Ectopic Myopic?

James Hrkach

Editor's Note: I received this response to Kelly and Diana Bowring's story "The Culture of Life Triumphs Amidst Hopeless Odds" about their search for moral guidance to resolve an ectopic pregnancy. Both the author of the following article and I laud the Bowring's determination take the time and attention necessary to form their conscience in accordance with Church teaching. But James Hrkach argues that the Bowrings cannot and should not generalize their discernment to everyone else faced with this heart-wrenching situation. The Church has not yet made an decisive pronouncement on this subject, and so, there is not yet a single right answer (though there are some wrong ones.)

I am standing beside a shoulder height rail-less concrete deck. I rest my hand on it to take a break from shearing hedges. A bulky, blind and deaf elderly man is wandering around on the deck in shoes with rock-hard soles. He steps squarely on my hand, the same one that has so often guided the old man lovingly to meals and to bed. In fear of losing the use of my hand, I look the situation over and realize a dilemma.

I could remove my now bleeding hand from under his shoe, but I will upset his stance and he will most likely plummet to the pavement below and be killed. I could shear my hand off and run for help, not causing a direct fall. But the limp hand, not attached to my stable body, will eventually slip and, attempting to balance on his own, he will fall to his death anyway. I need to do something. My hand's functions (and possibly that of my circulatory system) are in danger. What is the moral thing to do?

What a silly story...I mean, what is this guy doing out on a rail-less deck anyway?

And that is the same question we ask of the ectopic baby: what is he doing out there in the fallopian tube anyway?

Kelly Bowring's article, "The Culture of Life Triumphs Amidst Hopeless Odds", addresses the issue of what to do in the challenging medical/spiritual dilemma of ectopic pregnancy. Bowring (and his team of theologians) present a case for one particular solution, to the exclusion of all others. I am writing to challenge the logic of his solution so that all who have experienced or will experience ectopic pregnancy will not prematurely adopt the philosophy put forth in Bowring's article. I am, of course, in favour of obedience to the Magesterium if, and when, the Church speaks decisively on the matter.

I do not, in this article, intend to prove a point in contradiction to the conclusions drawn by the Bowrings. Furthermore, I respect the care with which they approached their personal dilemma on this matter. I quite likely would have chosen the route they did if I were presented with the information they had available to them. However, I believe that one should withold any spiritual pronouncement (in this case on scientific procedure) that is to this point still dependent upon philosophical discussion.

First to problems with the argument style used :

a) In the article, the Catechism entry #2270 is referred to immediately before the comment

"Therefore, any attempt to remove the living fetus, even if deemed non-viable...has always been recognized by the Church to be as gravely immoral".

Broad statements about the sanctity of life (#2270) should not be used to support specific difficult-to-reason matters. In addition, how long has it been that the Church or anybody has been able to deem pregnancies non-viable? It seems to me that it hasn't been 'always'.

Nor has any modern surgical procedure been "long accepted" as none of them have been 'long' in existence. It would be more prudent to define the length of Church acceptance rather than simply use the term "long" so as to indicate substantial historical support by mere connotation.

Lastly, stating that he had the "support of the Church" (capital 'C') may be a slight exaggeration on Bowring's part, considering that we are patiently waiting as the "Church judiciously deliberates on these issues before promulgating a definitive statement." Having the support of "certain members within the Church" is a very different thing than having the "support of the Church".

b) Bowring states that the Ethical and Religious Directives for Catholic Health Services (1995) concludes that "no intervention is morally licit which constitutes a direct abortion", even in the case of extrauterine pregnancies. He admits, however, that the Directives indicate that interventions that have as their direct "purpose the cure of a proportionately serious pathological condition...are permitted" (my emphasis).

This is the case, says the passage, even if it means the death of the unborn child. Bowring inserts the name of the only moral procedure (according to him) within the context of this explanation so as to say that this method is being spoken about in the above passages. It is my guess, since it appears bracketed in the passage, that it was not specifically referred to in the passage and that this connection is interpretive. If I am correct, the placement of this insertion is dangerously close to deceit.

Now, on to the core of the argument:

Basically, removal of the entire fallopian tube (containing a doomed life) is being favoured over leaving the tube in place and removing the fetus (also doomed) from the tube. A principle called "double effect" is said to be at work here. The death of the child becomes a somewhat morally distant "secondary effect" of the primary act of removing the tube. This, Bowring explains, renders the removal of the entire tube morally permissable and makes removal of the fetus alone an evil act. (Hence, my prelude's 'Shall I cut my hand off?' predicament.)

Catechism entry #2269, states clearly, however, that the

"fifth commandment forbids doing anything with the intention of indirectly bringing about a person's death" (my emphasis).

Are we to understand that this entry has exceptions where reproductive pathology is involved, but in all other cases indirect murder is forbidden? If so, maybe we can find ways to make other acts of murder 'secondary' by distancing them from a more 'primary' act. Then it would be permissable to kill others outside the womb too. Is this not where Mr. Bowring's argument leads? If there is truth in the matter of the 'double effect' principle, then it has to apply to all murder...not just abortion.

The one recurring principle in the Catechism's commentary on murder and abortion is "proportion" (see the Directives quote above). As far as I can see, the only argument that the Church has officially made thus far on the difficult issue as ectopic pregnancy is that when the 'proportion' of life loss indicates a comparatively better choice, it is possible to morally make that choice. (You know, the old cliff hanging dilemma; where you must decide whether to let go of the old woman or the young girl as you need your other hand freed up in order to save either one.) Because pregnancies can be accurately deemed non-viable and because proportionate life and death decisions are morally permissable, the issue of procedure becomes really quite redundant. In order to make procedure a substantial issue, one must asert that proportionate decisions are not permissable and that some other solution is required. The non-viability issue is the only officially substantial moral issue until the Church, in her Spirit-guided wisdom, reveals otherwise.

But this is not made clear in Bowring's article. The tone of his story is that he is presenting the only truth and all that's left is for the rest of us to come to our senses. I think his arguments, however, are not simple, complete nor strong enough to warrant authority at this time. To label an indirect act 'inculpable' when full knowledge of its secondary effects exists, doesn't seem quite congruent with the Catechism I am reading. Besides, the Bowring article seems to admit that it is the solving of a pathological problem that is a key factor in allowing even the proceedure that he is promoting. This is an expression of 'proportion' as well. Without it, the 'double effect' principle withers...not the kind of solid reasoning the Church has offered thus far.

I am concerned about people, especially women, who come across Bowring's article. Many who read it may sit in a pool of tears, thinking they have done the wrong thing to have attempted to save their tubes so that they might take even risky chances on further procreation. And all because of a technical error in how much tissue was removed with the ectopic child.

An argument or postion that equates a woman with an ectopic pregnancy who desperately wants her child with a woman who favours and/or denies the destruction of her child is a short-sighted one. God will indeed judge our works...but without considering the state of our heart?

Probably not.

James Hrkach April 24, 2000

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