The International Symposium on Excellence in Maternal Healthcare in Dublin, Ireland concluded that “direct abortion is not medically necessary to save the life of a woman.” The Sept. 8 press release also states,
We uphold that there is a fundamental difference between abortion, and necessary medical treatments that are carried out to save the life of the mother, even if such treatments results in the loss of the life of her unborn child.
We confirm that the prohibition of abortion does not affect in any way, the availability of optimal care to pregnant women.
Professor Eamon O’Dwyer, speaking for the symposium organizers, said that one of the goals of the symposium was to bring “clarity and confirmation to doctors and legislators dealing with these issues,” informing them that a pro-life ethic need not mean denying quality medical treatment to pregnant women.
Now, I am not an OB/GYN so I can’t speak on the data presented at the conference showing that abortion is never medically necessary (though the Association of Pro-Life Physicians agree with this conclusion), but I can address the distinction between direct abortion and medical treatment that will likely result in the death of the fetus.
A direct abortion is any procedure which intentionally terminates a pregnancy. For Catholics, at least, this pertains also to the conceptus prior to implantation, though most of the medical world recognizes a pregnancy to occur only after implantation. A direct abortion is considered an intrinsic evil by the Church and is never morally justified. It is considered a direct attack on life. The Irish Symposium argued that a direct abortion was also never medically justified, despite arguments to the contrary that safe recourse to abortion is necessary for maternal health.
There are other procedures which some call “indirect abortions.” I actually don’t like the term because it is confusing to the broader public (and to my classes) but “indirect abortion” refers to any medical procedure provided to a woman that results in the unintentional death of the fetus. For example, a woman with advanced uterine cancer finds out she is pregnant. Doctors recommend removing the uterus. Doing so will result in the death of the fetus, but doctors say that the procedure is necessary to save her life. Removing the uterus in this example may be justified and would not constitute a direct abortion.
The principle operative here is called the principle of double effect. This principle says that an action with two sets of consequences, both good and evil, may be performed if
1. The object of the action is not intrinsically evil
2. The direct intention of the agent is to achieve the good consequences, though the evil consequences may be foreseen
3. The evil consequences are not the means of achieving the good consequences
4. The good consequences outweigh the bad consequences.
Now, the PDE applies only in certain cases where causing grave evil is a necessary last resort. We often fail to specify the importance of last resort regarding the PDE but otherwise, the evil end is likely being used to promote the good end which is a violation of criterion #3. The classic example of the cancerous uterus above does not justify a hysterectomy in every case of uterine cancer during pregnancy. There may be other means of treating the cancer that would preserve both lives that should be discussed and tried if possible before resorting to an extreme procedure that will result in the death of the fetus.
The principle of double effect (PDE), when used correctly, keeps us from becoming vitalists regarding the life of the fetus and it establishes that physicians who oppose abortion can still provide exemplary treatment for pregnant women. In other words, we don’t have to do everything medically necessary to save the life of the fetus just because we oppose the direct killing of the fetus.
The Irish Symposium affirms a basic assumption behind the PDE, namely that we never need to commit evil so that good will come from it. We hear so much about keeping abortion legal for the rare cases that concern the life of the mother, but the Irish Symposium challenges us to consider whether those rare cases in which a direct abortion is necessary actually ever occur. The Symposium also reminds us that comprehensive care for a pregnant patient can and should include care for the unborn patient as well. Finally, the Symposium also confirms a basic principle of Catholic theology that faith and reason can never conflict. The opposition to abortion is not unreasonable even if it is grounded in religious convictions.
It is not at all clear that the Committee for Excellence in Maternal Healthcare is not just a pro-life group that chose not to call itself pro-life. The Irish Times said, “While many of the organisers have been involved in anti-abortion events in the past, a spokesman for the group, Dr Eoghan de Faoite, told The Irish Times the event was not linked in any way to the Pro-Life Campaign or any other organisation.”
It is difficult for me to believe that there are not circumstances, although perhaps rare, under which an abortion is the only way to save a woman’s life. Can any organization actually say an abortion is never medically necessary? Has there never been an abortion, ever, that saved a woman’s life? Isn’t it clear that in the case of the “Phoenix abortion,” the pregnant woman was, in the judgment of the entire medical team, going to die without an abortion? The Cleveland Clinic information on pulmonary hypertension says: “Although successful pregnancies have been reported in IPAH patients, pregnancy and delivery in PAH patients are associated with an increased mortality rate of 30% to 50%, and pregnancy should be avoided or terminated.” But it seems to me that any group that says an abortion is never medically necessary is just not credible. If they said rarely or almost never, that would be one thing. But they said never.
There does remain the question of what an indirect abortion is. Might the committee be implying that if an abortion really is necessary to save the life of a mother, then it is not a direct abortion. It was argued in the case of the Phoenix abortion that it was not a direct abortion, because it was the placenta that was targeted, not the fetus. The local archbishop did not accept that rationale, but so far as I know, it has not been definitively refuted. It seemed to me at the time that certain ideas of Germain Grisez and Elizabeth Anscombe were used to suggest alternative views of what might be considered direct and indirect abortion. Based on almost no information, I am guessing that the Committee for Excellence in Maternal Healthcare is not suggesting any novel approaches in moral theology that could be used to justify an abortion truly necessary to save the life of the mother as indirect. It seems to me they are making a medical statement, not a philosophical one.
It does seem to me, however, that the rationale for permitting a salpingectomy in the case of ectopic pregnancy is so far fetched that the rationale for the Phoenix abortion seems totally compelling by comparison. From what I have read, there was a general feeling that it was inhumane not to interfere before an ectopic pregnancy became life threatening, and so the problem was to come up with a rationale for some intervention that could be justified. T. Lincoln Bouscaren did that, and while it is a good thing he did, it seems to me a case of the Church (including the Holy Office) setting up a very difficult situation for moral theologians, forcing them to come up with a “workaround” to save women’s lives.