In an April 2001 editorial of this journal I argued that there is no moral parity between the deliberate abortion of an unborn child and certain other medical procedures in which the death of the unborn child is inevitable even though not directly willed. These latter procedures, I reasoned, may be morally responsible applications of the principle of double effect. By way of illustration, I referred to the removal of a fallopian tube, in which a fetus has become lodged, even though that surgical procedure (salpingectomy) necessarily involves the loss of the unborn child.
In response to that editorial I have received letters from members of the medical profession who challenge my position in two respects. First, they argue that my example is outdated, because we now have new surgical procedures, other than the removal of the fallopian tube, to deal with that problem. Second, one of the physicians, a professor at a distinguished university, disputes that my example is a proper appeal to the principle of double effect, because in this removal of the fallopian tube (to use his own words) “the primary objective is and always has been to destroy the growing gestation.”
Obviously, both of these objections deserve answers. With regard to the first, I can only say that I did not write in ignorance. I was already aware of the availability of other medical procedures, besides the removal of the fallopian tube, to deal with the problem. However, I was writing an editorial, not a lengthy and detailed study, and in such a setting it is normal to set limits on one’s recourse to illustrations. I will demonstrate presently that I am familiar with other surgical answers to the dilemma.
With regard to the second objection (that I incorrectly applied the principle of double effect), I must disagree with its premise about the intent of the surgical procedure under discussion. I urge, on the contrary, that if the destruction of “the growing gestation” (the author’s expression for “baby”) is the “the primary object” of any surgical procedure, then that procedure is intrinsically immoral. Deliberately to intend to take an innocent life, for whatever purpose, is murder pure and simple.
I limit myself to assessing three ways (that I know of) in which the medical profession may deal with a fallopian tube pregnancy.
First, the aforesaid surgery, salpingectomy, the removal of the fallopian tube that contains the fetus. The primary object of this procedure, I insist, is not the death of the child, but its removal from a place in the mother’s body where it is not supposed to be. The death of the child, though a necessary consequence of the surgery, is not what the surgeon seeks. When this surgery is performed in order to save the mother’s life, it is the fetus’s removal, not its dying, that is directly intended. In the case of salpingectomy, consequently, there is no specifically causal relationship between the death of the fetus and the saving of the mother’s life. On the hypothesis that there were some way to remove the fallopian tube and still keep the fetus alive, the latter option would be the proper moral choice.
Salpingectomy, then, is by intent an act morally different from the violent removal of a child from a mother’s womb or the killing of the child within the womb, procedures that are carried out for one purpose only—to destroy the child in order to prevent it from being born. In summary, the removal of the fallopian tube in such circumstances appears to be a perfectly sound application of the principle of double effect.
Second, a more sophisticated procedure known as salpingostomy, in which the fallopian tube is opened and the fetus removed. The fallopian tube is then surgically mended. This procedure is currently growing in popularity for the obvious reason that it preserves intact an organ necessary for future pregnancies.
Once again, nonetheless, one must insist that the directly intended purpose of this surgery is not to destroy the fetus but to remove it from a place where it is not supposed to be. Likewise, by way of a wilder hypothesis, we would have an identical moral case if the fetus somehow slipped its moorings and migrated, Minerva-like, to the mother’s brain. I hope no one would use the word “abortion,” in such a case, to describe its removal by a brain surgeon.
Simply put, I am arguing that if the fetus has become implanted elsewhere than in the uterus, its surgical removal is not correctly called an abortion (even though it is also a fact that ectopic pregnancies sometimes result in live births). In summary, salpingostomy seems to meet the moral criteria of the principle of double effect. That is, the death of the child is not directly intended, nor is there any causal relationship between the death of the child and the saving of the mother’s life. Abortion and salpingostomy, then, are morally distinct by reason of direct intent.
Third, a variety of non-surgical methods, usually involving the introduction of some toxic agent, directly intended to kill the fetus within the fallopian tube, so that it will be removed thence by the mother’s own biochemical response. I believe that these medical procedures, because they attack the life of the fetus as their intended object, are morally reprehensible. While such procedures have the advantage of being less intrusive than either the removal or opening of the fallopian tube, they have no moral parity. Nor does the relative “convenience” of those non-surgical procedures improve their moral status. God never promised us that a morally proper action will be more “efficient” than a morally deficient action.
I confess that I entertain no illusions that my further comments here will necessarily satisfy all those who challenged my original editorial, but it seems important that their objections be answered anyway. Christian minds over the centuries have settled many a moral quandary by recourse to established rational procedures for arriving at responsible decisions; one of these procedures is called the principle of the double effect. It is useful to review that rational exercise from time to time, even if, as I sometimes fear, we may end up simply carving it on the wall of a cave, just before Armageddon.
If I am in error on this matter, I will be happy for proper correction, of course, because I do not want to lead anyone astray with respect to God’s prohibition against murder. At this point, however, I must stand with the position I took in my April editorial.
—Patrick Henry Reardon
Patrick Henry Reardon is pastor of All Saints Antiochian Orthodox Church in Chicago, Illinois. He is the author of Christ in the Psalms, Christ in His Saints, and The Trial of Job (all from Conciliar Press). He is a senior editor of Touchstone.
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