What is the church's teaching on ectopic pregnancy?

[Daniel_Kane]

From Priests for Life - (Scroll Down to Question #6)


I am an oncology nurse and was asked to give methotrexate for an ectopic pregnancy on another floor since only oncology nurses can give chemotherapeutic drugs. I believe the pregnancy was tubal. Needless to say I refused because I was unsure of the morality of it. I do not know the entire patient situation since the patient was on another floor. Could you please explain the morality of this act according to the church’s teaching. I do not think the mother’s life was in danger at this particular time. Thanks and God bless you. P.S. I work at a catholic hospital

Answer: There is more than one medical way of handling an ectopic pregnancy. The relevant moral question is whether the method or action is in fact a killing of the child. If so, that is a direct abortion, which is never permissible for any reason. "Direct means that the destruction of the child is willed as the end or the means to another end. Sometimes ectopic pregnancies are handled this way, killing the child but leaving the tube intact. Such an action is morally wrong.

However, if what is done is that the damaged portion of the tube is removed because of the threat it poses to the mother, that is not a direct abortion, even if the child dies. What is done is the same thing that would be done if the tube were damaged from some other cause. The mother is not saved by the death of the child but by the removal of the tube. Because the death of the child in this case is a side effect which is not intended, and because the saving of the mother’s life is not brought about by the death of the child, such a removal of the damaged portion of the tube is morally permissible. The ethical rule that applies here is called the Principle of the Double Effect.

 

[ncjohn]

http://www.ewtn.com/library/PROLIFE/EXCEPT.TXT

Sheds some light and perspective but is written in technical philosophical language. In abstract, it supports the contention that removal of the tube along with the embryo is a licit act properly applying the principal of the double effect.

From EWTN.

Thanks, that was a pretty good article, though not definitive.

I did come to the conclusion that my interpretation should be valid under this, and was even strengthened by the statement:
Exception: To save the Life of the Mother:

…and if the action is necessary **and is the least harmful means ** for attaining the good effect.

Thanks again!

 

[Daniel_Kane]

My solitary contention from the begining (and in answer to the OP) is that it is licit to observe and see if the condition resolves or to remove the tube (or a portion). Common sense would indicate that one should employ a “minimalist” approach.

While we speak of an “ectopic pregnancy” this condition has a number of causes some preventable, some not, some treatable some not which is why the bishops use the language that they do in giving guidance to hospitals. At what point the diagnosis is made is also relevant to the type of treatment needed.

Current dirrection in this area proposes “milking” the tube to see if one can get the embyro to dislodge and reimplant in the uterus but so far such efforts have been unsuccessful.
What is clearly condemned is the use of chemical agents to attack the embryo.

Not a solitary author (Catholic or secular) has rejected the notion that either waiting or tube removal is immoral or illicit.

 

[WorBlux]

The chemical method is not any more a direct attack on the fetus that removal of the tube is.

The surgical method involves removal of the portion of the tube that the embryo is attatched to. The chemical method createws hormonal and physical changes so that the embryo cannot remain attatched.

The chemical method still has the the double effect when taking such a hormonal dose primarily to end the dangerous condition of the ectopic pregnency, and has the secondary effect of killing the embryo.

"The ethical principle governing this, and similar cases, is a
long-standing one called the principle of double-effect. It is explained
in this way: an action which terminates in two effects, one good and one
evil, may be undertaken if the action, by its nature, is not evil, and if
the good end is primarily intended and the first to be executed, and if
the good effect is at least equal to the evil effect, and if the action is
necessary and is the least harmful means for attaining the good effect.
"

Even this being said, it becomes apparent becomes harder to justify when the primary and secondary are very tied together and happen almost simotaniously. The chemical method does not poisen the embryo, rather it casues it to detatch from from the tubal wall, where it would cause harm to the mother, and after detatchment the embryo dies. Also taking in hormones or other medications is not intrinicly evil if it is taken into the body for a specific medical purpose.

Therefore I assert that both the chemical and surgical removal of a portion of the tube both fall under the principle of double effect, although I would except the chemical method to have a lower risk than the surgical.

 

[AlanFromWichita]

We have this comparison backwards.

The problem is not that I am trying to justify an illicit act to a licit means.

