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Seminar on the contraception-abortion nexus: questions and comments

Question:

"Thank you for this information, which is very valuable to us. Our century, marked by postmodernity, has led many to moral decline. I would like to know more about therapeutic abortion as tolerated by the Church. It is sometimes confusing, because some abortions could claim to be therapeutic. It would therefore be very useful to know what the principles of this type of case are. In friendship".
Parfait Angoa Olomo, student, Cameroon


Reply:

The position of the Church regarding what is usually called "therapeutic abortion" is the following:

1) For the Church, the life of the unborn child is sacred, just as the mother’s life is sacred, and everything must be done to safeguard these two lives (Evangelium Vitae n. 62). Priority cannot be given to one life over the other. The Church, therefore, considers so-called "therapeutic" abortion, whereby the child’s life is sacrificed to the benefit of safeguarding the mother’s, to be illicit (Evangelium Vitae n. 58).

2) In practise, when a pathology develops during pregnancy, that would be putting the mother’s life at risk, the right attitude, both during the pregnancy or at childbirth, is ‘armed surveillance’, with the possibility of inducing an early birth or a caesarean after the 25th week (viability threshold of the foetus) if the situation worsens and when one cannot wait for the child’s full term.

3) There are cases, however, when with no intention of directly making an attempt on the unborn child’s life, one is led, to safeguard the mother’s life, to institute an emergency therapeutic intervention that cannot wait for the child’s birth to be started, and has the death of the foetus as undesired but inevitable consequence. Such a therapy, surgical or otherwise, is acceptable according to the so-called principle of “double effect” or indirect voluntary that presupposes two conditions:

  • the act should not be bad in itself, as would be that of directly killing the child in his or her mother’s womb in order to be able to extract it more easily or to facilitate the treatment given to the mother; the bad indirect effect, i.e. the child’s death or the fact of putting the child in a situation in which it can only die, even if it was expected, must not have been wanted, neither as an end nor as a means;
  • no other act should exist, which would make it possible to reach the good desired effect.

The Congregation for the Doctrine of the Faith intervened after the Recife affair last year in order to clarify this point by declaring it legitimate to perform “an intervention not abortive in itself, which can have the child’s death as a collateral consequence: if, for instance, the preservation of the mother-to-be’s life, idependently from her state of pregnancy, required an emergency surgical operation or another therapeutic action, which would have as a side effect the unwanted and unintended but inevitable death of the embryo, such an act could not be qualified as a direct attack on an innocent life. Under these conditions, the operation can be legitimate, just as other similar medical interventions would be, as long as what is at stake is a high value good, such as life itself, and as long as it is not possible to postpone the operation till after the birth of the child nor to resort to another efficient remedy (Pius XII, address to the “Family Front” and to the Association of Large Families, November 27th, 1951) (note 1).

4) In some cases –which nowadays are very rare in industrialized countries but which can be found elsewhere– the mother’s life is directly threatened by the pursuit of the pregnancy, and the child’s life itself is also in danger, while the pregnancy has not yet reached the fetal viability threshold, i.e. 24-25 weeks. The Magisterium has made no explicit declaration regarding these borderline cases, which are therefore open to discussion by moralist theologians. My opinion is that in such cases, it is permitted to induce a premature delivery (or a Caesarian section) in order to save the mother’s life, even in the knowledge that the fetus will not be able to survive this act. This judgment was not made by weighing the goods (Veritatis Splendor n. 77), nor even is it based on the “double effect” principle, as applying it to this case is questionable and could lead to abusively justify a true direct abortion with a therapeutic objective. The only aim of the medical intervention must be to save the life that can be saved (in this case, the mother’s). No injustice is committed against the child, as would be the case if the mother’s life were chosen and granted a superior value to that of the child. Here, the doctor faces a single alternative:
a) abstaining, with the ensuing death of both the mother and the child;
b) acting to save the mother’s life, and birth of a child that is not viable and will rapidly die.

If alternative a) is chosen, the doctor is committing an inexcusable professional fault, as well as a serious injustice from a moral perspective (note 2). Alternative b) is not satisfactory from a moral perspective because it consists in performing an abortion of a child that is surely already condemned, but not dead yet. However, this alternative is chosen as a lesser evil.

Why can we choose b) if it is never permitted to commit an evil even for a good end? Because we find ourselves in a blocked situation where there is no moral alternative and where freedom of choice is lacking. An analogous situation is that of the decision taken to carry out an emergency salpingectomy or salpingostomy to save the woman’s life in the event of an imminent risk of a rupture of ectopic pregnancy (when the foetus may still be alive at the moment of the operation, albeit for a short time).

Msgr. Jacques Suaudeau


(1) Clarification de la Congrégation pour la Doctrine de la Foi, publiée le 10 juillet 2009 dans L’Osservatore Romano.
(2) Cf. Maurizio P.Faggioni, Problemi morali nel trattamento dell preeclampsia e della corioamniotite, Medicina e Morale, 2008/3, Maggio-Giugno 2008, pp. 483-526.