The Church and ectopic pregnancy for health care workers

[JReducation]

Thanks for the great replies everybody! And judging by the amount of debate this has caused, I guess now that you can all understand where I am coming from and why I had such a moral and ethical dilemma at work that day. I had all these same questions running through my head. I hope that none of you are ever put in this position.

First, I’d just like to clarify that I am a male midwife. It was assumed that I was female by some of the posters here, so I’d just like to clear that up, lol.

This is the best analogy that I could come up with on the day that I had the problem…

Two climbers hanging from a cliff suspended by a rope. The rope is breaking at the top. The climber closest to the top is alert, the climber at the bottom of the rope is unconscious. The rope will hold if the bottom climber is cut lose, and sent to his death. The top climber has no knife. I’m in a helicopter and have the choice of cutting the rope to save the top climber or letting them both die… The answer seems simple… but do you want to be that person who cuts the rope, sending the bottom climber to his death?

This is why I wanted an answer from the AAA forum because there is so much debate and I can’t seem to find a simple Church teaching on this scenario. I spoke to Priests and Sisters and many other people, and still can’t find an answer. I just wish the AAA forum had better prioritised my obviously concerning question…

Thanks again everybody, and continue the discussion!

I work for a diocese at the Respect Life office. You can write us there and we can give you the pastoral answers that you may need or point you to the Respect Life Office in your diocese.

Fraternally,

Br. JR, OSF

 

[JReducation]

Dang, man…I read your posts alot. You’re good. Really good. It’s like you do this for a living or something.

Maybe I do. If you’re male and single, we need more brothers to do this too.

Fraternally,

Br. JR, OSF

 

[rwillenborg]

Maybe I do. If you’re male and single, we need more brothers to do this too.

Fraternally,

Br. JR, OSF

Close. I’m married and female.
Good thing you went into this and not psychic readings!! LOL!

 

[JReducation]

Close. I’m married and female.
Good thing you went into this and not psychic readings!! LOL!

If you ever have the chance to do so, you can point your son toward the Franciscan Brothers of Life. See link below.

Fraternally,

Br. JR, OSF

 

[EnglishTeacher]

I just wish the AAA forum had better prioritised my obviously concerning question…

They’ve answered questions about termination of ectopic pregnancies several times before, although I don’t know if they have specifically answered your question about the healthcare worker’s level of responsibility.

Here is one of their answers, and also a link to the National Catholic Bioethics Center:

forums.catholic-questions.org/showthread.php?t=55211&highlight=ectopic+pregnancy

ncbcenter.org/NetCommunity/Page.aspx?pid=183

 

[momor]

Thanks for the great replies everybody! And judging by the amount of debate this has caused, I guess now that you can all understand where I am coming from and why I had such a moral and ethical dilemma at work that day. I had all these same questions running through my head. I hope that none of you are ever put in this position.

First, I’d just like to clarify that I am a male midwife. It was assumed that I was female by some of the posters here, so I’d just like to clear that up, lol.

This is the best analogy that I could come up with on the day that I had the problem…

Two climbers hanging from a cliff suspended by a rope. The rope is breaking at the top. The climber closest to the top is alert, the climber at the bottom of the rope is unconscious. The rope will hold if the bottom climber is cut lose, and sent to his death. The top climber has no knife. I’m in a helicopter and have the choice of cutting the rope to save the top climber or letting them both die… The answer seems simple… but do you want to be that person who cuts the rope, sending the bottom climber to his death?

This is why I wanted an answer from the AAA forum because there is so much debate and I can’t seem to find a simple Church teaching on this scenario. I spoke to Priests and Sisters and many other people, and still can’t find an answer. I just wish the AAA forum had better prioritised my obviously concerning question…

Thanks again everybody, and continue the discussion!

You are in a very difficult spot at your job. I hope you can find the definitive answer for your practice.