The problem is that my opposition is trying to justify an illicit end by claiming it was accomplished via licit means.

This is an ostrich-in-the-sand mentality toward “not killing” the child.

The evil end is that unnecessary damage is done. The baby dies both ways – unless you argue about how much pain it may suffer (in which case you give it an anesthetic). Therefore the only difference is in one case we have elective mutilation. Then we look into the sky and sigh, “yes, we had to do more damage, but the child knows that we weren’t angry with it.” Let’s face it; the child has to go and if that weren’t the case then nothing would have to be done medically at all. If we can’t face that reality then we are simply denying ourselves, and playing the role of martyr.

There is one possible benefit that could ameliorate the damage, I suppose, at least emotionally or spiritually if not physically. Perhaps it is emotionally advantageous for people to go ahead and suffer the damage because it feels like a penance for having to have taken the child. Of course, the parents knows that the child was doomed, but maybe suffering wounds and being partially or completely neutered sexually (depending on whether the other side is fertile) has a healing effect of some sort. That way, there may be physical damage, but the wounds of the mother will somehow make the mother have a sense of unity to the child’s plight. Sounds weird, but it makes more sense than what has been presented here as Truth.

Alan

 

[needmorelight]

Since I’m not a medical doctor, I tried to look up extrauterine pregnancies and found useful information from this site:
talkmedical.com/medical-dictionary/5219/Extrauterine-Pregnancy

and here: tabebak.com/Thesis/Gynae-Nursing/ECTOPICP.htm

This discussion has centered around the moral means of treating an ectopic pregnancy occuring in the fallopian tube but what about those that occur in other places like the abdominal cavity (e.g. the liver, spleen, or intestines)? ?) Does it entail removing part of whatever organ the embryo is attached to (anybody a doctor here?). In other words, is it also immoral to “separate” the embryo from its site of attachment, say by cutting the umbilical cord ? If we have answers on this scenario then that would probably help in the point that I will raise in the next paragraph.

I don’t have a problem with removing the fallopian tube as a moral means, and I *think * I understand why because of the principal of double effect this is a lot different from just using drugs to dissolve the embryo. I think Lorarose and some other people are just wondering why the principal of double effect cannot also apply to the act of surgically separating the embryo from the tube (probably along the same lines as separating a fetus in fetu from its host twin).

I also think Lorarose is sincerely concerned about leaving the mother sterilized. The first article that I linked did say that the chance of successful pregnancy drops if the fallopian tube is removed as opposed to sparing it (I don’t know how statistically significant this is though). On the other hand, it also says that surgery on a fallopian tube can predispose it to future ectopic pregnancies (which is not good).

 

[Katie1723]

I am reading all these posts and I am seeing some good points. But I would venture to say when it came right down to it, ALL would chose removal of the affected tube to save the life of the mother. You can all argue until hell freezes over, but when it comes right down to it, you have to have a mama before you can have a baby. And right now, removal of the ectopic is the ONLY way to save the mama.
Kathy

 

[AlanFromWichita]

Katie1723:

I am reading all these posts and I am seeing some good points. But I would venture to say when it came right down to it, ALL would chose removal of the affected tube to save the life of the mother. You can all argue until hell freezes over, but when it comes right down to it, you have to have a mama before you can have a baby. And right now, removal of the ectopic is the ONLY way to save the mama.

                          Kathy

According to the articles that needmorelight just posted, there are some times the fallopian tube must be removed, and some cases in which it can be saved. As one would expect, the chances of pregnancy are lower in the cases it is removed, as this effectively sterilizes one side – as long as the other side works the woman is not completely sterile.

No, when it comes right down to it, I don’t believe ALL have agreed that removal of the tube is morally licit when it is not required.

In all cases the baby must be removed but not in all cases must the tube also be removed. To claim that we must ceremoniously remove the tube as a kindness to the child is total nonsense; this way the child not only loses its life but the child may have fewer or no siblings as a result of its mother’s elective mutilation surgery.

Alan

 

[shannyk]

To claim that we must ceremoniously remove the tube as a kindness to the child is total nonsense; this way the child not only loses its life but the child may have fewer or no siblings as a result of its mother’s elective mutilation surgery.

