Ectopic Pregnancy Abortion Morality
Recently in CDF we had a discussion regarding the morality of NFP v. Contraception and that led to a discussion on the morality of abortion, the participant, “Joe,” stated he opposed abortion in all cases except in cases where the woman would die – like an ectopic pregnancy. Straying from the topic a bit, but bear with me for a moment… Joe stood in opposition to NFP because he feels (felt?) that it was inconsistent to oppose artificial birth control (ABC) methods of contraception, but Natural Family Planning (NFP) was somehow OK. Joe’s stance was very black/white – no “gray” area.” Well, then in the process of that debate Joe said he opposed all abortion except in cases where the woman would die. Oops! Joe’s morality just allowed for a “gray” area! Well, sort of. In reality ANY “abortion” at ANY time is immoral. If Joe’s morality were to be consistent between his stance on NFP and ectopic pregnancy – he would have to say that even in the case of ectopic pregnancy, let nature take its course. However, the Church has taught (see below) that if one is treating the “diseased tissue” (the fallopian tube) which if left alone will burst – killing both the mother and the baby – then a salpingectomy (see explanation below) is permissible. Why? Because the intent is not to abort the fetus, but to treat the diseased tissue which will end up killing both mother and baby if left in place. The intent is not abortion, rather it is to perform a medically necessary surgery to save the mother’s life. In this case it is not an abortion and should not be referred to as one. Sometimes drugs are used to kill the wrongly placed fetus and an abortion then follows – this is immoral and not allowed under any circumstances.
Below is some research I did while in this discussion and I wanted to preserve it for future reference – hence this blog entry.
Ectopic for Discussion: A Catholic Approach to Tubal Pregnancies
ISSUE: What is an ectopic, or “tubal,” pregnancy? What moral principles must be taken into account in treating a tubal pregnancy? What alternatives are available that respect both the mother’s life as well as the life of her unborn child?
RESPONSE: A woman’s egg or ovum descends from an ovary through the fallopian tube to the uterus. While on this path, the egg is fertilized and naturally continues this descent and implants in the uterus. Sometimes, however, the egg is impeded in its progress and instead implants somewhere along the way. This is called an ectopic pregnancy. “Ectopic” means “out of place.” Ectopic pregnancies are often called “tubal” pregnancies because over 95 percent occur in the fallopian tubes. (fertilized eggs can also implant in the abdomen, ovaries, or within the cervix).
A mother facing a tubal pregnancy risks imminent rupture of the fallopian tube. While the doctor would opt for the least risk and expense to the mother, all the options presented to her involve terminating the pregnancy. The mother, however, must respect both her life and that of her child.
There is no treatment available that can guarantee the life of both. The Church has moral principles that can be applied in ruling out some options, but she has not officially instructed the faithful as to which treatments are morally licit and which are illicit. Most reputable moral theologians, as discussed below, accept full or partial salpingectomy (removal of the fallopian tube), as a morally acceptable medical intervention in the case of a tubal pregnancy.
As is the case with all difficult moral decisions, the couple must become informed, actively seek divine guidance, and follow their well-formed conscience.
What If Both Lives Cannot Be Saved?
Q: If a woman has an untreated ectopic pregnancy, she and the baby will both die. That is inevitable. In this situation, is it permissible to have an abortion? The fetus cannot come to full term and will inevitably kill them both.
A: An ectopic pregnancy is one where a zygote implants out of place, usually in one of the fallopian tubes. By definition, an ectopic pregnancy is a pathological condition because a fetus cannot grow to full term there. Catholic moral theology has taught that the pathological section of a fallopian tube can be removed.
Catholic moral theologians speak of the principle of double effect. In this case, the primary goal is to remove the pathology that threatens a mother’s life. A growing fetus implanted in a fallopian tube will eventually rupture the tube, killing the mother and itself.
Removing that section of the tube has the secondary effect of ending the life of the fetus—a necessary but clearly regrettable action. This would not be a direct abortion, which is forbidden.
Does the Church approve of surgery for an ectopic pregnancy?
It is never permitted to directly kill an infant (or any other person for that matter, with the exception of self defense, just war and capital punishment), and so consequently, it is immoral to perform an abortion in the case of an ectopic pregnancy, even to save the life of the mother. This is immoral, whether it is done surgically or chemically. There are now available medications (such as methotrexate, or just recently RU-486) that are commonly used for tubular pregnancies, and that directly cause the living fetus to be aborted. This is always immoral.
However, if it can be established that the fetus is already dead (by ultrasound examination, for example), then clearly the surgical removal of the already dead fetus for the health of the mother is entirely permissible.
The difficulty arises when the fetus is still alive. The mother’s life is endangered through internal hemorrhage at that time. The moral theologians hold different opinions as to whether it is permissible to intervene surgically to remove the ectopic pregnancy before the death of the foetus. Some say that surgical intervention directly kills the foetus, which is immoral. Others say that it is not direct killing at all, but it is the removing of a mass of tissue (including the placenta) which has fixed itself in the wrong place (the fallopian tube instead of the uterus), in such a way as to cause a tumor invading the mother’s fallopian tube, rather like a malignant tumor. Just as it is possible to operate on a tumor of the mother, (e.g., in treatment of uterine cancer) even if as a consequence and indirectly the child will die, so also it is moral, they say, to surgically remove this abnormal mass of tissue, which contains the fetus. It is an indirect and unfortunate, though necessary, consequence that the fetus will die, but this is not willed in itself.
The principle used in this second opinion is the application of the principle of double effect, or the indirect voluntary. This is moral, provided that the bad effect, in this case the death of the unborn child is not directly willed in itself, and that there is a proportionate reason (such as saving the life of the mother), and that the good effect, namely saving the mother’s life does not directly come from the bad effect, the death of the child. The understanding of this solution depends upon the grasping of the gravity of the proportionate reason. The fetus that lodges in the fallopian tube cannot survive in any case, and if the mother is not treated she may very well hemorrhage to death, or be observed in hospital for several weeks, and her fallopian tubes can be so damaged by the ectopic pregnancy left untreated that she might never be able to conceive again.
Since there are opinions on both sides of this question, both can be safely followed in conscience. Consequently, it is permissible to have surgery, provided that it is not a direct abortion, but the removal of invasive tissue, but it is never permissible to take medications to kill the live fetus.