in complete separation on the right and left sides.” She then made the decision to abort her baby. abcnews.go.com/Entertainment/wireStory/apnewsbreak-wendy-davis-book-reveals-abortion-25304732

The church does not give permission to perform abortive acts on humans based on the reasons that the child will never reach viability

 

[Rau]

Yes I do know that an ectopic pregnancy is emergent, and non-viable. I’ve already received my response from the ethicist, who has given me a very good clear and theological response that yes I can give my assistance in these situations, but not for the reasons you stated (the baby not viable).

(I’ve read it twice now in the responses that I have received in this thread, that yes I can act and the explanation that I’m given is because the baby will never reach viability)…I’m really left unsatisfied with this reasoning…the viability argument just makes me cringe. I do want to point out that viability of the fetus, is not a measuring stick in which we are given a free pass by the church to make an aggressive act (abortion) against a baby.

-For example, an anencephalic baby is not viable, however it would be illicit for us to abort it.
-Recently it was revealed that a Texas lawmaker Wendy Davis, performed an act of abortion on her child because her baby was not viable. “the brain of the fetus had developed in complete separation on the right and left sides.” She then made the decision to abort her baby. abcnews.go.com/Entertainment/wireStory/apnewsbreak-wendy-davis-book-reveals-abortion-25304732

The church does not give permission to perform abortive acts on humans based on the reasons that the child will never reach viability

Are you able to share with us the gist of the rationale provided by the ethicist?

 

[Millie123]

Are you able to share with us the gist of the rationale provided by the ethicist?

Here is what he said:

Mrs." XXXXXX,"
From what you have said, I do not believe that you are in a morally compromised position.

Your work is generally innocent and for the sake of the good of the entire institution, which serves the good of the patients and the wider community. You do not make medical decisions or treat patients.

The fact that other agents at the hospital, such as particular physicians, may misuse your good work is not your fault. You have no influence over what these physicians decide to do. Indeed, it sounds like you are not even privy to what treatments they may offer to a patient or what they may eventually decide to perform. No, I do not think you are in any moral jeopardy by simply fielding calls and arranging for transportation. What happens between patient and physician is out of your control and beyond your knowledge.

As a side note, I would point out that although salpingectomy is clearly a moral procedure, as you note, and salpingostomy is not, there is considerable debate on whether methotrexate is morally acceptable under Catholic teaching. Personally, I have my doubts, but other orthodox Catholic moral theologians take the opposite view. This is an unsettled question within Catholic moral theology. Even salpingostomy is permissible if the embryo has died before the operation, which does indeed sometimes happen.

You have a good job and you have the right (and duty) to secure your own good and that of anyone who may depend on you. You cannot be held responsible if others make a wrongful use of your good work.

 

[MacQ]

Yes I do know that an ectopic pregnancy is emergent, and non-viable. I’ve already received my response from the ethicist, who has given me a very good clear and theological response that yes I can give my assistance in these situations, but not for the reasons you stated (the baby not viable).

(I’ve read it twice now in the responses that I have received in this thread, that yes I can act and the explanation that I’m given is because the baby will never reach viability)…I’m really left unsatisfied with this reasoning…the viability argument just makes me cringe. I do want to point out that viability of the fetus, is not a measuring stick in which we are given a free pass by the church to make an aggressive act (abortion) against a baby.

-For example, an anencephalic baby is not viable, however it would be illicit for us to abort it.
-Recently it was revealed that a Texas lawmaker Wendy Davis, performed an act of abortion on her child because her baby was not viable. “the brain of the fetus had developed in complete separation on the right and left sides.” She then made the decision to abort her baby. abcnews.go.com/Entertainment/wireStory/apnewsbreak-wendy-davis-book-reveals-abortion-25304732

The church does not give permission to perform abortive acts on humans based on the reasons that the child will never reach viability

You are absolutely correct…viability is not the ethical justification.
The life of the mother is.

 

[Rau]

You are absolutely correct…viability is not the ethical justification.
The life of the mother is.

