Ectopic Abortion

105 thoughts on “Ectopic Abortion”

1. I am afraid that I have disagreed and continue to disagree with this level of hair-splitting in Catholic moral theology. The problem is that, in order to maintain the absolute truth of the principle “the end NEVER justifies the means,” one winds up redefining the means with respect to the end to avoid having to make exceptions. Thus the present case: different methods of dealing with an ectopic pregnancy are presented, all of which obtain the same result. The only real distinction is in one case we can pretend that “Oops! The death of the baby was an unintended side effect” versus the other two, in which the death of the baby is supposedly “known” to have to occur. To me, that reasoning *itself* is morally illegitimate. The distinction between killing and murder depends on the intent or goal, and claiming that a morally justifiable homicide is NOT a case of “the ends justifying the means” is, to me, disingenuous sophistry trying to turn shades of gray into black and white.
   In the referenced article, “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). Yet when the act is known beforehand to result in the killing 100% of the time, without exception, it is simply self-deception to claim that the killing is not an intended result. To put it another way: the only way to *avoid* that result is to decline to perform the action, and the actor does not so decline, because *another* result is more important, morally. It is still lying to yourself, and I find lies of any sort problematic, considering who their father is.

2. Pope Paul VI, who, when teaching on matters of Faith and Morals for the entire Church, enjoyed the charism of infallability, disagreed with you. Read Humanae Vitae(it’s only 14 pages).

3. What MK denigrates as hair-splitting is really clear-thinking in difficult cases. But then, I’m sure he’s heard that reply before.

4. “Intent” is not the only factor distinguishing killing and murder. The objective character of the act itself is also a factor. And in ectopic pregnancy, it is legitimate to distinguish between methods that act directly on the child and those that act on its troubled environs.

5. In an etopic pregnancy the embryo is going to die no matter what, and very soon no matter what. I think God is rolling his eyes over our obsession against using MTX and salpingostomy vs. allowing salpingectomy. It reminds me of the Pharisees and their obsessions with the every detail of the law to the exclusion of all else. I understand that we want to do the right thing, but it seems to me the very best thing we can do in a situation like this is to make it as easy on the mother as possible. That said, I do realize that we are required to submit to the authority of the Church. But, I’m glad that God is the ultimate judge.

6. Okay, I will tiptoe out of the shadows to address this august company…(Think of any classroom scene from “The Paper Chase” where a guy in the back of the class raises his hand).
   I have always used what I call the “kamikazee question” when thinking about double effect. In other words, even though the kamikazee pilot has almost a 100 percent chance of dying in his attack, is he a suicide? What would he do if he hit his mark, and some how lived? Would he consider his mission a failure? I think not. If anything I believe he would consider it a great fortune and have at it again. His death might be a forgone conclusion, but not the INTENDED RESULT nor criteria of success. A spy who takes a cynanide pill in my opinion IS a suicide because his DEATH is the means by which he achieves his objective, and “failure to die” would be a failure of intent.
   If I was a homeowner and I had to use a shotgun blast to the chest to stop and intruder in my bedroom (and I’d do it, too) the question is, do I call an ambulace right away to help him, or do I let him die or even finish him off with a second shot. What is the desired end result, a safeguarded family or a dead intruder? The former is justified, the latter is murder.
   The death of an ectopic embryo cannot be the path THROUGH which we can travel to safeguard the mother, though other paths might have it as a secondary result.
   It may seem like splitting hairs, but intention is everything, and thank God we have a Catholic morality that understands that.

7. The necessity of hair-splitting is so difficult to explain. Therefore I leave it (as usual) to Chesterton:
   This was the big fact about Christian ethics; the discovery of the new balance. Paganism had been like a pillar of marble, upright because proportioned with symmetry. Christianity was like a huge and ragged and romantic rock, which, though it sways on its pedestal at a touch, yet, because its exaggerated excrescences exactly balance each other, is enthroned there for a thousand years…
   Last and most important, it is exactly this which explains what is so inexplicable to all the modern critics of the history of Christianity. I mean the monstrous wars about small points of theology, the earthquakes of emotion about a gesture or a word. It was only a matter of an inch; but an inch is everything when you are balancing. The Church could not afford to swerve a hair’s breadth on some things if she was to continue her great and daring experiment of the irregular equilibrium…
   It is always simple to fall; there are an infinity of angles at which one falls, only one at which one stands. – from Orthodoxy, ch. 6, “The Paradoxes of Christianity”.

8. No need to tiptoe, fz; you nailed it, clearly and concisely.

9. Oh – and btw, thank you for posting all this info (and that link to CUF) about ectopic pregnancy. My wife is pregnant again (hooray!), and I was trying to find info about this, just in case (God forbid!). Excellent timing – hopefully we will not need to use this info.

10. Mike, did you continue to read the article down to the section about embryo re-implantation or the future use of the artificial womb? I was having thoughts similar to yours and to Todds, but when I saw it from the perspective that we may have (albeit a low percentage hope) and someday may have better means to save the life of that child, my attitude changed entirely. Now I I see a substantial difference is that with MTX we’re just giving up whereas with more moral techniques, if nothing else, we’re planting the seeds for other/future medical technologies that may save that child by refining the techniques to extract that child while still alive.
    I think what is missing from your analysis is an acceptance of our basic human nature. We by nature like to do things the easy way. An acceptance of MTX flushes (excuse the pun) from our minds the reality that a baby was lost by allowing us not to look at that child. Doing this blocks from our minds the desire to consider investigating more advanced techniques to save that child. However, every time a doctor holds that baby in their hands he’s forced to confront the reality that he’s got a dying baby in his hands and inevitably will lead him to think about what could be done to save that child.

11. hi todd: you might want to check your facts re “In an etopic pregnancy the embryo is going to die no matter what, and very soon no matter what.”
    universal assertions are sitting ducks for exceptions, and yours admits of some, to say nothing of earlier identification and progressive –life saving– intervention techniques. fwiw.

12. I just want to thank Jamie and Ken. Both of your posts have enriched my perspective on this matter.

13. Are there any physicians or nurses reading this with any input? Has anyone heard of an ectopic pregnancy resulting in the fetus surviving? Does anyone know if there is any chance of a woman surviving an ectopic pregnancy without medical intervention (i.e. removing the fetus)? It makes me think of whether or not a woman commits a mortal sin by not trying to fend off a rapist who has a gun to her for fear of being killed by him.
    After reading these remarks…I’m staying single!

14. “Although there are ways of dealing with ectopic pregnancies that many orthodox Catholic moral theologians regard as morally licit, use of an abortifacient drug like Methotrexate is not one of them.”
    I guess this is really what I was asking in my last post. Jimmy, what are some of these? It just seemed to me like you and the above commentors were saying that it was preferable for the woman to die than to remove the fetus (which from what I understand would have an absolute 0% chance of survival). I’d be very interested to hear if I am wrong.

15. Salpingectomy is considered morally licit. In it, the tube or a portion of the tube is removed.
    http://en.wikipedia.org/wiki/Salpingectomy
    The procedure can be less morally problematic than methods that act directly on the child, such as salpingostomy (the direct removal of the baby), or methotrexate (a direct attack on the baby’s life).

16. Wow. So, to remove the tube with the baby in it is ok, and to remove the baby with no tube is not?? i wonder- what it the moral value of the tube?

17. Visitor… you need to reread the previous comments… Jaime and Ken did a great job explaining.

18. That’s the problem entirely: the “objective” character of the act is DEPENDENT upon the INTENT behind the act! Further, what you call “clear thinking” in difficult cases to my mind is often disingenuous sophistry. It is absolutely correct that intent matters a great deal. What is fuzzy thinking, to my mind, is to claim that *one* sort of intent can justify something, but on the other hand “the ends never, ever justify the means.” To put it another way: if the means are evil it does not matter what the goal in using them is – but that goal is used to determine whether the means are evil!
    In the hypothetical, in *none* of the three instances is the death of the baby a desired goal. The distinction is this: in one of the three, one can claim the death of the child was an “oopsie,” even though it occurs 100% of the time. That is not rationality, but rather rationalization. It is choosing one method because it “looks good,” which is like passing laws because they make us feel good, whether or not they actually accomplish the intended result.
    And I just did review Humanae Vitae. I do not see where the teaching on artificial versus natural contraception techniques has any bearing on this issue, unless your argument is that one should allow an ectopic pregnancy to run its natural course, killing both mother and child.
    Ken, I agree that it is wise to avoid “doing things the easy way” purely for convenience; where I disagree is that I fail to find a meaningful distinction between the three methods discussed in dealing with an ectopic pregnancy. All three involve interfering with the natural course.
    I also think it is a great idea to continue to research methods to save the life of an ectopically implanted baby, but believe that unless there is a *real* technique/procedure involved in trying to save the baby’s life using a particular method there (again) is no meaningful preference for that method. More particularly, if we had even an experimental artificial womb available where the baby could have a *chance* (any chance) at surviving, I would agree that there would be a real moral distinction. At present there is not.

