Moral Questions

Since the demise of “the questions people ask” there continue to be, from time to time, moral questions asked by our faithful. In the first of an occasional series we answer this month the question of ectopic pregnancy.

It is never permitted to directly kill an infant (or any other person for that matter, with the exception of self defence, just war and capital punishment), and so consequently, it is immoral to perform an abortion in the case of an ectopic pregnancy, even to save the life of the mother. This is immoral, whether it is done surgically or chemically. There are now available medications (such as methotrexate, or just recently RU-486) that are commonly used for tubular pregnancies, and that directly cause the living foetus to be aborted. This is always immoral.

However, if it can be established that the foetus is already dead (by ultrasound examination, for example), then clearly the surgical removal of the already dead foetus for the health of the mother is entirely permissible.

The difficulty arises when the foetus is still alive. The mother’s life is endangered through internal haemorrhage at that time. The moral theologians hold different opinions as to whether it is permissible to intervene surgically to remove the ectopic pregnancy before the death of the foetus. Some say that surgical intervention directly kills the foetus, which is immoral. Others say that it is not direct killing at all, but it is the removing of a mass of tissue (including the placenta) which has fixed itself in the wrong place (the fallopian tube instead of the uterus), in such a way as to cause a tumour invading the mother’s fallopian tube, rather like a malignant tumour. Just as it is possible to operate on a tumour of the mother, (e.g., in treatment of uterine cancer) even if as a consequence and indirectly the child will die, so also it is moral, they say, to surgically remove this abnormal mass of tissue, which contains the foetus. It is an indirect and unfortunate, though necessary, consequence that the foetus will die, but this is not willed in itself.

The principle used in this second opinion is the application of the principle of double effect, or the indirect voluntary. This is moral, provided that the bad effect, in this case the death of the unborn child is not directly willed in itself, and that there is a proportionate reason (such as saving the life of the mother), and that the good effect, namely saving the mother’s life does not directly come from the bad effect, the death of the child. The understanding of this solution depends upon the grasping of the gravity of the proportionate reason. The foetus that lodges in the fallopian tube cannot survive in any case, and if the mother is not treated she may very well haemorrhage to death, or be observed in hospital for several weeks, and her fallopian tubes can be so damaged by the ectopic pregnancy left untreated that she might never be able to conceive again.

Since there are opinions on both sides of this question, both can be safely followed in conscience. Consequently, it is permissible to have surgery, provided that it is not a direct abortion, but the removal of invasive tissue, but it is never permissible to take medications to kill the live foetus.