There is no right to abortion to achieve that end either. Licit procedures of course are directed at that end.

 

[bbentrup]

I’ve read it twice now in the responses that I have received in this thread, that yes I can act and the explanation that I’m given is because the baby will never reach viability)…I’m really left unsatisfied with this reasoning…the viability argument just makes me cringe. I do want to point out that viability of the fetus, is not a measuring stick in which we are given a free pass by the church to make an aggressive act (abortion) against a baby.

This is where the “viable alternatives” prong kicks in. In most cases, there is an alternative measure that maximizes life of mother and child: delivery of said child. Even if chances are increased only .0000000001% (or less) over direct killing. There is nothing wrong with simply waiting as it won’t hurt mother under the facts you give.

On the other hand, in the ectopic pregnancy, the viable alternative of waiting is not an option if we are to protect the life of the mother.

Because of viable options in the one case, removing the unviable embryo (or if you want, the fallopian tube) has a different moral result.

 

[MacQ]

There is no right to abortion to achieve that end either. Licit procedures of course are directed at that end.

I don’t understand your post.
I was referring to a licit procedure to deal with an ectopic pregnancy.
It is licit precisely because the life of the mother is at stake, and the procedure is directed with the intention of saving her life, not at ending the life of the embryo (even though that is the known outcome)

 

[Rau]

I don’t understand your post.
I was referring to a licit procedure to deal with an ectopic pregnancy.
It is licit precisely because the life of the mother is at stake, and the procedure is directed with the intention of saving her life, not at ending the life of the embryo (even though that is the known outcome)

Ok.

 

[weller2]

. The scenario is only sensible if my death in the fall is the anticipated reality.

Do you believe cutting the rope is moral 500m up a sheer rock face? Does it meet the double effect test to be moral?

Ah-ah. You’re now advocating consequentialism. Remember that Catholic Church ties moral value to the action itself, and neither circumstances nor consequences are allowed to weight it. There is no way you can demonstrate that cutting ropes is inherently evil, i.e. evil in any and all circumstances.

Remember that your argument in favor of the tube’s removal is essentially that the operation is not performed on the embryo, but on the tube, so the feticide is indirect, and as such does not fall under CCC2271.

Likewise, in this scenario, instead of kicking you off the rope (that would be a direct homicide), I’m acting on the rope itself, and now your death is indirect, though fully anticipated, consequence – which I can now handwave via the double effect doctrine.

This is reductio ad absurdum to show the layered hypocrisy of the Catholic viewpoint: first, it treats embryo removal as worse then murder, then it realizes that it would lead to killing women, so it exploits double effect to make the procedure licit anyway. The problem is that once you start to apply this double effect reasoning consistently, then you realize that it can be used to justify literally anything. For example, one can easily construct a scenario where double effect allows you to excuse genocide (hint: distinction between primary and secondary effects of nuclear weapons).

 

[Rau]

Ah-ah. You’re now advocating consequentialism. Remember that Catholic Church ties moral value to the action itself, and neither circumstances nor consequences are allowed to weight it. There is no way you can demonstrate that cutting ropes is inherently evil, i.e. evil in any and all circumstances.

Remember that your argument in favor of the tube’s removal is essentially that the operation is not performed on the embryo, but on the tube, so the feticide is indirect, and as such does not fall under CCC2271.

Likewise, in this scenario, instead of kicking you off the rope (that would be a direct homicide), I’m acting on the rope itself, and now your death is indirect, though fully anticipated, consequence – which I can now handwave via the double effect doctrine.

Actually - I think your first statement is wrong - I’ll post separately about that later.

I’m not advocating at all. I don’t know the answer to the rope questions!

As to the analogy with ectopic pregnancy, I don’t know if the rope is comparable to the tube.

You didn’t answer my questions. Is it moral for the person higher up the rope to cut the rope beneath him in the circumstances of a failing rope?