Alan, Have you ever considered the fact that removing the tube is a “kindness” (as you put it) to the mother?? In a situation like that (which I have been in if you’ll scroll up to my earlier post) there is no good solution. The woman is already traumatised by the precarious situation both she and her child are in. Faced with the fact that there is no way (as of now) to come out of it with a normal pregnancy, she knows whatever action she takes will, much to her dismay, end the life of her child, if it hasn’t already ended. Having been in this situation I can tell you I would have been TERRIFIED at the idea if ‘dissolving’ my baby, simply to save my fallopian tube. The idea of lying there while your child dissolves inside your body is hardly comforting. Removing my fallopian tube is hardly ‘elective mutiliation’. I would have never elected to remove my tube unless it HAD to be done. I’m not mutilated any more than someone who has their appendix removed. Nor am I sterile, as I have had 3 successful pregnancies since the removal of my tube.

 

[Joan_M]

AlanFromWichita:

According to the articles that needmorelight just posted, there are some times the fallopian tube must be removed, and some cases in which it can be saved. As one would expect, the chances of pregnancy are lower in the cases it is removed, as this effectively sterilizes one side – as long as the other side works the woman is not completely sterile.

No, when it comes right down to it, I don’t believe ALL have agreed that removal of the tube is morally licit when it is not required.

In all cases the baby must be removed but not in all cases must the tube also be removed. To claim that we must ceremoniously remove the tube as a kindness to the child is total nonsense; this way the child not only loses its life but the child may have fewer or no siblings as a result of its mother’s elective mutilation surgery.

Alan

“Removing the baby” is a direct abortion and forbidden by the Church. What part of this do you not understand? I do not believe that you - and any others of the same opinion - do not understand this, but just reject it.

 

[AlanFromWichita]

shannyk:

Alan, Have you ever considered the fact that removing the tube is a “kindness” (as you put it) to the mother?? In a situation like that (which I have been in if you’ll scroll up to my earlier post) there is no good solution. The woman is already traumatised by the precarious situation both she and her child are in. Faced with the fact that there is no way (as of now) to come out of it with a normal pregnancy, she knows whatever action she takes will, much to her dismay, end the life of her child, if it hasn’t already ended. Having been in this situation I can tell you I would have been TERRIFIED at the idea if ‘dissolving’ my baby, simply to save my fallopian tube. The idea of lying there while your child dissolves inside your body is hardly comforting. Removing my fallopian tube is hardly ‘elective mutiliation’. I would have never elected to remove my tube unless it HAD to be done. I’m not mutilated any more than someone who has their appendix removed. Nor am I sterile, as I have had 3 successful pregnancies since the removal of my tube.

I am happy that you were able to have more pregnancies. Obviously in your case, the other side was working.

No, you are no more mutilated than having your appendix removed, and there are evidently medical reasons that sometimes – maybe even often – it is unavoidable. That’s fine, and I certainly don’t have a problem with it.

What I want to know is why it bothers you that the child is killed one way instead of another? How is it kinder to the child, or more obedient to God, to use one method over the other? Your conscience should be completely clear of either method, as both methods saved your life and neither one took the baby’s life unnecessarily.

In your case, maybe there really wasn’t an option. If there was, then I don’t seem how the “image” of killing a baby and removing it is any more hideous than removing the tube with baby.

Alan

edit>> if it is a “kindness” to do the surgery, in cases it is not required, it is to allow our vision of what’s going on be less hideous than it actually is, which is deceptive but comforting I suppose.

 

[AlanFromWichita]

“Removing the baby” is a direct abortion and forbidden by the Church. What part of this do you not understand? I do not believe that you - and any others of the same opinion - do not understand this, but just reject it.

What part don’t you understand about playing word games that justify a greater harm, in the presumed case that doing so changes reality and thereby assuage our guilt – guilt and mourning over the baby?

1. Mother, doctor, baby go into the room.
2. Mother and doctor come back out alive, the baby is dead.
3. What diff does it make whether the baby is killed by chemicals – btw the way we “humanely” execute prisoners – or if the baby is killed by removing its lifeline – btw the way we did Terri Shaivo?

