Scratching my head over the issue with methotrexate use in ectopic pregnancy

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Benjinho

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Background: Ectopic pregnancies are pregnancies where the baby implants in a site other than the uterus and begins to grow. There is currently no medical technology that can remove the baby and put him/her in the uterus. Additionally, the baby will always die before birth and when doing so, puts the mother’s life in serious danger.

Currently, the only treatment is removal (and killing) of the baby in some way or another which always results in the baby’s death as a result of any of these procedures (even though he or she would inevitably die before birth anyway). This can be done using a drug called methotrexate or removal of the Fallopian tube (the most common site of ectopic pregnancies).

The Argument Against Methotrexate: I am reading that it is not morally permissible to use methotrexate because it interferes with DNA replication of the baby’s cells and his/her placenta (a body part babies use to get blood/nutrients from mom connected to baby through the umbilical cord and that they shed during birth) resulting in killing of the baby. It is thought that this is a direct attack on the baby.

The Proposed Alternative: I have also read that the morally permissible alternative is removal of the Fallopian tube itself, which is morally permissible because rather than the baby being directly attacked, the body part to which he or she is attached is simply removed and the baby dies as a result of this action.

Why I don’t see the Difference Between These Options: I have thought about it and I believe all of these options are direct attacks on the baby. While the removal of the Fallopian tube doesn’t put chemicals in the baby’s body and placenta, it does disconnect the baby from the mother’s body which the baby needs to stay alive (yes, you aren’t just removing the baby, but the baby is in the body part removed, which is no different).
To put it simply - Fallopian tube has a blood supply. This blood goes to baby through placenta/umbilical cord. Baby grows and lives because of this blood. Cut off the blood supply of the Fallopian tube (by removal), you cut off the blood supply of the baby, and you kill the baby. Mom will live because of this decision.

The Church has no official position on methotrexate use in ectopic pregnancies. But arguing that methotrexate is morally impermissible while Fallopian tube removal is, is like saying poisoning a terminally ill elderly woman is wrong but unplugging her life support or cutting the power to the nursing home where she lives is morally permissible.
 
If the Church has no official position, wouldn’t that make the methorexate option OK and thus there is no issue?
 
An ectopic pregnancy is not and never will be a viable pregnancy. It shouldn’t matter which way the pregnancy is terminated. It has to be done. The fetus is doomed from day of implant, and there’s nothing anyone can do to change the outcome. Why not save the tube to promote the likelihood of future pregnancies.
 
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This is an example of where ethicists and theologians spend a lot of time trying to reconcile the modern world with Church dogma, and then construct systems to make it work.

Basically, it’s ok to kill the fetus provided that you’re not intending to kill the fetus, which doesn’t make a lot of sense outside of theoretical theology. In the one instance, you’re killing the baby. In the other, you’re ending the pregnancy and killing the baby. Oops, the baby’s death is an unintended consequence, which is disingenuous enough to be a lie.

It’s a distinction without a difference (in the real world).

If they don’t draw the distinction, it leads to all sorts of slippery slopes like “life of the mother,” which we must not allow. so we make an exception for life of the mother but call it something else.
 
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Yeah, guess so…I’m just going through some mental exercises in case it ever does come up…
 
Benjinho said:
The Church has no official position on methotrexate use in ectopic pregnancies. But arguing that methotrexate is morally impermissible while Fallopian tube removal is, is like saying poisoning a terminally ill elderly woman is wrong but unplugging her life support or cutting the power to the nursing home where she lives is morally permissible.
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Poisoning a terminally ill elderly woman would indeed be wrong. So would be cutting the power to the nursing home, assuming that the power company knew there were someone inside whose life depended upon a steady supply of power. Power bills can be paid later, or repairs to the power system can be postponed (if that is the reason power is being cut).

Is the life support the only way the woman is being kept alive, that is, is the “terminally ill” part due to her being on life support without which she would die? Or is she terminal for some other reason, such as rapidly growing cancer that will soon kill her, life support or not?

If she is dependent upon life support, and if the decision has been made that this is an extraordinary measure that is only artificially extending her life, at great cost, great pain for a long period of time with no palliative effect, or that it is ultimately futile, then it seems that removing life support is morally permissible.
 
