Principle of Totality, Threat vs. Risk, and Hysterectomy

[Godefridus]

All right, I need some high-flying theological advice here for a former seminarian whose medical ethics training is bothering him.

Later this year, my girlfriend is going to get tested for the gene responsible for a much higher risk of ovarian and breast cancer in women. Her mother has just been through six chemotherapy treatments and just barely gotten out alive. So, it’s a serious issue.

Suppose she has the gene, and the risk of cancer both in her breasts and ovaries skyrockets. My question is, is the risk of cancer sufficient cause to employ the principle of totality and have either of those organs removed to save/preserve her life?

In my medical ethics course, we were taught that risk is not sufficient cause for damaging or removing healthy organs; the threat must be immanent. However, there is a complicating factor. Although breast cancer can be detected early, ovarian cancer is quite different; it can be quite advanced before it is ever detected.

My question is, isn’t there a possibility that a high-enough calculated risk would amount to an immanent threat and justify removing an organ?

Actually, I took a break in writing this post, and upon reflection, I can sort of answer my own question. Destroying a healthy uterus to reduce/eliminate risk of cancer to that organ is, AFAIK, wrong. The problem is that the ethical stakes are rather high; our reasons for damaging parts of our bodies cannot rest upon differences of degree alone. Either an organ is healthy, or it is not. 

At the same time I can't bring myself to argue this point with my girlfriend. Frankly I don't have the persuasion skills of angels; how do I tell a girl that she shouldn't reduce her otherwise high risk of fatal ovarian cancer to 0 because of medical ethics? :shrug: I need help. And I need a hug.

 

[puzzleannie]

ovarian cancer also has a promise of earlier successful diagnostics on the horizon, and more successful treatment rates. It is a treatable cancer with good prospects depending on age andother variables, and success rates are increasing even from 10 years ago. It is not an inevitable death sentence. Giving up her fertility like this is devastating to a young woman psychologically, as well as hormonally and many other ways. I don’t know about ovarian cancer, but even with the genetic risk of breast cancer, there are still far more cases where the gene is not present, so doing something so final and traumatic, without any guarantee, seems too draconian.

 

[setter]

My question is, is the risk of cancer sufficient cause to employ the principle of totality and have either of those organs removed to save/preserve her life?

In my medical ethics course, we were taught that risk is not sufficient cause for damaging or removing healthy organs; the threat must be immanent.

It is true to assessed risk is not sufficient criteria for removing healthy organs, and would constitute mutilation.

However, there is a complicating factor. Although breast cancer can be detected early, ovarian cancer is quite different; it can be quite advanced before it is ever detected.

Can not the same be said for many other bodily diseases?

My question is, isn’t there a possibility that a high-enough calculated risk would amount to an immanent threat and justify removing an organ?

This excerpt response from CONGREGATION FOR THE DOCTRINE OF THE FAITH addresses the question of healthy organ removal due to an assessed high risk potential health factor:

Q. 2.When the uterus (e.g., as a result of previous Caesarian sections) is in a state such that while not constituting in itself a present risk to the life or health of the woman, nevertheless is foreseeably incapable of carrying a future pregnancy to term without danger to the mother, danger which in some cases could be serious, is it licit to remove the uterus (hysterectomy) in order to prevent a possible future danger deriving from conception?

R. Negative.

It (direct sterilization) is absolutely forbidden … according to the teaching of the Church, even when it is motivated by a subjectively right intention of curing or preventing a physical or psychological ill-effect which is foreseen or feared as a result of pregnancy ».

In point of fact, the uterus as described in no. 2 does not constitute in and of itself any present danger to the woman.

vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_31071994_uterine-isolation_en.html

At the same time I can’t bring myself to argue this point with my girlfriend. Frankly I don’t have the persuasion skills of angels; how do I tell a girl that she shouldn’t reduce her otherwise high risk of fatal ovarian cancer to 0 because of medical ethics? I need help. And I need a hug.

Present her with what the Church teaches and let her come to her own conslusions.

 

[otjm]

Acouple of thoughts: and not with any intent to be harsh;

She is going to die anyway.

Has she (or you) looked at the leading causes of death for women of her age; and for the next 10 years block, and the next…? Neither of those cancers are.