Besides, I no longer believe that the Church teaches this specific act and medical condition. If you want to try the condescention approach, “what part don’t I understand?” then I’ll ask you to provide documentation that your assertion is even accurate. I reject that the Church teaches this, because it makes no sense.

Either that or the Church condones physically destructive rituals as a sacrifice to mourn the dead. :whacky:

Alan

 

[Daniel_Kane]

The following groups consider that the removal of a fallopian tube that contains an embryo is a licit act and is not considered a direct abortion (this is far from inclusive):

The American Life League: ALL embraces expert medical opinion that abortion can never be necessary to save the life of the mother. Proper treatment for ectopic pregnancy and uterine cancer that results in the unintended death of the child is not considered abortion, either morally or legally.

The Bishops of the U.S: In extrauterine pregnancy the affected part of the mother (cervix, ovary or fallopian tube) may be removed even though fetal death is foreseen, provided (a) the affected part is presumed already to be so damaged and dangerously affected as to warrant its removal, and that (b) the operation is not just a separation of the embryo or fetus for its site with the part (which would be a direct abortion) and that (c) the operation can not be postponed without notably increasing the danger to the mother. Ethical and Religious Directives for Catholic Heath Care Services, n 16.

National Catholic Bioethics Center (who drafted the above document).

Priests for Life: (question #6)
http://www.priestsforlife.org/questions.html

Homiletic and Pastoral Review (a theology journal - scroll down)
http://www.catholic.net/rcc/Periodicals/Homiletic/July99/questions.html

A very detailed paper by a Catholic scholar at Ave Maria:
http://www.uffl.org/vol12/bowring12.pdf

People who say such an act is a “physically destructive ritual as a sacrifice to mourn the dead” or “elective mutilation surgery”:

AlanFromWichita, no supporting documentation necessary

Individuals, Groups or Organizations that consider fallopian tube removal immoral, illicit or wrong in any way and have stated such a position publicly:

That being said, no one for certain, likes the result we have. 100 years ago, most everyone died. Today, most live and many proceed to have families. It has always been licit to remove a diseased or injured organ even if another life is present. In this particular instance numerous Catholic scholars, pro-life groups and 263 American Bishops speak with one voice without a wisper of dissent.

I hope and pray that the treatment will continue to advance to the point where one may reimplant the embryo and of course, this would be a welcome development.

To Alan or anyone else, I would love to see in all seriousness any documentation you have to support that the removal of a fallopian tube with a embryo within it is immoral or illicit, which seems to be your contention.

To the limits of my ability, I suspect that such documents do not exist because such a position is not reasonable by any measure.

 

[AlanFromWichita]

Daniel Kane:

To Alan or anyone else, I would love to see in all seriousness any documentation you have to support that the removal of a fallopian tube with a embryo within it is immoral or illicit, which seems to be your contention.

To the limits of my ability, I suspect that such documents do not exist because such a position is not reasonable by any measure.

You are probably right. I am not likely to produce such documentation because I agree it probably does not exist.

By the way, I’ve seen many of those same organizations you listed bashed in these forums for being too liberal. Before I heard such bashing I would have been impressed but now I’m pretty sure that none of these organizations speak definitively for the Church, so these are all opinions produced by theologians. If that is the case I’m not impressed because the sometimes the Lord reveals things to lowly chumps like me that the wise and learned do not understand.

Alan

 

[needmorelight]

The following groups consider that the removal of a fallopian tube that contains an embryo is a licit act and is not considered a direct abortion (this is far from inclusive):

The American Life League: ALL embraces expert medical opinion that abortion can never be necessary to save the life of the mother. Proper treatment for ectopic pregnancy and uterine cancer that results in the unintended death of the child is not considered abortion, either morally or legally.

The Bishops of the U.S: In extrauterine pregnancy the affected part of the mother (cervix, ovary or fallopian tube) may be removed even though fetal death is foreseen, provided (a) the affected part is presumed already to be so damaged and dangerously affected as to warrant its removal, and that (b) the operation is not just a separation of the embryo or fetus for its site with the part (which would be a direct abortion) and that (c) the operation can not be postponed without notably increasing the danger to the mother. Ethical and Religious Directives for Catholic Heath Care Services, n 16.

National Catholic Bioethics Center (who drafted the above document).

