The Church has got to be kidding on this one, right?

[pgoings]

Fr Hogan’s area of expertise seems to be medieval history rather than moral theology. His assertion that “women with the gene you describe have a very, very good chance in not developing breast cancer” is still a matter of vigorous scientific and medical debate, and is far from settled. If his conclusion is based on this, then it is perilously contingent. While he may, in fact, be entirely correct, I would not consider what he has written for EWTN’s forum to be the final word on the subject.

 

[setter]

fix:

Re: Preventive surgery. Answer by Fr. Richard Hogan - NFP Outreach on 10-25-2002

Thank you for this clarifying (name removed by moderator)ut.

 

[fix]

pgoings:

Fr Hogan’s area of expertise seems to be medieval history rather than moral theology. His assertion that “women with the gene you describe have a very, very good chance in not developing breast cancer” is still a matter of vigorous scientific and medical debate, and is far from settled. If his conclusion is based on this, then it is perilously contingent. While he may, in fact, be entirely correct, I would not consider what he has written for EWTN’s forum to be the final word on the subject.

I would agree his is not the last word. I would also say we have seen no “proof” that it is licit to excise a healthy breast. In fact, I think there is more eveidence to suggest it is illicit.

 

[fix]

setter:

Thank you for this clarifying (name removed by moderator)ut.

I am glad to add some information, but as I said I do not think his is the last word. I have not seen any evidence posted that would lead me to believe the Church says it is acceptable to eliminate a functioning part of the body because it may become diseased.

Now, what if it could be proven, as in some diseases, that genetic testing shows a certain pathologic condition will always occur if given certain facts. Not a likelyhood, but will happen each and every time?

 

[setter]

fix:

I am glad to add some information, but as I said I do not think his is the last word. I have not seen any evidence posted that would lead me to believe the Church says it is acceptable to eliminate a functioning part of the body because it may become diseased.

Now, what if it could be proven, as in some diseases, that genetic testing shows a certain pathologic condition will always occur if given certain facts. Not a likelyhood, but will happen each and every time?

Hence my original query:

Originally Posted by setter
I am wondering if anyone has a better understanding if “preventative” or “preemptive” amputation/surgical mutilation (with the unintended consequence of sterilization) is morally licit if it a medically assessed that a potential risk exists for the continued presence of a body organ as fulfilling “constitutes a threat to the complete organism”.

 

[pgoings]

fix:

I would also say we have seen no “proof” that it is licit to excise a healthy breast. In fact, I think there is more eveidence to suggest it is illicit.

The former is obviously true; the latter is possibly true. That said, it then becomes a matter for a woman to decide for herself, ideally under the guidance of her doctor and confessor. In any case, I would strongly caution against making broad statements which are to be applied to all women with similar circumstances. (Unless we are intending to revive Jansenism and condemn S. Alphonsus as a laxist!)

 

[pgoings]

fix:

Now, what if it could be proven, as in some diseases, that genetic testing shows a certain pathologic condition will always occur if given certain facts. Not a likelyhood, but will happen each and every time?

This would be great, but I submit that it is not necessary. There are examples in the literature of ectopic pregnancies which have resulted in the survival of both the mother and child, but the Church does not require any sort of “wait and see” position; the fallopian tube, containing, a then-viable fetus, may be excised immediately. Absolute certainty is a lovely idea, but generally unlikely to be found in the real world, and the Church admits this.

 

[fix]

pgoings:

The former is obviously true; the latter is possibly true. That said, it then becomes a matter for a woman to decide for herself, ideally under the guidance of her doctor and confessor. In any case, I would strongly caution against making broad statements which are to be applied to all women with similar circumstances. (Unless we are intending to revive Jansenism and condemn S. Alphonsus as a laxist!)

You would agree there are general principles that need to be understood? I accept each medical situation is different, but that does not mean there are not certain moral norms that may never be violated.

 

[fix]

pgoings:

This would be great, but I submit that it is not necessary. There are examples in the literature of ectopic pregnancies which have resulted in the survival of both the mother and child, but the Church does not require any sort of “wait and see” position; the fallopian tube, containing, a then-viable fetus, may be excised immediately. Absolute certainty is a lovely idea, but generally unlikely to be found in the real world, and the Church admits this.

I would say the analogy is flawed. An ectopic pregnancy is always pathologic. There is no one test one does to see if an ectopic pregnancy may occur and thus preventively excise part of a tube.