I would like to put a different spin on your analogy if I may that I think comes closer to a tubal ectopic scenario.
A climber is hanging on the edge of a cliff. A fellow climber who is unconsious is wrapped in a sleeping bag which is tied to the ankle of the climber. The climber cannot get to safety as long as the man in the sleeping bag is attached to his leg. Both will die if the weight of the unconscious man is not removed from his leg. There are only 2 possibilities.

1. A second climber hanging nearby can cut open the sleeping bag and allow the man inside to fall out. This of course means he falls to his death but the first climber can then get to safety.
2. The second climber can cut off the first climbers foot allowing the sleeping bag with the man inside to fall away but the man inside is killed. The first climber can then climb to safety.

In both cases the man in the sleeping bag will die. In both cases the desired end is to save the only life that can be saved (the first climber), not to kill the unconsious man who cannot not be saved under any circumstance.

Which method do you choose?

Does one method represent a higher moral good than the other? If so, why?

What is going to kill the first climber? Is it the sleeping bag attached to his leg or is it the weight of the unconsious man inside?

 

[manualman]

momor, you seem determined to avoid the reality that there is quite a difference between directly killing someone to save another life and saving a life even when the indirect outcome is the death of another (who would die anyways if no action is taken).

The point of my analogies is not to pigeonhole anyone on any other issue. The point is that when the unborn child is taken out of the picture ond both parties are universally acknowledged as human persons, this moral dilemma seems to be a LOT easier for people to resolve. The reason for that should quickly become clear to those honest enough to reflect on it.

 

[Whitacre_Girl]

momor, you seem determined to avoid the reality that there is quite a difference between directly killing someone to save another life and saving a life even when the indirect outcome is the death of another (who would die anyways if no action is taken).

The point of my analogies is not to pigeonhole anyone on any other issue. The point is that when the unborn child is taken out of the picture ond both parties are universally acknowledged as human persons, this moral dilemma seems to be a LOT easier for people to resolve. The reason for that should quickly become clear to those honest enough to reflect on it.

Manualman, I can sense your concern for those who do not yet see what you see. I am in the same boat as momor though. As we stated earlier in the thread, we would both follow church law if ever we were placed in a situation where action like this was needed. No questions asked. However, the reason we are asking these questions is to gain understanding. We do not currently see the logic of the church’s decision as we are following the command that those who lack wisdom should ask. We have stated as much earlier in the thread.

I really wish I could see the logic of the church in this, but I can’t. Do see the unborn child as completely human. I just can’t understand the decision in this case. I am working out my own salvation with fear and trembling just as everyone else, and asking for explanations along the way.

 

[manualman]

And I mean no disrespect to anyone struggling to understand! The whole reason I’m posting is to try to share why I DO see a difference.

The chemical abortion of the ectopic baby is a direct killing, no different than pulling a trigger. The surgical removal of the diseased tube, on the other hand is a response to the biological malfunction in the mother that will kill them both if left untreated. The loss of the baby in the process is an undesired and unavoidable side effect. There may come a day when the child can be relocated to the uterous (but probably not since the ectopic pregnancy likely shows no symptoms until the baby is already hurt by growing in the tube constrained environment).

The end result is NOT all that matters in life. Process and intent are crucial as well.

 

[momor]

Manualman, I can sense your concern for those who do not yet see what you see. I am in the same boat as momor though. As we stated earlier in the thread, we would both follow church law if ever we were placed in a situation where action like this was needed. No questions asked. However, the reason we are asking these questions is to gain understanding. We do not currently see the logic of the church’s decision as we are following the command that those who lack wisdom should ask. We have stated as much earlier in the thread.

I really wish I could see the logic of the church in this, but I can’t. Do see the unborn child as completely human. I just can’t understand the decision in this case. I am working out my own salvation with fear and trembling just as everyone else, and asking for explanations along the way.

Very well put. Thanks for very clearly and succinctly stating my position as well.