Priests for Life: (question #6)
http://www.priestsforlife.org/questions.html

Homiletic and Pastoral Review (a theology journal - scroll down)
http://www.catholic.net/rcc/Periodicals/Homiletic/July99/questions.html

A very detailed paper by a Catholic scholar at Ave Maria:
http://www.uffl.org/vol12/bowring12.pdf

People who say such an act is a “physically destructive ritual as a sacrifice to mourn the dead” or “elective mutilation surgery”:

AlanFromWichita, no supporting documentation necessary

Individuals, Groups or Organizations that consider fallopian tube removal immoral, illicit or wrong in any way and have stated such a position publicly:

Thank you for these links. Like I said I have no problem with removing the fallopian tube as a moral means of dealing with a tubal pregnancy. I did ask however for the moral means in treating an extrauterine pregnancy when the embryo is attached to the abdominal cavity or whatever organ besides the uterus or ovary. The Bowring paper probably has the best info I could get but doesn’t really give enough answers. On page 3 of that document, it says that “the embryo may grow to term and morally be permitted to advance so long as hemorrhaging is evaded but has a 20-fold higher mortality rate than tubal ectopic [pregnancy]”. I must have missed it but whose mortality rate is the author talking about, is it the mother’s or the embryo’s?

Now this expectant therapy under the heading “moral considerations” got my attention. On page 20 it said, “Expectant therapy is sometimes a legitimate moral way of handling ectopic
pregnancy. If it involves an ectopic in the abdomen or ovary not yet hemorrhaging, then
expectant therapy is advised because the baby may grow to term. However, this
management procedure may at other times be imprudent and irresponsible”. That’s all it says about abdominal ectopic pregancies.

So what happens when the mother does hemorrhage in an extrauterine pregancy? Should the doctor remove the embryo or the fetus from the site of attachment? But that would be considered direct abortion, wouldn’t it? Or should we remove part of the abdominal structure (whether it be the surface of the uterus, liver or the intestine) along with the embryo? But that would probably add further danger to the mother.

I realize that there are no easy answers with these questions and I’m hoping that we do have consistent teaching from the Church in ALL cases of ectopic pregnancies. I think the 4th condition of the principle of double effect (i.e., There must be a proportionate grave reason in order to allow the evil effect.) is the key to answering these questions.

 

[Lorarose]

I do not believe that you - and any others of the same opinion - do not understand this, but just reject it.

Wow…we must look so tiny from that view way up there

 

[Lorarose]

Having been in this situation I can tell you I would have been TERRIFIED at the idea if ‘dissolving’ my baby, simply to save my fallopian tube.

Actually the drug used does not “dissolve” the embryo, but rather inhibits the placental tissue from further growth. I am assuming this causes the emryo to be cut off from oxygen and nutrients required for life - which is exactly the situation when we cut the baby off from the tube as well.
So I’m not sure why one procedure would be terrifying and the other …not.

As far as my own “agenda” here…I am not on a mission to discredit the bishops’ statements - or to be full of pride (as one charitable poster suggested)
I simply do not buy into the argument that there is a real substantial moral difference between the procedures.
It seems to me that it would either be morally ILLICIT to have any of these procedures done - or it would be morally LICIT to have any of them done.

I knew a girl - a Jehovah Witness who was very prolife. She was also very eager to become a mother.
Her first pregnancy was ectopic. She refused the abortion at first.
She waited 2 weeks before she went in for the procedure.
I am not sure exactly when the practice of removing only a section of tube became common practice, but this was the early nineties and this option was not given to her.
To her - the only 2 options she had were to either wait it out, or have the abortion.
She was devastated, but she didn’t want to die.

So…a major issue I am dealing with is …is this girl guilty of the sin of murder? And when a woman has a tube partially removed - she is somehow doing something much different than what my friend did?

And because I see such little difference between the 2 procedures, I have a hard time pointing my finger at women who choose one option and say they’re guilty - and then point at other women and say they are innocent.

 

[Lorarose]

In any case, the embryo can not stay where it is.

This is the heart of the matter for me.
And I think my main point of contention is the issue of “intent”

It has been stated that if the “intent” is to treat the tube itself - then the death of the baby is acceptable.

