Life, death and the fallopian tube

Durga Thangarajah is a lucky lady. She was delivered on May 31 of a healthy daughter which had developed in her ovary. At any time the ovary could have ruptured to the great danger of mother and child. Only one in a 100,000 ectopic pregnancies is delivered safely, and usually action must be taken at an early stage.
Nearly all ectopic pregnancies take place in the fallopian tube, which leads from the ovary to the womb. The egg, and therefore the embryo, lodges there, and the pregnancy begins to develop. This is normally not diagnosed before the pregnancy is five to eight weeks old – and often later. This gives rise to an interesting moral problem. An obvious treatment is simply the removal of the fallopian tube. Of course, the developing baby dies, but, since this is a side-effect, it is not regarded as abortion.
This moral judgment is based on the principle of “double effect”. Two elements are involved: the therapeutic removal of the endangered fallopian tube and the death of the developing baby. One good effect and one bad effect resulting from a single medical action. The principle tells us that as long as the action itself is good, or morally neutral, and the side effect is not intended then, providing that the side-effect is proportionate, the action is justified.
A common application would be the bombing of a military target in a just war (an action which is, at least, morally neutral) when it is known that some civilian deaths are likely to be caused. The proportionality in each case would have to be judged. Similarly, the taking of the Pill to regulate the menstrual cycle is legitimate, even though the side-effect is chemically induced suspension of fertility.
But we might imagine that you are a surgeon preparing to remove a fallopian tube being asked by a colleague (who has not had the benefit of the cogitations of moral theologians) saying: “Hold hard, a moment. Why don’t you open up the fallopian tube, remove the foetus and allow the fallopian tube to recover?”
To which you reply: “But that would be direct abortion. I would be taking one innocent human life to save another. Can’t do that, I’m afraid.”
Your colleague persists. “Why don’t you use your common sense instead of looking up your little rule book? The foetus is going to die either way. But your way is going to risk the mother’s fertility by leaving her with only one, good, fallopian tube. And, if that gets damaged, she’s infertile for ever. Which is the better moral choice?”
And you answer… well, what do you answer? Tell us on Secondsightblog.
And how about Captain Oates on the Scott expedition, who walked out of the tent to a death which was as certain as jumping off a skyscraper. His intention was to relieve his comrades of the burden of assisting him home, but was his action suicide? If not, why not?
I hope that by now your mind is focused on moral questions because a different, but distantly related, problem arises in the question of kidney donation. A well-established principle of moral theology is that to remove an organ from a living person is justified when it is necessary for the good of the whole body. The removal of a diseased fallopian tube, as above, is justified because the organs are subordinate to the good of the whole body. But how about removing a healthy kidney in order to transplant it to another person?
That would not cause a moral blink nowadays but, when the operation first became a theoretical possibility some 50 years ago, many theologians argued that mutilation, as it was called, could not be justified when it was for the sake of a another body. Gerald Kelly, a meticulous Jesuit authority who specialised in such matters, concluded that we recognised that kidney donation was right, and in some instances heroic, “by a sort of instinctive judgment”, although he noted that many other theologians disagreed.
Later it was to be argued that, since the donor retained one kidney, which was sufficient for good health, this was not a true mutilation. But this is a very thin, and perhaps desperate, argument, for no one can doubt that the removal of a kidney leaves the donor in a permanently more hazardous state than before. Contrast it with blood donation where the blood lost is swiftly replaced by the system.
Nowadays of course kidney donation has papal commendation, and the moral issue is dead. But we are still left with Gerald Kelly’s response which I translate liberally as “chop your logic as you may, there are instances where you simply have to trust the judgment of common sense infused by love”. Or, put in theological terms, “prudence informed by charity”. I like it.
I have recently read that a reliable therapy for baldness is castration. Thinning almost to a point of disappearance though my hair may be, it does not sound a particularly attractive step. Fortunately both instinct and moral logic stand together on this one, and I am not tempted.
But who am I to decide such questions on your behalf? Would you have removed the fallopian tube or just the baby? Share your views with us on this site. And spare a thought for Origen, one of the greatest of the early Church Fathers, who, according to Eusebius, sought castration for the sake of the Kingdom. At least he may have had the consolation of a good head of hair.

