Moral Action in the Face of Life-Threatening Pregnancies

The Blog of LOGIA: A Journal of Lutheran Theology ^ | May 31, 2013 | Gifford Grobien

[Fester Chugabrew]

Recent high profile events—the Gosnell trial and the septicemia of Savita Halappanavar in Ireland—have again raised the question if abortion is ever acceptable, such as in attempts to save the life of the mother.

There are at least two ways of thinking about such dilemmas in the Christian moral tradition. The first, which can be traced at least as far back as Thomas Aquinas, relies on the principle of double effect. The second, more familiar to the Lutheran communion, is the method of casuistry, the detailed study of all the factors and circumstances of a case in order to determine the correct course of action. At root, however, both ways can be complementary. When one gives attention to the details of a moral case, he may periodically find himself in a moral dilemma, wondering which action has moral authority. The principle of double effect is one way of discerning the right action.

The principle of double effect relies on four sub-principles: 1) the act itself must not be intrinsically, morally evil; 2) a good effect is intended from the act; 3) the good effect is not produced by means of an evil effect, that is, evil is not a means to good; and 4) there is a proportionate reason for allowing the evil—there is no less harmful way to accomplish the good.

At first glance, it would seem that saving the life of the mother in cases such as an ectopic pregnancy, preeclampsia, or septicemia would violate the principle of double effect, especially points 1) and 3). Deeper consideration is necessary in these cases.

[Fester Chugabrew]

Abortions to save the life of the mother are a misnomer. The best action is to attempt to save and preserve life, with the understanding circumstances may result in death to either child, mother, or both.

[Sherman Logan]

In an ectopic pregnancy the child absolutely cannot survive to birth. If not aborted, the mother will also die.

Any reasonable person will concede that it is better to lose one life than two.

[svcw]

My daughter had pre-eclampsia with all her pregnancies (which did not start until 30-32 weeks).
She never had an abortion the babies were born at 34, and 35 weeks.......fine and healthy.
She could have chosen killed them, instead she worked with her doctor carefully monitoring and evaluating the situations.

[Mrs. Don-o]

I think you're right, Fester: inducing early delivery (or accomplishing it surgically) is not the same as abortion, because it is not intended to kill the child. If you can induce, and attempt to save both, that's what you do. Even if the baby cannot survive either in or outside of the mother's womb, simply transferring from one doomed environment to another, does him no (futher) harm and permits his parents or other caregivers to hold him and keep him comfortable while he passes away.

It doesn't mean you can dismember, crush, poison, or in any other way directly assault the baby. It means he can be birthed and cared for as you would care for any other dying infant.

This is a good article; deserves careful (and prayerful) reading.

[Fester Chugabrew]

Thank you. Yes. I am not familiar with the intricacies of ectopic pregnancies, but am hesitant to accept the word “absolute” as applicable, if only because we may be able to make a way. Whatever we do, it is best to treat all human life with respect, and give the benefit of the doubt when uncertain.

[Sherman Logan]

Possibly I was over-positive.

But I still think it obvious that it is better to lose one life than two.

Several decades ago my wife and I took an emergency childbirth midwifery class as part of preparation for a home birth. Part of the class was about the history of midwifery.

Till recently, midwives in remote areas, and probably today in really remote areas, did not have caesarean to fall back on in emergency. Sometimes twins are misaligned in a way where one is trying to be born breech while the other’s head locks and prevents the birth.

In such a case the midwife’s only option was to remove the head of one of the babies so the other baby could be born.

Appalling, but the alternative was to lose both babies and the mother. In such a case, as the article discusses, killing is not the intent, saving life is the intent.

[Mrs. Don-o]

Removing an ectopic pregnancy is a morally justified procedure. It is not, however, an "abortion" and should not be called one. It is morally and medically quite different from an abortion.

I don't think the day is far off when a baby will be able to be saved in most cases of ectopic pregnancy, e.g. they could remove the fallopian tube; implant it, embryo and all, in the mother's uterus; then slit the tube open (imagine slitting a section of a drinking straw lengthwise) so placenta and baby have room to develop.

BTW, there have been (exceedingly rare) cases when a baby implanted ectopically on the mother's inner abdominal wall, and both survived. The baby had to be delivered surgically, of course.

[Sherman Logan]

I think technically it is an abortion, as is what we more routinely call a miscarriage.

But I get your point. The purpose of elective abortion, what we usually call just “abortion,” is to produce a dead baby.

If a dead baby is the tragic result of attempts to treat a medical condition, that is entirely different. It’s the difference between first degree murder and a patient dying in surgery.

[Fester Chugabrew]

Indeed. The post referenced here mentions “that in very infrequent cases, babies and mothers may actually survive an ectopic pregnancy.” (The web link link therein seems to be dead.) The right thing to do, as we know, if to make every effort to preserve innocent life when we can.

I note with interest as well, how the author mentions instances of killing that are within the realm of moral rectitude. Also that moral choices are not a matter of self-justification in the scheme of eternal matters.

[Sherman Logan]

Here are links to stories about ectopic pregnancies survived by mother and child.

http://realchoice.blogspot.com/2011/05/another-baby-survives-ectopic-pregnancy.html

Haven’t found anything like a statistical analysis. In a world with 6B people, lots of weird stuff will happen. Given the way an ectopic pregnancy works, I really don’t think survival is anything to bet the farm on.

[Salvation]

Saint Gianna Molla died so that her baby could live.

Prepare to be amazed! The 2nd miracle of St. Gianna Molla

Daughter of St. Gianna Molla to Visit U.S. for the First Time
A Holy Couple Reunited in Heaven—Death of Pietro Molla, Husband of St. Gianna Beretta Molla ....
Catholic Health Center for Women Opens in Manhattan (Gianna Center)
Daughter of Saint Gianna Beretta Molla Attends US March for Life
A patron saint for life (Gianna Beretta Molla)
Pope Canonizes Gianna Molla; Secular Media at a Loss
Bl. Gianna Beretta Molla
Gianna Beretta, Who Died for Her Unborn Child, to Be Canonized (She Refused Cancer Treatment)
Gianna Beretta Molla Offered Life For Her [Unborn]Child
Blessed Gianna[Gianna Beretta Molla]

[LadyDoc]

the correct procedure in locked twins is to push the child back and unlock the heads and then proceed to delivery. However, this takes skill...

don’t read furthur if you have a queasy stomach.

usually in such cases, the first twin ends up dying before decapitation. And decapitation could result in a perforated uterus and dead mother if done by a midwife...which is why partial birth abortion is so dangerous...the mother’s uterus is softer than the baby’s skull so is often injured.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3573520/
Locked twins can be avoided by cesarean delivery in all cases in which first baby is not vertex. However, if the first baby is already partially delivered as breech, disimpaction can be tried by pushing both heads upward out of the pelvis under anesthesia. If this cannot be done, cesarean with abdominal delivery of both fetuses may be the safest route.

[trebb]

I grew up in the Catholic Church. I remember a Nun telling us that if an adult was driving a car and got into a situation where he could either hit and kill a child, or go over a cliff/bridge to his own death, he should save himself and kill the child. The reasoning being that an adult might not be truly saved and the child was not of age to be condemned - the child was a sure thing for Heaven. Back in the 50’s early 60’s they didn’t equate abortion into the deal, but I wonder what actual doctrine would say - save a sinner and ensure a child gets to Heaven or save a child and open up the possibility of two lost souls (adult who may not be saved and child who may come of age and decline the Gift).