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25 February 2011

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bearing

(I should add that it is my understanding that there is some debate among orthodox theologians, who all recognize that methoxetrate treatement is illicit, about whether the middle-ground salpingostomy route is permissible or not. I happen to be convinced by the more morally conservative line of reasoning, and I trust I'd remain true to it if I ever were in the sad situation of having to deal with an ectopic pregnancy.)

Jennifer Fitz

Bearing, you a braaave lady bringing up ectopic pregnancy.

One thing I am unclear on: For the longest time, I was fairly certain that preterm live delivery, even so early in the pregnancy that the baby could not possibly survive, was a legitimate choice for proportionately serious reasons. (Such as certain death of the mother otherwise).

During the great Pheonix Hospital debates, someone told me that no, this was not a morally acceptable choice per the Church. (But, said by a person who disagreed with the church on that point.)

I would be interested to hear from someone who is knowledgeable on that particular question.

Charlotte (Matilda)

I tried to email you but it bounced back. I have a question regarding counting calories. Could you email me?
Thanks!

bearing

Jennifer, I consider this post not really about ectopic pregnancy, but more about the principle of double effect and the strange places it seems to lead us. I get tired of examples involving busloads of orphans crossing train tracks.

I'm unclear on that same thing, the preterm delivery, too. It's obvious that a baby may be delivered one week early for a proportionate reason. Two, six, ten weeks early... I don't see why there should be a bright line. (Let's assume hypertension or pre-eclampsia, something that is expected to get worse as the pregnancy progresses...) My thought is that you carefully monitor both baby and mother and do your best to take care of both, only acting when one of them reaches a critical point. Assuming the mother both wants the baby to live and wants herself to live, I think it would be safest to give her the best information possible about her condition and let her call the shots. I mean, that's what I would want if I were the mother.

Delores

Well... on ectopic: I have had 2.

The first one was while we lived in Abu Dhabi. I had never heard of one and it was hard to diagnose and they were not sure (at first) but all I was told was this: the baby CANNOT live, and I could very easily die. And I also knew that the Muslim country would not perform an abortion unless it were necessary. Well, at least I trusted that at the time. We were not catholic at the time. Eventually there was just too much concern, they went in and saw it was there and removed it. I have no idea how, other than that I kept my tube.

Which led to ectopic #2. We thought it might be, but were unsure and just waiting it out. That was a horrible time and we were catholic and I was just so unsure. But, the tube ruptured, so there was no real choice in the matter. In a way, to me the baby was already dead; but I could still live. I guess I feel like the decision was made for me.

But looking back on those two instances I realize how little 'moral theology' I had at the time. Would I have acted differently? I doubt it. I have always understood it that the ectopic baby will never live, so it is not like killing it; it is simply preserving the life of the mother -- they are doing good, but no harm. Perhaps I am oversimplifying, and I could easily be wrong.

For me the issue gets more fuzzy with situations like uterine cancer discovered when a woman is pregnant.

bearing

Delores, that's exactly why we need to be able to trust that our Catholic hospitals are on board with Church teaching -- because when an ordinary layperson seeks medical care, if they choose a Catholic institution *on purpose*, they should be able to trust that the staff will give them all the information they need, and that they will not violate the sanctity of life. (As a matter of medical ethics, I absolutely think it's fair, if there is a procedure that Catholic hospitals won't do for moral reasons, to explain that they don't do it and why. Ultimately it is the patient who makes the call whom to seek treatment from.)

Anyway, it is difficult to see why one leads to the other, although my experience has been that sitting down and thinking through it, the connections make sense.

Re: deadly uterine cancer discovered when a woman is pregnant, I was under the understanding that hysterectomy is permitted in that sad situation. You may remove the uterus to save the mother -- that's double effect -- but you can't schedule an abortion on Monday and a hysterectomy on Tuesday. So in a way it's not fuzzy at all, at least in the abstract. From the P.O.V. of the mother, of course -- who has the right to decide whether to risk her own life, as she may freely choose to do (cf. St. Gianna Beretta Molla) or whether to save it at the cost of her child's life, as she may freely choose to do -- it is not abstract at all....

bearing

... but about the procedure you had done in Abu Dhabi, like I said, as far as I know there is debate about whether the tube section has to be removed or whether the embryo can be removed licitly in that circumstance. (Certainly if the embryo is already dead it can be removed however works.)

Delores

But then I ask: what is the ultimate difference? If the tube is removed, the baby dies; if the baby is removed another way, the baby dies. Am I theologically incorrect in thinking along those lines? I would never support the drug-kill method, I guess that seems too direct.

I am guessing I had the salpingostomy since I kept my tube -- I was obviously unconscious at the time, and I don't think they asked my husband. My Dr. was a devout Muslim woman, assisted by her devout Muslim husband, and I guess I always figured (like I said) they would not do anything to harm a baby.

Curious: has an ectopic pregnancy ever been saved?

Robin

No fluff here; no sir. That's what I love about this blog.

My 14 yo loved the double effect explanations. And I'm still pondering the ectopic give drugs/take the baby/take the tube solution.

bearing

Another thing that I think can give some clarity about double effect is to stop focusing on all the people who could be suffering harm from the actions under consideration -- that is, to stop focusing on the ill pregnant woman and her baby, to stop focusing on the orphans on the train tracks or the assailant in Jennifer's bathtub -- and instead focus on the agent, the one who is actually on the point of DOING the critical act -- the one whose will ultimately has to decide to pull the trigger, throw the switch, prescribe a drug or wield a scalpel. They too have choices to make. Assume he does not consent to directly harm an innocent person. *Assume that one who intentionally harms an innocent person is himself grievously harmed* by taking that action. Look at it from the p.o.v. of the *doctors* of the ill pregnant woman, for example. If you assume that they harm themselves by the act of killing an innocent, and that they have a right to refuse to do it, does that clarify things at all?

Delores

Great point, Erin. So for the doctor, it does make a difference.

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