Have either of you looked at the causes that seem to be related? Specifically, the interplay of abortion and breast cancer, and ABC (the Pill) and breast cancer? Much of the research has been supressed, but is starting to come out that there seems to be more than a vague correlation.

And what do the studies show of cancer vs. number of births? Is there any correlation to breast feeding?

What are the statistical chances of either occuring if she has this gene? Meaning, what are the chances of it not occuring if she has it? And what are the chances of her dying from a stroke or a heart attack if she has the gene (they are not related, but I believe they kill more women than cancer…)?

And what are the chances of her dying in a car accident if she has the gene (probably the same as if she didn’t have it)… I think you get the gist.

 

[Ani_Ibi]

Apply this analysis using a pencil and paper:

Principle of Double Effect:

For the act in question to be licit, all Five Tests for Double Effect must be met.

1. The object of the act must not be intrinsically contradictory to one’s fundamental commitment to God and neighbor (including oneself), that is, it must be a good action judged by its moral object (in other words, the action must not be intrinsically evil);
2. The direct intention of the agent must be to achieve the beneficial effects and to avoid the foreseen harmful effects as far as possible, that is, one must only indirectly intend the harm;
3. The foreseen beneficial effects must not be achieved by means of the foreseen harmful effects, when no other means of achieving those effects are available;
4. The foreseen beneficial effects must be equal to or greater than the foreseen harmful effects (the proportionate judgment);
5. The beneficial effects must follow from the action at least as immediately as do the harmful effects.

Object of the Act

There are two categories of intention: proximate intention and indirect (remote or circumstantial) intention. It is the proximate intention which counts.

 

[pathia]

ovarian cancer also has a promise of earlier successful diagnostics on the horizon, and more successful treatment rates. It is a treatable cancer with good prospects depending on age andother variables, and success rates are increasing even from 10 years ago. It is not an inevitable death sentence. Giving up her fertility like this is devastating to a young woman psychologically, as well as hormonally and many other ways. I don’t know about ovarian cancer, but even with the genetic risk of breast cancer, there are still far more cases where the gene is not present, so doing something so final and traumatic, without any guarantee, seems too draconian.

Not quite true. My mother was diagnosed with it just two years ago. She has been on the verge of death since, and it was diagnosed relatively ‘early’. Ovarian cancer is much more incredibly deadly compared to breast cancer, it just doesn’t occur as often, so you hear little about it. My mom was given a 2% of living more than a year, and keep in mind she was diagnosed early compared to most women. Out of her local support group, everyone she knew from when she was initially diagnosed is now dead.

If you ever watch the show House, someone asks him what to do for ovarian cancer and he says “Buy a pine box”. Now this is cruel, but from my family’s experience mom is the exception rather than the rule. Ovarian cancer is more or less a death sentence. The five year survival rate for even early diagnosis is less than 40% and then 10year survival rate is even lower

I fear every day that this could be the last day with my mother, and she’s only 45.

 

[Seatuck]

Not quite true. My mother was diagnosed with it just two years ago. She has been on the verge of death since, and it was diagnosed relatively ‘early’. Ovarian cancer is much more incredibly deadly compared to breast cancer, it just doesn’t occur as often, so you hear little about it. My mom was given a 2% of living more than a year, and keep in mind she was diagnosed early compared to most women. Out of her local support group, everyone she knew from when she was initially diagnosed is now dead.

If you ever watch the show House, someone asks him what to do for ovarian cancer and he says “Buy a pine box”. Now this is cruel, but from my family’s experience mom is the exception rather than the rule. Ovarian cancer is more or less a death sentence. The five year survival rate for even early diagnosis is less than 40% and then 10year survival rate is even lower

I fear every day that this could be the last day with my mother, and she’s only 45.

Pathia, I’m so sorry.

We haven’t gone far enough with research etc. There are many risk factors that are questionable. There are preventative measures that are questionable. This week there was a report that the pill reduces the likelihood. I don’t recommend the pill as it heightens the risk for other cancers but that research must tell us something that could lead to a better option. I truly hope so. Treatment methods are questionable.I was very disappointed when doing a little research on the topic. I thought we had made better progress. It’s really a terrible disease.

