The Church and ectopic pregnancy for health care workers

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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 🙂
(bold mine)

Let’s say for the sake of argument that this procedure (transfer from the tube to the uterus) has been accomplished at least in a few cases in rabbits (rabbit lovers, substitute another mammal), but not yet in humans. At what point does it become acceptable to attempt this procedure in a human, knowing that the first try by definition must be an experiment? Although similar, bunnies and people are very different and the differences are not small.

How much of a chance of success must one have in order to perform the experiment on a person, particularly knowing that it may cause the death of a human being?

For better or worse, I am as confused as some on this thread, and I have been giving lots of thought to the rationale of the Church in the matter of ectopic pregnancies. So I am looking for an honest answer here.
 
(bold mine)

Let’s say for the sake of argument that this procedure (transfer from the tube to the uterus) has been accomplished at least in a few cases in rabbits (rabbit lovers, substitute another mammal), but not yet in humans. At what point does it become acceptable to attempt this procedure in a human, knowing that the first try by definition must be an experiment? Although similar, bunnies and people are very different and the differences are not small.

How much of a chance of success must one have in order to perform the experiment on a person, particularly knowing that it may cause the death of a human being?

For better or worse, I am as confused as some on this thread, and I have been giving lots of thought to the rationale of the Church in the matter of ectopic pregnancies. So I am looking for an honest answer here.
I’m a Mystical Theologian. I specialize in matters of the soul. I’m not a medical ethicist, though we did take several courses during our formation years while working on our doctorate in theology. I start out by saying that so that no one is misled believing that I’m a scholar in this area. I just happen to have studied this for two years, which is insignificant compared to the years the moral theologians study this or the years that we study the growth and anatomy of the soul.

That being said, I’ll give you a few principles to start with. There is no fixed number that says now can you can experiment with this. However, moral theology is about two things: revelation and reason. Revelation guides reason. Reason tells us that at some point we have to switch from animal testing try it on a human being. Revelation tells us that we cannot put a human being at risk unnecessarily and where there is little or no hope of success. That would be a violation of man’s dignity. Man is not a guinea pig.

With this information in mind, I would say that at some point a treatment has to be attempted on a human being, just as we did with vaccines and transplants. But you must have had sufficient success with non-human animals to justify attempting a procedure or treatment on a human being. If you’re rate of success with rabbits is 60%, that’s not a reasonable number. If your rate of sucess with rabbits is 95%, you have a more acceptable number. Do you see what I mean? There is no magic number. But you must have enough successs with non-human animals to try with human beings. Even there, you must fulfill two important moral obligations.
  1. Your intent is to save the life of the mother and child. You don’t go into this with a casual attitude that the child is going to die anyway, so it’s worth the risk. The child has a dignity and that has to be respected. His mother’s dignity does not trump his own. If that’s your attitude, then cut the tube and let the child die a natural death.
  2. I would say that both parents must agree. A child is not his mother’s property or an organ in her body. He is a son or daughter. He has a mother and father who are responsible for his well-being. Therefore, they must agree to take this chance for the sake of mother and child. If one parent disagrees, a moral abitrator must be brought in. The physician is not a good arbitrator. No matter how good the doctor is, he or she has a vested interest in attempting the procedure and has little or no training in moral theology. Unless the father is out of the picture, he must step up to the plate and assume responsibility for the life of this child. This he does by participating in the decision making.
Does this hellp?

Fraternally,

Br. JR, OSF 🙂
 
(bold mine)

Let’s say for the sake of argument that this procedure (transfer from the tube to the uterus) has been accomplished at least in a few cases in rabbits (rabbit lovers, substitute another mammal), but not yet in humans. At what point does it become acceptable to attempt this procedure in a human, knowing that the first try by definition must be an experiment? Although similar, bunnies and people are very different and the differences are not small.

How much of a chance of success must one have in order to perform the experiment on a person, particularly knowing that it may cause the death of a human being?

For better or worse, I am as confused as some on this thread, and I have been giving lots of thought to the rationale of the Church in the matter of ectopic pregnancies. So I am looking for an honest answer here.
In cases where the investigating surgeons are ready to start human experiments (probably at a large teaching hospital) women who meet the criteria for the experimental group would be advised about the experiment. The risk/benefit would be explained and compared to the usual treatment and they would make the choice to participate or not. By the time it reaches this stage the surgeons would be pretty certain the procedure would be successful. The percentage of acceptable risk would be determined by the ethics committee overseeing the study.

