then why would it be ok to indirectly kill an unborn child that is inside a portion of a fallopian tube?
Just to be clear, the church has not been clear on rather this is, or is not, the case. The Church took its first stance on the morality of abortion for the sake of the mothers life in 1884. It was even more direct in1889 when it prohibited:
“[A]ny surgical operation which is directly destructive of the life of the fetus or the mother.” - Tribunal of the Holy Office
Some moralists thought that ectopic pregnancies would be an obvious exception (since the fetus’ lifespan is limited to months and has a certain prognosis of death, also, this was pre-plasma and antibiotics, so a fellopian rupture was much more likely to be fetal than today), so the question was posed:
“Is it ever allowed to extract from the body of the mother ectopic embryos still immature, before the sixth month after conception is completed?”
The Tribunal answered in 1902:
“No; according to the decree of 4 May, 1898; according to which, as far as possible, earnest and opportune provision is to be made to safeguard the life of the child and of the mother. As to the time, let the questioner remember that no acceleration of birth is licit unless it be done at a time, and in ways in which, according to the usual course of things, the life of the mother and the child be provided for” - Tribunal of the Holy Office
Next T. Lincohn Bouscaren, an ethicist, argued:
“[T]he tube has become so debilitated and disorganized, or destroyed by internal hemorrhage, that it now constitutes in itself a distinct source of peril to the mother’s life even before the external rupture of the tube.”
Bouscaren conceded that it was a “thin distinction”, but insisted that it was enough to invoke the principle of double effect. The “Bouscaren Approach” is still widely taught in bioethics classes in Catholic High Schools, but is actually not how the situation is widely handled in Catholic hospitals today.
Remember, at the time Bosucaren proposed the idea ectopic pregnancies were generally found when symptoms like vaginal bleeding, fainting from blood pressure drops, etc. were present. From a practical, medical perspective, the difference between performing a full or partial salpingectomy (removal of all or part of the fellopian tube) was moot. In fact, it was even believed that a full salpingectomy was superior because the scarring from a partial removal could increase the chance of future ectopic pregnancies.
Following the same “fine distinction”, moralists later rejected salpingostomy (removal of just the fetus). However, it did not escape everyone’s notice that the existance of the procedure brings the “fine distinction” itself into question. After all, if the minimum corrective act for the tube is simply removing the fetus, does the tube itself truly constitute a legitimate health risk?
The real problem for Catholic health care givers started with early detection and MTX. This leaves us with a difficult situation. Between antibiotics, plasma, etc., there is a real question as to rather the criteria for double effect are even met (note in the Catholic Encyclopedia, under “Abortion” that the effects must have equal or greater effect). Namely, that the fetus’ life is certainly lost, but while the pregancy represents a serious health risk to the mother, it is not, with any degree of certainty, a mortal situation.
Next, if a salpingectomy is performed early, the “thin distinction” does not exist at all. It is another prescribed procedure (partial sterilization) performed on healthy tissue, to somehow ‘avoid’ what everyone realizes is an abortion of medical necessity from being ‘direct’. This puts doctors in a terrible bind. The diagnosis is the same (ectopic pregnancy), but the surgery represents higher risk, higher cost, and an inferior health outcome (partial sterilization).
So, increasingly we are seeing arguments that MTX, a chemical abortificant, also meets ‘double effect’ in these cases. For example, in 2000 there was an article in the LINACRE QUARTERLY and in 1996 CHA published an article on adhering to the Directives that proposed MTX meeting the principle of double effect.
Double effect is not the only argument being used. For example, last year an article published by the National Catholic Bioethics Center argued that MTX was permissable, not because of double effect, but because the fetus was “dead or dying”. The argument is basically that it isn’t a pregnancy at all, but an interrupted miscarriage. The article did not elaborate on why our teachings on euthanasia do not apply, but the protocol is in use at several Catholic hospitals in the US.
Personally, I think they are direct abortions. But I am biased.