Patients with ectopic pregnancies

[bbentrup]

It currently would have a zero% survival rate (essentially instant death) and this together with the fact the procedure is directed at the child causes it to be viewed as attacking the child.

I assume you are being slightly loose here, and you would acknowledge that how others view this act is irrelevant. You are suggesting that in this case morality turns on whether the embryonic child is actually “attacked” or not, right?

If we’re hanging from a cliff by a quickly fraying rope, with you underneath me, and I cut the rope under me after having accurately calculated that if I don’t, our combined weight will cause us both to fall, did I attack you? I would hazard not. But if I instead remove your grip by force causing you to fall, you might reasonably say that I have attacked you. In both cases, I might hope for your unlikely safe landing, but that might well be irrelevant.

I concede that I see some parallels, which if the analogy is accurate, might see removing the fallopian tube as a non-attack but removing the embryo directly as an attack. Certainly, your perception that I am attacking you is not controlling as to the morality, as I can easily imagine situations in life where I am attacking you even if you think I am not, and situations where you think I am attacking you where I am not. Only God determines with certainty whether your perception of reality actually matches reality (ontology).

The harder question is whether use of force to remove you directly from my rope (or the human embryo from the tube) is necessarily an attack. If not, you have to concede the argument or come up with a new standard of harm. Certainly not all actions that place force, even harmful force, on another are attacks (such as pushing you out of the path of an oncoming car). But in the normal way of thinking, I concede that actions directed to your person that result in your death would be.

Another line of questioning that could favor direct removal your grip from the rope not being an attack is whether your life is innocent or not. If we can’t both survive, you likely have a duty to let go to save my life (if I let go, we might both fall). Your failure to live up to that duty might cast you as an unjust aggressor here whose life is no longer “innocent.” I say “might” since I’m not willing to take a side on that question. But also, even if the life is no longer innocent in the rope situation, the parallel to the embryo might not work since the embryo truly lacks “choice” (i.e., he/she cannot choose to fall off the rope for the sake of the other). Can the mother make that choice for the embryo? Again, uncertain in my mind, but it might be possible.

Since I can’t improve your situation in the rope example, it might be ontologically correct to state that force on you is not an attack but a sad duty. So it might be with the baby in the fallopian tube.

Not an easy question either way.

 

[Rau]

I assume you are being slightly loose here, and you would acknowledge that how others view this act is irrelevant. You are suggesting that in this case morality turns on whether the embryonic child is actually “attacked” or not, right?

Yes. A suggestion that removing the child was an attempt to save it (as well as the mother) - ie. a good (or neutral) act - would be of dubious credibility. Removing the tube is overtly not an attempt to save the child, not an attempt to kill it (there are easier ways…). It is an attempt to remove a tube that nature decrees is going to rupture - a good act, with a bad side-effect.

If we’re hanging from a cliff by a quickly fraying rope, with you underneath me, and I cut the rope under me after having accurately calculated that if I don’t, our combined weight will cause us both to fall, did I attack you? I would hazard not. But if I instead remove your grip by force causing you to fall, you might reasonably say that I have attacked you. In both cases, I might hope for your unlikely safe landing, but that might well be irrelevant…

The harder question is whether use of force to remove you directly from my rope (or the human embryo from the tube) is necessarily an attack. If not, you have to concede the argument or come up with a new standard of harm. Certainly not all actions that place force, even harmful force, on another are attacks (such as pushing you out of the path of an oncoming car). But in the normal way of thinking, I concede that actions directed to your person that result in your death would be.

I’m not familiar with this model, so I need to make this up on the fly. But it seems that how we came to be in this juxtaposition and specifically the nature of my aims **might ** be relevant.

If I am your good friend, and we are jointly climbing a rock face, I’d hope you’d not be inclined to cut the rope (I’m no hero), not to throw spikes at me and not to kick my fingers with your boots. I suspect none of those actions can be regarded as a morally good, or neutral, act in itself (as required by the double effect principle). I believe I am entitled to lay down my life (cut the rope) to save you, but I’m not so sure you can make that decision for me.

Removing me from the rope appears to be an attack on me, somewhat akin to a shot of methotrexate. Is cutting the rope any different - I don’t think so - you’re removing me from you, which reduces the strain on your rope (and your life). You’re not addressing the part of the rope that is rupturing, but rather (one of the underlying causes (me)). Not that you wish me dead, but in the moment, you prefer to select which of us shall live - after all, you could have jumped to save me (though you say later that you can’t). You have no self-defence argument, because I am not attacking you - I am in the same “boat” as you - I too (like the child) am an innocent - but as you ask below - do I have a duty to save you?? Regrettably you seem to have no choice akin to the “tubal operation”. I’d rather you set out to repair the rope above you before it ruptures. Cutting the rope (below you) is not analogous to the tubal operation - you are not treating anything (let alone a person).