I was thinking of some genetic conditions, that if tested for, always express themselves as pathologic in a person.

 

[pgoings]

fix:

You would agree there are general principles that need to be understood? I accept each medical situation is different, but that does not mean there are not certain moral norms that may never be violated.

There are general principles and there are also inviolable norms, as you say. However, this situation requires the application of the general principles to a moving target of medical knowledge, without going against any of the inviolable norms. This is never an easy thing to do, and as our understanding of science changes, the morality of specific acts changes.

 

[pgoings]

fix:

I would say the analogy is flawed. An ectopic pregnancy is always pathologic. There is no one test one does to see if an ectopic pregnancy may occur and thus preventively excise part of a tube.

I was thinking of some genetic conditions, that if tested for, always express themselves as pathologic in a person.

I’ll admit that it’s not a perfect analogy, but it has some merit. It is a fact that ectopic pregnancies which are allowed to progress naturally do not always result in the death of the mother and child, although this is the far, far rarer outcome. However, since there is a finite possibility of survival, can the Church permit a medical procedure which also results in the death of the embryo or fetus? The answer, as we know, is yes. It cannot, therefore, be a question of requiring absolute certainly of harm.

Further, you are correct to point out that an ectopic pregnancy is inherently pathological, but then the question becomes one of determining whether the occurrence of a genetic predisposition is itself pathological. In a sense it’s a question of semantics, but it seems that we must avoid defining “pathological” so narrowly that it requires current or imminent damage to be occurring, as this would tend to rule out any non-symptomatic condition.

 

[fix]

pgoings:

There are general principles and there are also inviolable norms, as you say. However, this situation requires the application of the general principles to a moving target of medical knowledge, without going against any of the inviolable norms. This is never an easy thing to do, and as our understanding of science changes, the morality of specific acts changes.

The question Setter asks is excising the organ an inviolable norm?

 

[pgoings]

fix:

The question Setter asks is excising the organ an inviolable norm?

The answer is obviously not. It is clearly licit to excise a breast or uterus when certain pathological conditions exist; the question is whether these conditions can be said to exist when a genetic predisposition is present. On this question there is both disagreement among theologians and a set of widely varying scientific and medical opinions, which underlie our understanding of “pathological.”

 

[fix]

pgoings:

I’ll admit that it’s not a perfect analogy, but it has some merit. It is a fact that ectopic pregnancies which are allowed to progress naturally do not always result in the death of the mother and child, although this is the far, far rarer outcome. However, since there is a finite possibility of survival, can the Church permit a medical procedure which also results in the death of the embryo or fetus? The answer, as we know, is yes. It cannot, therefore, be a question of requiring absolute certainly of harm.

I guess I am a bit dense here. The situation you are referring to is not one a prevention. It has occured. That some survive does not relate to the question of intervening before pathology strikes or even if it strikes.

Further, you are correct to point out that an ectopic pregnancy is inherently pathological, but then the question becomes one of determining whether the occurrence of a genetic predisposition is itself pathological.

Yes, that is part of the point. If a gentic disease will always present itself as life threatening is different then if it may present at all.

In a sense it’s a question of semantics, but it seems that we must avoid defining “pathological” so narrowly that it requires current or imminent damage to be occurring, as this would tend to rule out any non-symptomatic condition.

Why? It is a question of a condition actually occuring and if the therapy is licit.

 

[setter]

fix:

In a sense it’s a question of semantics, but it seems that we must avoid defining “pathological” so narrowly that it requires current or imminent damage to be occurring, as this would tend to rule out any non-symptomatic condition.

Why? It is a question of a condition actually occuring and if the therapy is licit.

Not to get hung up on semantics, but how can a “pathological condition” be diagnosed (and in need of treatment) with out the presence of identifiable symptoms or genetic markers?

 

[fix]

setter:

Not to get hung up on semantics, but how can a “pathological condition” be diagnosed (and in need of treatment) with out the presence of identifiable symptoms or genetic markers?

I am trying to say that if a test exists that says one will definitely contract cancer will that justify preventive surgery, not just a test that says there is some degree of chance.

My question is related to the post where Fr. Hogan seems to be saying that just because some chance exists one may get cancer is not reason enough to remove a breast. Am I making sense?

 

[fix]

pgoings:

The answer is obviously not. It is clearly licit to excise a breast or uterus when certain pathological conditions exist; the question is whether these conditions can be said to exist when a genetic predisposition is present. On this question there is both disagreement among theologians and a set of widely varying scientific and medical opinions, which underlie our understanding of “pathological.”

