PIXABAY

Commentary

Dispelling fears about pregnancy complications and abortion restrictions

An expanded version of this essay also appeared on the University of Notre Dame’s “Church Life Journal” website, https://churchlifejournal.nd.edu/articles/4-persistent-abortion-myths-debunked/.

Ever since the Supreme Court overturned Roe v. Wade, abortion rights supporters have attempted to craft a narrative that pregnant mothers suffering from complications during pregnancy will be denied care by practitioners fearful of prosecution under laws that prohibit abortion. They assert that women with ectopic pregnancies, miscarriages or life threatening conditions will not receive appropriate medical care, leaving them at risk for serious illness or even death. The fear and confusion created by these assertions are eliminated with a proper understanding of Catholic teaching.

The Principle of Double Effect

The Principle of Double Effect helps guide decision making on many moral issues, especially those surrounding complications during pregnancy. According to this principle, if certain conditions are met, someone can perform an action that is intended to produce a good effect, yet an anticipated but unintended bad effect occurs at the same time. 

Four conditions govern this principle. First, the action itself is morally good or morally neutral, neither good nor bad. Second, only the good effect of the action is intended.  The bad effect, while foreseen, is not intended. Thirdly, the good effect does not occur by means of the bad effect. Finally, there must be a proportionally grave reason to permit the bad effect.

Miscarriage vs. abortion: what is the difference?

Abortion is the directly intended termination of a viable fetus at any point after conception. In simpler terms, it is the intentional, direct killing of a baby before it is born. With this definition in mind, abortion is never morally permissible as it is the deliberate killing of an innocent human being.

On the other hand, a miscarriage is the spontaneous loss of a pregnancy before the 20th week of pregnancy, while loss of the pregnancy after 20 weeks is a still birth. The key difference between an abortion and a miscarriage is that an abortion is the direct, intentional killing of a human being, while a miscarriage occurs spontaneously without anyone intending harm to the unborn child. 

Sometimes after a miscarriage, a medical procedure called dilation and curettage (D&C) is necessary to remove the remaining tissue that did not pass spontaneously. Abortions performed before 14 weeks gestation use the same technique. The critical difference is that with a miscarriage, the fetus has already died and the D&C is performed to treat ongoing bleeding or prevent infection, while with an abortion, the D&C is performed to directly kill a viable fetus.

Ectopic Pregnancies

Ectopic pregnancy occurs when the fertilized egg grows outside the uterus. Under normal circumstances, the fertilized egg travels from the fallopian tubes and implants in the wall of the uterus. On occasion, instead of implanting in the uterine wall, the embryo starts to grow outside the uterus, resulting in an ectopic pregnancy. The vast majority of ectopic pregnancies occur when the embryo becomes lodged in the fallopian tubes. The pregnancy cannot be sustained and eventually the embryo will die. 

In some cases, the pregnant woman is carefully monitored and the embryo dies naturally and the remaining tissue absorbs on its own. However, in other circumstances, treatment becomes necessary, or the life of the mother is at serious risk. Medications or surgery can be used to treat an ectopic pregnancy, and the principle of double effect helps us understand which treatments are morally permissible. 

There is universal agreement among Catholic ethicists that surgical removal of the fallopian tube carrying the pregnancy (salpingectomy) is morally permissible. During this procedure, the desired good effect is saving the mother’s life and the anticipated yet undesired bad effect is the death of the embryo. This surgery involves removing the affected fallopian tube, which is morally neutral. The mother’s life is saved, not by killing the embryo, but by removal of the diseased fallopian tube. There is a proportional reason to tolerate the bad effect: the mother’s life is saved. 

Catholic ethicists are divided whether other methods to treat ectopic pregnancies are morally permissible. Methotrexate is a chemotherapy agent that can also be used to treat an ectopic pregnancy. Some ethicists see this medication as a direct attack on the embryo, and thus not morally permissible, while others see this medication as directed towards tissues that eventually will form the placenta and is permissible as it does not directly attack the embryo itself. 

Salpingostomy is another surgical procedure that can be used to treat a tubal pregnancy. During this procedure, the embryo is excised from the fallopian tube, but the tube is left otherwise intact. Most ethicists see this as a direct killing of the embryo and not ethically allowed.   

Early Induction of Labor

Most obstetricians consider 23-24 weeks as the age of viability. Can induction of labor before 23 weeks gestation ever be ethically justified? 

The two most common conditions that threaten the life of the mother are preeclampsia and premature rupture of membranes. In preeclampsia, the mother develops uncontrolled hypertension, placing her at risk for seizures, hemorrhage, stroke and other serious complications. The source of the problem is not the developing fetus, but the placenta. In preeclampsia the placenta releases a hormonal signal to which the mother responds with increasing blood pressure. In most situations, the blood pressure will continue to rise to dangerous levels that put both the mother and the fetus at risk. If the pregnancy is beyond 24 weeks, both the mother and baby benefit from early induction of labor. However, if induction of labor occurs prior to 23 weeks, only the mother benefits as the baby will likely die. Can this be morally justified?

Induction of labor prior to 23 weeks can be morally permissible using the principle of double effect. In this case, saving the life of the mother is the desired good effect, while the death of the baby is the foreseen, but undesired bad effect. The four standards of the double effect principle are fulfilled: 1) The action of inducing labor is morally neutral. 2) The intent is to treat the diseased placenta while the death of the baby is the unintended consequence of labor induction. 3) The means of saving the mother’s life is removal of the diseased placenta; the death of the baby is not the means by which her life is saved. 4) Saving the life of the mother is a proportionally grave reason to tolerate the unintended death of the baby.

Premature rupture of membranes can lead to life threatening infection for both the mother and the developing baby.  While antibiotics can be used in some cases to prevent infection, often early induction of labor is needed to treat a life-threatening infection in the mother. The ethical issues in this situation are very similar to preeclampsia.

Lethal Fetal Anomaly

In some unfortunate situations, during prenatal testing (usually by ultrasound or with sampling of amniotic fluid), a baby is diagnosed with a congenital anomaly that is incompatible with life outside the womb, even if the pregnancy is carried to term. Unless the mother develops serious complications (such as preeclampsia), it is not morally permissible to induce labor early as the child has the moral right to have his or her life prolonged for the remaining weeks of the pregnancy. 

Conclusions

Life-threatening complications associated with pregnancy are often heartbreaking and medically complicated. These difficult situations can be exploited by abortion rights supporters who claim that women will be allowed to die if abortion is not available. Catholic moral teaching and tradition guides us through these complex decisions and morally appropriate solutions can be found.