"Children are a blessing from the Lord, the fruit of the womb a reward." (Psalm 127:3)
The Culture of Life Triumphs Amidst Hopeless Odds
by Kelly Bowring
used with permission
Medical technologies are advancing at such a rate that it has been difficult for Church teaching to keep pace. Still, within the new moral dilemmas born from these medical breakthroughs, the long-standing principles of moral doctrine apply and serve adequately to guide the Christian through the labyrinth of moral and medical options to the light of truth. Having recently experienced such a crossroad of science versus faith, I would like to share with you about the brief but remarkable life of my baby. Her life began about six weeks ago, when because of routine charting with NFP (Natural Family Planning), we wondered at the possibility of being pregnant with our fifth child. After two over-the-counter pregnancy tests, our hunch was confirmed. Surprised and overjoyed, we immediately began to pray for this new life and to thank God for His wonderful gift.
Over the next two weeks, our joy turned into concern and uncertainty, as we soon learned that the pregnancy was not going normally, and was possibly ectopic. We immediately gave the whole situation and the baby to the Lord. I decided to do some research, and soon discovered that, statistically, in most ectopic pregnancies, the baby embeds in the fallopian tube. Some have proposed that this occurs because of use of contraceptives or from pelvic inflammatory / sexually transmitted diseases (STDs), however neither was the case in our situation. When tubal pregnancy occurs, there is no chance of survival. As the baby attaches to the tube and grows, the tube eventually ruptures, ending the life of the baby, which then also becomes life threatening to the mother.
I discovered in my research that there is a moral debate in progress today concerning various procedures for solving the problem of tubal pregnancies that are discovered while the baby is still alive. The first procedure is for the mother to take a pill, methotrexate, which breaks down the environment around the fetus in the fallopian tube, thus directly causing a miscarriage. The second procedure, called linear salpinotomy (ostomy), is performed by entering the fallopian tube through the belly button, making a small incision in the unruptured fallopian tube, and directly removing the fetus from within the tube through a suctioning measure. The goal of these two procedures is to directly remove the fetus while saving the fallopian tube and thus intending to safeguard the possibility of future pregnancies.
Interestingly, both procedures are often presented to patients exclusive of any moral factors, only as assuring the least damage to the mother's body. What doctors admit though, is that these procedures usually leave the fallopian tube scarred, significantly increasing the chances of future ectopic pregnancies, and thus actually setting up the situation for the occurrence to happen again.
As the day arrived, the doctors confirmed that Diana did have a tubal pregnancy. During the waiting time and on the day of decision, the doctors offered to us both medical procedures as the only two possible alternatives to the situation. In the consultation, when I asked one of the doctors about the "baby," she correctingly referred to the baby as "a mass of cells", "a blob of tissue," as "non-viable", and as matter-of-factly needing to be removed in the most "conservative" way, one that would be least damaging to the mother.
Aware of the moral implications, I entered into a brief dialogue with the doctors at this point and reminded them that we were in a Catholic hospital. As for Diana and myself, I went on, we saw this situation more from a moral perspective than from a medical one. I explained to them that, as the fifth commandment makes clear, human life fully begins as the moment of conception, when the egg is fertilized, and must be absolutely respected and protected as such from that moment onward (cf. Catechism #2270). Therefore, any attempt to directly remove the living fetus, even if deemed non-viable (as is eventually the case in tubal pregnancies), is and has always been recognized by the Church to be as gravely immoral and an evil act, essentially similar to abortion.
Though I did not at the time delve into the particular moral reasons why each of the only two proposed procedures the doctors suggested to us were specifically immoral, it suffices to do so now. The first procedure, whereby the mother ingests the methotrexate pill to cause miscarriage, is essentially the same approach as the "morning-after pill", just at a later stage in fetal development. The second procedure, salpinotomy, as well, is aimed at directly intending, by the procedure itself, to terminate the life of the baby. Both procedures are abortive and hold the same moral culpability as abortion.