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About Quentin

Science Editor, Catholic Herald. Portrait © Jacqueline Alma
This entry was posted in Bio-ethics, Catholic Herald columns. Bookmark the permalink.

10 Responses to Life, death and the fallopian tube

  1. Horace says:

    Many people consider the principle of “double effect” [i.e. One good effect and one bad effect resulting from a single action. … as long as the action itself is good, or morally neutral, and the side effect is not intended then, providing that the side-effect is proportionate, the action is justified] as a piece of Jesuit sophistry (or casuistry), although the concept goes back at least to St Thomas Aquinas.
    The real difficulty, as I see it, lies in determining that “the action itself is good, or morally neutral” since the morality of an action cannot be separated from the intention of the doer (Thomas Aquinas again :- Now moral acts take their species according to what is intended . . II-II, 64,7).
    To argue that removal of part, or all, of a fallopian tube is morally neutral but that “shelling out the child from the damaged tube” is equivalent to an abortion and therefore morally unacceptable, seems to me unreasonable.
    Perhaps Gerald Kelly had the right idea, that we must guide our actions “by a sort of instinctive judgment”.

  2. Blue says:

    Even if the removal of the foetus, in Quentin’s account, sounds like common sense, surely there’s a question of principle here. Once we accept that the foetus can be removed directly in order to save the mother;s life we are in abortion territory. After that it has become only a question of degree. How about the mother’s health, including psychological health? Where do you stop?

  3. Juliana says:

    Surely there’s no discussion here! If a woman has an ectopic pregnancy and she’s in danger of death from peritonitis, both she and the baby will die unless she’s operated on and the fallopian tube cut out plus baby (foetus) sadly. I’m sure Aesop would have had something to say about this “choice” which is no choice at all. The mother has a chance of life and of conceiving again (I only have one working ovary and I have 4 children) and she may have other children already who need a mother.

    The foetus/baby has no chance.
    I can’t see this as an abortion except by the most hair-splitting argument.

    I know there was a freak fallopian tube baby born the other day, but presumably the mother wasn’t aware and had no crippling pain, unlike 99.9% of ectopic pregnancies.

  4. Trident says:

    I am with Blue on this one. No one can argue that removing the baby directly is not abortion, straight and simple. Here’s a quote from Charles Curran, who is a very unpopular theologian with the Church so he makes a good witness. He is describing the accepted teaching, although I think he doesn’t agree with it.
    “It would, however, be direct abortion if the fetus were merely taken out of the tube and the tube left in place. One cannot remove the fetus from the mother – even one that in the best medical understanding, can never come to term and which now threatens the life of the mother.”
    That seems pretty clear to me, just as Horace and Juliana’s view leads gradually but certainly down a dangerous slope. Neither of them can claim that they are against killing one human being in order to save another. This is the danger of muddled thinking.

  5. Frank says:

    I think the principle of ‘double effect’ is theologically reasonable rather than casuistic. The intention is to save the mother’s life, not to kill the foetus. Yet, given modern biotechnology and all that goes with test-tube babies, why could not the developing foetus now be implanted in the womb at the same time as the dieseased tube is removed. In the past that was not an option – but today?
    Oates’s intention was to attempt to save his companions, not to end his own life – even though that was the result of his action. So again, not suicide – any more than those poor people trapped in the Twin Towers, who chose to jump out of the window rather than be roasted, wanted to die. I see them as ‘fleeing from’ rather than ‘jumping towards’ death.
    When a soldier thrusts himself in front of a gun to save a colleague, he is trying to save a life; his own death might result but it is not deliberate suicide.
    In all these case it is the ‘motive’ that matters. Jesus Himself said, ‘Greater love than this hath no man…’

  6. Blue says:

    Of course intention is important, but it’s not the only thing. What happens if you have an aged relative dying slowly and in great pain? You could have a sincere intention of kindness in administering a treble dose and killing her off. You might not be culpable because you were mistaken in your judgement, but it would still be objectively wrong. The minute you start depending on intention alone you have given up the idea of anything being wrong in itself. Is that the way to go? Tens of thousands of abortions take place through good intentions. Enough to pave the road to Hell.