 

[SeekerJen]

Two comments:

1. A fellow alumna from my high school was diagnosed with ovarian cancer at age 25. She went into remission and has been okay since (this was 6 years ago).
2. My grandmother did die from it at age 53, but she was able to have seven children and see several of her grandchildren born and her youngest son married (my dad) before she passed away. If she’d known about the gene and had her ovaries removed early, I certainly would not be here typing this post.

I think such a pre-emptive strike could be tragic. At this point your girlfriend does not know what will happen. If she waits, she may never develop ovarian cancer. If she does, it may not be until later, when she has experienced the joy of a family. If she has her organs removed now, she will never be able to bear children and she will go into immediate menopause (which brings with it a higher rate of breast cancer).

I can understand her fear. I worry about it too, especially with the family history. Even so, that doesn’t seem like a justification for destroying her fertility.

 

[Ani_Ibi]

pathia:

Ovarian cancer is more or less a death sentence.

Most cancers are now treated as chronic diseases.

pathia:

The five year survival rate for even early diagnosis is less than 40% and then 10year survival rate is even lower

These “survival” boundaries are a marketing ploy of the APA. They do not address “cure.”

Two cancers are curable. The rest are not. And that has not changed in the last 25 years. Question is: why not?

 

[pathia]

Most cancers are now treated as chronic diseases.

These “survival” boundaries are a marketing ploy of the APA. They do not address “cure.”

Two cancers are curable. The rest are not. And that has not changed in the last 25 years. Question is: why not?

Uh…what does the APA have to do with cancer? They deal with mental issues, not medical.

There is no cure because it continues to reoccur. Mom’s cancer has technically been ‘cured’ four times, her tests go completely negative, there are no more cells, but then they reoccur another year later.

 

[Imryl]

Have either of you looked at the causes that seem to be related? Specifically, the interplay of abortion and breast cancer, and ABC (the Pill) and breast cancer? Much of the research has been supressed, but is starting to come out that there seems to be more than a vague correlation.

Statistically speaking, a correlation is not a completely general measure of the strength of a relationship. What does that mean? That means, that just because something shows a very strong correlation doesn’t mean that you can infer one thing is causing the other.

An example:

In 1985 (or maybe it was 1995, I’m not exactly sure of the exact date). A study came out that showed a VERY strong correlation between drinking coffee and lung cancer. What they didn’t take into account were other aspects of their patients lives. Namely… the fact that a large number of coffee drinkers also indulged in smoking cigerettes.

The point is when you watch the news, or hear/read about something be sure to understand exactly what the words mean. You can simply not draw any direct conclusions from things with that type of lingo.

Trying to link breast cancer to BCP and abortion is absurd without concrete evidence. (And I’m talking about these studies, not your comments) That seems paramount to trying to scare people from making decisions that ultimately effect their lives and no one elses.

Meaning, what are the chances of it not occuring if she has it? And what are the chances of her dying from a stroke or a heart attack if she has the gene (they are not related, but I believe they kill more women than cancer…)?

Those are much better questions.

You should talk to her about it. Help her at least come up with questions she can ask her doctor so she can make an educated decision. Ultimately it is her choice and it is a very serious decision… She will most certainly need someone to talk and you can be there for her.

 

[Ani_Ibi]

Imryl:

Trying to link breast cancer to BCP and abortion is absurd without concrete evidence.

There is a process to producing concrete evidence. We have the two polarities of investigation which are: look at the evidence and do the math. (Observation and theory.)

A correlation has been drawn between breast cancer and abortion.

This, as you have pointed out, does not meet the standard of proof which merits putting the equivalent of the surgeon general’s cigarette message on the front door of an abortuary.

However, it does not warrant suppressing the information outright. Women contemplating abortions need to know the possibilities. At present those possibilities are being suppressed wrongfully.

Also, funding needs to go toward investigating the correlation between breast cancer and abortion. Particularly because a case can be made in theory (doing the math) for the risk.

 

[Ani_Ibi]

pathia:

Uh…what does the APA have to do with cancer? They deal with mental issues, not medical.

Is there not an American Pharmaceutical Association? OK. I see on my other screen that it is abbreviated APhA. My bad.

pathia:

There is no cure because it continues to reoccur.

Circular reasoning. Non sequitur.

pathia:

Mom’s cancer has technically been ‘cured’ four times, her tests go completely negative, there are no more cells, but then they reoccur another year later.

