Ectopic Pregnancies

[Nihil Obstat]

Also I'm sure that [url="http://www.priestsforlife.org/"]Priests for Life[/url] would be willing and able to address the issue.
I attended a small lecture given by a priest from Priests for Life Canada about mercy killing, and if their priests are half as intelligent as this man was, then they are an invaluable resource to the pro-life movement.


EDIT: I just remembered the name of the priest I met. It was Fr. Tom Lynch, who is the national director of Priests for Life Canada.

Edited April 27, 2010 by Nihil Obstat

[Nihil Obstat]

Here's a good article I just read:


Moral Principles

In the case of an ectopic pregnancy, the lives of both the mother and child are placed at risk. The moral teachings of the Church call for medical treatment that respects the lives of both. Most recently, the U.S. Conference of Catholic Bishops reiterated these principles:

· In the case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.[2]

· Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.[3]

On one hand, there can be no direct attack on the child (direct abortion) to save the life of the mother. On the other hand, the life of the mother is equally valuable and she must receive appropriate treatment. It might be that the only available remedy saves the life of the mother but, while not a direct abortion, brings about the unintended effect of the death of the child. Morally speaking, in saving the life of the mother, the Church accepts that the child might be lost.

This principle applies in other pregnancy complications as well. With severe hemorrhaging, for example, if nothing is done, both will die. In respecting the life of the mother, the physician must act directly on the uterus. At that time the uterus loses its ability to support the life of the embryo. The mother’s life is preserved and there has been no intentional attack on the child. The mother and the uterus have been directly treated; a secondary effect is the death of the child.

Another example arises in the treatment of uterine (endometrial) cancer during a pregnancy. The common treatments of uterine cancer are primarily hysterectomy (surgical removal of the uterus) and sometimes chemotherapy or radiation therapy. Again, taking the life of the baby is not intended, but a hysterectomy does mean the removal of the womb and the death of the child. Yet, if a hysterectomy must be performed to save the life of the mother, the Church would deem the procedure morally licit.

Thus, a moral distinction must be made between directly and intentionally treating a pathology (a condition or abnormality that causes a disease) and indirectly and unintentionally causing the death of the baby in the process.

This distinction is derived from a moral principle called “double effect.” When a choice will likely bring about both an intended desirable effect and also an unintended, undesirable effect, the principle of double effect can be applied to evaluate the morality of the choice. The chosen act is morally licit when (a) the action itself is good, (b) the intended effect is good, and (c) the unintended, evil effect is not greater in proportion to the good effect. For example, “The act of self-defense can have a double effect: the preservation of one’s own life; and the killing of the aggressor. . . . The one is intended, the other is not” (Catechism, no. 2263, citing St. Thomas Aquinas).

Proposed Treatments

Catholic Theologians typically discuss the morality of three common treatments for ectopic pregnancies according to the principle of double effect.[4] One approach utilizes the drug Methotrexate (MTX), which attacks the tissue cells that connect the embryo to its mother, causing miscarriage. A surgical procedure (salpingostomy) directly removes the embryo through an incision in the fallopian tube wall. Another surgical procedure, called a salpingectomy, removes all of the tube (full salpingectomy) or only the part to which the embryo is attached (partial salpingectomy), thereby ending the pregnancy.

The majority of Catholic moralists reject MTX and salpingostomy on the basis that these two amount to no less than a direct abortion. In both cases, the embryo is directly attacked, so the death of the embryo is not the unintended evil effect, but rather the very means used to bring about the intended good effect. Yet, for an act to be morally licit, not only must the intended effect be good, but also the act itself must be good. For this reason, most moralists agree that MTX and salpingostomy do not withstand the application of the principle of double effect.

The majority of Catholic moralists, while rejecting MTX or a salpingostomy, regard a salpingectomy as different in kind and thus licit according to the principle of double effect. What is the difference?

A partial salpingectomy is performed by cutting out the compromised area of the tube (the tissue to which the embryo is attached). The tube is then closed in the hope that it will function properly again. A full salpingectomy is performed when implantation and growth has damaged the tube too greatly or if the tube has ruptured. These moralists maintain that, unlike the first two treatments, when a salpingectomy is performed, the embryo is not directly attacked. Instead, they see the tissue of the tube where the embryo is attached as compromised or infected. The infected tube is the object of the treatment and the death of the child is indirect. Since the child’s death is not intended, but an unavoidable secondary effect of a necessary procedure, the principle of double effect applies.