 

[momor]

I see the hair splitting we are doing as very similar to the same kind of polar opposite hair splitting we abhor from the late-term abortion proponents. They fight tooth and nail to maintain their position (and prevent laws from being enacted) that says a full term fetus killed in the womb that never took a breath is not a murder victim. They feel they have to hold to this (even though I suspect some are disgusted by it) because they are afraid that to do otherwise opens the door a crack to declaring any fetus a person and ending all abortion.

Put aside for the sake of argument that they are killing a baby and just focus on the (il) logic they use. How is a baby who is 8.5 months old but still in the womb any different than the same baby taken by cesarean section 1 minute later who takes a breath? They can make all kinds of biological, philosophical and even legal arguments for how the distinction is meaningful based on that one breath. But it still comes down to hairsplitting. The baby is alive and viably able to live separate from it’s mother’s body in either case. How can it be anything but murder? I see the Catholic position of arguing a moral distinction between removing an ectopic fetus and removing the tube around it to be just as disingenous.

I guess the point I am trying to make, probably very poorly, is that reason and logic always matter and have to match up with the reality of a given situation. We can’t allow ourselves to become so rigid and fearful that we refuse to take a position of reason and logic because we fear that doing so would be to open the door a crack to our opponent and risk losing everything. If something is reasonable and logical that shouldn’t happen.

I’m back after a long reflection.

I have come to the realization that what I really believe in my heart is actually more conservative than what the Church holds and this is why I have been having such trouble with the logic and why the distinctions over methods seem silly to me.

I could never end the life of a child that was not 100% doomed to begin with and where without the intervention to remove the baby the death of the mother is 100% certain. I could never agree to the removal of my cancerous but pregnant uterus if there was any chance the baby could grow inside long enough to live outside the womb. Likewise I could never agree to remove the tube around an ectopic pregnancy if there was any chance the baby could live to viability even if it meant risking my life to do so.

This is the position I have always held and before I started reading here on CAF I thought it was the position of the Church as well. So I realize I have been struggling because I have never seen this issue as being about removing a diseased organ and cannot bring myself to do so now. I see it as being about a procedure to save the only life that can be saved when both are 100% doomed without it. For now I conclude that for myself I could morally allow any procedure that would do so and I would choose whichever one seemed best for my health.

I have also been struggling with the distinction between NFP and contraception and sterility and impotence rules on marriage. This realization of how conservative I really am has helped me clarify my thinking on some of the illogic I find in those Church positions too. As modern medicine continues to bump up against theology we will continue to have these struggles. We are constantly building our capability to know and do things medically that we couldn’t conceive of when our theology was being formed. I think the Church has in fact opened the door a crack on some issues and it attempts to justify the moral /theological dissonance that results with what I think are silly distinctions. Unfortunately research and technology will probably always race ahead of the ethical dilemmas they create. I am sure this has been part of God’s plan for the world all along and He is watching how we respond.

Thank you to everyone for the discussion.

 

[JReducation]

I would suggest this, I’ve used it myself and it works. When I don’t understand where the Church is coming from, I remind myself that God does not split hairs and that the Church is the voice of God on all matters regarding faith and morals, including justice. Abortion is an issue of justice.

If the Church says that doing it this way is moraly acceptable and that way is not acceptable, I don’t stop asking for a claridication. But I always begin by saying, I know that the Church is right and I’m wrong. But I just want to understand why I’m wrong. I’m not tyring to prove that I’m right. I can’t possibly be right and be in opposition to the Church.

This actually helps me approach the question from another angle. I’m no longer debating with the Church. I’m acknowledging that I’m wrong and trying to figure out where I went wrong. If I someday figure it out, it may help me in other areas of life. Because it is very rare that we commit a mistake only once in our lives.

Fraternally,

Br. JR, OSF

 

[Whitacre_Girl]

And I mean no disrespect to anyone struggling to understand! The whole reason I’m posting is to try to share why I DO see a difference.