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HomeschoolDad said:
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Benjinho:
The Church has no official position on methotrexate use in ectopic pregnancies. But arguing that methotrexate is morally impermissible while Fallopian tube removal is, is like saying poisoning a terminally ill elderly woman is wrong but unplugging her life support or cutting the power to the nursing home where she lives is morally permissible.
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Poisoning a terminally ill elderly woman would indeed be wrong. So would be cutting the power to the nursing home, assuming that the power company knew there were someone inside whose life depended upon a steady supply of power. Power bills can be paid later, or repairs to the power system can be postponed (if that is the reason power is being cut).

Is the life support the only way the woman is being kept alive, that is, is the “terminally ill” part due to her being on life support without which she would die? Or is she terminal for some other reason, such as rapidly growing cancer that will soon kill her, life support or not?
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Yes. I’m making an analogy to an unborn baby early on who couldn’t survive without being attached to mom aka “life support.”
 
Benjinho said:
The Argument Against Methotrexate: I am reading that it is not morally permissible to use methotrexate because it interferes with DNA replication of the baby’s cells and his/her placenta
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You know what else interferes with the growth and nutritive development of the embryo? Removing it from its life-source:
the mother’s body.

As you point out, it’s difficult to see the difference since both involve “interference” known to be fatally detrimental to the embryo.

The only way the distinction stands is by reference to 1) intention and
2) whether the mechanics of the procedure “directly” or “indirectly” cause the embryo’s death.

Catholic moral theology includes “intention” in the moral-analysis of any human action.

It is what distinguishes the man giving alms on the street in order to gain the praise of observers, from the man who gives alms on the street out of compassion for his fellow man.

Interferences with pregnancy are no exception to the rule that intention matters.

So in regards to intention, I say, yes, a true distinction is made between a situation in which the destruction of the embryo is the (intended) means, and the loss of the embryo is an (unintended) effect.

Removing the fallopian tube is permissible on the ground that it has become “pathological” and is the same procedure that would be performed if, say, a tumor were growing there.

What I think is more interesting, and little more tricky, is the distinction between “direct” and “indirect”.

Why is the removal of the fallopian tube (or the section where the embryo is lodged) considered permissible, but making an incision along the tube and “scooping” the embryo out, not?
Another morally problem-
atic technique involves cutting
along the length of the fallopian
tube where the child is embedded
and “scooping out” the living
body of the child, who dies
shortly thereafter. The tube can
then be sutured back up. This ap-
proach, like the use of methotrexate,
leaves the fallopian tube largely intact for possible future pregnancies, but also raises obvious moral objections because it directly causes the death of
the child.
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Pacholczyk, Fr. Tad, “When Pregnancy Goes Awry”, Making Sense of Bioethics (October 2009), p.1-2.

What makes this a “direct cause” of death?

Why isn’t the scooping out of the embryo in this case comparable to induced labor? The embryo dies yes, but not because you intend it to die (we are assuming a case in which the doctor has a prolife conscience and is treating both the mother and child as patients), but because of its non-viability which if you had a way of transforming into viability (e.g. technology) you would do so.
 
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Ana_v said:
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Benjinho:
The Argument Against Methotrexate: I am reading that it is not morally permissible to use methotrexate because it interferes with DNA replication of the baby’s cells and his/her placenta
Click to expand...
You know what else interferes with the growth and nutritive development of the embryo? Removing it from its life-source:
the mother’s body.

As you point out, it’s difficult to see the difference since both involve “interference” known to be fatally detrimental to the embryo.

The only way the distinction stands is by reference to 1) intention and
2) whether the mechanics of the procedure “directly” or “indirectly” cause the embryo’s death.

Catholic moral theology includes “intention” in the moral-analysis of any human action.

It is what distinguishes the man giving alms on the street in order to gain the praise of observers, from the man who gives alms on the street out of compassion for his fellow man.

Interferences with pregnancy are no exception to the rule that intention matters.

So in regards to intention, I say, yes, a true distinction is made between a situation in which the destruction of the embryo is the (intended) means, and the loss of the embryo is an (unintended) effect.

Removing the fallopian tube is permissible on the ground that it has become “pathological” and is the same procedure that would be performed if, say, a tumor were growing there.
Click to expand...
My problem with this point for indirectness is that it argues for a difference by re-defining the fetus. It defines the fetus as a pathology in the Fallopian tube to justify his/her removal with the tube, whereas the fetus is correctly defined as human life when methotrexate is used. The fetus is a human life in either case.
 