19. given the clear response from mk, and the politely ignored facts (jaime, and ken, and “skyhawk”)- i just want to know, then: what is the moral value of the tube? is it morally licit to remove the baby, in the tube, when you very well know that the baby in the tube is NOT going to be given the chance to develop after romoved? how can any of you believe that there is any distinction?

20. MK:
    “The ‘objective’ character of the act is DEPENDENT upon the INTENT behind the act”
    There is the object or goal of an act itself = “what I am doing”, and there is the subjective intent of the actor. These are distinct concepts. Even with a good subjective intent one cannot commit an act that in itself has an illicit object.
    So if you mean “the moral quality of the choice is dependent upon the intent behind the act,” as well as the object of the act itself, and the circumstances surrounding it, I agree.
    Visitor:
    In assessing ectopic pregnancy treatments, we are assuming that the circumstances justify it and that there is a proper subjective intent (i.e., I am not trying to kill the child). The issue is whether the “object” of MTX or salpingostomy make them different kinds of acts than salpingectomy, even though the child’s death is nearly certain.
    The proposed distinction justifying salpingectomy over the other two is that it does not attack the child’s body, but the mother’s pathologic tube, so that one can describe it as not directly intending the child’s death.

21. Okay, I want a direct answer to this question: If I had an ectopic pregnancy, then what am I suppose to do? Let the pregnancy go on and die along with the baby? Though thank goodness, I’m single and not pregnant, this situation can happen to any woman. What is one supposed to do then?

22. I’m a man, taking MTX for a chronic medical condition. Incidentally, my doctor has said MTX lowers sperm count but does not cause sterility or birth defects. We shall see. But I do find this discussion interesting, because MTX is in a class of drugs called antineoplastics and has been used in the past as chemotherapy (these days there are typically much stronger drugs available). The idea of using a cancer drug to kill an ectopic fetus speaks volumes, IMO.
    About salpingectomy: Could not an argument be made that such an act is equally anti-life as the other options, given that removing a fallopian tube would decrease the likelihood of FUTURE conceptions?

23. Veronica: “If I had an ectopic pregnancy, then what am I suppose to do? Let the pregnancy go on and die along with the baby?”
    If you have the chance, check the end of the CUF article linked to in Jimmy’s article. Personally, if I had an ectopic pregnancy, I would choose re-implantation or possibly moving the embryo down the tube where it is larger (and thus, unlikely to rupture). And pray fervently for St. Gianna Molla’s intercession.
    With re-implantation (moving the embryo to the uterus), you may have a very small chance of the embryo living, but that chance definitely exists, as opposed to salpingectomy, which has no chance of the embryo surviving. Eugenicists would detest it, given the short life span generally resulting, but then, they hate everyone who’s not perfect. Better to live 6-10 years than to die immediately. My doctor would probably have a cow because they like to go by the book and don’t care particularly for potentially defective children (consult any woman who has chosen not to abort her child with Down’s Syndrome to see how the OBs abuse them). I’d just find another one.
    Interesting that this discussion has revolved around the question of the immorality of ectopic treatment, rather than what to say, in compassion, to the relative.
    “This situation can happen to any woman.” Before you become a mother, doctors and women’s magazines lead you to believe that everything from pre-eclampsia to hysterectomies are totally random and there is nothing you can do to prevent anything. As you have more babies, you learn that many of these conditions are caused by lifestyle, and are often (not always) preventable. Ectopic pregnancies are increased by a number of things, including chemical abortions and sterilizations. Read up; you’ll be less scared!
    God bless.

24. Veronica, read the article that Jimmy posted as “Read about that here”. It state that most theologians think the process called salpingectomy (that removes the section of the tube the baby is in) is morally acceptable.
    So no, you don’t have to “Let the pregnancy go on and die along with the baby”.
    Read the whole article because I felt it did a good job of walking through the various issues and completely laying out the logic for most theologians perspective.

25. Very seldom is etopic pregnancy caught UNTIL it becomes a life threatening situation for the mother. Unless you are trying to become pregnant, you generally don’t know you are pregnant until 8-12 wks. (your 1st ultrasound is not until 12 wks or better unless you have complications) The time in which etopic pregnancies become life threating.
    But I don’t hear anyone arguing another aspect of this horrible reality. When a woman has an etopic pregnancy that becomes life threating, it usually involves one of the fallopian tubes, removal of the tube and more often than not (As I understand it) the ovary as well. This in turn decreases the womans chances of concieving a child normally. That is unless you have a case like a friend of mine, where both tubes were affected and now there is so much scar tissue that she was never supposed to concieve. Thankfully she has a miracle baby! But that is like a 1 in 1000 case. So I guess the question that I am trying to ask is this, if something can be done to save the mother, and her ability to bear viable children, even though the baby in an etopic pregnancy is usually not viable (how do you really know at that gestation) what do you do. Now, I must state this…I am AGAINST abortion, But, I am not sure how I feel about it, if it is medically neccessary to save the mothers life and possibly her ability to concieve and bear children. I am also not real fond of assisted contraception.

26. Veronica-
    A Salpingectomy is an option that would be morally licit.
    I emotionally agree with MK at least as far as being unable to appreciate the difference between the Salpingectomy and the salpingostomy. The intent is the same, the results are the same,the damage to the mother is less, but the difference is the inability to (as MK says) say “oopsie” when you are done.

27. I did a cursory search of Medline, as I was curious about some of these points myself.
    A review paper I came across stated that there does not seem to be any difference in future fertility when comparing salpingectomy, or salpingostomy, although there is some controversy surrounding this. There may be other reasons for prefering one over the other.
    As far as cases of fetuses surviving…I guess if you look around enough you may find a few anecdotal cases, but it is certainly not the norm.
    “Watchful waiting” is an option if the pregancy is early enough. The paper I read mentioned that up 50-70% of ectopic pregnancies resolve spontaneously, if detected early enough. The farther along the pregnancy is, the less likely this is to occur.
    As far as reimplantation of the embryo, I could not find any references regarding this. The article Jimmy linked to suggests that this was done on an experiemental basis, and was not extensively attempted. I doubt that this would even be an option, as it would probably be difficult to find an OB who would even be familiar with how the procedure would be done. Hope this helps!

28. As I understand it, the pharmacology of MTX is such that it can be used to treat ectopic pregnancy because it changes the lining of fallopian tube so that the placenta is unable to remain attached to it (specifically it inhibits the growth of a certain type of cells). If this is true, then it acts on the fallopian tube rather than the fetus itself. Since it has been established that acting on the fallopian tube (by removing it or sections of it) is morally licit in such a case, I would like to have some clarification from the Church before unconditionally condemning the use of MTX. So far I have been unable to find any such clarification. Theologians are divided on this question, and the equiprobabilism of S. Alphonsus teaches that, in the absence of an authoritative ruling, either opinion (if the cases are equally strong) may be followed.

29. Michele,
    Like with any other organ or part of the body, if a tube is diseased/disordered, especially in a serious case like this where a ruptured tube is life-threatening, surgery is a licit option. The fact that the tube belongs to the reproductive system has no bearing on anything.
    In the case of an ectopic pregnancy, the tube itself presents a medical emergency and must be dealt with to save a life. It has either ruptured, or will rupture.
    This is not to be confused with elective sterilization, which is another matter entirely. In these cases, there is no disease/disorder but a woman gets her tubes cut/burned or any other procedure when there is no licit reason for it.
    The two are not the same. Hope that helps.

30. Btw… it depends on the kamikaze pilot. Many pilots were all for killing Americans, some just wanted to do their duty, and some were “volunteered” for the position because they came from dissident or pacifist families.
    However, all kamikaze pilots who survived would have done their level best to either kill themselves or fake death, as coming back alive would have meant not just shame, but physical danger to their families from the regime and their neighbors.
    Dying was thus indeed more than half the objective to a kamikaze. While doing damage was important, it was more important to the pilot that he die than that he hit the target and do damage.

31. “Intention is everythying” -FZ
    Well, exactly, and the intent is the same no matter which method is used-to save the mother’s life. The difference is that you can disingenuously claim that removing the tube only “may” cause death, as if that’s some random and unlikely side effect, rather than a virtual certainty.

32. Maureen,
    You can provide cites for this?

33. One problem I see here is that while the majority of reliable Catholic theologians side against using methotrexate, not all of them do. How on earth can you get someone to regard as a sin a procedure that pro-life Catholic theologians defend?

