Ectopic Pregnancies: Intent v. Knowledge

Julian Velasco responds to Karen Stohr's most recent comment on ectopic pregnancies:

Karen Stohr asks, “What grounds are you using for saying that the craniotonomy/salpingostomy constitutes the physical act of killing the baby, whereas a hysterectomy/salpingectomy does not?”  She then adds, “In order to argue that the former are grave moral wrongs, you would *also* need to argue that they are intentional killings, that death is the aim.”  I disagree with this method, but let’s play it out.

As for her first question, she seems not to appreciate the import of the use of the term “physical act” and uses it as she might use the term “act.”  As I read it, however, “physical act” means the uncontextualized act undertaken by the actor.  I would say (with Richard, I think) that there is a difference in the physical acts between the craniotonomy/salpingostomy and the hysterectomy/salpingectomy based on the directness of the action's impact.  The former, which action is taken on the baby and directly leads to the baby's death, is killing.  The latter, which action is taken on the mother and only indirectly leads to the baby's death, is merely letting the baby die.  (In order to argue that a salpingostomy is merely letting the baby die, you would *at least* have to remove the baby perfectly intact from the mother.  I do not see how the argument can be made for a craniotonomy at all.)  But even if the argument on her first question fails, then we are left with the conclusions that both are killing (not that neither is), and that both are immoral if intentional.

So we move on to intention.  I think that one need not establish that “death is the aim” (i.e., end, goal, desire, etc.) in order to establish an “intentional killing.”  That is the whole point of the principle of double effect.  One might have a perfectly noble aim and still be limited in the means they may choose to achieve it.  In a craniotonomy/salpingostomy, one is intentionally killing the baby for the sake of the mother.  The intent to kill is there, albeit an intent with respect to means, not an intent with respect to ends.  In a hysterectomy/salpingectomy, on the other hand, one is not intending the death, either as the means or as the end.  One merely knows that the death will result.  Without more, knowledge is not enough to impute moral culpability.

So even using Karen’s method, a craniotonomy/salpingostomy constitutes an act of killing that is intentional.  The death may not be desired, but there is a morally significant difference between “not desiring” and “not intending.”  On the other hand, a hysterectomy/salpingectomy at most constitutes an act of killing (and that is disputed), but certainly not one that is intentional.

Rob