I would guess that removing a fetus from the tube with the intention of trying to save it’s life would be an acceptable procedure for the Church if the baby is certain to die without it.
 
In cases where the investigating surgeons are ready to start human experiments (probably at a large teaching hospital) women who meet the criteria for the experimental group would be advised about the experiment. The risk/benefit would be explained and compared to the usual treatment and they would make the choice to participate or not. By the time it reaches this stage the surgeons would be pretty certain the procedure would be successful. The percentage of acceptable risk would be determined by the ethics committee overseeing the study.

I would guess that removing a fetus from the tube with the intention of trying to save it’s life would be an acceptable procedure for the Church if the baby is certain to die without it.
It is only acceptable to the Church if it passes the scrutiny of the Church’s medical ethics committee, not the committee overseeing the study. We hear what they have to say and we put it up to own own ethics committee for judgment.

Currently the Church uses the National Catholic Bioethics Center in Washington DC for the whole Church. They are considered the top experts on Catholic ethics and have the support and trust of the Holy See.

Fraternally,

Br. JR, OSF 🙂
 
I’m a Mystical Theologian. I specialize in matters of the soul. I’m not a medical ethicist, though we did take several courses during our formation years while working on our doctorate in theology. I start out by saying that so that no one is misled believing that I’m a scholar in this area. I just happen to have studied this for two years, which is insignificant compared to the years the moral theologians study this or the years that we study the growth and anatomy of the soul.

That being said, I’ll give you a few principles to start with. There is no fixed number that says now can you can experiment with this. However, moral theology is about two things: revelation and reason. Revelation guides reason. Reason tells us that at some point we have to switch from animal testing try it on a human being. Revelation tells us that we cannot put a human being at risk unnecessarily and where there is little or no hope of success. That would be a violation of man’s dignity. Man is not a guinea pig.

With this information in mind, I would say that at some point a treatment has to be attempted on a human being, just as we did with vaccines and transplants. But you must have had sufficient success with non-human animals to justify attempting a procedure or treatment on a human being. If you’re rate of success with rabbits is 60%, that’s not a reasonable number. If your rate of sucess with rabbits is 95%, you have a more acceptable number. Do you see what I mean? There is no magic number. But you must have enough successs with non-human animals to try with human beings. Even there, you must fulfill two important moral obligations.
  1. Your intent is to save the life of the mother and child. You don’t go into this with a casual attitude that the child is going to die anyway, so it’s worth the risk. The child has a dignity and that has to be respected. His mother’s dignity does not trump his own. If that’s your attitude, then cut the tube and let the child die a natural death.
  2. I would say that both parents must agree. A child is not his mother’s property or an organ in her body. He is a son or daughter. He has a mother and father who are responsible for his well-being. Therefore, they must agree to take this chance for the sake of mother and child. If one parent disagrees, a moral abitrator must be brought in. The physician is not a good arbitrator. No matter how good the doctor is, he or she has a vested interest in attempting the procedure and has little or no training in moral theology. Unless the father is out of the picture, he must step up to the plate and assume responsibility for the life of this child. This he does by participating in the decision making.
Does this hellp?

Fraternally,

Br. JR, OSF 🙂
It does help, thank you.
 
I know this is a good year later… so if I don’t receive any replies it wouldn’t surprise me! 😃 But I came across this thread because I was researching the Catholic theology on Ectopic pregnancies… and what a great thread it was! One thing that I was struggling with understanding, that I would REALLY love Br. (JReducation) to go into further is the idea of moving the baby from tube to uterus. I can totally understand that you don’t want to cause direct harm to baby, especially if there is little if any chance to help said baby survive. But at the same time, there is something very compelling to me about trying it, no matter how small the chance, even if it hasn’t been shown to have good chances of survival. Isn’t this respecting the life of the baby more so than removing the tube? It seems to be analogous to a patient who has a tumor on their brain that needs to be removed or they will die within a couple of weeks… the doctor knows the high chances of the person being killed from operating on them, yet is holding out hope for the very slim chance that they will survive. It helps that this analogous situation is a real one 😛 (I have a dear friend that went through this very thing with her daughter and she made it and is completely normal now!!) If you remove the tube completely, the baby will die. If you move the baby to uterus, there is a chance he/she could survive. I was just reading about a case where a doctor in 1915 did just that and the mother carried said baby boy to term!

