As I understrand it, this is a sitution that can develop fairly early, like maybe 12th week of pregnancy or so, for which the prognosis is very, very poor for the mother. Part of the moral dilemma is that nobody is quite sure what causes it, but it might be caused by abnormal function of the placenta.
Now, as I undersand it, the placenta is a shared, feto-maternal organ composed of cells and tissues of both the mother and the baby. The part that faces toward the baby develops (like the umbilical cord and the anmionic membrane) from the baby's blastocyst: in other words, it is one of the external organs of the baby. The part that faces the mother's uterine wall develops from the mother's endometrial cells: it's part of the internal develoment of her pregnant uterus.
Here's the thing: the fetal placenta and the maternal placenta, are intricately intertwined. Zillions of tiny maternal spiral arteries mesh together with the fetal villi, kinda like velcro hooks and loops, keeping the villi bathed in maternal blood, for essential nutrient and gas exchange.
OK, bottom line, say acute pulmonary hypertension is indeed caused by a placental disorder. If the placenta were the mother's organ, it would clearly be OK to remove this malfunctioning organ in order to save the mother's life. If it's the baby's organ, then you can't attack the placenta (e.g. remove it) because you're attacking the baby himself.
Whether you prematurely deliver the baby from the womb at this stage or not, it has no effect whatsoever on his survivability. Either way, his survivability is zero. But if you remove baby and placenta, the baby dies (as he would anyway) but the mother's hypertension rapidly resolves and she regains normal heart function. It saves her life.
Keep in mind that there's a lot they don't know about exactly how this works.
I have read that reptable Catholic prolife ethicists are divided over this one: can you remove the baby and placenta from the womb at 12, 13, 14 weeks or not?
I have my own opinion, but I'd like to hear yours.
Acute pulmonary hypertension is a new one on me. I’ll take it that the situation is as you describe.
One question is whether the theory that the placenta causes it has good grounds for support, or whether it’s just a theory, as yet uncertain. There would be less reason to do it if it is a far out theory. It “might” be caused by the placenta? What are the grounds for thinking—or speculating—this? And what is the cause—an allergic reaction to the placenta? But let’s say that the chances are 50-50.
In that case, it seems to me that the decision what to do is up to the mother. The doctor should acquaint her with all the medical facts and odds. Then, as with the case of whether or not to have chemotherapy, it would be up to the mother. This strikes me as an especially hard decision, if as you say the cause of this condition is uncertain.
It doesn’t strike me as relevant whether the placenta consists of the mother’s or the baby’s tissue. Clearly it is needed for the baby’s survival, whereas it is not a vital organ for the mother.
Certainly this is a hard one. I would be inclined to say that the placenta should not be removed, since it is uncertain whether or not it is the problem—but I think the decision probably is up to the mother in a case like this. A hard one.
I'm not a Catholic moral theologian or a physician. So if I were to hazard an opinion, I'd really be in a deeper part of the pool than where I should be.
If I were to offer a WAG, it would focus on: is there a way to resolve or ameliorate the physical illness where the treatment does not consist of killing the baby? If a treatment of the woman's body cures or manages the illness, and happens to lead to the death of the child, that would be, in my guess, licit. But if the treatment of the woman happens to be the direct, intentional killing of the child, then that wouldn't be licit.
In other words, the woman may not be licitly treated through the action of killing the child.
Whether placentas are part of the woman's body or part of the child's body, or both is way beyond my knowledge. Whether the only cure here is to directly remove the placenta is also way beyond my knowledge. Whether there is some way to understand the actions of the treating physician so that one does not violate the absolute moral precept that one may not directly, intentionally kill and innocent human being to benefit another human being is beyond my ability to understand the moral issues tied up in this particular set of circumstances that you describe.
I do remember once reading a dubium from the latter half of the 19th century where the question was asked whether one could licitly intentionally induce an early labor and birth well before any realistic point of viability, even knowing that the birth would result in the death of the child, for the purposes of saving the mother's life. The answer from the Church was in the negative. An induced early labor and birth that would not have otherwise occurred, at a point in pregnancy where it was known that the child just could not survive, could not be a treatment for the woman, as it would have been through the direct, intentional killing of the child that the woman's life was saved, rather than as an unfortunate byproduct of a treatment of the woman's body.
This seems to me the closest similar circumstances of which I've heard an answer expressed by the Church.
sitetest