If, on the other hand, I am a murderous SOB, waiting to kill you as you reach the top of the cliff, and in the course of my inept struggles, I come to be hanging on the rope myself (below you), I’d fully understand (really!) if you sought to cut me adrift. And perhaps you could morally justify that on the grounds that my murderous threat to your life continued as we both hung on the rope.

Another line of questioning that could favor direct removal of your grip from the rope not being an attack is whether your life is innocent or not. If we can’t both survive, you likely have a duty to let go to save my life (if I let go, we might both fall). Your failure to live up to that duty might cast you as an unjust aggressor here whose life is no longer “innocent.” I say “might” since I’m not willing to take a side on that question. But also, even if the life is no longer innocent in the rope situation, the parallel to the embryo might not work since the embryo truly lacks “choice” (i.e., he/she cannot choose to fall off the rope for the sake of the other). Can the mother make that choice for the embryo? Again, uncertain in my mind, but it might be possible.

Not sure why you can’t jump and save me (I lack rock climbing knowledge!). But nevertheless, I suspect my culpability for not surrendering my life is minimal. Whether you can compel it is questionable. I agree that the child is the ultimate in “innocence”, and maybe there is some greyness for the climber.

Since I can’t improve your situation in the rope example, it might be ontologically correct to state that force on you is not an attack but a sad duty. So it might be with the baby in the fallopian tube.

To my mind, this is the “counter-argument” to the Catholic viewpoint on handling ectopic pregnancy. Removing the tube avoids the direct attack, but removing just the child (by any means actually) can be argued as a duty to minimise harm to persons.

Not an easy question either way.

Yes, and sufficiently mentally taxing as to suggest the making of the “wrong” choice - in the circumstance of ectopic pregnancy - might not be as grave as ordinarily assumed.

 

[LeafByNiggle]

Another reason why find it difficult to draw a firm distinction between removing the section of tube and removing the child is that there is a continuum of actions connecting these two actions. On one hand you have removal of the tube, or section of tube containing the baby. Then you consider modifying the amount of tube removed, taking smaller and smaller sections. At the other end of the continuum you have a token piece of tube and a baby being removed. At what point can anyone say “that is not enough tube”? Removing the baby with just a small piece of tube hanging on to him to maintain the fiction that we are not really removing the baby but a section of tube that just happens to have a baby attached is not morally different from removing the baby without any tube attached.

 

[Tigg]

I’m a Catholic not a machine…I’m not a mindless drone. Pardon me for trying to remain faithful to the teachings of the church. And trying to clarify appropriate actions on my part that could potentially place me in mortal sin and possibly excommunicate me from the church…or maybe my concerns are unfounded and there isn’t a moral issue here that I’m seeing. I just have questions regarding the morality of the situation that I could potentially be placed in. Your advise is basically telling me to just do my job and shut up…which isn’t helpful at all. God gave me a brain, and a conscience, and the church…when Im confused about a moral question why can’t I use what God has given to me (ie the church, or my fellow catholics) to help gain clarity on this situation?

@bookcat–thank you for your advice. I sent them an email.

May you be richly blessed for wanting to place your faith and fidelity to the Church above your job. I’m happy that you are discerning (a gift of the Spirit) so as not to be fooled by bad advice on an internet forum. I applaud you for conscientiously seeking moral good and please, just let the word “scrupulous” pass you by. Listen only to the advice of the Catholic ethicist and be at peace!

 

[Jaaanosik]

Oh, but yes you are. If you were to simply acknowledge that ectopic pregnancy is always treated by removal of the embryo (with or without the tube), then you’d have to agree that any procedure aiming to treat this must fall under CCC 2271, as removal of the embryo is means to preventing rapture of the tube.

The truth here is that a diseased tube is a moral/legal fiction created to avoid having the procedure classified as abortion. The tube will not rupture because it is inherently faulty – it will rupture because the growing fetus will subject it to stresses larger than it is intended to handle. (Blaming the tube is akin to trying to to pump a 2bar car tyre to 10bar, getting maimed in the resulting explosion and then suing the tyre manufacturer for a faulty product.) However the diseased tube smoke screen allows you to treat the resulting fetal death to a secondary, unintended consequence instead of means to saving the woman – it makes the abortion indirect, and so CCC 2271 no longer applies.

