Posted on 05/17/2010 8:58:40 PM PDT by GonzoII
In late 2009, an abortion took place at St. Joseph's Hospital and Medical Center in Phoenix after a hospital ethics committee deemed the abortion necessary to save the life of the mother. Sister Margaret Mary McBride, the hospital’s vice president of mission integration, was a member of the committee that made the decision and has since been assigned new duties.
The hospital has defended its decision, while Bishop Thomas Olmsted warned that Catholics who formally cooperated in the abortion were automatically excommunicated.
The Diocese of Phoenix said in a May 14 statement:
The Most Rev. Thomas J. Olmsted, Bishop of the Roman Catholic Diocese of Phoenix, released the following statement today in response to the acknowledgement by officials at St. Joseph's Hospital and Medical Center to the media that an unborn child was killed several months ago at St. Joseph's through a direct abortion:
(Excerpt) Read more at catholicculture.org ...
I would also point that your use of the term abortion is misleading. Any termination of any pregnancy is medically called an abortion. A miscarriage is called a spontaneous abortion, etc. The problem that you have is justifying your previous statement that there is no abortion that is not elective.
Unlike most miscarriages, ectopic pregnancies don't always resolve themselves on their own and require medical intervention. The act of surgically removing the baby and therefore terminating the pregnancy is an abortion, it's just NOT an elective one. And that's where people who are rabidly pro-life run into problems. I should know...I used to be rabidly pro-life. I just hope no one else ever has to go through what I did in order to learn to be a little more realistic about it.
Any one of you pro-lifers want to answer me do so, don't expect a reply...I have dealt with your zealousness enough...
To many of you, the life of the mother means nothing, just the life of the baby...you are in fact not pro-life, only life as you define it...
Do any of you ever wonder or are concerned about the agonizing decision some women have to go through to make such decisions...my life and the raising of my other children or die and have (possibly) another motherless child...
We are not talking about the females that use abortion for birth control or ho's that get preg. but real life mothers and wives of families..
Ectopic preg. always ends in removal or rupture and death of the baby or possibly death for both...
There have been a couple of very rare cases where the pregnancy was outside of the uterus, and usually the placenta implanted on the intestine or other organ, several of these have been carried to term and c-sectioned but we are not talking about the rare.
I agree with TNdandelion....
“I just hope no one else ever has to go through what I did in order to learn to be a little more realistic about it.”
I am a retired nurse. I am well aware of how medical and common terminology differ. I have had four high-risk pregnancies, two of which ended in the death of my children, two of which ended happily. At that point, my husband got a vasectomy, to end any further risk to me
I am not rabidly pro-life, I am simply pro-life. Before I was a religious person, I was pro-life. Your apparent assumptions about my knowledge base are erroneous. Surgical treatment of ectopic pregnancy is not an elective abortion. If surgery is required for maternal hemorrhage, it’s not elective. There are only two cases worldwide that ended in live children being born of an ectopic pregnancy that I know of, and until I looked it up, I knew of NONE.
I don’t know what you mean by “being a little more realistic about it.” An ectopic pregnancy is incompatible with a living child, unless it’s one for the record books.
Having lost two of my own babies, my heart breaks for anyone who loses a child, no matter how long it has lived. Because of my loss, I cannot understand why anyone would deliberately kill an unborn child. I don’t like to use other than common terminology, ie “miscarriage” and “abortion” because very few non-medical people do.
I don’t understand why you think this woman had an ectopic pregnancy; I didn’t see it in the article. Did I miss something?
Here is a discussion regarding ectopic pregnancy and church doctrine from Catholics United for the Faith
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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.
DISCUSSION: According to the Centers for Disease Control (CDC),[1] ectopic pregnancies have increased in frequency and now number roughly 100,000 a year.
Though detection and treatment have greatly improved, ectopic pregnancies still pose a serious health risk to the mother. Ectopic pregnancies are the leading cause of maternal deaths in the first trimester. While they often end in early miscarriage, waiting indefinitely for miscarriage to occur poses a grave threat to the mother. By ten weeks (in the case of a tubal pregnancy), the fallopian tube will likely rupture, causing severe hemorrhaging that can result in death. Such cases most often occur when the ectopic pregnancy is not diagnosed. Hence, most deaths caused by ectopic pregnancies each year are among minority groups and the poor whose access to prenatal care is limited.
Who are at risk for an ectopic pregnancy? All women are susceptible. However, there are factors that can increase the risk, namely: smoking, sexually transmitted diseases, tubal sterilizations, fertility drugs, and previous occurrences.