Dr. T. Lincoln Bouscaren,[5] an early 20th-century ethicist and canon lawyer, argues that though the pathological condition is caused by the presence of an embryo in the fallopian tube, nonetheless “the tube has become so debilitated and disorganized, or destroyed by internal hemorrhage, that it now constitutes in itself a distinct source of peril to the mother’s life even before the external rupture of the tube.”[6]

Bouscaren admits that this is a “fine distinction,” but he essentially argues that the infection in the tube, though related to the pregnancy, is sufficiently distanced from the pregnancy to constitute a pathological condition of its own. He maintains that the inevitable rupture is the final end of a single pathology, i.e., a diseased and ever-worsening tube.

Dr. Bouscaren arrives at the same conclusion as the majority of Catholic moralists, that both the partial and full salpingectomy is licit. Some critics of this conclusion argue that salpingectomy is morally indistinguishable from salpingotomy or MTX. Therefore, Dr. Bouscaren’s explanation is helpful and would benefit from further elaboration by contemporary moral theologians.

There are two circumstances that make the use of any of these treatments morally acceptable. The first occurs when an ectopic pregnancy has been diagnosed, but no signs of life exist. The morality of treatment for ectopic pregnancies concerns the absolute value of human life. Conversely, there is no such moral consideration if the embryo has succumbed—there is no taking of human life (assuming a reasonable effort has been made to detect life).

The second circumstance occurs when the fallopian tube ruptures, whether or not the embryo is alive. A ruptured tube presents an immediate threat to both mother and child. If nothing is done, both will die. The doctor is morally obligated to act, even though only one life can be saved. The rupture is the cause of the child’s death, not any procedure the doctor performs. These two circumstances, miscarriage and rupture, present fundamentally different moral questions from instances in which both mother and child are alive and the fallopian tube itself does not pose an immediate threat to the mother’s life.

Wait and See

Catholic moralists generally assume in their discussion of treatments for ectopic pregnancy that treatment will not be postponed. Perhaps most moralists believe there is no reasonable possibility to save the child. There are options, discussed below, but the availability of these options is virtually non-existent at this time. Other options are generally not even considered, because the standard protocol calls for only one of the three treatments that have been discussed thus far.

Surgical treatments, however, increase the risk of future ectopic pregnancies and/or reduce fertility, and there are situations in which postponing surgical intervention can be medically advantageous. “Expectant therapy” (or “expectant management”) is basically close observation in the hope that the pregnancy will resolve itself naturally. A combination of reduced hormone levels (movement toward miscarriage) and location of the embryo in a less constrictive part of the tube can indicate a decreasing chance of rupture.

While there are anecdotal accounts of fetuses living to six months without the tube rupturing, postponing surgery indefinitely is dangerous, given the virtual certainty of rupture long before viability. So, it’s one thing to wait a short period of time for miscarriage to occur spontaneously. It’s quite another to forego intervention altogether in anticipation of a life-threatening tubal rupture. Such a high-risk course of action is rightly discouraged and can even be indicative of a reckless disregard for the life of the mother.

If Only

There is a case that took place in 1915 in which a doctor, in the process of removing a tumor from a uterus, discovered an early tubal pregnancy. The operation on the tumor had left an incision in the uterus. The doctor transferred the embryo to the uterus through the incision. The embryo implanted, and the mother eventually gave birth to a healthy baby. The same hospital allowed further attempts at embryo transferal. Only a very small percentage were successfully implanted and born. Of those, the majority did not live very long. Most died between the ages of six and 12 years. With such low odds of the birth of a healthy baby, it is rare nowadays for medical professionals to consider embryo transferal. Recently a doctor at a Catholic fertility institute attempted three embryo transferals with none surviving to birth.

Among future possibilities might be the development of the artificial womb. Some shudder at such an option because of its possible abuse by those who want a child but wish to avoid pregnancy. However, a morally deficient motivation doesn’t nullify the potential of the technology itself. No one would question life support for a child who is born prematurely and cannot live on its own. An artificial womb could theoretically provide adequate life support for a child at an earlier stage.

[url="http://www.cuf.org/faithfacts/details_view.asp?ffID=57"]Full article at this link.[/url]

[Slappo]

Great article Nihil!

The MTX drug is the one I was referring to. I've heard some argue that it is different than an abortion and is morally permissible. I personally would strongly strongly discourage my wife from doing so if an ectopic pregnancy occurred and plead that she waits it out to see if the pregnancy will resolve itself and if no resolution is reached before the risk of rupture is present, then encourage the removal of affected tube.