As one moral theologian, Fr. Thomas J. O'Donnell, S.J., a consultant to the U.S. Catholic Conference Committee for Continuing Directives for Catholic Health Facilities puts it: "the (direct) removal of a non-viable fetus from the site of the implantation (fallopian tube), has always been recognized in the teaching of the Church as a grave moral evil aborting a fetus from a fallopian tube is no different than aborting it from the uterus itself." On this, the NCCB document, Ethical and Religious Directives for Catholic Health Services (1995), states: "In case of extrauterine (including ectopic) pregnancy, no intervention is morally licit which constitutes a direct abortion."
On the other hand, the document continues: "Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman (i.e. a salpingectomy) are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child" (#45, 47). Despite these directives, some theologians unfortunately contend that methotrexate and salpinotomy may be permitted. Part of the debate on these procedures, is that like the infamous pre-Humane Vitae debates over contraception, these two [abortive] procedures have yet to be, by direct name only, condemned by the Church. Meanwhile, many patients are unaware of the moral issues, or that there even are any.
As the consultation with the doctors continued, I then proceeded to introduce into the list of possible procedures, the long accepted, Church-sanctioned and morally permissible procedure, called a salpingectomy (which they later admitted was an easier and less risky operation, though in their opinion, archaic and 'unnecessarily harsh' to the mother's body), an operation which entails directly removing the dangerously damaged fallopian tube in the area where the baby is located. By the principle of double effect, as a non-directly intended secondary effect, the life of the baby would then be lost as well, in the saving of the life of the mother. But, as I explained to the doctors, this procedure was radically different from both of their original proposals, due to the intention and action of the procedure itself, despite the similar outcome. This was the simple application of the principle that "the ends do not justify the means" -- all of the actions taken toward a good end must be good in themselves, or the whole thing is bad. The doctors somewhat reluctantly agreed to perform the procedure that I had proposed.
While in the hospital waiting room that morning, the first magazine that Diana picked up, was the Catholic Medical Association's Journal, called The Linacre Quarterly (dated February 1999). She suggested to me that somehow it might be pertinent to our situation. Upon glancing at the index, she immediately noticed among the many articles, one on ectopic pregnancy. I quickly read the article, which went to great lengths to argue and confirm every detail of our decision thus far in this matter. At one point, the author, Dr. John E. Foran, M.D. stated: "Therefore since the immediate effect of methotrexate and saplingotomy(ostomy) is the death of the fetus, the principle of double effect (as some try to apply it) is not applicable because the act is evil." He directly and clearly confirmed our decision that the two procedures initially suggested by the doctors were immoral. He also went on to verify that the third procedure, the one I had suggested, was morally good. This revealed itself as a Providential and timely coincidence, which in turn gave Diana and I a resolved sense of peace with the decision we had made.
Within Dr. Foran's article, as well, Dr. May, a moral theologian at the John Paul II Institute in Washington, DC, was cited as having written on this topic. I had just spoken with him briefly a few days earlier about Diana's developing situation and decided to call him right then to confer about the final prognosis and our plan. He confirmed all of our decisions. I also asked him about the possibility of transplanting the fetus into the uterus, but he regretfully informed me that this was presently just an experimental theory (only 2 recorded cases in history), and that he was not aware of any doctor who could do it. Meanwhile, I was able to give a copy of Dr. Foran's article to the doctors.
Finally, as a last possible option, I wondered if we could possibly simply let the 'chips fall where they may' and disregard or postpone our plans for surgery, hoping instead for a miracle. I soon realized that such a notion seemed to us to be morally imprudent, especially given the following three factors: 1) Diana's life was at risk; 2) there was no chance of survival for the baby; 3) and most importantly, we had the long-standing and clear support of the Church for this procedure in our situation.
So, Diana and I were left with a few moments to grapple with the notion of having decided to consign the doctors to save Diana's life while also, at the same time, allowing the death of our daughter, and ironically of feeling morally required to do so at that. We felt in a similar way as perhaps Abraham must have felt leading his son Isaac to sacrifice or like Mary offering her Son Jesus on the Cross. But, at the same time, we discussed how we felt an overwhelming sense of peace and assurance knowing that God's Hand was at work in all of this and knowing she was giving up her life for her mother, like a "martyr" for life, a Holy Innocent. We gathered holy water to have the baby baptized (the nurse later did baptize the baby just after surgical removal). We decided to name our baby Maria Goretti Bowring, due to that day being July 6, the feast of St. Maria Goretti.