Do you have any insight into this more? It seems to me, (coming from a mother of 7 in her late 20’s who hopes God blesses her with many more children!) that if I were put in this situation, I would strive to save the life of the baby, even if it’s very unlikely that he/she would survive. An added good is the fact that you could also save the tube (maybe, if it’s not damaged too much), and then be able to raise many more little souls for God. However, I admit that I can also see how this mindset can be dangerous… ultimately God is the decision maker, whether it’s for more or no more children.

Also, as an aside, my understanding of the ectopic pregnancies FROM A MEDICAL standpoint, (not moral) is that it is quite easy for the doctors to repair the tube so it is quite healthy… although you do have a higher chance for another ectopic. It sounded like many were insinuating that once repaired, the tube is a risk to the mother, and I don’t think that’s quite the situation. 🙂
 
I know this is a good year later… so if I don’t receive any replies it wouldn’t surprise me! 😃 But I came across this thread because I was researching the Catholic theology on Ectopic pregnancies… and what a great thread it was! One thing that I was struggling with understanding, that I would REALLY love Br. (JReducation) to go into further is the idea of moving the baby from tube to uterus. I can totally understand that you don’t want to cause direct harm to baby, especially if there is little if any chance to help said baby survive. But at the same time, there is something very compelling to me about trying it, no matter how small the chance, even if it hasn’t been shown to have good chances of survival. Isn’t this respecting the life of the baby more so than removing the tube? It seems to be analogous to a patient who has a tumor on their brain that needs to be removed or they will die within a couple of weeks… the doctor knows the high chances of the person being killed from operating on them, yet is holding out hope for the very slim chance that they will survive. It helps that this analogous situation is a real one 😛 (I have a dear friend that went through this very thing with her daughter and she made it and is completely normal now!!) If you remove the tube completely, the baby will die. If you move the baby to uterus, there is a chance he/she could survive. I was just reading about a case where a doctor in 1915 did just that and the mother carried said baby boy to term!

Do you have any insight into this more? It seems to me, (coming from a mother of 7 in her late 20’s who hopes God blesses her with many more children!) that if I were put in this situation, I would strive to save the life of the baby, even if it’s very unlikely that he/she would survive. An added good is the fact that you could also save the tube (maybe, if it’s not damaged too much), and then be able to raise many more little souls for God. However, I admit that I can also see how this mindset can be dangerous… ultimately God is the decision maker, whether it’s for more or no more children.

Also, as an aside, my understanding of the ectopic pregnancies FROM A MEDICAL standpoint, (not moral) is that it is quite easy for the doctors to repair the tube so it is quite healthy… although you do have a higher chance for another ectopic. It sounded like many were insinuating that once repaired, the tube is a risk to the mother, and I don’t think that’s quite the situation. 🙂
Tansferring the baby from the tube to the uterus is an area of surgery that I am unfamiliar with. Therefore I cannot speak to it specifically. I can say that the moral rule is that any direct and intended attempt to terminate the life of the baby in order to save the life of the mother is immoral.

If this process exists and it works, I don’t see how it is an attempt to terminate the baby’s life. It would seem to my medical layman’s mind to be an attempt to save the baby. The baby may die in the attempt, but he does not die because someone deliberately tried to kill him. That’s the difference between this procedure and the usual procedure is that in the usual procedure the idea is to take the baby out of the tube and cast her aside in order to save mother and tube. In effect, mother and doctor agree that the mother’s life warrants the deliberate termination of the child’s life. You can never take an innocent life to save a life. The rule is that you must do whatever is in your power to save both lives. If there is such a procedure, such as moving the infant from the tube to the uterus, it sounds like it’s an attempt to save both lives.

Again, I’m not surgeon or a medical ethicist. I can only apply the rule as it is written in moral theology. You may never attempt to directly and knowingly kill an unborn child. Such an act is the gravest form of child abuse, because it is the murder of a helpless child.