Moral Principles
In the case of an ectopic pregnancy, the lives of both the mother and child are placed at risk. The moral teachings of the Church call for medical treatment that respects the lives of both. Most recently, the U.S. Conference of Catholic Bishops reiterated these principles:
· In the case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.[2]
· 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.[3]
On one hand, there can be no direct attack on the child (direct abortion) to save the life of the mother. On the other hand, the life of the mother is equally valuable and she must receive appropriate treatment. It might be that the only available remedy saves the life of the mother but, while not a direct abortion, brings about the unintended effect of the death of the child. Morally speaking, in saving the life of the mother, the Church accepts that the child might be lost.
This principle applies in other pregnancy complications as well. With severe hemorrhaging, for example, if nothing is done, both will die. In respecting the life of the mother, the physician must act directly on the uterus. At that time the uterus loses its ability to support the life of the embryo. The mother’s life is preserved and there has been no intentional attack on the child. The mother and the uterus have been directly treated; a secondary effect is the death of the child.
Another example arises in the treatment of uterine (endometrial) cancer during a pregnancy. The common treatments of uterine cancer are primarily hysterectomy (surgical removal of the uterus) and sometimes chemotherapy or radiation therapy. Again, taking the life of the baby is not intended, but a hysterectomy does mean the removal of the womb and the death of the child. Yet, if a hysterectomy must be performed to save the life of the mother, the Church would deem the procedure morally licit.
Thus, a moral distinction must be made between directly and intentionally treating a pathology (a condition or abnormality that causes a disease) and indirectly and unintentionally causing the death of the baby in the process.
This distinction is derived from a moral principle called “double effect.” When a choice will likely bring about both an intended desirable effect and also an unintended, undesirable effect, the principle of double effect can be applied to evaluate the morality of the choice. The chosen act is morally licit when (a) the action itself is good, (b) the intended effect is good, and (c) the unintended, evil effect is not greater in proportion to the good effect. For example, “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” (Catechism, no. 2263, citing St. Thomas Aquinas).
Proposed Treatments
Catholic Theologians typically discuss the morality of three common treatments for ectopic pregnancies according to the principle of double effect.[4] One approach utilizes the drug Methotrexate (MTX), which attacks the tissue cells that connect the embryo to its mother, causing miscarriage. A surgical procedure (salpingostomy) directly removes the embryo through an incision in the fallopian tube wall. Another surgical procedure, called a salpingectomy, removes all of the tube (full salpingectomy) or only the part to which the embryo is attached (partial salpingectomy), thereby ending the pregnancy.
The majority of Catholic moralists reject MTX and salpingostomy on the basis that these two amount to no less than a direct abortion. In both cases, the embryo is directly attacked, so the death of the embryo is not the unintended evil effect, but rather the very means used to bring about the intended good effect. Yet, for an act to be morally licit, not only must the intended effect be good, but also the act itself must be good. For this reason, most moralists agree that MTX and salpingostomy do not withstand the application of the principle of double effect.
The majority of Catholic moralists, while rejecting MTX or a salpingostomy, regard a salpingectomy as different in kind and thus licit according to the principle of double effect. What is the difference?
A partial salpingectomy is performed by cutting out the compromised area of the tube (the tissue to which the embryo is attached). The tube is then closed in the hope that it will function properly again. A full salpingectomy is performed when implantation and growth has damaged the tube too greatly or if the tube has ruptured. These moralists maintain that, unlike the first two treatments, when a salpingectomy is performed, the embryo is not directly attacked. Instead, they see the tissue of the tube where the embryo is attached as compromised or infected. The infected tube is the object of the treatment and the death of the child is indirect. Since the child’s death is not intended, but an unavoidable secondary effect of a necessary procedure, the principle of double effect applies.
Dr. T. Lincoln Bouscaren,[5] an early 20th-century ethicist and canon lawyer, argues that though the pathological condition is caused by the presence of an embryo in the fallopian tube, nonetheless “the 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.”[6]
Bouscaren admits that this is a “fine distinction,” but he essentially argues that the infection in the tube, though related to the pregnancy, is sufficiently distanced from the pregnancy to constitute a pathological condition of its own. He maintains that the inevitable rupture is the final end of a single pathology, i.e., a diseased and ever-worsening tube.
Dr. Bouscaren arrives at the same conclusion as the majority of Catholic moralists, that both the partial and full salpingectomy is licit. Some critics of this conclusion argue that salpingectomy is morally indistinguishable from salpingotomy or MTX. Therefore, Dr. Bouscaren’s explanation is helpful and would benefit from further elaboration by contemporary moral theologians.