The reason a Catholic doctor must resort to this moral fiction is because the Catholic Church, contrary to Jewish law, denies the woman right to self-defense in this scenario and throws in an excommunication sanction to boot. This results in a paradoxical situation where removing an ectopic pregnancy without resorting to the above excuse carries a much more severe canonical sanction than murder. Yup, saving a woman’s life will get you excommunicated while intentionally killing her will not.

If CCC 2271 and related sanction were simply dropped, then, per CCC 2270, abortion would have been simply equated with homicide. This would end the absurd distinction between direct and indirect feticide, and therapeutic abortion would be a licit form of self-defense provided all other treatment options were exhausted (this follows naturally from applying CCC 2264 in this situation).

Morality of an act can not be determined without object, intentions and circumstances. All three have to be present. If one of these changes then the act changes.

One might argue that the discussed procedure is not abortion and it can never be an abortion.

The abortion is an intentional killing of embryo under normal healthy circumstances.
Once the circumstances change then we can not talk about the abortion it has to be a different act.

I know what CCC says but CCC has some other contradictions and logical fallacies.
For example CCC 1756:
“It is therefore an error to judge the morality of human acts by considering only the intention that inspires them or the circumstances (environment, social pressure, duress or emergency, etc.) which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object; such as blasphemy and perjury,** murder **and adultery. One may not do evil so that good may result from it.”

… and CCC 2263:
"The legitimate defense of persons and societies is not an exception to the prohibition against** the murder of the innocent that constitutes intentional killing.** “The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not.”

So which one of these two paragraphs is false?

 

[LeafByNiggle]

Morality of an act can not be determined without object, intentions and circumstances. All three have to be present. If one of these changes then the act changes.

Sometimes this is correct, but not always. As you quote in CCC 1756 below, there are some acts for which the circumstances do not morally excuse the act.

One might argue that the discussed procedure is not abortion and it can never be an abortion.

There have been at least three procedures discussed in this thread. Which one do you mean? Clearly chemical injection is a form of abortion.

The abortion is an intentional killing of embryo under normal healthy circumstances.

No, abortion is the intentional killing of any live embryo under any circumstances.

I know what CCC says but CCC has some other contradictions and logical fallacies.
For example CCC 1756:
“It is therefore an error to judge the morality of human acts by considering only the intention that inspires them or the circumstances (environment, social pressure, duress or emergency, etc.) which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object; such as blasphemy and perjury,** murder **and adultery. One may not do evil so that good may result from it.”

… and CCC 2263:
"The legitimate defense of persons and societies is not an exception to the prohibition against** the murder of the innocent that constitutes intentional killing.** “The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not.”

So which one of these two paragraphs is false?

These two paragraphs of the Catechism do not contradict each other. The principle of double effect is not an exception. It is a clarification.

 

[Phemie]

Morality of an act can not be determined without object, intentions and circumstances. All three have to be present. If one of these changes then the act changes.

One might argue that the discussed procedure is not abortion and it can never be an abortion.

The abortion is an intentional killing of embryo under normal healthy circumstances.
Once the circumstances change then we can not talk about the abortion it has to be a different act.

I know what CCC says but CCC has some other contradictions and logical fallacies.
For example CCC 1756:
“It is therefore an error to judge the morality of human acts by considering only the intention that inspires them or the circumstances (environment, social pressure, duress or emergency, etc.) which supply their context. There are acts which, in and of themselves, independently of circumstances and intentions, are always gravely illicit by reason of their object; such as blasphemy and perjury,** murder **and adultery. One may not do evil so that good may result from it.”

… and CCC 2263:
"The legitimate defense of persons and societies is not an exception to the prohibition against** the murder of the innocent that constitutes intentional killing.** “The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not.”

So which one of these two paragraphs is false?

Aggressor implies intent. The embryo has no intent to kill his/her mother, it is not considered an aggressor.

 

[Jaaanosik]

…
These two paragraphs of the Catechism do not contradict each other. The principle of double effect is not an exception. It is a clarification.

Please, re-read the bold part.
One is supposed to be immoral solely on the object alone.
The intention is needed to differentiate murder from self-defense in the second paragraph.

That’s a contradiction.
The murder includes/assumes bad intentions by definition. There is no way around that. Murder can not be determined without intentions.
Self-defense is a different act because of different intentions.