34. First, I don’t think I would say anything to the woman. Most likely her doctor just told her she had an ectopic pregnancy which had no chance of surviving and which would almost certainly in a few weeks rupture and put her life in danger, and she needed to have a procedure NOW to take care of it…and she said Oh my God…there’s really no chance the baby could be allright? none? and while she was still asking this her husband said, where are the papers, we’ll sign, how soon can you do it? Under those circumstances she isn’t morally guilty of abortion. In the unlikely circumstances that she understood the different procedures and their moral implications, well then, she isn’t going to benefit from the words of our distinguished reader.
    As for the theory behind this, which seems so farfetched to some, the principle of double effects can help us do some very kind acts while avoiding truly terrible ones. The example I am most intimate with is the issue of pain relief in the last stages of terminal cancer. Surely it would be wrong to kill people because they were in horrible pain. Surely it would be wrong not to do anything you could to relieve their pain. So what we do is give enough morphine to relieve their pain but not kill them. But if then it seems that they need more morphine to relieve pain, we give it, just a little bit more at a time, always trying to find a way to relieve pain without deliberately killing, but aware that this amount of medication may hasten their death. I have given a shot of morphine that I thought might just push a person over the edge…but was very glad when it didn’t and he lived through a few more shifts. Now a practical realistic person could easily say, What’s the point of dragging out the whole business like that; you know a combination of cancer and morphine is going to kill this person within a few days; why wait for them to grimace or show restlessness to give them another 2cc’s…Why not give them 20 cc’s and end their suffering, and that of their family who are clearly wiped out from hanging around the hospital all hours of the day and night?
    Well, because we are not in the business of killing people. It’s wrong to kill people. It’s right to relieve pain, though, and that’s what we do, even when it also hastens death.
    So in this case of the ectopic pregnancy, a part of the mother, the tube, is swelling and soon sure to split open and bleed into the intestinal cavity, probably killing her. So it has to be removed. But it has an embryo in it, which will be killed in the process. That’s very sad. (I haven’t heard anything about there being a process of reimplantation which if it worked would resolve this quandry.) And it isn’t really an “oops” like a mistake; it is anticipated, just not intended.
    On the other hand, now there is an option to relieve the problem by directly killing the embryo. Essentially this is an early abortion, not to save the life of the mother, but to save the tube of the mother. The person who helpfully said that maybe the methotrexate does not kill the embryo or fetus but only makes the tube inhospitable to
    it gave me hope for a minute (for I would also like to save tubes, being generally in favor of fertility) but then I thought, if something flushed out a pregnancy implanted in the uterus by making the lining unfavorable for it, wouldn’t that be a form of abortion? Yes, I am afraid so.
    I can understand the frustration of the person who says, Case I, result, dead fetus, mother minus one tube, Case II result, dead fetus, mother has both tubes, which is better? But then, in my cancer pain, morphine scenario, we have Case I result patient dies on hospital day 10,an insurance company, or Medicare charged for 10 days of expensive nursing care (which is what the hospital “bed” charge is essential for) having possibly suffered some pain during that time,and a very frazzled family. Case II, patient dies on hospital day 3, using 7 fewer days of expensive nursing care, possibly suffering less, with a less tired family. But in case I the nurses and the family know that they have done their best to relieve the person’s pain without deliberately causing his death. They know that in their turn, should they come to that hospital, they can trust their caregivers not to be motivated by the concerns of insurance companies to ease them out faster and oh so much cheaper!
    Susan Peterson

35. It’s so interesting to me that a salpingotomy (removing the baby from the tube) is good with Mother Church, where with sufficient research, transplanting the baby could be achieved, if more people opted for this. MTX, which blocks progesterone, the, um, *glue* which helps the baby *stick*, is not good with Mother Church, and further use provides more support to the abortion industry, because more use hones its abuse.

36. the intent is the same no matter which method is used-to save the mother’s life.
    No. Your intent is what you actually intend to do, not what consequences you expect to happen, no matter how reasonably you expect them. An action to kill the baby where saving the mother’s life is a consequence of killing the baby has the intent to kill the baby.

37. Methotrexate attacks primarily the fetus and his placenta rather than the fallopian tube, according to several medical sources. This makes sense since methotrexate is an anti-cancer drug whose purpose is to stop rapidly developing cells.
    http://www.medic8.com/healthguide/articles/ectopicpreg.html
    http://www.medicinenet.com/methotrexate/article.htm
    http://health.yahoo.com/ency/healthwise/aa84234
    http://humrep.oxfordjournals.org/cgi/reprint/13/4/1063

38. ..that last link should read:
    http://humrep.oxfordjournals.org/cgi/reprint/13/4/1063.pdf

39. An ectopic pregnancy is a non-viable pregnancy. Which means that if no action is taken, the baby will not survive, and it may very well take the mother’s life with it, in all probability. I still do not understand all the splitting of hairs over which method is used to terminate the non viable pregnancy. Killing the baby directly by a drug or killing the baby by removing the baby *and* part of the tube amounts to the same thing. It is not a viable pregnancy, therefore, it is not an “abortion” but a medical procedure to save the life of the mother.

40. And I add: God is the one who decided the baby would die in utero.

41. God has decided that we will all die at some point, but that in itself is not a license to murder one another directly, as both a means and the end to any problem.
    What we’ve established is, as technology these days stands, the baby will die regardless of whether we do something or do nothing.
    One thing we can do is try to save the mother, to keep the diseased tube from taking two people down instead of just one.
    We already established that we can’t kill the baby to do so, because killing is killing. The direct killing of the baby may not be the means by which to save the mother, no matter the end result.
    Another thing has been determined, though–the fallopian tube in question is in a diseased state. We are within licit boundaries to treat this tube, just as we are allowed to treat any other part of the body. (Note: the fact that it belongs to the reproductive system has no bearing on the matter. Surgery on the reproductive system is just as licit as with other parts of the body, despite a risk of reduced fertility. That’s not anti-life. Nobody here would say a man with testicular cancer shouldn’t have surgery–that’s crazy.)
    Our intention is clear: Saving the mother. If we don’t do that, then we let disease kill 1.) the baby and 2.) bring the mother down to die along with the baby.
    But we’re within our licit boundaries to treat the mother just as we’d treat anything else wrong in her body, with the baby’s dying as an unintended side effect. You cannot say our intention is to kill the baby at all–in these cases we’d use means to save the baby as well, if only technology made it possible. (Hopefully some day it will).
    Salpingectomy is not directly killing the baby. The baby’s death cannot be called the intended result any more than “bodily mutilation” resulting from any type of surgery can be called the intended side effect of surgery. You don’t accuse amputees or anyone else who’s had surgery, of intending to mutilate their bodies, and using sophistry to rationalize it away, do you? You don’t declare them morally culpable for intending to mutilate their bodies, do you?
    Intentions certainly do matter.

42. I still do not understand all the splitting of hairs over which method is used to terminate the non viable pregnancy.
    The reason is that in Romans 3:8 God the Holy Spirit speaking through the pen of St. Paul told us that we can never do evil so that good may result.

43. “The reason is that in Romans 3:8 God the Holy Spirit speaking through the pen of St. Paul told us that we can never do evil so that good may result.”
    Who is doing an evil? The pregnancy is non-viable– regardless of what is done– it is still non-viable. God made it non-viable. Not the mother. Not the doctor. God did. Non-viable.

44. K says: “We already established that we can’t kill the baby to do so, because killing is killing. The direct killing of the baby may not be the means by which to save the mother, no matter the end result”
    But when you cut the tube with the baby (embryo) in it, you are still directly taking its life. It is this act which directly kills the baby.

45. It’s not direct. You’re taking out the diseased tube, and that is also the sole intention. The baby happens to be in it, yes. But this is an indirect, incidental, albeit unfortunate result. Just as removing a cancer-ridden set of testicles which happen to contain and produce sperm, has the indirect result of sterilizing a man and the intention is not to sterilize him at all. Certainly you don’t find a man morally culpable for incidentally, unfortunately sterilizing himself, in trying to save himself from cancer?

46. 
    But when you cut the tube with the baby (embryo) in it, you are still directly taking its life. It is this act which directly kills the baby.
    I kind of see what you’re saying, but actually, it’s the pathological tube itself which is already slowly killing two people. The treatment for it is an intervention to save who we can save, without directly killing anyone. Now, you could say the act itself of taking the tube out is a direct cause of death, but I think it coul dbe argued that keeping the diseased tube itself intact, killing two people, is an extraordiary means for keeping a baby alive, whose outcome will be death, regardless. Hmmm.

47. Sorry for the typos, my hands are cold!

48. “Intention is everythying” -FZ
    Well, exactly, and the intent is the same no matter which method is used-to save the mother’s life. The difference is that you can disingenuously claim that removing the tube only “may” cause death, as if that’s some random and unlikely side effect, rather than a virtual certainty.
    It’s actually not true that “intention is everything”. Catholic moral theology notes several components to an act, including the “object” of the act and the “intent” of the act. All components of an act must be licit for an act to be morally good. The “object” is the act itself, separate from intent, and it can be intrinsically evil, thus negating any positive value associated with a good intent. The killing of an innocent person is always and everywhere intrinsically evil. No intent can modify the evil nature of the object of the act.