The chemical abortion of the ectopic baby is a direct killing, no different than pulling a trigger. The surgical removal of the diseased tube, on the other hand is a response to the biological malfunction in the mother that will kill them both if left untreated. The loss of the baby in the process is an undesired and unavoidable side effect. There may come a day when the child can be relocated to the uterous (but probably not since the ectopic pregnancy likely shows no symptoms until the baby is already hurt by growing in the tube constrained environment).

The end result is NOT all that matters in life. Process and intent are crucial as well.

I totally get that. The thing I am wondering if the child is removed and an attempt is made to transplant it to the uterus. I would think this would be the best options since all is being done in this case to try to save both. It will likely result in the death of the child, whereas the removal of the tube would certainly kill the child. In this case, the child can be treated with all care to be moved to where he or she should be, and the tube that was damaged is repaired, making future ectopic pregnancies less likely, and does not impact the mother’s fertility. It would, in fact, help it!

What is the decision on that? The motive here would be to try to save both mother and child. At least, this is what I would try to do if it were me. shrugs

 

[JReducation]

I totally get that. The thing I am wondering if the child is removed and an attempt is made to transplant it to the uterus. I would think this would be the best options since all is being done in this case to try to save both. It will likely result in the death of the child, whereas the removal of the tube would certainly kill the child. In this case, the child can be treated with all care to be moved to where he or she should be, and the tube that was damaged is repaired, making future ectopic pregnancies less likely, and does not impact the mother’s fertility. It would, in fact, help it!

What is the decision on that? The motive here would be to try to save both mother and child. At least, this is what I would try to do if it were me. shrugs

I’M NOT A DOCTOR OF MEDICINE AND I DON’T PLAY ONE ON TV.

From what I have read, the slicing the tube and sewing it up again can leave scar tissue in the tube which may cause another ectopic pregnancy. I don’t know if you can implant the fetus into the uterus at this stage. If there were such technology available, it would certainly be worth the theological exploration.

Fraternally,

Br. JR, OSF

 

[Whitacre_Girl]

I’M NOT A DOCTOR OF MEDICINE AND I DON’T PLAY ONE ON TV.

From what I have read, the slicing the tube and sewing it up again can leave scar tissue in the tube which may cause another ectopic pregnancy. I don’t know if you can implant the fetus into the uterus at this stage. If there were such technology available, it would certainly be worth the theological exploration.

Fraternally,

Br. JR, OSF

IIRC, there was a post made earlier by a nurse that explored the vaious treatment options, and this was one. It is good at trying to repair the tube, but obviously all attempts made to transplant the child fails. (if it is attempted at all)

Would it be immoral as a catholic woman to make such a request of the surgeon?

 

[momor]

IIRC, there was a post made earlier by a nurse that explored the vaious treatment options, and this was one. It is good at trying to repair the tube, but obviously all attempts made to transplant the child fails. (if it is attempted at all)

Would it be immoral as a catholic woman to make such a request of the surgeon?

I think this is where the surgical technology will be heading but it’s not there yet although there may be experimental programs doing this. The transplantation would involve additional risk to the woman’s health by having to make an entry into the uterus (bleeding, rupture, infection, fetal death requiring a subsequent D&C, all the usual stuff). A surgeon would not do that on their own unless they had received training ( added - and the outcomes of the experimental surgeries justified it.) It would be like flying by the seat of their pants and that’s not acceptable when there is any risk to the patient involved.

 

[momor]

I would suggest this, I’ve used it myself and it works. When I don’t understand where the Church is coming from, I remind myself that God does not split hairs and that the Church is the voice of God on all matters regarding faith and morals, including justice. Abortion is an issue of justice.

If the Church says that doing it this way is moraly acceptable and that way is not acceptable, I don’t stop asking for a claridication. But I always begin by saying, I know that the Church is right and I’m wrong. But I just want to understand why I’m wrong. I’m not tyring to prove that I’m right. I can’t possibly be right and be in opposition to the Church.