If you recall, I stated earlier that I had been told that most cancers these days are treated as chronic diseases.

My caution is that talking about “survival rates” distracts us from focussing on “cure rates.”

 

[pathia]

Is there not an American Pharmaceutical Association? OK. I see on my other screen that it is abbreviated APhA. My bad.

If you recall, I stated earlier that I had been told that most cancers these days are treated as chronic diseases.

My caution is that talking about “survival rates” distracts us from focussing on “cure rates.”

First part. Mom is not treated by a pharmacist, pharmacists have absolutely nothing to do with chemotherapy. She is treated by an oncologist in a hospital where laboratory techs inject her with the chemotherapy treatments. There is no pharmacist involved at any point. She is not prescribed medications. Chemotherapy is essentially heavy metal poisoning and requires a hospital itself to administer it properly, not someone behind a counter dispensing pills. Are you sure you’re referencing the proper organization?

That would be because at least in ovarian cancer, the ‘cure’ rate is below 5%. The chance of reoccurance even after complete successful treatment is over 90% if not over 95%. Mom will never be cured, the only hope is to keep it gone for over a year so the chemotherapy doesn’t kill her instead.

Touting a ‘cure’ rate of 2-5% is not very uplifting.

 

[Imryl]

There is a process to producing concrete evidence.

We have ways of measuring the likelyhood of an occurence. We do not have a way of producing concrete evidence in most cases. Once something has been observed enough, (who determines when is enough I don’t know), then something can be widely accepted… usually over time. But at any time it can be disproven or narrowed down to something more specific if something contrary to the original conclusions are observed.

Remember, the world was flat and at the center of the universe at one time.

A correlation has been drawn between breast cancer and abortion.

A correlation can be drawn between almost anything.

However, it does not warrant suppressing the information outright.

The human body can naturally abort a fetus. The chances that THAT is a cause of breast cancer is probably insignificant. What would more likely be the culprit is the sudden change in hormones inside the womans body. Regardless of whether the mothers body naturally rejected the fetus or if it was a medical procedure.

That’s probably why there isn’t as much money going into that hypothesis. You’d have better luck going after BCP since that chemically alters a womens physiology.

Having said that I really don’t think this is the thread to debate semantics.

Godefri - If you’re serious. Help her come up with questions for her doctors. She would probably want to hear these thoughts from them.

 

[Ani_Ibi]

Imryl:

A correlation can be drawn between almost anything.

And when one is, then the next step is to produce a hypothesis and then test that hypothesis. Not sweep the whole thing under the carpet because it is inconvenient to one’s political philosophy. Which is what has happened to many of the initial studies done on the effects of abortion.

Imryl:

The human body can naturally abort a fetus.

Yes.

Imryl:

What would more likely be the culprit is the sudden change in hormones inside the womans body. Regardless of whether the mothers body naturally rejected the fetus or if it was a medical procedure.

Yes. Sudden changes resulting directly from abortion – whether spontaneous or not.

Now, look at the dramatic increase in the number of non-spontaneous abortions in the last 25 years and the dramatic increase in the number of breast cancer diagnoses in the same time.

Imryl:

That’s probably why there isn’t as much money going into that hypothesis.

Non sequitur. Unsupported conjecture.

Imryl:

You’d have better luck going after BCP since that chemically alters a womens physiology.

Why cherry pick? BCP and abortion both alter a womens physiology.

Imryl:

Having said that I really don’t think this is the thread to debate semantics.

I’ll follow your lead then?

 

[Ani_Ibi]

pathia:

First part. Mom is not treated by a pharmacist,

Strawman. No one has said that patients are treated by pharmacists.

pathia:

pharmacists have absolutely nothing to do with chemotherapy.

Another strawman. The pharmaceutical industry has a lot to do with chemotherapy. Where do you think the chemotherapy drugs come from? Who do you think participates in the research? Who do you think profits from the sale of chemotherapeutic drugs?

pathia:

She is treated by an oncologist in a hospital where laboratory techs inject her with the chemotherapy treatments. There is no pharmacist involved at any point.

Wrong. The pharmacists send the chemo up to the nursing stations. The pharmicists also fill the prescriptions for anti-emetics and other take-home drugs.

pathia:

She is not prescribed medications.