49. I got my mind cranking further on this. Now I also wonder how much of this might be due to a problematic, all-encompassing definition of “pregnancy”. It occurred to me that it could be a matter of semantics and accustomizing ourselves to certain labels.
    “Pregnancy” is normal, natural implantation in a womb. Ectopic “pregnancy” actually might not be “pregnancy” at all; the only commonality it shares with “pregnancy” is the implantation part, and it is a pathological situation, not what “pregnancy” was intended to be.
    If we consider this idea, then it would further the case that expecting “nature” to take its course in such a “pregnancy”, resulting in the death of both mother and child, amounts to taking extremely extraordinary means to prolong the death of the child who is at the mercy not of a scalpel, but a pathological situation.

50. Some things to add: In a normal pregnancy in the true definition of the word, there is no pathology, and no implantation where there shouldn’t be. In an ectopic “pregnancy” (sic), we have an unnatural situation in which a woman is being an extraordinary means of life support. Why?
    1.) It is not natural, it is pathological.
    2.) She may be organic, but it’s still not a “natural” means of life support.
    3.) It is costly, but in this case the cost is more than financial. The cost of “life support” in this case is another life.
    4.) It is prolonging the death of the child, at the mercy of this situation, when the outcome is death regardless.

51. K, yes, this is not a pregnancy. This is a “non-viable pregnancy”. Please note, the tube is not diseased. It is not being cut out because of disease, it is being cut out because there is a non-viable embryo there. In the case of taking the drug, which expels the poor unfortunate embryo, the tube returns to normal.
    I would even venture to argue that the drug (the one used in treating cancer, not the RU486 drug) may be the more moral way to go than the surgery since there are less risks to the mother in the use of the drug (a one time deal) than in undergoing surgery, as all surgery has a large number of risks.

52. NonAnonymous, you ignore the fact that even though yes, the embryo is destined for death, that does NOT give us a license to kill it. I mean, technically, everyone is destined for death, but that doesn’t mean that we can kill them. (That’s a veeery weak argument, but whatever.)

53. K, yes, this is not a pregnancy. This is a “non-viable pregnancy”. Please note, the tube is not diseased. It is not being cut out because of disease, it is being cut out because there is a non-viable embryo there. In the case of taking the drug, which expels the poor unfortunate embryo, the tube returns to normal.
    I would even venture to argue that the drug (the one used in treating cancer, not the RU486 drug) may be the more moral way to go than the surgery since there are less risks to the mother in the use of the drug (a one time deal) than in undergoing surgery, as all surgery has a large number of risks.
    I understand where you’re coming from. I’m introducing another plausible perspective here–that our all-inclusive term “pregnancy” which includes pathological situations like this, is at the root of the problem. I propose that it isn’t actually a “pregnancy” at all, but a situation which reduces the mother to being an unnatural, unintended extraordinary means of life support. Give what I said a second read and let me know what you think; it seems I may be onto something. Language has interfered with our proper understanding of things before, and is notorious for doing so. (For example, I also don’t believe that oral and anal “sex” is actually “sex” either, just because we learned to label them as such).

54. Looking over the article that is linked in this post, I find this: “While the Church has not spoken officially about the morality of specific treatment options, she does provide several principles rooted in the natural law concerning human life. In applying these principles, the great majority of moral theologians agree that the salpingectomy does not constitute a direct attack on the life of the baby and is morally licit. A couple may serenely choose this option in good faith without fear that they are violating Church teaching.”
    It seems that the debate over surgery vs drugs is not a settled one as far as official Church teachings goes. The article constantly refers to “many orthodox moralists believe” which implies that some orthodox moralists do not. And this quote clearly states there is no definitive Church ruling on it.
    The matter then is how to pastorally deal with the devout Catholic couple who have had the great misfortune to experience this ectopic pathology. This article suggests the the surgery option is a bit more comforting than the drug option. However, there is no definitive ruling from the Church on it. Therefore it would be wrong to admonish a devout couple who has gone with the other option (the drug). In fact, to do so may cause even greater spiritual and emotional harm. After they have gone through the agony of losing their child, being told they have murdered him may bring untold irreparable damage.
    Always err on the side of charity.

55. K said: “Give what I said a second read and let me know what you think; it seems I may be onto something. Language has interfered with our proper understanding of things before, and is notorious for doing so.”
    I agree with you completely! Yes, you *are* onto something. Which I thought I got across to you in that very comment that you quoted of mine. 🙂
    This is what I was taught ten years ago when counseling at a crisis pregnancy center. Ectopic “pregnancies” are not really pregnancies because they are non-viable.
    I am wholeheartedly against abortion in all of its forms. But abortion is bringing on the death of a viable embryo, ending a viable pregnancy. Ectopic “pathologies” are sadly and unfortunately not viable pregnancies.

56. This might possibly be a case where theologians are barking up the wrong tree, entirely. Possibly all of this splitting hairs was never necessary, and what we’re really looking at is an “extraordinary means” situation, albeit not the kind we’re used to exploring. Hmmmm!

57. Any other thoughts on this?
    It seems that all along, theologians have been assuming that since we call “ectopic pregnancies” (sic) “pregnancies”, then therefore the matter has to do with what is abortion and what isn’t–as if we were talking about a normal pregnancy, simply because there is an implantation and an embryo. All because we call an ectopic “pregnancy” a pregnancy, when pregnancy is supposed to be something else.
    If you look at it as the pathological situation that it is, you can see that the mother and child are actually in a situation that applies more to the concept of “extraordinary means”. The mother in this case is not a natural means of life support as in the case of normal pregnancy. Her supporting the child in this case is completely unnatural.
    If “pathology”=”natural”, we’d have no grounds for attempting to remedy any type of pathology, including cancer, diabetes and the common cold. Pathology ≠ natural.
    Prolonging the child’s death in such a situation is just as unnatural as unnecessarily prolonging death in other artificial, “extraordinary means” situations.
    The tube itself isn’t actually pathological. Rather, the tube becomes a means of unnatural, extraordinary, pathological life support that it was never intended to be. So the teachings about extraordinary means kick in.

58. NonAnonmymous,
    Please stop using the term “non-viable pregnancy”: it’s a cop-out. As a physician, I can tell you there are only two possibilities:
    1. Either the fetus is already dead, and MTX is permitted, as Mr. Akin already pointed out
    or
    2. the fetus is alive, and directly killing it is outright murder.
    The future, inevitable death of the fetus if no action is taken is absolutely irrelevant. What matters is whether it’s alive NOW.

59. What matters is whether it’s alive NOW.
    I propose that what matters, is that its death is merely being prolongated by extraordinary means.

60. Doing nothing can not be an extraordinary means.

61. K,
    What extraordinary means? I specifically said, “if no action is taken.”

62. In other words, the tube itself has become the extraordinary means of keeping the child alive. Like artificial life support, it is not the natural way of things for a tube to host a pregnancy. It is also too costly; the cost being, the mother’s life, to spare an insignificant amount of time for a child, whose outcome is death regardless . The tube provides no proportionate comfort to the child about to die. (If anything, being squished by a tube, small and constricted by design would cause discomfort, assuming an embryo at that stage could be capable of registering such a thing as discomfort.)
    It fits the “extraordinary means” scenario too well.
    We’re not used to dealing with “extraordinary means” situations like this because the “pregnancy” label throws us off. Theologians seem to have been assuming that the “pregnancy” label implies that there is a natural process to ectopic pregnancies with which we must not interfere, which is why their sole focus has been on what is abortion and what isn’t. I think they missed the real picture entirely.

63. “In other words, the tube itself has become the extraordinary means of keeping the child alive.”
    This is a huge stretch, to the point of being illogical. The woman is born with a tube, it is a completely natural and ordinary entity prior to this process, and although this process is pathological (i.e., not normal), there is no way you can say that it’s not natural, in a biological sense. No third party (doctor, scientist, etc.) has introduced anything artificial into this scenario.
    And the “too costly”, “death regardless” and “no proportionate comfort” clauses can be used to justify euthanasia or murder in millions of scenarios. It’s still murder.
    The extraordinary means argument just won’t fly.
    And it’s not about terminology (“pregnancy”, “non-viable”, etc.); it’s about directly killing a fetus.