Fraternally,

Br. JR, OSF 🙂
 
Thank you, I think this makes sense. I am still wrapping my brain around the whole argument, but I think the sediment is settling after talking to hubby and with your reply as well. 😃 I think there is still a part that doesn’t quite understand it fully (the fine difference between removing the tube and the removal of the baby), but on the other hand I can understand the directness of the action too. Maybe after a few days I’ll finally be settled about it! 😛
 
Here is an opposing opinion

zenit.org/article-29448?l=english

In nutshell:
  • the question is opinion, not definite Church teaching
  • Methotrexate does not kills the fetus, only removes it from the tissue to which it clings.
In my opinion:
  • many Americans voted for politicians who voted for or directly ordered wars, which intentionally killed people, most of them innocent.
  • related to ‘do not kill’ there should be no difference according to the tools used to kill, to kill by suicide bomb is as much wrong as to kill by the safety of 5000 feet with airplane bombs; in this case to kill by surgical knife is the same as to kill by chemicals.
  • in the traditional morality the Eskimo women who in a cold winter night sit out to the ice to save food for the younger was exonerated from suicide.
 
Where did you find the info that the question is opinion and not Church Teaching? I would be interested to read further on the subject.

Is William May considered orthodox? Does anyone know? I did a basic search for him and he seems to be, but not sure.
 
Where did you find the info that the question is opinion and not Church Teaching? I would be interested to read further on the subject.

Is William May considered orthodox? Does anyone know? I did a basic search for him and he seems to be, but not sure.
I searched carefully the Vaticanm.va site and found no reference for ectopic pregnancy, except that some promoting fertility methods could cause that.

An opinion should be read for its intrinsecal value, not for labeling the speaker. No ‘ism’ is depository of the truth or lie.
 
Many of links that were posted here seem to be lumping ectopic and tubal together for the purposes of the issue in question (while most are tubal, the term covers anything outside the uterus).

I am confused regarding an ectopic pregnancy that is not tubal, specifically where the fetus is definitely not in one of the fallopian tubes and definitely not in the utereus. In this instance the life of the mother and future pregnancies is at immediate risk, and removing the tube isn’t an option, thus rendering the drug the only safe option for the mother.
 
Many of links that were posted here seem to be lumping ectopic and tubal together for the purposes of the issue in question (while most are tubal, the term covers anything outside the uterus).

I am confused regarding an ectopic pregnancy that is not tubal, specifically where the fetus is definitely not in one of the fallopian tubes and definitely not in the utereus. In this instance the life of the mother and future pregnancies is at immediate risk, and removing the tube isn’t an option, thus rendering the drug the only safe option for the mother.
I’m a bit confused about that too. Those are unique and rare situations and can only be dealt with on an individual basis because the outomes can vary.

If the abdominal pregnancy has progressed to the life of the woman being in “immediate risk” as your senario above, they wouldn’t be using methotrexate. If the woman’s life is in danger, and she’s bleeding out because of a rupture, they would do surgery to stop the bleeding. The unintended result of trying to stop the bleeding may be the death of the fetus, but that’s not the primary intention.

They may suggest the usage of methotrexate when it’s first diagnosed though. And of course, a Catholic cannot take it if they want to be in communion with the Church. They’d have to opt for surgery.

Since the age of viability for a fetus is 20 weeks, you can wait until viability and have a caesarean — if you can wait and nothing has hemorrhaged already! But of those rare cases, most of them aren’t diganosed until the woman is full term, and by that time the medical team is working to save both.

Sometimes they make it to viability and the woman, though she loses a lot of blood, can be transfused and saved. But a lot of times the fetus dies or is severely deformed (there is no amniotic barrier, etc).

So, if the fetus is already dead, of course, they just remove it. If the fetus is alive but the woman is hemorrhaging, the bleeding of course has to be managed and part of that management is removing the fetus (whether the fetus is viable or not). The death of the fetus is an unintended effect of treating the mother for hemorrhage.

The placenta and sac is a problem if it has embedded into any organs in the woman’s body. They might tie if off and leave it in to resolve on its own because trying to take it out my rupture her gut or blood vessels. They have to work towards finding the bleed, and stopping the bleed, without causing more damage. But it can be a real mess. I hope I never see one of those!
 