There are two circumstances that make the use of any of these treatments morally acceptable. The first occurs when an ectopic pregnancy has been diagnosed, but no signs of life exist. The morality of treatment for ectopic pregnancies concerns the absolute value of human life. Conversely, there is no such moral consideration if the embryo has succumbed—there is no taking of human life (assuming a reasonable effort has been made to detect life).
The second circumstance occurs when the fallopian tube ruptures, whether or not the embryo is alive. A ruptured tube presents an immediate threat to both mother and child. If nothing is done, both will die. The doctor is morally obligated to act, even though only one life can be saved. The rupture is the cause of the child’s death, not any procedure the doctor performs. These two circumstances, miscarriage and rupture, present fundamentally different moral questions from instances in which both mother and child are alive and the fallopian tube itself does not pose an immediate threat to the mother’s life.
Wait and See
Catholic moralists generally assume in their discussion of treatments for ectopic pregnancy that treatment will not be postponed. Perhaps most moralists believe there is no reasonable possibility to save the child. There are options, discussed below, but the availability of these options is virtually non-existent at this time. Other options are generally not even considered, because the standard protocol calls for only one of the three treatments that have been discussed thus far.
Surgical treatments, however, increase the risk of future ectopic pregnancies and/or reduce fertility, and there are situations in which postponing surgical intervention can be medically advantageous. “Expectant therapy” (or “expectant management”) is basically close observation in the hope that the pregnancy will resolve itself naturally. A combination of reduced hormone levels (movement toward miscarriage) and location of the embryo in a less constrictive part of the tube can indicate a decreasing chance of rupture.
While there are anecdotal accounts of fetuses living to six months without the tube rupturing, postponing surgery indefinitely is dangerous, given the virtual certainty of rupture long before viability. So, it’s one thing to wait a short period of time for miscarriage to occur spontaneously. It’s quite another to forego intervention altogether in anticipation of a life-threatening tubal rupture. Such a high-risk course of action is rightly discouraged and can even be indicative of a reckless disregard for the life of the mother.
If Only
There is a case that took place in 1915 in which a doctor, in the process of removing a tumor from a uterus, discovered an early tubal pregnancy. The operation on the tumor had left an incision in the uterus. The doctor transferred the embryo to the uterus through the incision. The embryo implanted, and the mother eventually gave birth to a healthy baby. The same hospital allowed further attempts at embryo transferal. Only a very small percentage were successfully implanted and born. Of those, the majority did not live very long. Most died between the ages of six and 12 years. With such low odds of the birth of a healthy baby, it is rare nowadays for medical professionals to consider embryo transferal. Recently a doctor at a Catholic fertility institute attempted three embryo transferals with none surviving to birth.
Among future possibilities might be the development of the artificial womb. Some shudder at such an option because of its possible abuse by those who want a child but wish to avoid pregnancy. However, a morally deficient motivation doesn’t nullify the potential of the technology itself. No one would question life support for a child who is born prematurely and cannot live on its own. An artificial womb could theoretically provide adequate life support for a child at an earlier stage.
Prayerful Discernment
It is the task and duty of those in the relevant professional fields, especially Catholics, to seek for means by which life at whatever stage can be preserved, protected, and nurtured. Unfortunately, the thrust of contemporary medical technology has been to terminate the tubal pregnancy as directly as possible without any consideration of ways to save the life of the embryo. This renders the application of the “double effect” theory to tubal pregnancies problematic, as the intended good of preserving the mother’s health seems to be accomplished directly through the efficient taking of the child’s life. This can be especially disturbing to Catholic couples who face this situation.
While the Church has not spoken officially about the morality of specific treatment options, she does provide several principles rooted in the natural law concerning human life. In applying these principles, the great majority of moral theologians agree that the salpingectomy does not constitute a direct attack on the life of the baby and is morally licit. A couple may serenely choose this option in good faith without fear that they are violating Church teaching.
Because the salpingectomy is considered by most theologians to be morally acceptable, the issue becomes how long to wait before proceeding with this invasive treatment, given the grave health risk posed by the ectopic pregnancy. This will vary from case to case. Sometimes the immediate risk is low and allowing the miscarriage to occur naturally preserves the mother’s fallopian tube. Conversely, there are also cases in which the fallopian tube itself is so compromised that it must be immediately removed to preserve the life of the mother.