64. Dr Batjacboy, yes, killing a *fetus* would be an act of murder, most certainly, because for it to have gotten to the fetus stage means that it would have been implanted somewhere that it could grow normally. However, we are not talking about a fetus, we are talking about an ectopic situation which means an *embryo*, as this is in the fallopian tubes. It is therefore incorrect to say it is outright murder.
    Read the CUF article more carefully. Taking the life of the child in the case where it is a viable pregnancy, even if it is to save the life of the mother, is never licit. That is the sin of abortion. Killing the fetus, or embryo in this case is indeed outright murder.
    However, in ectopic pathology, where the pathogen in question is an embryo, there is no viable pregnancy here at all, and therefore it is licit to remove the pathogen. I know that the pro-abortion lobby has used this term “non-viable pregnancy” to the point of convoluting its meaning. But please do not confuse those word games with this. Ectopic “pregnancy” is the rare case which does indeed have the valid claim on the label, “non-viable”.
    Removing the fallopian tube with the embryo, as Mr Akin suggests, would directly be the cause of the embryo’s death just as taking the drug would be the direct cause of its death. Mr Akin advises the surgery, as “many orthodox moralists” do, over the choice of using MTX. Both cases directly cause the death of the unfortunate embryo. So you are essentially saying that Mr Akin is also advising outright murder, as the surgery does in fact directly kill the embryo.
    Otherwise, if the removal of the embryonic pathogen is outright murder, as you seem to be proposing, would you advise a woman who is experiencing an ectopic “pregnancy” to let it ‘run its course’ and take her chances with her own life, knowing fully well that her baby’s life will not grow beyond the embryo stage, and taking no course of action will more than likely bring on her own death?
    Which brings up another moral question. (Mr Akin, if you are following these comments 🙂 If a woman chooses the option of doing “nothing”, neither to undergo the surgery nor to take the drug (assuming she has adequate medical access and financial means), would she be culpable of the mortal sin of suicide?

65. NonAnonymous,
    “Removing the fallopian tube with the embryo, as Mr Akin suggests, would directly be the cause of the embryo’s death just as taking the drug would be the direct cause of its death.”
    Wrong. Removing the tube (salpingectomy) does not directly kill the fetus/embryo. The death of the fetus/embryo is a consequence of the treatment of the diseased tube, not a direct act on the fetus/embryo itself.
    “Mr Akin advises the surgery, as “many orthodox moralists” do, over the choice of using MTX. Both cases directly cause the death of the unfortunate embryo.”
    Wrong again. See above. The surgery that can be recommended is salpingectomy (removing the tube); a salpingostomy is the one that directly kills the fetus, and it is considered immoral.
    “So you are essentially saying that Mr Akin is also advising outright murder, as the surgery does in fact directly kill the embryo.”
    Wrong again. Please re-read his post–he did not say what you claim he said. Salpingectomy is OK, salpingostomy and MTX are wrong.
    “Otherwise, if the removal of the embryonic pathogen is outright murder, as you seem to be proposing, would you advise a woman who is experiencing an ectopic “pregnancy” to let it ‘run its course’ and take her chances with her own life, knowing fully well that her baby’s life will not grow beyond the embryo stage, and taking no course of action will more than likely bring on her own death?”
    No, salpingectomy is permissable, like the CUF article said. The point is, MTX is clearly not.

66. Who is doing an evil? The pregnancy is non-viable– regardless of what is done– it is still non-viable. God made it non-viable. Not the mother. Not the doctor. God did. Non-viable.
    Wait a minute…are you saying that the pregnancy is non-viable?

67. K, your “extraordinary means” argument is superb and perfect logic! “Like artificial life support, it is not the natural way of things for a tube to host a pregnancy.”
    Exactly! Which is why it is not viable.

68. NonAnonymous,
    Please answer this question, yes or no: In the scenario we’re discussing, is the embryo in the tube alive when the treatment begins?
    Remember: yes or no. Using the term “non-viable” is won’t fly.

69. Batjacboy, please read several comments up where I posted that the Church has not definitively ruled on this and I quote the CUF paragraph. It is as of now a matter of debate among “orthodox moralists”.
    And the tube is not “diseased”; when the pathogen (embryo in this case) is removed, it returns to normal health, if it has been treated early enough.

70. Batjacboy, yes indeed the embryo is alive!
    And to remove the tube with it, will indeed be the act which brings about its death.

71. Batjacboy, since we both agree the embryo is alive, how can you say that one method of killing it is better than another method?

72. those two comments with no name are mine —
    forgot to sign, sorry 🙂

73. NonAnonymous,
    You wrote, in response to my yes or no question:
    “Batjacboy, please read several comments up where I posted that the Church has not definitively ruled on this and I quote the CUF paragraph. It is as of now a matter of debate among “orthodox moralists.”
    Did you not understand the “yes or no” part? 🙂
    “And the tube is not “diseased”.”
    Of course it is!!! The inflammatory reaction that ensues in the tube can cause a rupture of the tube and the death of the mother. If the tube is “treated” by killing the embryo directly, it’s still murder, even if “it returns to normal health, if it has been treated early enough”.
    Next poster:
    “Batjacboy, yes indeed the embryo is alive!
    And to remove the tube with it, will indeed be the act which brings about its death.”
    No, the death comes as a forseeable result of the primary act of removing the now-abnormal tube, but only since we don’t have the technology to keep the embryo/fetus alive at this stage of development (if we did, the surgeon would be obligated to save it).
    “Batjacboy, since we both agree the embryo is alive, how can you say that one method of killing it is better than another method?”
    It is the Catholic Church which says one method is better than the other. As the CUF article states: it’s the difference between a direct, bad act and indirect consequence of a good act (removing the abnormal tube). In Catholicism, direct killing (MTX) is wrong; the indirect death, according to the Catholic Church’s long-standing Double Effect principle, is permissable, although unfortunate; but it’s actually a world of difference morally, compared to directly (and I mean DIRECTLY) killing the embryo.
    BTW, I’m not saying anything new; all of this was described in other posts above.

74. “Batjacboy”
    You have a SUPERHERO name!
    coooool!
    Do you need a sidekick?

75. This is a huge stretch, to the point of being illogical. The woman is born with a tube, it is a completely natural and ordinary entity prior to this process, and although this process is pathological (i.e., not normal), there is no way you can say that it’s not natural, in a biological sense. No third party (doctor, scientist, etc.) has introduced anything artificial into this scenario.
    Let me rewrite this. Pathology ≠ Natural.
    This is a huge stretch, to the point of being illogical. The woman is born with a throat, it is a completely natural and ordinary entity prior to this process, and although strep throat is pathological (i.e., not normal), there is no way you can say that it’s not natural, in a biological sense. No third party (doctor, scientist, etc.) has introduced anything artificial into this scenario.
    Therefore it is wrong to treat a strep throat.

76. Please answer this question, yes or no: In the scenario we’re discussing, is the embryo in the tube alive when the treatment begins?
    Remember: yes or no. Using the term “non-viable” is won’t fly.
    Nobody’s denying that it is alive. However, so are people who are hooked up to unnatural means of life support, such as an iron lung.

77. Just for the record here, NonAnonymous and I are not in complete agreement. I don’t agree that it matters whether it’s an embryo or a fetus, nor do I necessarily think that the embryo is the pathogen itself.
    What I’m saying is that the tube is an unnatural means of life support in a fatal situation where the outcome is death regardless.
    Sure the embryo is alive. But so are people on iron lungs or using other extraordinary (disproportionately costly, offering no proportionate comfort, in a terminal situation, etc.) means to prolong death when their outcome is death regardless. The teachings on extraordinary means don’t ignore the fact that the patient is indeed alive.
    The embryo itself is one of two people suffering from a pathological and fatal situation where death is the only outcome if things proceed without intervention. In the embryo’s case, insisting that it belongs where it shouldn’t be in nature–the tube–simply because it is alive, is exactly like saying a person in an iron lung needs to remain where they are simply because they’re alive, nevermind the fact that it fits the scenario of “extraordinary means” (and also quite an unnatural situation.)
    Pathological situations such as ectopic syndrome cannot be considered “natural” by a long shot. We do not treat pathological situations as “natural” simply because of their organic component. If we did, and pathological=natural, then we’d have to be consistent and never allow ANY type of medical intervention when someone is ill. We would refuse all medications, all surgery, blood transfusions, etc.
    If the embryo were in its proper place, a uterus, then we wouldn’t have this question. The Church does address situations in which removal of an embryo/fetus may not be the end and means of fixing a situation. In this case, it is abortion, plain and simple. So a diabetic with very high blood pressure and an embryo in her uterus could not licitly obtain an abortion to remedy the physical peril she is in.
    An embryo in the tube, however, is another matter. Unlike a uterus, which is the natural place and the natural means of supporting life through pregnancy, the tube is not designed for this and this isn’t a natural situation. It’s an extremely extraordinary situation and meets all of the criteria.

78. K says “In other words, the tube itself has become the extraordinary means of keeping the child alive…It fits the “extraordinary means” scenario too well.”
    I’m not sure where this argument leads us. How would we withdraw the extraordinary means? Would using Methotrexate be the equivalent of administering a lethal injection to a dying person? Would a salpingectomy be a withdrawal of the extraordinary means?
    Does the application of extraordinary means principles negate the evil of directly taking a life?
    K, in your argument you seem to be saying that the child, by being in the wrong place, ceases to be a child.