I still struggle with the Church’s reasoning that removing a “diseased” tube (for example) that ends the life of a fetus is morally different than direct removal of that fetus. I liken this reasoning to a mental reservation. The surgical intent behind both procedures is the removal of the fetus which is what is presenting the threat to the mother (and the tube). Saying the tube is the problem - not the developing fetus - is disingenuous. I think we can have the same mental reservation to do good while directly removing the fetus as we have when removing the tube.
 
I still struggle with the Church’s reasoning that removing a “diseased” tube (for example) that ends the life of a fetus is morally different than direct removal of that fetus. I liken this reasoning to a mental reservation. The surgical intent behind both procedures is the removal of the fetus which is what is presenting the threat to the mother (and the tube). Saying the tube is the problem - not the developing fetus - is disingenuous. I think we can have the same mental reservation to do good while directly removing the fetus as we have when removing the tube.
I kinda struggle with the same thing… at the same time, I can see how one is a direct attack, and one is not. I can kinda wrap my brain around it, but it’s not completely settled either.

So my more conservative side says that even doing that is wrong if the tube isn’t already damaged and needs removal.

On the other hand, another thing that doesn’t set well is that IF this is allowed, I can kinda see how using a drug to flush out the baby could be allowed too… because your intention is not to kill the baby, but to remove the blockage. But that doesn’t quite seem right either.

This is just one area that I think I am going to have to accept the Church’s authority on. If I ever get into this position, I would probably ask my very holy and well knowledgeable FSSP priest about it and accept his say-so with obedience. I pray that never happens.

Ideally, the baby would have passed already and it would be a moot point :crying: ; or you could find a doctor who would attempt to save the baby by removing and trying to get the baby to take to the uterus, where he/she would be safe. IF you could find a pro-life doctor who would do that.

Hopefully some pro-life doctors would start going down this path, and research the possibility of saving the baby. If it could be done back in 1915, couldn’t it be done much easier now? I really resent the anti-life culture… they are so focused on nasty stuff instead of good, holy things.
 
Maybe I’m getting too personal with the thought process…

I keep thinking that if I were in the position, that I would want to save the baby, I would gladly die for said baby if that would save baby, etc… but if baby could not make it, it seems hard to think that you would have to not only have the baby die, but also remove the tube too.

I have a hard time accepting that you can pull the tube out with baby and let baby die… and yet it’s not okay to simply remove the baby directly from the tube and let the baby die; not because you are trying to kill the baby, but because the baby is blocking the tube and can’t be there!

As a hypothetical: can you remove the uterus AND baby from a woman who’s life is in danger; causing the baby to die; even if the uterus is not damaged already? For instance, if the woman had a serious form of hypertension? I kinda doubt it. So if the tube is not already damaged, can you in good moral conscience remove it along with baby? Is it any different than the above scenario? :eek:

Am I getting too mental about this? LOL 😃
 
Maybe I’m getting too personal with the thought process…

I keep thinking that if I were in the position, that I would want to save the baby, I would gladly die for said baby if that would save baby, etc… but if baby could not make it, it seems hard to think that you would have to not only have the baby die, but also remove the tube too.

I have a hard time accepting that you can pull the tube out with baby and let baby die… and yet it’s not okay to simply remove the baby directly from the tube and let the baby die; not because you are trying to kill the baby, but because the baby is blocking the tube and can’t be there!
The Church allows removal of the tube in the case of tubal pregnancy because the primary intervention is removal of the tube, rather than removal of the fetus. The action can only be on the diseased organ in order to be compliant with Church rules. That’s why you can’t just remove the baby and save the tube, according to Church rules. The primary intervention cannot directly remove the fetus.
As a hypothetical: can you remove the uterus AND baby from a woman who’s life is in danger; causing the baby to die; even if the uterus is not damaged already? For instance, if the woman had a serious form of hypertension? I kinda doubt it. So if the tube is not already damaged, can you in good moral conscience remove it along with baby? Is it any different than the above scenario? :eek:
Yes. You can remove the uterus and fetus from a woman whose life is in danger even if the uterus is not damaged already. For instance, in the case of a tubal pregnancy, once a diagnosis is made, the Church allows for prescribed treatment. And really, the only reason such a diagnosis is made is because the woman is showing signs and symptoms of tube trauma…so even though you can’t see it, it is being damaged. Now, some women might want to wait it out (for example, they might wait for it to resolve on it’s own, or for the fetus to leave the tube on it’s own), but the Church does not require a woman hemorrhage and bleed out before interventions are done. But it is her right to wait it out if she wants. Just as it’s her right to seek medical attention and consent to treatment once a diagnosis is made.