As it turned out in the end, the original doctors who had suggested the [abortive] procedures did not perform the surgery. Diana went into surgery as their shifts' changed and instead a well-respecting Catholic doctor performed the surgery and was very openly inspired by our example of morality, as he shared with us afterwards in the follow-up visits. We have thanked the Lord for this doctor.
In all of this, I have, during and since, felt a great wonder and privilege at the gift of our baby. A priest friend of ours recently told us that the Lord has shown His love for our family in a special way by giving us such a close and powerful intercessor in Heaven. We are thankful to the Lord for giving us the knowledge to be aware of the moral issues at stake in our situation and for the grace to have been faithful to His Church's teachings, and the joy and peace it has brought.
It is interesting that this debate has elicited so much controversy and opinion, most of which we have noticed to be misinformed, on the topic of tubal pregnancies. John E. Foran, MD, in his article in the Linacre Quarterly, stated concerning the tubal pregnancy moral confusion, "the debate must be brought to a conclusion with unambiguous teaching from the Magisterium. About this, Fr. J. A. Di Noia, O.P., executive director of the NCCB's Doctrine and Pastoral Practices office, stated: "Tubal pregnancy is another example of the moral issues being raised by modern medical advances. Conscientious of the moral issues involved," he continued, "the Church judiciously deliberates on these issues before promulgating a definitive statement." In the meantime, he agreed, "the Church's wellspring of moral teachings can act as a guide in such matters."
Diana and I are also hoping, in the telling of our daughter's story, to encourage hospitals, doctors and other parents faced with this same moral dilemma to make the right moral decisions. May Maria Goretti Bowring's life, like that of other innocents of tubal pregnancies, encourage the Church to explicitly clarify her definitive teaching in reference to tubal pregnancies. Since Diana still has one fallopian tube intact, she and I are praying for the Lord to bless us with more children.
Tested in Fire
by Diana Bowring
used with permission
July 6, 1999 was one of the hardest days in my life. I found out that my baby would not live another day. The pregnancy began with a surprise and a bit of worry and then grew into confusion and in the end resulted in giving her up. In the course of the six weeks, I actually was praying I was having a normal pregnancy, I petitioned God to please not let my baby die. I still had not fully grasped though the end results of an ectopic pregnancy.
July 6th came and my husband and I went to the hospital. Our perfectly formed baby was at 6 weeks. gestation and for reasons unknown had implanted in my right fallopian tube. I had 2 hours to grapple with the decision of ending my baby's life to save mine. I bought a tiny little angel in a praying stance at the gift shop along with a one decade pink rosary and a card. My husband and I wrote love notes to our baby and then we went to the chapel to pray and offer our child to Jesus through Mary. We got some holy water for the nurse to Baptize the baby after removal. As I was waiting to go into the operating room, I could not stop grieving for a baby who was about to die. I immediately felt an immense canyon between me not wanting to end the life of this precious gift and a mother who willingly walks into a clinic to end her baby's life in the name of choice. I had no choice, my baby was going to die. My Catholic doctor reassured me going in that there was nothing else I could do. He visibly was touched at such an immense feeling that I already had for this child. I woke up and she was gone. My right fallopian tube had been cut out and the effect of that was the loss of our baby girl.
Everything went "o.k." in the surgery. They had also found a cyst on my left ovary that had ruptured. The Dr. knew we were planning on having future children and did his best to preserve my fertility on that side. I am "recovering" as best as anyone can in this type of situation.
I share my story to help me in healing but also to try to communicate to those of you who have never experienced the loss of a baby and those of you who have.
Those of you who haven't lost a baby, I understand your non-understanding. It's one of those things that you can say "I just don't know how you feel." That is ok. I felt the same way when I had previously heard of friends who lost babies to miscarriage. I always said "that must be terribly hard to deal with." And now I can say. "Yes, it is." I do want to talk about what happened. I do want you to remember my baby.
To read a response to the Bowring's decision and choice, click here.