79. Very fascinating discussion! I think K’s argument that the mother has become an extraordinary means of support is intriguing, but there are some misunderstandings among the various parties.
    One of them regards the focus on the “viability” of the pregnancy by NonAnonymous. “Viability” refers to the *child* – its ability to live outside the womb. It’s a term tossed out by proaborts who say “if you can’t live on your own, you can’t live.” A red herring, since 3-month-olds can’t live without their parents, proper shelter, and food, either. It does not matter whether the pregnancy is “viable.” What matters is the *child*. It is true that the child, the embryo, cannot ever survive (with current technologies) past a certain age (say, 3 more weeks, for example). That does not give us the right to kill it. Imagine a child born 30 years ago with Cystic Fibrosis. She could never live to 70 years old; does that make it okay to kill her at 5 yrs old? Of course not. “God has already decided that” that child will die early, but we have no right to bring that death about directly. Likewise, it is true that “God has already decided that” the baby doomed to implant ectopicly must die there, but we have no right to bring that death about directly. Being born is not a magic moment, prior to which the length of your life (or the adequacy of your shelter) can be used as a reason to kill you.
    Non-viable pregnancy? Abortion is wrong because it is the termination of a CHILD, not because it is the termination of a pregnancy. The pro-aborts tried that one, too, redefining “conception” to be after implantation so that they could claim the Pill and embryonic stem cell research are morally different from abortion. The focus on pregnancy is incorrect; we must focus on the child.
    God bless all.

80. Another misunderstanding seems to be in K’s analogy comparing the pathology of the ectopic pregnancy to that of a strep throat.
    “‘This is a huge stretch, to the point of being illogical. The woman is born with a tube, it is a completely natural and ordinary entity prior to this process, and although this process is pathological (i.e., not normal), there is no way you can say that it’s not natural, in a biological sense. No third party (doctor, scientist, etc.) has introduced anything artificial into this scenario.’
    Let me rewrite this. Pathology ≠ Natural.
    This is a huge stretch, to the point of being illogical. The woman is born with a throat, it is a completely natural and ordinary entity prior to this process, and although strep throat is pathological (i.e., not normal), there is no way you can say that it’s not natural, in a biological sense. No third party (doctor, scientist, etc.) has introduced anything artificial into this scenario.
    Therefore it is wrong to treat a strep throat.”
    You have misstated his conclusion. His conclusion is not “it is wrong to treat an ectopic pregnancy,” but, “an ectopic pregnancy is not an extraordinary means of life support.” I believe that his point stems from the fact that the Church’s teachings on extraordinary means have to do with human beings utilizing human ingenuity to prolong a life, with new medicines, techniques, etc. I believe that his point is that simply letting a (albeit pathological) pregnancy progress is not utilizing human ingenuity in any way. It is not artificial. I don’t know whether K’s reasoning (that ect. preg. is “extraordinary means”) is a legitimate path to follow (certainly fascinating!), but even if so, the analogy used in the quoted section above is inaccurate, the logic untenable.

81. No matter what the arguments may be for how to bring about the end of the life of the embryo … I just don’t think I could do it. If I’m hanging from a cliff by one hand, with my daughter hanging from my other hand, and the only possible way to save either of us is to let go of her to pull myself up with both hands … I’m going to keep holding on to her. I’ll lay myself at the mercy of God, our guardian angels, St. Gianna, everyone, that some way, some how, we’ll both make it out (passer-by, landing on a cushion of air, outright miracle …), but I’ll never let her go.

82. the analogy used in the quoted section above is inaccurate, the logic untenable.
    Hi, I know what you’re saying; I accidentally made it easy to miss the point of why I made the analogy, and I should have made my point in a different, less-confusing way, instead of using that analogy.
    The claim which I was refuting, was the claim that since an eptopic situation isn’t “artificial”, then it is therefore natural. This refutation is all I was getting at with the analogy.
    The fact that disease–any disease, syndrome or disorder–has an organic nature, has never resulted in the Catholic Church calling it “natural”, in the sense that it is the natural, intended order of things or a part of natural law. We simply don’t call disease or disorder “natural”. We do not consider ourselves subject to “laws of disease” in the way that we are subject to natural law, nor do we treat disease as though it is a part of natural law. Incidentally, and I stress incidentally if we did, and any type of pathology were to be considered “natural”, as the previous poster claimed, then we would have to say that we do not have the moral freedom to treat any illness at all, ever.
    Nature intends for a pregnancy to be the implantation in a uterus. Anything out of that is not not normal, and not ordinary, and not the natural order of things, despite the organic nature of the situation. That’s what pathology is. So an eptopic situation is actually not a pregnancy at all, in nature’s intended definition of the term, and so the term “pregnancy” is misleading theologians and causing them to try to apply teachings about pregnancy which actually aren’t applicable to the situation.
    Pathology ≠ “Natural”.
    Although a fallopian tube is not artificial , we’re still not talking about anything truly natural . Pathology is not ideal, and it isn’t natural–true to nature–simply by virtue of the organic nature of components involved (a fallopian tube, a baby) and its lack of any artificial component. No disease is “natural”. Bottom line: we’re dealing with a tube quite unnaturally hosting an embryo, even if the tube itself isn’t artificial.
    I think the label, “ectopic pregnancy” is throwing the theologians off. The “pregnancy” in “ectopic pregnancy” implies something natural and ordinary–in accordance with nature and natural law–about a situation when there is nothing ordinary or truly natural about it or about pathology in general. It’s not what a pregnancy is supposed to be. If you call it an “ectopic pregnancy , as we’ve been conditioned to call it, then you’re going to be preoccupied with what is abortion and what isn’t, and bark up the wrong tree. Theologians are trying to apply “natural law” principles to a pathological situation and this is holding them back.
    So yes, a fallopian tube can be an extraordinary means of keeping an embryo alive, in the same sense that artificial means can be. In both cases, there is something unnatural, something not in accordance with nature, despite one situation involving only organic components and the other involving organic and artificial components.
    Now, the Church laws about abortion we do have so far, do seem to at least implicitly presuppose implantation in a uterus. At the very least, they do not explicitly include ectopic “pregnancy” in the relevant teachings–and this is probably a good thing, since theologians are still battling this out.
    It seems clear that removal of an embryo from a uterus is never to be the end or means of treating a mother in physical peril–even if her life is in jeopardy–and I can understand why the Church teaches this. You can’t call the child itself a “pathology” or something to be remedied, and in my understanding, I don’t see that we have the authority to choose one life over another.
    What hasn’t been considered, up till now, is this concept of a fallopian tube acting as an extraordinary means of prolonging death. It’s one thing to abort a child in a perfectly natural situation, a uterus–just where natural law would have it. But a child in a fallopian tube is not in a truly natural situation to begin with. Not unless you want to start calling “pathology” natural, a part of natural law, and be willing to give up medicine entirely. While the child isn’t the pathogen, he or she, along with the mother, is a victim of a fatally pathological situation like any other person in a terminal situation, and the tube–although organic–is not the natural place for that child to be. It’s quite an extraordinary place to be, and the means by which it is being used to prolong death can be argued to be extraordinary means. The cost of the mother’s life is pretty extraordinary and not a proportionate cost for another day or so of life for the child. No proportionate comfort is being given. The outcome will be death, regardless. Etc.
    J asks: I’m not sure where this argument leads us. How would we withdraw the extraordinary means? Would using Methotrexate be the equivalent of administering a lethal injection to a dying person? Would a salpingectomy be a withdrawal of the extraordinary means?
    Feel free to think of my point for argument’s sake and join in with your ideas.
    When we speak of withdrawing extraordinary means, we’re used to thinking of taking a tube out of a person, taking a person out of an iron lung, etc. Well, here we potentially have a new situation, but procedure is now unimportant; the word “withdraw” means many things besides “take out”. For example, to “withdraw” extraordinary means can mean taking someone out of an iron lung. It can also mean taking a tube out of a brain-dead person. It can also mean withholding further chemotherapy from a patient who is not going to benefit from it except to prolong inevitable death.
    I wouldn’t use Methotrexate; that is not withdrawing extraordinary means, but rather, it seems parallel to euthanasia , even if the situation is a fatally pathological one.
    Withdrawing extraordinary means–but not euthanizing–in this case, will mean separating the baby surgically somehow from the unnatural life support, i.e. the tube. At this point, since there’s not an actual, natural “pregnancy”–a pregnancy established in the uterus as nature intended, there isn’t an abortion either, but rather, it is simply a withdrawing of extraordinary means—likewise, withdrawing chemotherapy from a person who isn’t proportionately benefitting from it is not equal to killing that person.
    Eager to hear more thoughts on this. Thanks for tolerating my wordiness if you read this much.