  7. Frank says:

    An intent to kill cannot be a good intention; when you deliberately overdose the elderly relation you are murdering him/her. A court of law should call this murder (though they often change this to manslaughter); they would not call it murder if a doctor administered morphine to alleviate pain, which had the secondary effect of subduing the heart-rate (and therefore causing death.) I also agree with absolute principles. It is an absolute principle that you must not set out to kill someone deliberately (outside a war zone) as that goes against the 5th Commandment. Are you confusing feelings and intentions? You might feel sorry, sad, sympathetic: but you intend to kill, whether it is the unborn child or the elderly.

  8. I wonder whether the clue to an answer to all this lies in Frank’s reference to Captain Oates. This is an example of someone choosing to move into a fatal environment for the sake of others. Of course the baby in the fallopian tube is not capable of making such a decision, but one might argue that in such a case the decision could be made on its behalf. It is, so to speak, what a ‘reasonable’ baby would choose. One cannot say that it is being deprived of its right to life since either removal of the tube or direct removal of the baby will result in its death. The last sentence is important because it excludes abortion for a baby suffering from a disability such as cystic fibrosis or Down’s Syndrome – let alone a hare lip.

  9. jtbubez says:

    I would challenge the view that ‘the taking of the Pill to regulate the menstrual cycle is legitimate, even though the side-effect is chemically induced suspension of fertility’.

    Following its development, because no technology existsted to show otherwise, it was assumed that the Pill worked by suppressing ovulation and that may have been the case with early formulations. However, to overcome side effects, since around 1970 the hormonal content has been reduced.

    Following work by a group of reproductive endocrinologists in 1994, it was found that one of the effects of the Pill is to thin the lining of the womb making it “hostile” to implantation. Furthermore, the Pill has been shown not to suppress ovulation in all cases and indeed, albeit in a small number of instances, fertilisation has been shown to have taken place but without subsequent implantation. Even the manufacturers state that there is a failure rate associated with the Pill as a contraceptive.

    As Catholics, we need to ask ourselves at what point does the body and soul of a newly conceived human life come together. Once sperm and ovum fuse, we have neither sperm nor ovum. Indeed, we have all the genetic material to create a unique new human being. Even such a rudimentary examination would surely lead one to conclude that body and soul come together at fertilisation.

    I fear that purely physiological considerations do not lead to a complete answer on questions of this kind. For more information, may I suggest, ” Does the Birth Control Pill Cause Abortions?” by Randy Alcorn.

    The Pill as a medication may well be legitimate for a single woman. However, can the Pill be used justifiably by a married woman? On the one hand, there is a medical condition to treat, but on the other, there is the possibility that a child will be conceived which then fails to implant. It would seem that the “evil” exceeds the “good” and that the only morally correct solution would be to refrain from relations while the need for such treatment persists.

    • Crystal says:

      I myself had an eptopic pregnancy in 2010. My doctor took the fetus and “saved” my fallopian tube since at the time of surgery he found I had hydrosalpinx in my other tube and could never concieve from that side. 2 years later I became pregnant and was over the moon… Until I found out at 6 weeks this was also an eptopic pregnancy and had emerency surgery where again the fetus was removed but the fallopian tubes both left in. I then went to a reproductive surgery and fertility specialist. She informed me that after one tubal pregnancy my chances of another one rose to 50% and with my diseased left tube in place I was bound to have a eptopic or early misscariage from the leaking toxic fluid into my uterus. After my second my chances rise to over 75% and I was playing a very life risking game listening to the advice to “try again”. So from the view of the patient (one who has been there) I say you put the patient who is laying on your tables life first… I very well could have died had I not had early ultrasound diagnosing my second eptopic I had absolutely no symptoms. On my first one in 2010 i had ruptured and began bleeding vaginally so I was rushed in for an ultrasound and rushed into surgery and afterward shown pictures pf my blood filled abdominal cavity (yet my extremely damaged tube stayed). I have one child and 3 step children and a family that would be at a loss had I not made it to this point. I WISH my doctor had put my life and well being first 2 years ago so I wouldn’t have gone through that pain again physically and emotionally and now I just had both Fallopian tubes removed because of extreme damage. My tube with hydrosalpinx was swollen to 13 cm and EXTREMELY painful and my right side was blocked at the end near my ovary and had a gaping hole from my last eptopic removal 5 months ago! I have had pain everyday since that surgery where a doctor “saved” my tube… To me all he did was prolong my suffering and put my life further at risk! Save the life of the patient on your table.

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