I don’t believe that the “intent” of anyone in that operation room is primarily to treat the tube.
I don’t believe the surgeon rushes the woman to the OR because the primary concern on his mind is the tube.
I don’t believe the woman agrees to emergency surgery is concerned with her tube, so much as she is concerned with the growth of the embryo inside the tube.
This is splitting hairs.

I think foremost on everyone’s mind is the danger presented by the continuing growth of the embryo.
That is why there is a rush to surgery.

I think the primary intent to the tubal extraction surgery is to STOP that growth in the tube - which is a direct act upon the embryo.

I don’t believe that a chemical “attack” on the placental tissue is somehow different than removing the organ the embryo relies upon for life.

And when the surgery is over, and it is considered to be a success…it is because the embryo is no longer growing inside of that tube.

I think it is contradictory when, on one hand, a catholic will say…the unborn baby is a “…person, whose life is to be respected and whose death, even if inevitable, is not to be hastened for the benefit of any other person…”
And then on the other hand condone a procedure that does just that.

I have gone through the paper posted by Dan…thank you.
It does seem that right now…if a woman keeps her tube intact after the removal of the embryo the risk to having further ectopic pregnancies may make that risk not worth the while.
I also did not know there was a procedure where the tube is sectioned, the embryo removed, and then the pieces of tube replaced. I could not tell for certain if this was “acceptable” to the Church or not.

As for the claim there is unanimous agreement among theologians on this…the paper posted by Dan shows this is not true. Theologians do disagree, and they are still in the process of discussing the nuances of applying moral theology to different procedures.

As for the claim this is the position of the Magisterium…the paper posted by Dan shows this is not the case either.
In fact, the author surmises that the “brief” statement made by the Bishops invites further discussion so arguments could be presented to the Magisterium for a future, more definitive declaration.

And as for me, at this moment…I remain “stuck” on this issue of “intent”
I don’t think that when we SAY a procedure is for a certain purpose, that it necessarily truly is the primary purpose.

It is like calling a bribe a “gift”. It is still a bribe no matter what you try to call it.

 

[AlanFromWichita]

Lorarose:

I think the primary intent to the tubal extraction surgery is to STOP that growth in the tube - which is a direct act upon the embryo.

Thank you. It isn’t as if we are operating on a tube that is swelling for some strange reason we don’t know, and then afterwards look at it and say, “oh my stars! There was a baby in there! How terrible it had to be there during that.”

That is just plain stooopid.

I don’t believe that a chemical “attack” on the placental tissue is somehow different than removing the organ the embryo relies upon for life.

No. One’s like watching what we are doing while pulling the plug on its life support. The other is to destroy the life support because we can’t bring ourselves to unplug it.

Again, greater damage for rhetorical gain.

And as for me, at this moment…I remain “stuck” on this issue of “intent”
I don’t think that when we SAY a procedure is for a certain purpose, that it necessarily truly is the primary purpose.

It is like calling a bribe a “gift”. It is still a bribe no matter what you try to call it.

I am in a difficult financial situation. I must steal money, but I’m going to say that I’m not stealing it because I’m going to use it to feed my family. Maybe this afternoon I’ll see how that line goes over at a few convenience stores. :yup:

Alan

 

[Consecrated]

AlanFromWichita:

What part don’t you understand about playing word games that justify a greater harm, in the presumed case that doing so changes reality and thereby assuage our guilt – guilt and mourning over the baby?

1. Mother, doctor, baby go into the room.
2. Mother and doctor come back out alive, the baby is dead.

3. What diff does it make whether the baby is killed by chemicals – btw the way we “humanely” execute prisoners – or if the baby is killed by removing its lifeline – btw the way we did Terri Shaivo?

Not that this resolves the discussions going on here, but if you’re going to compare an emergency surgery on an ectopic pregnancy with Terri’s case, I think it’s important to keep in mind, that Terri’s lifeline was a MACHINE, the baby’s is a PERSON. This comparison completely fails because of that simple fact.

Observe:

1. Machine, Doctor and Terri going into room
2. Machine and Doctor come out of room, Terri is dead.

Rediculous? Yep.

Preserving the baby’s lifeline (i.e. Mama) at baby’s expense (however indirectly) has competely different theoligical implications than Terri’s case had… apples and nectarines here folks.