83. K, thanks for the clarification on Methotrexate. This still leaves me with the salpingostomy which separates the child from the tube by incising the tube and removing the embryo. This differs from the salpingectomy which removes a section of the tube with the embryo in it. It’s considered a partial if an attempt is made to reconnect the tube. According to another post, the outcome of the two appear to be the same with regard to future fertility. One (using your example) removes the child from the life support. The other removes the life support from the child. The only distinction seems to be that the salpingostomy acts, is said, directly against the child, whereas the salpingectomy acts directly against the tube. The distinction seems to be awfully small here, but it’s there all the same.
    What I don’t see is how the “extraordinary means” argument deals with this distinction. It doesn’t render the distinction irrelevant. Whether you call it an ectopic pregancy or an ectopic pathology, the embryo is still an embryo. I’m not aware of any reasoning that allows us to treat it as other than a person. I think your line of reasoning is a good one and it’s taking us to the same place. “Surgically somehow” means salpingectomy.

84. I acknowledge that I may not be the brightest person around but I have studied this issue for a long time and I have to admit I still don’t get how a full salpingectomy is less of an attack on the baby than a salpingostomy. I have read everything anyone has ever suggested and I am no closer to figuring it out. So I have had to resign myself to the fact I never will and thank God every day that I am a man.

85. Hi J,
    “K, thanks for the clarification on Methotrexate. This still leaves me with the salpingostomy which separates the child from the tube by incising the tube and removing the embryo. This differs from the salpingectomy which removes a section of the tube with the embryo in it. It’s considered a partial if an attempt is made to reconnect the tube. According to another post, the outcome of the two appear to be the same with regard to future fertility. One (using your example) removes the child from the life support. The other removes the life support from the child. The only distinction seems to be that the salpingostomy acts, is said, directly against the child, whereas the salpingectomy acts directly against the tube. The distinction seems to be awfully small here, but it’s there all the same.
    It actually renders the distinction moot. Since we’re no longer talking about an abortive situation where a child is in utero as nature intended, but rather, an extraordinary means situation, then there is no need to worry about which procedure might be abortion and which isn’t. Any separation from life support is a separation; the word “withdrawing” doesn’t imply that there must be a strict “towards” or “away” motion to/from the patient, and between the patient and the extraordinary means, which must be adhered to in order to licitly withdraw support. In the case of an iron lung, you’re removing the person from it. It’s more practical to remove the patient from the lung than it is to brace the patient, suspending him or her in air, while you roll the lung out from around him/her. In the case of a tube in a truly brain-dead person, it’s easier to take the tube out when disconnecting machines, than it is to suspend the tube and roll the patient’s bed away until the tube is no longer in situ. “Withdrawing” can also mean “withholding”. All that’s really being talked about is reversing the use of extraordinary means, or separating the patient from it in a way that depends on what the means are. Proponents of saving the fallopian tube would be able to argue that all that’s needed, is opening the tube and taking the baby out–much like you’d remove a patient from an iron lung. Since we’re talking about extraordinary means and not abortion, they’re free to argue that. Does this help?
    Joselyn, you unwittingly stumbled across an excellent analogy with your hanging-off-the-cliff scenario! I’d been trying to think of one, but couldn’t. Your analogy was good and I slept on it…
    In such a situation as the one in your cliff analogy, with little time to think, there is so much distress that I really can’t see a person being culpable one way or the other, even if the mother chooses to die with the child, and even if there exists a clear right and wrong thing to do. The trauma certainly mitigates, if not eliminates, culpability for making the wrong decision; I can’t imagine that it wouldn’t. However…
    What we’re trying to determine here is whether letting go=killing, in a fatal situation such as this. Is letting go of the other person tantamount to killing? That seems to be the question. We need to eliminate the expectations we put on mothers by virtue of their being mothers, these expectations which are rooted in emotion, which have nothing to do with the subject at hand and which cloud things unnecessarily.
    Picture the situation in the analogy. You’re hanging onto the cliff, and the child is hanging onto you. If your child, hanging from your hand, were of the age of reason, and he could see that he could save you by letting go of you, would anyone dare say that he is guilty of killing himself? On the contrary, there’d be no end to the praise over what a hero/saint the child was. He didn’t kill himself, the fatal situation is the culprit/killer which determined at least one person was going to die. (I like this sudden spin in the analogy because it eliminates the interference of the strong–albeit natural–maternal emotions and expectations which could get us sidetracked.) It seems that letting go is not tantamount to killing/suicide.
    If the situation were reversed, and it were YOU who were hanging onto your child, and you decided to let go and fall to your death in order that the child might pull himself back up and be saved, then did you just kill yourself, and thereby damn your soul? Certainly not! The situation is the killer, again, and the situation has determined that one person will die regardless of whether you grip or loose your hand. Some people, in retrospect, might even call you, the mother, morally negligent and selfish if you hadn’t let go to save the person you were holding onto, because of the expectations people have of mothers, which in this case go beyond what is actually reasonable. But no “killing”, “murder”, or “suicide” has occurred if the mother decides to let go so that her child can live.
    What either of you can do in the fatal situation, is save a life, whereby one death is unfortunate, unintended, incidental in the process, and is going to be the outcome regardless of what is done. As much as one of you would love to be the means by which both of you are saved, you don’t have that option. As much as you couldn’t bear to live while the other dies, it doesn’t mean two deaths are “right”.
    The two of you are at the mercy of a fatal situation, a situation which will kill at least one of you, no matter whether you loose your hand or keep it gripped. The situation is the killer, not you. The situation is the killer, not the child. You have no choice in that matter. The search for the real killer doesn’t whittle down to a hand. It’s the situation.
    Emotion understandably makes it extremely hard to maintain a rational perspective. I tried to envision myself in the cliff scenario with my husband hanging onto me, and emotion made me want to die with my husband every single time I repeated the scenario. Letting go was too hard. That doesn’t necessarily mean that dying with him would be the right thing to do. It’s certainly what I’d want to do, but what we want isn’t always meant to be a determining factor in morality. (However, since letting go is extremely hard and perhaps too hard, I tend to think culpability for my choice would be quite mitigated if not eliminated. I quite rightly love my husband very much. A mother and a child quite rightly and naturally love one another. There’s certainly no intent to die, and you’re certainly not fully consenting to death either.)

86. And if one person’s action of “letting go” in order to save the other is not killing/suicide, then letting go because you happen to be the person on the top–as in Jocelyn’s original analogy–is not killing either. It’s not your intention and you certainly didn’t consent to being in this situation, or killing in any form. Granted, it would be difficult, if not impossible for some people, to let go. But the gripping and loosing of hands doesn’t decide whether there will be deaths; the fatal situation itself has already determined that there’ll be at least one death, not you. Trying to be a “martyr” only makes sense if it has a prospect of saving the child or at least if dying is the reasonable, rational, and required thing to do. If holding on has no prospect of helping and is unreasonable, irrational, and not required, then it’s not really martyrdom at all, but unnecessary death.

87. I apologize for my intermittent responses. I have to get back to life, the universe, and homeschooling. I wish I had time to philosophize more often, though!
    I posit that the mother dangling from the cliff, refusing to let go, commits NO sin. She merely does not let go, and hopes for some miracle. This is Frodo at Amon Hen, choosing to go to Mordor – although Boromir furiously points out that it is certain death, with no chance of success. But Tolkien, and Terri Schindler-Schiavo, said, “Where there is life, there’s hope.”
    The baby in the tube is *not* dying. It WILL die. But is NOT dying. Just as the man trapped in a 46th floor office, with an inescapable fire between him and the door is not dying. Or the bedridden senior trapped in a hospital during massive hurricane flooding. She is not dead. She will die, because the power is out and the waters are rising, and there is no medicine and will be no food for days. But she is not dying.
    Because the baby in the tube is not dying, the tube (or, his mother) is not an extraordinary means of *keeping him alive*.
    I understand your distinction between removing baby & MTX, and how you believe your perspective renders the baby or baby/tube distinction moot. But I think the problem is in the very assumption from which those conclusions follow: that the mother is not a pregnancy host, but an extraordinary means of life support. She is not, because the baby is doomed, but not dying.
    Your argument that the “situation,” not the mother, decided that at least one must die is very dangerous. That justifies the employees at the New Orleans nursing home who hightailed it, leaving their wards to drown. And if the mother is an extraordinary means, then any means of preserving embryos conceived in vitro is, too, and readily set aside. We should have no qualms about letting them all die. If “the situation” determined it, the MTX could be okay, too, although this is a little more analogous to those in NO who euthanized their patients before hightailing it.
    I’ve enjoyed entertaining your argument and thinking through it. But as a mother, “Where there’s life, there’s hope.” God bless your St. Patrick’s Day!