[Slappo]

double post

Edited April 27, 2010 by Slappo

[Archaeology cat]

[quote name='Nihil Obstat' date='27 April 2010 - 01:54 AM' timestamp='1272329648' post='2100673']
Another thing about ectopic pregnancies, if I understand correctly, is that the death of the baby is assured in any case, since there can be no nutrients supplied via the fallopian tube. At that point the moral path is to save the mother, as long as you don't directly kill the baby to do so.
[/quote]
I think there are some doctors who will keep the mother under observation until the tube ruptures, and then will perform an emergency surgery to remove the tube. At that point, the child is already dead, from what I understand, and the doctor is acting solely to save the mother. This is not always a possible solution, I imagine, but I think it's been done.

Oh, and while I don't know the exact rate of ectopic pregnancies, I imagine that some of the increase comes from certain types of birth control. The mini-pill and IUDs both make ectopic pregnancies more common, if I remember correctly.

[Slappo]

[quote name='Archaeology cat' date='26 April 2010 - 10:32 PM' timestamp='1272346373' post='2100840']
I think there are some doctors who will keep the mother under observation until the tube ruptures, and then will perform an emergency surgery to remove the tube. At that point, the child is already dead, from what I understand, and the doctor is acting solely to save the mother. This is not always a possible solution, I imagine, but I think it's been done.

Oh, and while I don't know the exact rate of ectopic pregnancies, I imagine that some of the increase comes from certain types of birth control. The mini-pill and IUDs both make ectopic pregnancies more common, if I remember correctly.
[/quote]

I would think that it is not always possible and not always very safe. Not sure on any safety risks though, I'd also imagine quite painful (although to keep an act morally licit rather than gravely sinful, is there any amount of pain we ought not be willing to go through?!).

And of course, yet another reason not to use birth control .

[britannia]

I had an ectopic pregnancy. I had no idea that I was pregnant but ended up in hospital having collapsed from what I learned to have been blood loss. There were two choices: death for me and the baby (leaving my other child motherless) or just death for the baby. A baby which is implanted in the fallopian tube cannot be saved. I saw the nine-week foetus on the scan. It was heartbreaking.

The 2 out of 100 statistic is correct

[Archaeology cat]

[quote name='Slappo' date='27 April 2010 - 06:34 AM' timestamp='1272346491' post='2100842']
I would think that it is not always possible and not always very safe. Not sure on any safety risks though, I'd also imagine quite painful (although to keep an act morally licit rather than gravely sinful, is there any amount of pain we ought not be willing to go through?!).

And of course, yet another reason not to use birth control .
[/quote]
I agree.

[quote name='britannia' date='27 April 2010 - 08:30 AM' timestamp='1272353430' post='2100863']
I had an ectopic pregnancy. I had no idea that I was pregnant but ended up in hospital having collapsed from what I learned to have been blood loss. There were two choices: death for me and the baby (leaving my other child motherless) or just death for the baby. A baby which is implanted in the fallopian tube cannot be saved. I saw the nine-week foetus on the scan. It was heartbreaking.

The 2 out of 100 statistic is correct
[/quote]
I'm so sorry for your loss.

[Cherie]

[quote name='Archaeology cat' date='27 April 2010 - 01:32 AM' timestamp='1272346373' post='2100840']
I think there are some doctors who will keep the mother under observation until the tube ruptures, and then will perform an emergency surgery to remove the tube. At that point, the child is already dead, from what I understand, and the doctor is acting solely to save the mother. This is not always a possible solution, I imagine, but I think it's been done.
[/quote]

I know a woman whose ectopic pregnancy ruptured while she was at the doctor's. While even having access to emergency care, she was seconds away from death. It was very scary -- had she not been at the doctor's when she was, they said she certainly would have died. (You are right, AC--when the tube ruptures, the child has died).

It's a terrible situation for a mother to be in - very heartwrenching in so many ways. Let us pray for those who experience it!

Edited April 27, 2010 by CherieMadame

[Archaeology cat]

[quote name='CherieMadame' date='27 April 2010 - 11:58 AM' timestamp='1272365927' post='2100885']
I know a woman whose ectopic pregnancy ruptured while she was at the doctor's. While even having access to emergency care, she was seconds away from death. It was very scary -- had she not been at the doctor's when she was, they said she certainly would have died. (You are right, AC--when the tube ruptures, the child has died).

It's a terrible situation for a mother to be in - very heartwrenching in so many ways. Let us pray for those who experience it!
[/quote]
Ah, didn't know it was that imminent when the rupture occurs.

And yes, let us pray for them.

[tinytherese]

Terra Firma on here had an ectopic pregnancy.



This thread reminds me of St. Gianna Molla, but her case was very different.

[N/A Gone]

I fully intent to respond, just busy right now and there is a lot to read.