Thursday, April 23, 2009

follow up to abortion question

Hello Fr. A.,

Ave Maria.

I have a question regarding a debate I've been having online about abortion and was wondering if you could help me. The discussion turned at one point to the example of the little girl in Brazil which led to the general question about exceptions for saving the life of the mother. I did my best to explain the principle of double-effect (which even to me sounds a little like splitting hairs, but it does make sense, so onward) and used the example of ectopic pregnancy/ salpingectomy, but I think I got back up against a wall when posed with the scenario of when the life of the mother is in imminent danger and the baby must come out, even if it is unable to survive outside the womb. It seems to me that this is morally reasonable (if the mother dies, both die; but if at least one can be saved, we would have the duty to do so), but I couldn't help but wonder. If the baby must be removed with the intention of saving the mother, isn't the direct action still an abortion? The duty to save the life is there, I believe, but how do we explain this without undermining the definition of a direct, intentional abortion being morally forbidden? In other words, don't both aspects have to be negated for double-effect? And how do I explain this? Please help!


The principle is that no harm may be directly done to the innocent life. The position of the Church is that there are no exceptions for direct abortion, even in the case where the mother's life is in danger. Indirect abortion is permitted only when there is a proportionate reason, namely, when the life of the mother is in danger. Indirect abortion would include such things as the removal of the womb with the child intact in the case of uterine cancer, or the "salpingectomy" (which I presume is the sectioning of the fallopian tube with the embryo in it) in the case of an ectopic pregnancy. Based on the principle the "salpingectomy" would be permissible, but a chemical abortion would not, even if it is safer for the woman and if it more likely to leave her fertility intact.

Catholic tradition resolves moral questions on the basis of principle, because morality is, in fact objective. The Church always distinquishes, and rightly so. When people who are testing our moral system pose hard cases, they take the application of the principle to the smallest detail and to the most fine distinctions. Those distinctions may seem to be paper thin, but they are nevertheless consistent with the prinicple. People will take the hard case and test the principle, in the case of direct abortion when the mother might otherwise die, asserting that its application is heartless; however, once the coherence of our moral system is thus compromised, it becomes the pretext for resolving any case that one deems "hard" without a principled solution.

In fact direct abortion is rarely, if ever, necessary to save the life of a mother, and the distinctions that are involved are not as thin as our opponents assert. Those opponents often fail to distinguish between a physical act and a moral act. Since there seems to be little difference, physically, between indirect and direct abortion, especially when the end result is the same, they deem the moral act to be the same in each case; however, morality is not determined by physical factors but by metaphyscal ones: object (nature) of the act; intention and circumstances. In the case of direct abortion, namely, the direct and intentional killing of an innocent child, regardless of its physical similarities with justifiable indirect abortion, the object of the act is intrinsically evil and may never be done.

I hope this helps.

Father A

I'm still not quite resolved on this, though. It would seem that we come to the conclusion that it is not permissible to surgically remove the baby, but it is permissible if we take the whole uterus with it. I have to admit, that's a hard pill to swallow.

But I come back to Fr. A's assertion that such cases where direct abortion to save the life of the mother are rarely, if ever, necessary. I believe he is right, but in the case at hand of the girl in Brazil, there are too many unanswered questions and other options for us to be able to answer this question with certainty.

My feeble fence-sitting on such a hard case, as Fr. A called it, is a luxury I can now afford, but I pray for all those faced with such a decision. God grant them guidance, and grant us all mercy.

I'd appreciate any help on this from my fellow pro-lifers.


Matthew Siekierski said...

The direct action is not an abortion if there is an actual attempt to keep the baby alive. If the baby has developed enough to pose an immediate risk to the mother, then most likely the baby has a chance at survival, given proper care.

As an example, my personal life involves an extremely early C-section for my wife (4th child). The risk wasn't to my wife, but my unborn daughter. She had stopped growing, and her heart rate wasn't recovering quickly from the "practice" Braxton-Hicks contractions. The best thing for my child was an emergency C-section, even though she was only 26 weeks gestation. She was 640 grams (1lb, 6.5oz) at birth, and spent 15 weeks in the hospital.

Now, had my daughter died instead of lived (she's 2-1/2 now, and doing great), it wouldn't have been an abortion, since the direct intent of the medical intervention was to save her life, not end it. A high-risk but moral decision to give her the best chance of survival possible.

With that as my background, I hope you can understand why someone like me sees a clear difference between medical intervention where assistance, no matter how high-risk, is offered to the baby and a direct abortion, where the intent is to directly kill the baby.

Mike in CT said...

Thanks for the input on that Matthew (and I'm glad to hear about your daughter).

The scenario you describe is what I was trying to get at with an earlier post ("The tragedy in Brazil") but another commenter raised the point about if the child were well before viability and therefore removing the child offers no chance of survival.

Now, I am not versed in medicine enough to posit the circumstances where a pre-viable child in the womb threatens the mother's life (except where the threat actually comes from another condition relating to the child, though not the child herself), but it's a question that is important to understand.

Matthew Siekierski said...

It would be interesting if such a case actually exists. Pregnancy can bring difficulties for a woman, but I can't say I've ever heard of a case where a woman's life was threatened by a normal uterine pregnancy when the unborn baby was still very small. In the case of the girl in Brazil, the danger would come from the size of the twins...but they could be carried for quite a while without endangering her (uterine rupture, preterm labor, or whatever due to the size of the babies and the youthfulness of the girl).

Sorry I didn't see the earlier post, it would have saved me some typing ;)

Viability is a moving target. I doubt my daughter would have been considered "viable" 50 years ago. The only way for doctors to truly know if the baby is viable is to put in the effort to keep him alive. Even if the baby is not considered viable, the doctors should try.

And take this example. Doctors thought the woman was over 23 weeks pregnant, when she was really less than 22 weeks. They would have considered the baby non-viable, but Amelia lived.

I suppose if there really was no chance of survival for the baby, given current technology, and "delivery" was done knowing there was absolutely no chance for the baby, then it would be the same as an abortion. But I find the probability of such a circumstance arising so remote (pre-viability pregnancy significantly threatening the mother's physical existence) that it doesn't make sense to me to bother. If somebody could show how such a situation would even be possible, I'd ponder it more. Otherwise, even if the baby was 20 weeks gestation born under today's medical technology, so long as the doctors put in a real effort to save the life of the baby (instead of going through the motions, or just letting the baby die), then I wouldn't categorize it as abortion.

Anonymous said...


I can't really say much more than I have already except to underscore that there is a real distinction to be made between the physical act and the moral act. For example, a gangland execution may look physically very much like a state execution, but no matter what your opinion on the question of the death penalty, the two are morally distinct. The Church's position against the use of the death penalty today is not posited on the basis of an alleged similarity with vigilante justice.

Matthew's point is well taken. If anything can be done, and nowadays much can be done, to save the child in the event of the necessity to risk its life to save the mother, then obviously we must do it.