Abortion, Casuistry, and Dancing on the Head of a Pin, Part II
In my previous article, I explored why the Catholic Church’s teaching on abortion should not be blamed for Savita Happlanavar’s death. These observations suggest to me three analogies to which this might be likened. In order, they are self-defense; life-support removal at the end of a person’s life; and the removal of an ectopic pregnancy, or, better still, of a malignant tumor from the womb. None of these scenarios is considered murder, all are (or can be) morally licit, and yet in each scenario a person dies as a direct result of the action taken.
Concerning self-defense, the Catechism of the Catholic Church, citing Saint Thomas Aquinas, states:
“‘The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor…The one is intended, the other is not’….Therefore it is legitimate to insist on respect for one’s own right to life. Someone who defends his life is not guilty of murder even if he is forced to deal his aggressor a lethal blow….Legitimate defense can be not only a right but a grave duty for someone responsible for another’s life” (CCC 2263-2265).
Even in this case, the child is not exactly an aggressor, it is true, but if by allowing him to remain in the womb the life of the mother is guaranteed forfeit, then defense of the mother’s life allows for the child to be removed. Moreover, if the lives of both mother and child will be lost by allowing the child to remain in the womb, but the former might be saved otherwise, then it seems to me that it is a “grave duty” (though an unfortunate one) to remove the child from the womb, e.g. by inducing labor.
Concerning my second analogy — life-support removal at the end of a person’s life — the womb is effectively a great life-support system for a child, though at the beginning of life rather than its end. Here the Catechism states that
“Discontinuing medical procedures that are burdensome, dangerous, extraordinary, or disproportionate to the expected outcome can be legitimate; it is the refusal of ‘over-zealous’ treatment. Here one does not will to cause death; one’s ability to impede it is merely accepted. The decision decisions should be made by the patient if he is competent and able or, if not, by those who are legally entitled to act for the patient, whose reasonable will and legitimate interests must always be respected” (CCC 2278).
In essence, then, the medical procedures are analogous to the child’s remaining in the womb. If this will cause the mother to die, then it is clearly a “burdensome, dangerous” “procedure.” Applying this reasoning, it is permissible to induce labor. Indeed, the USCCB’s Ethical and Religious Directives for Catholic Health Care Services notes that
56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that in the judgment of the patient offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.
57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.
58. In principle, there is an obligation to provide patients with food and water, including medically assisted nutrition and hydration for those who cannot take food orally. This obligation extends to patients in chronic and presumably irreversible conditions (e.g., the “persistent vegetative state”) who can reasonably be expected to live indefinitely if given such care. Medically assisted nutrition and hydration become morally optional when they cannot reasonably be expected to prolong life or when they would be “excessively burdensome for the patient or [would] cause significant physical discomfort, for example resulting from complications in the use of the means employed.” For instance, as a patient draws close to inevitable death from an underlying progressive and fatal condition, certain measures to provide nutrition and hydration may become excessively burdensome and therefore not obligatory in light of their very limited ability to prolong life or provide comfort.”
If the womb is like a life-support system—a respirator, for example—and the amniotic fluid and placenta have become infected, even toxic to the baby, and if the baby is dying anyway, it seems to me that inducing labor is justified by the USCCB’s Directives. This is analogous to removing life-support (not food and water, just the respirator) from the terminally ill, which again seems to be permissible in the case “extraordinary or disproportionate means of preserving life,” meaning “those that in the patient’s judgment do not offer a reasonable hope of benefit or entail an excessive burden.” In this case, the “patient” (the baby) is “not competent to make this decision, so it falls to the mother and father—and the loss of the mother’s life is certainly an “excessive burden.” To extend the analogy further, the “life support system” was failing, so unplugging it doesn’t kill the baby, though it may hasten death.
I turn then to my last analogy, which is the most obvious and the most easily comparable. It is and I think always has been morally licit to remove the fallopian tubes during an ectopic pregnancy, saving the mother’s life even if this causes the baby to die [7]. The same is true of removing a malignant tumor from the womb, which may also cause the death of the child. The same is again true of undergoing chemotherapy to treat cancer, which again can cause the death of the unborn child. Inducing labor and removing the child from the womb in the case of toxicity should be viewed no differently. To return one last time to the USCCB’s Directives document:
“47. Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.
48. In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”
An extrauterine pregnancy means an ectopic pregnancy, and the removal of the Fallopian tubes has been permitted in these cases as morally licit. It is not a direct abortion, and, by extension, neither is inducing labor—by C-section or with forceps-assistance—in the case where this is the only way to save the mother’s life. Certainly, giving antibiotics is one form of permissible “treatment.” So surely would be the removal of the infected amniotic fluid and placenta, even if this resulted in also delivering the pre-viable child [8]. As the Human Life International statement on Mrs Halappanavar’s death notes, “The Church’s position in these difficult cases is always to save both patients – both mother and child.”
Since this case happened in Ireland, it is worth hearing what the Irish bishops have had to say about this. His Excellency the Most Reverend Joe Fleming wrote that “Abortion is never the basis for a humane or compassionate solution.” The good bishop writes that
“international experience indicates that once abortion is introduced, even for apparently very restricted or limited situations, it becomes more widespread than was first intended….The Constitution recognises ‘the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect’ that right. The clear intention, therefore, is to protect and cherish equally the lives of both the mother and her unborn child.
In fact, Ireland, without abortion, is recognised as one of the safest countries in the world to be a pregnant mother. This is something about which we should be proud and is a tribute to the excellent care provided by hospital staff who treat both mother and unborn child with equal dignity and respect as people in their own right. Clearly, if the life of the mother is threatened, by illness or some other medical condition, the care provided by medical professionals will make sure that she receives all the medical care needed.
In a small number of cases, however, the treatment given may unintentionally result in the death of the unborn child. But in such cases the life is never directly and intentionally taken and everything is done to save the child.
The key moral issue, therefore, for Catholics is that the life of the unborn can never be taken intentionally.”
That should as always be our guiding principle: respect for human life—both the mother’s and the child’s. The Catholic Church allows for action to be taken to save one when inaction results in the loss of both—the principle of double effect—and all doctors, Catholic or otherwise, should be familiar with this principle as a basic part of their medical ethics training. While the Church—and, for that matter, Irish law—might be clearer in the particulars, or might better communicate them, the principle is quite sound.
—-Footnotes—-
[ [7] This fact will change, however, if/when some method is developed which allows an ectopic pregnancy to be successfully and reliably treated without removing the Fallopian tube and thus killing the baby.
[8] National Review even quotes Fr Tadeusz Pacholczyk, Director of Education for the National Catholic Bioethics Council, as saying,
““If it were the case, for example, that she suffered from a serious placental infection unable to be controlled by other remedies, it would have been allowable to induce labor under a proper application of the principle of double effect. Such an action would not constitute a direct abortion, but maternally directed therapy to remedy the infection, with the secondary, unintended effect that the life of the child would be lost.”