So if a pregnant woman is diagnosed with uterine cancer, and treatment is recommended right away. The Church allows her to be treated. If she can’t wait for viability and her uterus is removed (primary intervention), she can do so, even though there is a fetus in it (secondary), because the primary intervention is to remove a diseased organ. She can also start cancer treatments, while pregnant, if her doctor says it can’t wait, even while pregnant because the primary interventions are treating the diseased organ. The fact that the fetus may be affected by the treatments is an unintended side effect. Yes, you absolutely can choose to wait until viability, but the Church does not require a woman to do so.

With hypertension, the Church requires treatment of the hypertension as the primary actions. So the primary interventions must treat the hypertension according to the rules of the Church. If the primary interventions that target the hypertension itself (like medications) harm or kill the fetus, it’s an unintended side effect (secondary). But the fetus cannot be directly acted on UNLESS that treatment is removing the fetus after viability (cesaerean) and continuing to treat the fetus to term. It’s not like you’re removing the fetus before viability and allowing it to die. You’re removing it and continuing to treat it to term. That’s allowed because the intention is to treat both. And according to my text books, the age of viability is 20 weeks. Of course, the longer the better, but if it can’t wait, and efforts are taken to save BOTH, it is allowed by the Church.
Am I getting too mental about this? LOL 😃
No, you’re not. But understand that another woman may not be willing to take the same risks, for whatever reason, and that the Church doesn’t require it. Whether it’s the thought of other children at home, or elderly parents at home, or a husband at home, or for whatever reason, another woman might not want to risk death in a high risk situation that you might be willing to take and the Church doesn’t require it.
 
Rence;6547129:
First off I accept that this is the Church’s teaching, but it does leave me scratching my head.

Tubal pregnancies are doomed from the start, the baby will never survive to the age of viability and we don’t yet routinely “transplant” them to the uterus. Instead of using a drug to terminate the non-viable pregnancy we incidentally terminate the pregnancy by removing the fallopian tube to prevent hemorrhage and possible maternal death. What have we done that is morally better? Nothing in my opinion. The baby loses it’s life either way but now the mother has lost a fallopian tube which may impede her future fertility and she has been subjected to a potentially dangerous surgery.
Take two similar but fundamentally different cases: Case 1: A fireman runs into a burning building and finds two injured people. He carries one out leaving the other to fend for himself but that one eventually dies. He saved the one person but could not save the other.
Case 2: A fireman runs into a building and finds two injured people. He shoots one and carries the other to safety. One person lives and one dies. Same result as case 1 but very different.

Intent is very important. It is never permissible to intentially kill an innocent child in the womb, but if a fetus dies while saving a mothers life and there was no other way to save both, then you have made the best of a bad situation.
 
Take two similar but fundamentally different cases: Case 1: A fireman runs into a burning building and finds two injured people. He carries one out leaving the other to fend for himself but that one eventually dies. He saved the one person but could not save the other.
Case 2: A fireman runs into a building and finds two injured people. He shoots one and carries the other to safety. One person lives and one dies. Same result as case 1 but very different.
Thanks, but those “comparisons” never did help me to understand. No matter how hard one tries, they just don’t compare. But thanks for trying 🙂 I understand what the Church’s teaching are and I understand why, but to me there is no difference between taking methotrexate and removing the tube. The end result is the same and the intent is the same. They don’t compare with a fireman shooting a civilian, sorry 🙂
Intent is very important. It is never permissible to intentially kill an innocent child in the womb, but if a fetus dies while saving a mothers life and there was no other way to save both, then you have made the best of a bad situation.
That’s what I said: “…the primary interventions are treating the diseased organ. The fact that the fetus may be affected by the treatments is an unintended side effect…”
 
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