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Benjinho said:
My problem with this point for indirectness is that it argues for a difference by re-defining the fetus. It defines the fetus as a pathology in the Fallopian tube to justify his/her removal with the tube, whereas the fetus is correctly defined as human life when methotrexate is used. The fetus is a human life in either case.
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My rule of thumb is to ask what if the tube was about to rupture and there was no baby in it?

Yes. I’m ignoring the fact that the baby is the reason the tube would rupture.

However in this, very hypothetical, situation it would seem that the tube would be removed like an appendix is.
 
CMKrauss said:
An ectopic pregnancy is not and never will be a viable pregnancy. It shouldn’t matter which way the pregnancy is terminated. It has to be done. The fetus is doomed from day of implant, and there’s nothing anyone can do to change the outcome. Why not save the tube to promote the likelihood of future pregnancies.
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Because the embryo is still a person.
 
Elf01 said:
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Benjinho:
My problem with this point for indirectness is that it argues for a difference by re-defining the fetus. It defines the fetus as a pathology in the Fallopian tube to justify his/her removal with the tube, whereas the fetus is correctly defined as human life when methotrexate is used. The fetus is a human life in either case.
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My rule of thumb is to ask what if the tube was about to rupture and there was no baby in it?

Yes. I’m ignoring the fact that the baby is the reason the tube would rupture.

However in this, very hypothetical, situation it would seem that the tube would be removed like an appendix is.
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But there isn’t a requirement for the tube to be “about to rupture” to remove it when an ectopic fetus is in it.
 
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Benjinho said:
But there isn’t a requirement for the tube to be “about to rupture” to remove it when an ectopic fetus is in it.
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Ovulation means that the ovary released an egg cell.
The egg cell moves down the Fallopian tube, slowly. It takes about five days to get to the uterus.
Conception (fertilization) occurs when the egg is still in the first third of the Fallopian tube.
The zygote will migrate and divide, migrate and divide until about day five after ovulation, when it is now in the uterus and can implant.

If there is damage to the Fallopian tube, the zygote gets “stuck” in the tube and can’t move forward. However, it continues to grow, and because the tube isn’t endlessly stretchy, it will rupture.
 
We’re not moral consequentialists. In one case the human life is treated as a disease. In the other the inflamed tissue of the mother is removed. There’s a difference between intentional killing and letting a human die because we don’t have the resources to help it.
 
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0Scarlett_nidiyilii said:
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Benjinho:
But there isn’t a requirement for the tube to be “about to rupture” to remove it when an ectopic fetus is in it.
Click to expand...
Ovulation means that the ovary released an egg cell.
The egg cell moves down the Fallopian tube, slowly. It takes about five days to get to the uterus.
Conception (fertilization) occurs when the egg is still in the first third of the Fallopian tube.
The zygote will migrate and divide, migrate and divide until about day five after ovulation, when it is now in the uterus and can implant.

If there is damage to the Fallopian tube, the zygote gets “stuck” in the tube and can’t move forward. However, it continues to grow, and because the tube isn’t endlessly stretchy, it will rupture.
Click to expand...
It will eventually rupture, but ectopic pregnancies are not necessarily imminently dangerous. If the fetus is small enough, his or her attachment to the tube would be the only reason to remove the tube rather than secondary disease from his or her growth (inflammation, bleeding, etc.).
 
Wesrock said:
We’re not moral consequentialists. In one case the human life is treated as a disease. In the other the inflamed tissue of the mother is removed. There’s a difference between intentional killing and letting a human die because we don’t have the resources to help it.
Click to expand...
As I have stated, there aren’t any requirements for disease secondary to the fetus’s attachment to the Fallopian tube to remove the Fallopian tube with the fetus inside, and many times ectopic pregnancies are found without such secondary disease present (i.e., only present issue is fetus’s attachment to the tube). Really, the only morally consistent way to treat ectopic pregnancies would be to wait until there is another reason (bleeding, infection, etc.) to remove the tube, i.e. no “prevention.”
 
Benjinho said:
It will eventually rupture, but ectopic pregnancies are not necessarily imminently dangerous. If the fetus is small enough, his or her attachment to the tube would be the only reason to remove the tube rather than secondary disease from his or her growth (inflammation, bleeding, etc.).
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I’m not a trained moral theologian (which is why I posted a link to the bioethics center), but I don’t believe you have to wait until it becomes a life-threatening emergency.
But I’m not swearing to this, either. But check the link.
 
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