Often patients are, depending on their medication regime.

pathia:

Chemotherapy is essentially heavy metal poisoning and requires a hospital itself to administer it properly, not someone behind a counter dispensing pills.

Much of the chemo is administered in a hospital. Some is not. Pharmacists dispense drugs to either the nursing stations or to the patient directly . These drugs have been developed between the pharmaceutical industry and research specialists.

pathia:

Are you sure you’re referencing the proper organization?

Yes I am sure.

pathia:

That would be because at least in ovarian cancer, the ‘cure’ rate is below 5%.

Are you referring to a cure rate for ovarian cancer? Or the survival rate?

pathia:

The chance of reoccurance even after complete successful treatment is over 90% if not over 95%. Mom will never be cured, the only hope is to keep it gone for over a year so the chemotherapy doesn’t kill her instead.

As I have said before, most cancers – not just ovarian cancer – are now treated as chronic diseases.

pathia:

Touting a ‘cure’ rate of 2-5% is not very uplifting.

The cure rate of 2-5% came from where?

 

[pathia]

Strawman. No one has said that patients are treated by pharmacists.

Another strawman. The pharmaceutical industry has a lot to do with chemotherapy. Where do you think the chemotherapy drugs come from? Who do you think participates in the research? Who do you think profits from the sale of chemotherapeutic drugs?

Wrong. The pharmacists send the chemo up to the nursing stations. The pharmicists also fill the prescriptions for anti-emetics and other take-home drugs.

Often patients are, depending on their medication regime.

Much of the chemo is administered in a hospital. Some is not. Pharmacists dispense drugs to either the nursing stations or to the patient directly . These drugs have been developed between the pharmaceutical industry and research specialists.

Yes I am sure.

Are you referring to a cure rate for ovarian cancer? Or the survival rate?

As I have said before, most cancers – not just ovarian cancer – are now treated as chronic diseases.

The cure rate of 2-5% came from where?

Please don’t contact me offboard. It’s one thing that I possibly broke protocol in contacting you by private message, but there’s no reason to attack me via other means.

 

[seekerz]

Strawman. No one has said that patients are treated by pharmacists.

Another strawman. The pharmaceutical industry has a lot to do with chemotherapy. Where do you think the chemotherapy drugs come from? Who do you think participates in the research? Who do you think profits from the sale of chemotherapeutic drugs?

Wrong. The pharmacists send the chemo up to the nursing stations. The pharmicists also fill the prescriptions for anti-emetics and other take-home drugs.

Often patients are, depending on their medication regime.

Much of the chemo is administered in a hospital. Some is not. Pharmacists dispense drugs to either the nursing stations or to the patient directly . These drugs have been developed between the pharmaceutical industry and research specialists.

Yes I am sure.

Are you referring to a cure rate for ovarian cancer? Or the survival rate?

As I have said before, most cancers – not just ovarian cancer – are now treated as chronic diseases.

The cure rate of 2-5% came from where?

Where is you proof that the APA has anything to do with this?

Ovarian cancer is almost a death sentence even though many cancers today are treated as chronic diseases. Unlike many cancers, there is little or no way to detect it until it has advanced to the point of treatment being able to make little difference. It’s not so much a question of whether effective treatment exists, but how late it is before treatment can be started.

Detection of cancer as far as I know has nothing to do with the APA.

 

[aurora77]

Ovarian cancer is almost a death sentence even though many cancers today are treated as chronic diseases. Unlike many cancers, there is little or no way to detect it until it has advanced to the point of treatment being able to make little difference. It’s not so much a question of whether effective treatment exists, but how late it is before treatment can be started.

Just to toss this out–there is a kind of ovarian cancer that is considered borderline. It shows up young, and if detected early, is curable in most people. I don’t know if this would show up on genetic screening; I assume it would, but what do I know?

As a young (I’ll be 30 in two weeks) woman in this situation, I would recommend against the pre-emptive hysterectomy. I had mine last week because I have this borderline ovarian cancer. If I knew 10 years ago what I know now, I would not have had the procedure done pre-emptively. I could have gotten hit by a bus at 21, does that mean I should never have left my house? It’s good to know what risks we face in life, but we are all going to die someday; to undergo serious surgery for a problem that may or may not develop is crazy, in my opinion.