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November 8, 2009

Applying double-effect principle in ectopic pregnancy

By Father William Grogan

The Oct. 25-Nov. 7 edition of this paper included a column by the neuroscientist - priest Father Tad Pacholczyk. It addressed the morality of three approaches (two surgical and one pharmaceutical) used to resolve the lifethreatening, often fatal tragedy of pregnancy attachment outside the womb. (extrauterine/ ectopic pregnancy).

He asserted that only one — a surgical approach — is morally acceptable and the other two are morally objectionable.

His opinions do not represent the teaching of the church nor mainstream moral thinking faithful to the magisterium on this topic.

This issue has been reviewed by the cardinal’s Bioethics Committee three times in the past six years. In those reviews, note was taken of the concerns his column raised. But, these concerns were not found to be contrary to church thinking. Some writers like the author do not agree with this. Yet, the Holy See’s Congregation for the Doctrine of the Faith has not addressed the matter — though the topic has been supposedly before it for almost a decade.

Because such pregnancies are not uncommon and their outcome potentially fatal, a fuller discussion in the column should have occurred. A more adequate treatment would have included the following key points consistent with Catholic moral analysis.

First, the two surgical procedures are morally acceptable because the intent behind the surgery is to heal damaged tissue, not directly kill the fetus. Besides the appropriate moral intent, the surgical act is acceptable. In light of the risk of the mother bleeding to death caused by the attachment’s damage and possible rupture of the site, time is of the essence in these circumstances.

The surgical procedure he questions is tolerated because again the purpose is to remove with as little risk as possible to the mother the damaged tissue at the site where tragically the cells have attached. In removing the damaged tissue, the doctor, as is the case with the removal of a cancerous womb in a pregnant woman, foresees but does not intend the demise of the embryonic/fetal person. Thus it is morally acceptable and has been since first advanced over 40 years ago by the conservative Jesuit moralist Father John Connery.

The columnist also argues that the use of methotrexate, a chemical often used with cancer therapy, is not morally acceptable. Its hypothesized outcome is the dissolving of those embryonic or fetal cells which have attached sadly to the wrong and often lethal place within the mother’s body. It is used when medically appropriate as an alternative to surgery to avoid the latter’s risk of infection and other problems.

Morally, it is tolerable because it is not factually clear, as the author notes, as to what exactly is dissolved and also if a moral distinction at that early stage of development should occur between the attaching cells and the other parts of the terminal pregnancy.

Again, the intent is to remove the cells which are attacking the health of the mother, not attack directly the fetal/embryonic person. The moral object/purpose of this intervention is to address damaged tissue and start the healing process. It is not to kill the embryonic person.

In both situations, as well as in the surgical intervention the columnist accepts, other measures to allow the continuation of the pregnancy do not exist. These emergency circumstances then allow for the use of the moral reasoning known as the principle of double effect (or multiple outcomes) to address this type of tragedy. In all three measures, it is always affirmed there are two lives present. No one advances that an abortion is acceptable. These measures do not constitute an abortion.

The church’s wisdom notes the tragedy and sadness the unintended, though foreseen, loss under these limited circumstances presents. It uses its wealth of reflection to reason how the matter can be addressed morally and both lives respected — the mother’s as well as the young fetus/embryo.

While some commentators like this neuroscientist- priest are free to note their reservation on this or any other matter, church teaching supports a broader perspective. Some may not agree with the moral calculus used. However, it has served our magisterium and others within the church well.

Catholic mothers, physicians and nurses are morally free to use the two surgical and pharmaceutical approaches when it appears the pregnancy will not resolve itself naturally. In doing so they witness to the Gospel of life in using their God-given talents to respect life even when it cannot be preserved.

Grogan serves as recording secretary of Cardinal George’s archdiocesan Bioethics Committee. He wrote this column in response to a column by Father Tad Pacholczyk, director of education at the National Catholic Bioethics Center.