 

[Jaaanosik]

Aggressor implies intent. The embryo has no intent to kill his/her mother, it is not considered an aggressor.

It’s unfortunate that embryo is in a position that it cannot survive. It’s an accident.
Accidents happen … lightning kills people, …

For abortion to be an abortion it has to include bad intentions under certain circumstances.
When this is not met then it’s an analysis of a different act.
This is a fundamental general principle of morality determination of an act explained in CCC 2263.

 

[MacQ]

I have a job related question. I’m a nurse and I just got a new job at a large hospital in my community in a department where my tasks are consuiting physicians from outside smaller hospitals to physicians in my larger hospital, and arranging patient transport to make sure that patients are getting transferred to the appropriate department. I’m not having any patient contact at all. My job is a desk job in which I’m basically on the phone with physicians for my entire shift. So I’m not at the bedside providing patient care.

My question is this. For patients with ectopic pregnancies, which is a medical emergency, the only moral treatment is to remove the total fallopian tube. However many times the treatment is methotrexate or, only removing the baby from the tube (which would be immoral because thsee treatments are abortion). Keep in mind that when I’m on the phone I have no say over what treatments the doctor will prescribe for a patient, also sometimes the doctors do not say what treatments they will provide.

Is it immoral for me to arrange transport for patients with ectopic pregnancies to physicians who may or may not prescribe an abortive treatment for their ectopic pregnancy? Morally would that be helping someone to procure an abortion?

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.

 

[MacQ]

Just do the job you are paid to do. It is not your job to make moral judgements.

I beg to differ. It should ALWAYS be our job to consider the moral implications of what we are doing.
That statement would have fit into the German SS in the 1940’s.

 

[LeafByNiggle]

Please, re-read the bold part.
One is supposed to be immoral solely on the object alone.
The intention is needed to differentiate murder from self-defense in the second paragraph.

That’s a contradiction.
The murder includes/assumes bad intentions by definition. There is no way around that. Murder can not be determined without intentions.
Self-defense is a different act because of different intentions.

The problem is two different senses of the word “intentions”. This word can be used to describe what you intend to do, or it can be used to describe why you intend to do it.

For example, if you shoot an aggressor with gun, you might aim at his leg. That would be what you intend to do - to stop him. But because of your bad aim, you might hit him in the heart and kill him. That would be unintentional killing because** what** you did was not exactly what you were trying to do. And that is the kind of “intentions” referred to in CCC 2263.

However the sense of “intentions” used in CCC 1756 refers to the “why” rather than the “what”. For example, if a man procures an abortion for his wife so that she will not be inconvenienced by giving birth in the middle of her final year in law school, or med school, it does not matter if that women goes on to be the best legal advocate in the world for the disadvantaged, or if she goes on to discover a cure for cancer. The best intention (referring to “why”) cannot excuse an act which is objectively evil.

Since these two paragraphs refer to different sense of the word “intentions”, they are not contradictory.

 

[Phemie]

It’s unfortunate that embryo is in a position that it cannot survive. It’s an accident.
Accidents happen … lightning kills people, …

For abortion to be an abortion it has to include bad intentions under certain circumstances.
When this is not met then it’s an analysis of a different act.
This is a fundamental general principle of morality determination of an act explained in CCC 2263.

Yes, that’s why removing the tube is morally allowed and removing the embryo by surgical or chemical means is not.

In the first the direct action is the removal of all or part of the fallopian tube. That the baby dies is an unwanted, though inevitable, secondary effect.

In the other two options the direct action and intention is to get rid of the baby by either surgical or chemical means. The intent is to get rid of the child to preserve both the life and the fertility of the mother.

In no circumstance is it morally right to intentionally kill the baby to save the mother.

Just as it is not right in cases where the pregnancy occurs in the abdomen, to go in and remove the baby before it’s viable. Such pregnancies are dangerous but have been known to go full term and not be discovered until the time of a section.

 

[Jaaanosik]

The problem is two different senses of the word “intentions”. This word can be used to describe what you intend to do, or it can be used to describe why you intend to do it.

For example, if you shoot an aggressor with gun, you might aim at his leg. That would be what you intend to do - to stop him. But because of your bad aim, you might hit him in the heart and kill him. That would be unintentional killing because** what** you did was not exactly what you were trying to do. And that is the kind of “intentions” referred to in CCC 2263.