88. Joselyn, it was a pleasure to bounce ideas back and forth with you. I might address your points later when I get a break from other things, but it was so refreshing to “argue” with someone like you that I just had to say so. 😀

89. My heart breaks to hear your discussion. It comes to my mind that many of you might not have ever had to face this situation so I will describe my experience.
    6 weeks ago I learned I was pregnant. I was ecstatic after having lost my 1st baby to a natural miscarriage at 5 weeks. Due to lack of ovulation, I had to use Clomid to concieve. Little did I know this put me at an increased risk of an ecoptic pregnancy (BTW there are instances where two pregnancies a viable and an ecoptic occur at the same time). At 2 weeks pregnancy, I started to spot. I was told my HCG (pregnancy hormone) and progesterone was low and to expect another miscarriage. I prayed to God over and over to save the life of my child and to raise my HCG. He did for the time being and over the next month my HCG raised but not to typically levels. Every day I prayed to God,Jesus, Mary, and the Holy Spirit to let me carry this baby to term. At 6 weeks (this monday–now thurs), I had an ultrasound to determine the source of bleeding. Dr. said there was no sign of an infant present in my uterus and that it was most likely ecoptic. I was sent home. I asked for a second opinion. On Tuesday night, I woke up doubled over in pain. I made it to the restroom where I threw up before feeling faint. My skin began to get clammy and I had to lay down on the bathroom floor before I fainted. Afraid of going into shock along I cried out to my husband to wake up. He did not. I had to crawl over to him to wake him up to call emergency. I was taken to the hospital with very low blood pressure — which the doctors ascribed to pain. I was given 4 ultrasounds which found that there was no baby in the uterus but fluid and tissue parts were in the tube suggesting a tubal pregnancy. Because of my pain, my doctor’s suggested Methotrxate as a means of ensuring that the tube would not burst. By that point, I had word that my HCG had dropped 30 points to a low 273 suggesting the pregnancy was not, in my doctor’s terms, ‘viable’. I agreed and was given the drug. I do not believe in abortion and was horrified to discover that this life-saving procedure is grouped in that class! How inhumane and unsympathetic you are to judge a woman who is in this situation as a murder. I prayed all day, every day for God to give me a miracle baby. To let my baby be viable. You cannot restrict God’s power. If he meant me to carry this baby, I believe that he would have sent me signs that the baby COULD be saved. i.e. HCG rising at an appropriate rate. Lack of pain. Chance of baby seen within one of my 5 ultrasounds. I believed in miracles and I tried everything I could to petition the life of my child. In the end, I opted for a chance that would end an already failing pregnancy in my hope and belief that the action would allow me to have several more successful pregnancies. Why should the lives of potential future pregnancies be regarded as less than the life of a baby who in all probability (<99.99999%) will not survive and could have killed myself? Honestly, I note most of you are men. Surely you must know the level of hope that exists in a pregnant woman's heart. If you don't surely God does. I cannot believe that God would want us women to be further punished (because this is what any miscarriage feels like). My intent was to save my child until it was shown unviable. Transplantation is not a reasonable option (having read several medical journals). My belief is that God himself chose to have the pregnancy non-viable--for whatever reason-- if it is not placed in good soil (the uterus). It is the seed that fell among the rocks.
    Knowing that is still considered abortion... I would still make the choice again in the same situation. The pregnancy is not viable... no heart beat... no sac... no healthy placenta... no baby.
    Judge not lest yee be judged. Peace be on those women who are in my position whom have suffered the same loss and have stumbled on this site.

90. Hi,
    I am now [url=http://www.fertilised.com]7 months pregnant[/url], everything is going well apart from the usual “getting bigger”
    pains but I am used to that after having 4 previous children.
    Since my last child was born I have seriously improved by lifestyle and “tried” to become
    more health conscious
    I have just read an article that I found very worrying & I wanted to ask if anyone else has
    heard of this.
    [url=http://fertilised.com/article.cfm/id/222454][b]Researchers have found the presence of numerous harmful pesticides in the placentas of
    pregnant women[/b][/url]
    Seems the food that we eat which we thought was well made & safe actually isn’t!
    Are you risking your babies health by eating the WRONG food?
    Here is the link to the article I found http://fertilised.com/article.cfm/id/222454
    Interested to have your feedback on this please!
    Thanks
    (Pregnant) Pamela
    xx

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98. I cannot believe that there are actually people out there who would even consider the removal of an ectopic pregnancy anything other than necessary in the emergency situation that it is. Anyone who considers this abortion or sinful or anything of the like are just sick, brainwashed creeps. All of us who have had ectopic pregnancies and survived wanted our babies and grieve for our babies. Whether the baby is alive or not at the time of treatment is irrelevant, IT WILL NOT SURVIVE! And if nothing is done, neither will the mother, end of story. Maybe you freaks should get into the real world and start thinking for yourselves. I despise the fact that anyone looking of the web for help coping with an ectopic pregnancy would come across this site and you all make them feel worse, what kind of people does that make you? Godly? Give me a break.

99. In 1996, I suffered an etopic pregnancy. I do not know how far along it was; I only know that I suddenly became gravely ill and a doctor had the presence of mind to give me a pregnancy test despite the fact that I thought there was no way I could be pregnant since I had what I thought was my period. Instead, I was bleeding due to the medical situation. Over the next few days, I had a multitude of blood tests and finally an ultrasound. After the ultrasound, I was called upstairs to my OBGYN. She told me to immediately go to the hospital, where she had already made arrangements for them to admit me. She said I had an etopic pregnancy, which had to be immediately removed. I knew about etopic pregnancies because my mother told me that my grandmother had almost died from one when she was a child. The doctor who admitted me told me that they would try to do the least invasive procedure possible to presevere my fertility. When I awoke, I was told that luckily they were able to save my tube. The surgery was no picnic and required a good deal of recovery time. Twelve years ago the drug option was not available (or at least not widely available), so surgery was my only choice. I was twenty years old at the time with no children. Preserving my fertility was of the utmost importance (after saving my life, of course). The embryo has 0 chance of survival. Zero. Forcing a more invasive method on the mother is only doing more damage to her body for no good reason. This is not an abortion; it is an emergency medical procedure done to save a life. I read all the posts and cannot feel convinced that this discussion is about anything other than splitting hairs. It really does sound like the arbitrary rules of the scribes and pharisees, which did not truly come from God at all. I would recommend that any woman who has the misfortune of suffering from this terrible problem take her doctor’s advice and go with the least invasive, least damaging method possible. Recommending that women do anything else is irresponsible, even negligent. It may result in her death or serious injury. I hope anyone that is recommending a woman submit herself to a more major surgery just for the sake of being able to pretend that it is somehow more moral can live with the possiblilty of encouraging a woman to make a fatal choice. (I don’t buy the intention argument; the baby is going to die 100% of the time, regardless of method or even the choice to do nothing.) At least this site is not as bad as some evangelic sites that promote doing nothing at all and allowing a rupture, which I’ve seen several people pass off as not a big deal. I really wish more doctors would visit these sites and set the record straight about the dangers of not acting quickly in such emergency situations. As for anyone who has suffered through this, you know as I do that this is an unbelieveably difficult situation and a serious medical problem. As for the orginal poster, your relative needs your support and kindness right now, not your criticism. Give her that support.

100. Hi there
     I’m a God fearing woman. I’ve had 2 ectopics, one where they aborted and I was cut up about it to teh degree that I was in depression for nearly a year, then I fell pregnant again. Happy days. Without my knowledge, it was another ectopic which ruptured. This was the most traumatic experience of my life and i have never seen my husband so helpless and afraid. Yes, it is immoral to abort, i’m not arguing or justifying it, but having been through the worst case scenario, having lost 2.5 litres of blood due to internal bleeding, having major surgery to save my life and nopw having only a mere 20% chance of ever conceoving again, I understand the medical aspect of the approach. An ectopic is one of the most painful experiences one can ever go through. I still cry over our loss, the situation and teh fact that I might never be able to have children of my own ever again, all because an ectopic ruptured. At the end of the day everythign is in God’s hands. You will be judged individually for what you have, said and whatever else the circumstance may be, but seriously, this is not an experience anybody should or want to wish on anybody. It’s not that you’re willing to abort a life, the fetus cannot survive in the tube, it will grow, but as it gets no nourishment, it will die. If in my case it stills grows and ruptures, the motehr can die. My Dr’s exact words were so cold and clinical to me when i refused to abort: “I can’t save both of you, either we abort or both of you die.” Maybe that should be the greater question we should be asking ourselves. Are we selfish in doing so? Until teh day comes when ectopics can be predicted well in advance, I hope and pray that no woman should ever endure or go through this experience.

101. Ectopic pregnancy is something i have had expereince with but i do not condone abortion i belive that everyone should be given a chance to life after conception.

102. Ectopic pregnancy is something i have had expereince with but i do not condone abortion i belive that everyone should be given a chance to life after conception.

103. If all trolls could only write in unintelligible languages…

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     For the last couple of months because of minor improvement of a life of the population, the price for the real estate in Russia have considerably grown. Falling of dollar in средине September and in general has resulted before the big jump of the prices. According to data capital риелторов, the prices for habitation in residential suburbs have grown rather on 15-20 %, and in city on 2-4 %. According to the majority of forecasts, the rise in prices on the real estate will proceed and further. However the fact, that a similar apartment or the house
     The Chicken

105. Why did you spoil the magic, TMC?…

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