This actually helps me approach the question from another angle. I’m no longer debating with the Church. I’m acknowledging that I’m wrong and trying to figure out where I went wrong. If I someday figure it out, it may help me in other areas of life. Because it is very rare that we commit a mistake only once in our lives.

Fraternally,

Br. JR, OSF

It’s entirely possible that I just haven’t heard the explanation of the moral theology yet that will make clear to me the reason the Church holds this position but I’ll keep trying to find it.

 

[Seatuck]

I just had an ectopic pregnacy and got back from the hospital yesterday. I asked this exact question to my surgeion. My fertility will NOT be reduced to 50%, my eggs from left ovary, my left tube was removed, will make their way over to the right one and my chances of getting pregnant again are that same as anyone else. I am thankful that I was not a candidate for the use of Methotrexate because I made me uncomfortable that I was intentionally aborting my child…on the other hand, I didn’t know that this was considered an abortion, so thank God I didn’t have that done. Unfortunately, so some woman, ectopic pregnancies are emergencies so they don’t get an opportunity to really research these moral issues, thankfully we had the surgery.

I’m sorry for your loss.

 

[Seatuck]

Thanks for the great replies everybody! And judging by the amount of debate this has caused, I guess now that you can all understand where I am coming from and why I had such a moral and ethical dilemma at work that day. I had all these same questions running through my head. I hope that none of you are ever put in this position.

First, I’d just like to clarify that I am a male midwife. It was assumed that I was female by some of the posters here, so I’d just like to clear that up, lol.

This is the best analogy that I could come up with on the day that I had the problem…

Two climbers hanging from a cliff suspended by a rope. The rope is breaking at the top. The climber closest to the top is alert, the climber at the bottom of the rope is unconscious. The rope will hold if the bottom climber is cut lose, and sent to his death. The top climber has no knife. I’m in a helicopter and have the choice of cutting the rope to save the top climber or letting them both die… The answer seems simple… but do you want to be that person who cuts the rope, sending the bottom climber to his death?

This is why I wanted an answer from the AAA forum because there is so much debate and I can’t seem to find a simple Church teaching on this scenario. I spoke to Priests and Sisters and many other people, and still can’t find an answer. I just wish the AAA forum had better prioritised my obviously concerning question…

Thanks again everybody, and continue the discussion!

Catholics are not permitted to use Methotrexate to treat ectopics because that treatment is considered a direct abortion.It is simple teaching that we do not cause abortions. I’m surprised you haven’t seen direct teaching on that.

cuf.org/faithfacts/details_view.asp?ffID=57

books.google.com/books?id=TJtqLPr3lCYC&pg=PA184&lpg=PA184&dq=william+may+methotrexate&source=bl&ots=TyCZZqWa98&sig=KOJtMW8EdM3OvqUCKKb4K5TMJxo&hl=en&ei=Rv7QS8yaOsSclgfUrNm1Dw&sa=X&oi=book_result&ct=result&resnum=2&ved=0CA4Q6AEwAQ#v=onepage&q=william%20may%20methotrexate&f=false

uffl.org/vol12/bowring12.pdf

For more information contact the National Catholic Bioetics Center.

 

[JReducation]

IIRC, there was a post made earlier by a nurse that explored the vaious treatment options, and this was one. It is good at trying to repair the tube, but obviously all attempts made to transplant the child fails. (if it is attempted at all)

Would it be immoral as a catholic woman to make such a request of the surgeon?

Unless there is the technology to make this happen, it would not be morrally correct to attempt this. You can’t experiment with a human life.

The whole point of this discussion and revelation is that any direct killing is never allowed. When you extract the tube with the infant in it, the infant will die of natural causes. When you take the infant out, he dies because you intended to kill him.

In the case of a transplant from the tube to the uterus. I don’t know if such a precudure has ever worked. I would have to say that you err on the side of the moral good. That moral good is not to attempt it unless there is some hope that it will work. If it has never worked, what is the hope?

Fraternally,

Br. JR, OSF