**However the sense of “intentions” used in CCC 1756 refers to the “why” rather than the “what”. ** For example, if a man procures an abortion for his wife so that she will not be inconvenienced by giving birth in the middle of her final year in law school, or med school, it does not matter if that women goes on to be the best legal advocate in the world for the disadvantaged, or if she goes on to discover a cure for cancer. The best intention (referring to “why”) cannot excuse an act which is objectively evil.

Since these two paragraphs refer to different sense of the word “intentions”, they are not contradictory.

CCC 1756 is clear. There are no intentions just moral object alone, independent of intentions and circumstances.
What are you fabricating then?

 

[bbentrup]

[A]n 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.

Careful, this statement is a little too broad. Just because a procedure can be done licitly doesn’t mean it can’t be done illicitly. If the requisite intent is there to directly kill the child, it is a form of murder via abortion. Hopefully, no one thinks like that, but it is possible.

 

[weller2]

Aggressor implies intent.

Not really – an insane person cannot be ascribed intent, and attacker’s (in)sanity is never a factor in judging whether self-defense is permissible – the only factor is whether the attacker poses a credible threat.

 

[Jaaanosik]

Yes, that’s why removing the tube is morally allowed and removing the embryo by surgical or chemical means is not.

**In the first the direct action is the removal of all or part of the fallopian tube. That the baby dies is an unwanted, though inevitable, secondary effect.

In the other two options the direct action and intention is to get rid of the baby by either surgical or chemical means. The intent is to get rid of the child to preserve both the life and the fertility of the mother. **

In no circumstance is it morally right to intentionally kill the baby to save the mother.

Just as it is not right in cases where the pregnancy occurs in the abdomen, to go in and remove the baby before it’s viable. Such pregnancies are dangerous but have been known to go full term and not be discovered until the time of a section.

I understand what you are saying but as it was mentioned before this is one hypocritical ethical hair-splitting argument. It really is.

It appears though the circumstances put any of these procedures into different position than the abortion.
The combination of the intentions and the circumstances is very different from the abortion therefore the morality of the act is analyzed differently.

 

[weller2]

If I am your good friend, and we are jointly climbing a rock face, I’d hope you’d not be inclined to cut the rope (I’m no hero), not to throw spikes at me and not to kick my fingers with your boots. I suspect none of those actions can be regarded as a morally good, or neutral, act in itself (as required by the double effect principle). I believe I am entitled to lay down my life (cut the rope) to save you, but I’m not so sure you can make that decision for me.

Except that I’m not cutting you off to kill you. I’m cutting off everything below myself in order to decrease strain on the rope. This will have an unfortunate side-effect of killing you, but this effect is not intended, it is only an unavoidable consequence of cutting the rope.

Further, you cannot claim that I have killed you to save myself. I have only cut you loose to save myself, and the action of cutting you loose (which, in itself, is morally neutral) has both the positive effect of lessening strain on my rope, and the negative effect of you getting killed. However, as there is no causal relationship between your death and lessening stress on my rope (you don’t have to die, the bottom of the pit may be soft) – the means-end condition is satisfied.

Thanks to double effect I have just committed an indirect murder.

 

[Rau]

Another reason why find it difficult to draw a firm distinction between removing the section of tube and removing the child is that there is a continuum of actions connecting these two actions. On one hand you have removal of the tube, or section of tube containing the baby. Then you consider modifying the amount of tube removed, taking smaller and smaller sections. At the other end of the continuum you have a token piece of tube and a baby being removed. At what point can anyone say “that is not enough tube”? Removing the baby with just a small piece of tube hanging on to him to maintain the fiction that we are not really removing the baby but a section of tube that just happens to have a baby attached is not morally different from removing the baby without any tube attached.

Removing the child, while ensuring a bit of tube comes along for “show”, sounds like removing the child. That sounds equivalent to methotrexate. I assume the operation aims to remove a linear length of tubes about same size as the attached child.

 

[Rau]

Except that I’m not cutting you off to kill you. I’m cutting off everything below myself in order to decrease strain on the rope. This will have an unfortunate side-effect of killing you, but this effect is not intended, it is only an unavoidable consequence of cutting the rope.

Further, you cannot claim that I have killed you to save myself. I have only cut you loose to save myself, and the action of cutting you loose (which, in itself, is morally neutral) has both the positive effect of lessening strain on my rope, and the negative effect of you getting killed. However, as there is no causal relationship between your death and lessening stress on my rope (you don’t have to die, the bottom of the pit may be soft) – the means-end condition is satisfied.

Thanks to double effect I have just committed an indirect murder.

. 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?