Another scenario (contrived) comes to mind. Consider 2 climbers, utilising ropes in an “upside down Y” configuration. Each hangs on his own rope segement, side by side, but the rope segments join above them into a common segment, which is fraying./failing. Do both men act morally if they frantically try to cut each other’s rope segment?

 

[Rau]

…Remember that [the] Catholic Church ties moral value to the action itself, and neither circumstances nor consequences are allowed to weight it. There is no way you can demonstrate that cutting ropes is inherently evil, i.e. evil in any and all circumstances.

To avoid confusion, the act itself is only one of the criteria to be met. The guidelines provided by the principal of double-effect that must be met for an act to be moral are:

1. 
   *]The intended act must be good in itself. The intended act may not be morally evil.
   *]The good effect of the act must be that which is directly intended by the one who carries out the act. The bad effect that results from the act may be foreseen by the agent but must be unintended.
   *]The good effect must not be brought about by using morally evil means.
   *]The good effect must be of equal or greater proportion to any evil effect which would result.
   *]Acts that have morally negative effects are permissible only when truly necessary, i.e., when there are no other means by which the good may be obtained.
   
   I agree with you that cutting the rope is not intrinsically evil, and that conclusion can be drawn without thinking about the consequences, but only because the other criteria (eg. point 4) take that into account. As the list makes clear, other criteria, including the agent’s intentions viz a viz the bad effect and its dimensions relative to the good effect, etc., all factor in to judging whether the act is morally acceptable.
   
   Cutting the rope in this scenario does indeed appear to meet the criteria to be moral. Throwing your pick at me to knock me off the rope would not be moral.
   
   I’d be interested to know from a lawyer how the law considers such scenarios.

 

[MacQ]

Remember that your argument in favor of the tube’s removal is essentially that the operation is not performed on the embryo, but on the tube, so the feticide is indirect, and as such does not fall under CCC2271.

.

This piece of the argument really bothers me…that somehow it’s only ok if the tube is also removed (which in practice it most often is). I don’t know if *reductio ad absurdum *applies as a philosophical argument, but it is indeed absurd.

This operation is never undertaken (by mother or physician) with the primary intent of killing the embryo.

Taking only a piece of the tube (leaving a partial one) is medically and ethically suspect, as that would increase the risk of an abdominal ectopic in the future. I don’t think it’s ever done. If done to satisfy some moral code, it is empty and misguided. It satisfies NO moral code. It simply allows someone to rationalize it as so.

Extracting the embryo or using medical means to leave the tube intact is not medically preferable, but might be an ethical choice in some circumstances–for example,
what if the woman only has that one fallopian tube? Then it could be argued that attempting to save that tube for a future pregnancy is better than removing all chance of that.

The argument about having to take the tube to make it moral reminds me of the other disingenuous games people play to get around rules.
Sorry, but it’s…absurd.

 

[Jaaanosik]

To avoid confusion, the act itself is only one of the criteria to be met. The guidelines provided by the principal of double-effect that must be met for an act to be moral are:

1. 
   *]The intended act must be good in itself. The intended act may not be morally evil.
   *]The good effect of the act must be that which is directly intended by the one who carries out the act. The bad effect that results from the act may be foreseen by the agent but must be unintended.
   *]The good effect must not be brought about by using morally evil means.
   *]The good effect must be of equal or greater proportion to any evil effect which would result.
   *]Acts that have morally negative effects are permissible only when truly necessary, i.e., when there are no other means by which the good may be obtained.
   
   I agree with you that cutting the rope is not intrinsically evil, and that conclusion can be drawn without thinking about the consequences, but only because the other criteria (eg. point 4) take that into account. As the list makes clear, other criteria, including the agent’s intentions viz a viz the bad effect and its dimensions relative to the good effect, etc., all factor in to judging whether the act is morally acceptable.
   
   Cutting the rope in this scenario does indeed appear to meet the criteria to be moral. Throwing your pick at me to knock me off the rope would not be moral.
   