I should have been more precise. Is excising a healthy organ because it may become pathologic licit?

 

[setter]

fix:

I am trying to say that if a test exists that says one will definitely contract cancer will that justify preventive surgery, not just a test that says there is some degree of chance.

My question is related to the post where Fr. Hogan seems to be saying that just because some chance exists one may get cancer is not reason enough to remove a breast. Am I making sense?

Even with evolving medical knowledge for pathological determination and predictability, the moral question needs to be determined (by those charged with this responsiblity) of whether imminent threat of serious harm to the organism is sufficient reason to licitly remove an non-pathological organ, especially if the organ is in itself a basic human good, i.e., reproductive good.

 

[fix]

setter:

Even with evolving medical knowledge for pathological determination and predictability, the moral question needs to be determined (by those charged with this responsiblity) of whether imminent threat of serious harm to the organism is sufficient reason to licitly remove an non-pathological organ, especially if the organ is in itself a basic human good, i.e., reproductive good.

That seems like the issue to me.

 

[Pug]

setter:

Properly understood as a basic human good, removal of a woman’s uterous is a direct assault on the reproductive good, hence the conditions/criteria of the Principle of Totality (link) with the Principle of Double Effect (link) need to be met in order for the procedure to be morally licit.

Truly, I am somewhat surprised to see disagreement here, so I am trying to figure out the source. I am not good at tracking these long threads, so bear with me. I agree one must not directly intend to and attack a basic human good. That is why we have the idea of when things are a side-effect. I am talking about a situation in which the uterus is removed, and sterility will result INdirectly, ie as a side effect. If the woman wanted sterility, then cutting her tubes would suffice. But it doesn’t suffice. That has no effect on future cancer risk. Do we agree it is indirect here (I specify that she is not secretly seeking sterility)?

If you have access to The Way of the Lord Jesus, volume 3, Difficult Moral Questions, by Germain Grisez, please see question 53 (it is only a few pages). I presume it is not legal for me to type it out here?

I am familiar with double effect as a concept. I will try to use the website you provided, but I have not learned via this precise definition:

1. The object is reduction of cancer risk. The object is overall total bodily health. There is argument on this thread about reduction of risk as an object, but that is not the argument you gave against my hypothetical, so I will let this one pass.
2. The woman is not seeking sterility. If that were her object, she could just accept having her tubes cut. But I specified that this would not meet her needs.
3. Sterility is not in itself causing the reduction of cancer risk. I don’t think it is like the case of making a person sterile specifically so they can’t get pregant again. Then the sterility is what is doing the deed. But it is the lack of a uterus, not sterility per se that is reducing cancer risk. Otherwise cutting the tubes would work. Sterility itself does not reduce cancer risk. The bad side effect is not producing the good.
4. That the woman won’t get uterine cancer follows at least as immediately from the removal of the uterus as that she won’t be able to carry a child in the uterus.
5. The reason I mention age has to do with how removal of a uterus has an effect on a woman based on her age. Removal of a uterus from a younger woman has the side effect of sterility, a huge side effect. Removal of a uterus from a 55 year old woman does not have that side effect, as she is already sterile (from menopause). The removal of a uterus from the 45 year old woman who has just cause to abstain for the remainder of her fertile years is less affected by sterility than a 25 year old woman just married. You cannot accept certain side effects without proportionate reason. That is part of the principle of double effect, so far as I know. If accepting the side effects would break the golden rule or be disproportionate somehow, you can’t do it. Removal of a uterus to prevent some future thing on a woman who is 25 and just married and is fertile and is free to reproduce is not reasonable. But the 45 yr old woman has already reached the decision that she is not morally free to seek pregnancy.

Also, the reason I specify that she is currently pregnant is that her impending cesarean section is what is making the additional surgical risk minimal (to meet the burden of it being in the best interest of overall bodily health). Removal of a uterus from a woman just to reduce cancer risk is probably not balanced out right if she has to undergo an entire surgery for it. Surgery carries serious health risk.

Although your objection did not appear to be on the grounds of #1, it seems to me that is the most promising basis for one. Either that or you attempt to say that one cannot pursue one good to the detriment of a different good, even if only as a side-effect (and you are classifying health and reproduction separately). But I assume that is not your argument.

Sorry this is so long! Also, I have no desire to go against Church teaching. I am just trying to work out the specifics of this hypothetical scenario as an exercise in understanding.