The course of treatment the woman chooses should be determined by her informed conscience. This means that she must strive to understand the natural law regarding the value of life—her own and the baby’s—and choose a course of action that will respect both. She must also become informed about alternative treatment and the facts related to her own condition. She can then prayerfully discern the course of action she will take.
[1] Much of the statistical information in this Faith Fact was gathered from the CDC
[2] National Conference of Catholic Bishops. Ethical and Religious Directives for Health Care Services (Washington, DC: NCCB, 1994), 28
[3] Ibid., 47.
[4] Cf. William E. May, Catholic Bioethics and the Gift of Human Life (Huntington, IN: Our Sunday Visitor, Inc., 2000), 182-83.
[5] T. Lincoln Bouscaren, Ethics of Ectopic Operations (Chicago, IL: Loyola University Press, 1933).
[6] Ibid., 160-61.
RECOMMENDED READING:
Holy Bible (Catholic edition)
Catechism of the Catholic Church
Vatican II Documents
Catholic Bioethics and the Gift of Human Life by William May
Medicine and Christian Morality by Thomas J. O’Donnell, S.J
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Again, any woman who faces this has my deepest, most heartfelt sympathy. It is not my wish to quarrel, or even to discuss this further, unless you do. My aim is only to clarify my position on the remarks you took exception to, and to share the pain of the loss of babies with all those who have experienced it.
I do not know of ANYONE who thinks that surgery to treat an ectopic pregnancy is an “abortion.”
And, since this isn’t a medical forum, I use the common words, “Abortion” for elective termination, and “Miscarriage” for the loss of a child by spontaeous abortion. I am well aware of the medical terminology, just don’t see much point using it here. Besides, threatened and incomplete abortion aren’t terms that apply here.
I still don’t see anywhere it was mentioned that the mother in the article had an ectopic (outside the uterus) pregnancy, did you?
Having experienced two high-risk pregnancies that ended in the deaths of my children, I completely understand, and deeply sympathize.
McBride was part of the discussion about the surgery, described as urgent. It involved a serious illness, pulmonary hypertension. The condition limits the ability of the heart and lungs to function and is made worse, possibly even fatal, by pregnancy. --Link.Since you are a nurse, you would probably have your recommendations for someone with this malady. I go the holistic route (in combo with standard medicine or instead of), and I would have suggested (early on!) this woman see an acupuncturist, and also look into essential oils. The therapeutic type (only!) can and WILL heal a multitude of ailments, even of the serious nature (such as Frankincense is now being tested for treating cancer). --Link.
I agree with you. On very rare occasions where its save none or save one you have to try to save one.
The article states that the woman was critically ill and was in a life or death situation with what is described as pulmonary hypertension.
My criticism is based on your statement that all abortion is elective. And I was also concerned about your question of any mother that doesn't realize her obligation to her unborn child's welfare surpasses her own obligation to herself. That is not a reasonable statement in the face of such medical emergencies. Not every child can be saved and there's no reason to expect the mother to risk her life when there is no hope for the child.
I am very sorry for your own loss.
Only using that term for elective procedures is one of the problems in this case. This religious leader is either crazy or he's so jaded by the term that he can't imagine it being anything but an abortion of convenience. That, IMO, is a problem.
Was there really no other way? Impossible to tell from this story. Too often, it seems that once the issue is deemed " to save the life of the mother" no further effort is made to save the child. Only if we make the decision first that abortion is wrong no matter what, will every means necessary be used to save both mother and child.
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I believe this is correct, because the baby cannot grow and survive outside the womb.
Technically surgery for ectopic pregnancy is an abortion if the baby is still alive. However, this surgery is medically necessary and morally permissible because the baby WILL DIE no matter what and the mother WILL DIE if the surgery is not performed.
Thanks. Imho, if one begins from the right perspective, everything falls into place.
I believe this would fall under the doctrine of "secondary effect." The fallopian tube is inflamed and will burst and, therefore, needs to be removed. So the removal of that tube to prevent it from being burst is the primary condition being treated there. The secondary effect is that there is a baby growing in that tube that will, necessarily, not survive the removal of that tube.
Hopefully, technology will improve so that one day the tube can be removed and the baby will be able to be implanted in the uterine wall where it should be.
So they say.
Yes, that’s the same thing I understand.
What did you go through?
Agree
Thanks, mark.
Who are these "rabid pro-lifers" who don't want a woman to be allowed to have an abortion when the alternative is her certain death?
Can you point to a SINGLE credible pro-life group that believes this?
Or are you, and I suspect this is the case, simply trying to smear the entire pro-life movement as "rabid"?
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