   I’d be interested to know from a lawyer how the law considers such scenarios.

1. 
   The big issue is #3 as well, how can we determine morally evil means?
   CCC 1756 says: “… independently of circumstances and intentions, are always gravely illicit by reason of their object; … murder”
   … but CCC 2263: “… the murder of the innocent that constitutes intentional killing… The one is intended, the other is not.”
   The question, does the murder as a moral object include intentions and circumstances or not. It’s obvious that unless we know intentions and circumstances we don’t know if we are dealing with a murder or not. Is that a fair statement?
   
   The next step is straightforward. Let’s exchange the murder for the abortion in the text above … unless we know intentions and circumstances we don’t know if we are dealing with an abortion or not.
   An abortion is a killing of an embryo with bad intentions under woman’s healthy conditions/circumstances.
   When the circumstances change then we have a different analysis of a different act. It does not appear we can be talking about an abortion anymore.
   This is all based on the Church’s teaching CCC 2263.

 

[MacQ]

An abortion is a killing of an embryo with bad intentions under woman’s healthy conditions/circumstances.
When the circumstances change then we have a different analysis of a different act. It does not appear we can be talking about an abortion anymore.
This is all based on the Church’s teaching CCC 2263.

I do not think this qualifies in any way as an abortion in the moral sense.

 

[bbentrup]

I’d be interested to know from a lawyer how the law considers such scenarios.

I’m a licensed but very novice lawyer. I’m not sure you spelled out exactly what scenario you had in mind for analysis.

For one thing, remember the layer of prosecutorial discretion. What may be technically murder under the law does not always have to be prosecuted because of extreme circumstances unlikely to be repeated again. Does the prosecutor want to waste state resources on prosecuting and potentially punishing the crime? In the rope examples, it would serve little to no deterrent value as the situation would be unlikely to repeat itself.

Nevertheless, what happens if the local D.A. wants to prosecute? There are other layers, such as a jury which ignores the law for their own private sympathies (happens all the time) or, if they do their duty and find the accused guilty, clemency actions by governor or similar office may also deliver the criminal.

But focusing on the law itself, the law in a criminal case looks for a guilty mind (mens rea). Civil lawsuits arising from the circumstances would look at a different question: it would normally infer intent from the substantial likelihood of the consequences. In certain circumstances, the civil lawsuit might allow for an affirmative defense of private necessity (yes, I caused the death, but I had necessity to justify my actions), but the defendant in a criminal trial for murder (and only in the case of murder) can never use the defense of necessity since one life is just as important as another’s.

All first-year law students are exposed to the famous British case Regina v. Dudley and Stephens (en.wikipedia.org/wiki/R_v_Dudley_and_Stephens) where a shipwrecked crew at the brink of starvation cannibalizes the weakest crew member until they can be saved (speculative). They do last a few more days, and in fact, are saved, and brought to trial. They put forward a defense of necessity which the English courts of the time properly rejected over much anguish, realizing the temptation to live. Yet, the judges when giving the death penalty also recommended clemency from the crown, which was later granted. I recommend reading the full wikipedia link above if law and murder by “necessity” is of interest.

Modern commentaries, such as The Case of the Speluncean Explorers, usually speculate that their actions were not criminal. I disagree, thinking the English judges struck the perfect tone.

I realize I may have completely missed your legal point. If so, please clarify and I’ll try again.

 

[Bookcat]

This piece of the argument really bothers me…that somehow it’s only ok if the tube is also removed (which in practice it most often is). I don’t know if *reductio ad absurdum *applies as a philosophical argument, but it is indeed absurd.

This operation is never undertaken (by mother or physician) with the primary intent of killing the embryo.

Taking only a piece of the tube (leaving a partial one) is medically and ethically suspect, as that would increase the risk of an abdominal ectopic in the future. I don’t think it’s ever done. If done to satisfy some moral code, it is empty and misguided. It satisfies NO moral code. It simply allows someone to rationalize it as so.

Extracting the embryo or using medical means to leave the tube intact is not medically preferable, but might be an ethical choice in some circumstances–for example,
what if the woman only has that one fallopian tube? Then it could be argued that attempting to save that tube for a future pregnancy is better than removing all chance of that.

The argument about having to take the tube to make it moral reminds me of the other disingenuous games people play to get around rules.
Sorry, but it’s…absurd.

It is not absurd. And it is not that one just goes right in and removes the tube. One waits…and watches.

If the tube becomes a threat to the Mother - then the removal of the Tube can be argued go be permitted morally.

If the child is a child and never be directly killed. And this not only regarding “intent”.

---

Something may remind one of one thing that it is not when a person does not have the background to see that it is not that thing. Such happens in all sorts of avenues of life. But appearance or reminding one of such does not mean that such is such. Rather it is something quite different.

(I am though just passing through this thread again and do not plan to get all into it further - one can see my response in the early pages --where I referred the person to the experts)

 

[Rau]

I’m a licensed but very novice lawyer. I’m not sure you spelled out exactly what scenario you had in mind for analysis.

Your rope climbing scenario. I concluded above in response to Weller that cutting the rope is morally acceptable, but throwing a pick at my head to dislodge me is not. I’d like to know if the law would exonerate you in either or both circumstances. I’d also like to know if others agree that cutting the rope is moral, and whether I applied double effect correctly.

 

[Rau]

…The problem is that once you start to apply this double effect reasoning consistently, then you realize that it can be used to justify literally anything. For example, one can easily construct a schenario where double effect allows you to excuse genocide (hint: distinction between primary and secondary effects of nuclear weapons).

In a post above, I list the elements that need to be satisfied for an act to be moral under the double effect principle. Using those elements, can you work through an example of it justifying something that you believe is plainly immoral?

 

[Rau]

The big issue is #3 as well, how can we determine morally evil means?
CCC 1756 says: “… independently of circumstances and intentions, are always gravely illicit by reason of their object; … murder”
… but CCC 2263: “… the murder of the innocent that constitutes intentional killing… The one is intended, the other is not.”
The question, does the murder as a moral object include intentions and circumstances or not. It’s obvious that unless we know intentions and circumstances we don’t know if we are dealing with a murder or not. Is that a fair statement?

The next step is straightforward. Let’s exchange the murder for the abortion in the text above … unless we know intentions and circumstances we don’t know if we are dealing with an abortion or not.
An abortion is a killing of an embryo with bad intentions under woman’s healthy conditions/circumstances.
When the circumstances change then we have a different analysis of a different act. It does not appear we can be talking about an abortion anymore.
This is all based on the Church’s teaching CCC 2263.

If the killing were the intention, it is a bad one. In licit ectopic pregnancy treatment/ procedures, the killing is not the intention at all.

The health of the woman is not central to what makes a procedure an abortion (immoral). See the conditions I listed for an act to be moral under the double effect principle. CCC2263 is pointing out the reality of double effects, and noting they are not the same as “exceptions” to other principles such as the prohibition on murder of innocents.

The rope climbing example is a less emotive example to discuss.

 

[Jaaanosik]

If the killing were the intention, it is a bad one. In licit ectopic pregnancy treatment/ procedures, the killing is not the intention at all.

The health of the woman is not central to what makes a procedure an abortion (immoral). See the conditions I listed for an act to be moral under the double effect principle. CCC2263 is pointing out the reality of double effects, and noting they are not the same as “exceptions” to other principles such as the prohibition on murder of innocents.

The rope climbing example is a less emotive example to discuss.

What is important to notice in the CCC paragraph is that without intentions and circumstances there is no possibility to determine if the act is murder or not therefore all three aspects of the act - object, intentions and circumstances are inseparable in order to determine a morality of an act.

When we use the same logic then it’s reasonable to conclude that any treatment is licit because the circumstances will never be the same as it is in a case of an abortion.
This is no exception but standard object, intentions and circumstances analysis.