Regarding our conversation on ectopic pregnancy, Boston College law prof Greg Kalscheur, S.J. recommends a 1993 article from Theological Studies by James Keenan, "The Function of the Principle of Double Effect." (I don't have the link.) Here's the abstract:
The casuistric principle of double effect should be applied taxonomically rather than geometrically as is currently being done. The geometric application assumes that the principle can be used as moral justification for any action which fits the four conditions of the principle. Instead, the principle should be recognized as an abstraction representing common aspects of paradigm cases which contain their own internal certitude. The taxonomic analysis shows that the principle does not apply to the case of ectopic pregnancy, although it fits the principle geometrically.
In the article, Keenan quotes John Noonan's conclusion that "whenever the embryo is a danger to the life of the mother, an abortion is permissible. At the level of reason nothing more can be asked of the mother."
And John McGuinness writes because he is:
becoming uncomfortable with the prominent role the "burining building" hypothetical is playing in the moral analysis on MOJ, as it has several probalem that make it ill-suited as a moral guide. First, as Prof. Penalver noted when he introduced the hypothetical, there is a significant moral difference between choosing to save one person over another, and deliberately killing one person for the benefit of another. Second, there's often a gap between what we "would" do and what we "should" do. If I came home today and found a man with a knife standing over the bloody corpses of my wife and children, it's likely I would do some things that are not morally correct. Third, this type of analysis would work to justify all sorts of discrimination. A white racist would probably save a white baby over a black baby -- does this make segregation OK? The ingrained discrimination is precisely what we are trying to confront. The "burning building" is almost a tautology -- I would discriminate against embryos; therefore discimination is OK. Fourth, your particular use of it is flawed -- you say that the choice between an embryo or your wife would not be difficult becuase several chidren depend on her for love and care. But I suspect the choice between your wife and your newborn child would at least be difficult (although perhaps the same), even though nobody is dependent on the newborn child. The hypothetical may be a useful tool for uncovering what our initial moral intuition is, but it should not be one of the first tools we reach for in evaluaing the morality of policies.
Just to be clear, I do not mean to suggest that the fact of my favoring my wife's life over our early-stage embryo's life establishes its moral correctness. But it raises some questions for me, especially because I am confident that if I was presented with the dilemma 100 times, I'd make the same decision 100 times, and if I reflected deeply on my decision for many months, I'd remain resolute in its correctness. It's not just a function of my personal bias because if a stranger in the same situation asked for my advice, I'd tell him the same thing. And it's not the same as reacting in passion to the sight of the person who has just murdered my family. It is a decision that seems grounded, in a meaningful way, in the core convictions of my conscience. (Hence the relevance of the burning building hypo: in that case, I would not only find it morally acceptable to rescue the infant instead of the blastocyst, I would find it morally unacceptable to rescue the blastocyst instead of the infant.)
So again, if I choose to save my wife by ending the life of our embryo -- and if I choose what may be the safest route by removing the embryo itself, rather than the tube -- is my conscience improperly formed? And if so, what moral insight am I lacking?
To take the inquiry to another level, if the natural law is written on our consciences, whose conscience would tell them to let the mother risk death instead of removing the embryo? And if the vast majority of persons of faith who do value life, including pre-born life, would choose my course of action on this issue, then where else is the natural law written?
Rob
Friday, October 27, 2006
My colleague Elizabeth Brown points out that Nicaragua may simply be following the lead of its neighbor El Salvador, which adopted a total abortion ban in the 1990s. Elizabeth explains:
El Salvador’s ban admits no exceptions, not even to save the life of the mother. The Archbishop in El Salvador was a strong supporter of El Salvador’s ban. Proponents of the ban claimed that medical science has advanced to the point where abortion is NEVER needed to save the life of the mother.
Article 1 of El Salvador's constitution declares that the prime directive of government is to protect life from the "very moment of conception." The penal code detailing the Crimes Against the Life of Human Beings in the First Stages of Development provides stiff penalties: the abortion provider, whether a medical doctor or a back-alley practitioner, faces 6 to 12 years in prison. The woman herself can get 2 to 8 years. Anyone who helps her can get 2 to 5 years. Additionally, judges have ruled that if the fetus was viable, a charge of aggravated homicide can be brought, and the penalty for the woman can be 30 to 50 years in prison. El Salvador is very aggressive about enforcing its ban on abortions. Doctors are not allowed to treat ectopic pregnancies until either the fetus is dead or the fallopian tube ruptures, which places the life of the mother in danger.
Back in April, The New York Times reported from El Salvador:
According to Sara Valdés, the director of the Hospital de Maternidad, women coming to her hospital with ectopic pregnancies cannot be operated on until fetal death or a rupture of the fallopian tube. "That is our policy," Valdés told me. She was plainly in torment about the subject. "That is the law," she said. "The D.A.'s office told us that this was the law." Valdés estimated that her hospital treated more than a hundred ectopic pregnancies each year. She described the hospital's practice. "Once we determine that they have an ectopic pregnancy, we make sure they stay in the hospital," she said. The women are sent to the dispensary, where they receive a daily ultrasound to check the fetus. "If it's dead, we can operate," she said. "Before that, we can't." If there is a persistent fetal heartbeat, then they have to wait for the fallopian tube to rupture. If they are able to persuade the patient to stay, though, doctors can operate the minute any signs of early rupturing are detected. Even a few drops of blood seeping from a fallopian tube will "irritate the abdominal wall and cause pain," Valdés explained. By operating at the earliest signs of a potential rupture, she said, her doctors are able to minimize the risk to the woman.
Is this really what a culture of life demands?
Rob
Regarding my question about Nicaragua's total abortion ban, Georgetown philosophy prof Karen Stohr explains:
Without knowing the details of the law, I'm guessing that they are defining abortion as the intentional killing of a fetus, with the understanding that not all procedures that result in the fetus's death are properly considered to be abortions. For instance, everyone (I think!) agrees that it's permissible to treat an ectopic pregnancy by way of salpingectomy, or the excision of the fallopian tube. This of course results in the baby's death, but it's not considered intentional killing on the double effect grounds that the death is not serving as a means to treating the woman's life-threatening condition. (There is much more disagreement about whether other treatments for ectopic pregnancy constitute abortions, but that's neither here nor there.) Likewise, inducing labor prior to viability to treat a woman's life-threatening eclampsia or HELLP syndrome would not be considered abortive, even when it's known in advance that the baby cannot survive. I don't know enough about obstetrics to know whether there is always a non-abortive procedure that would save a woman's life, nor do I know whether the non-abortive procedures would ever carry significantly higher maternal health risks compared to the abortive procedures. I take it that the Nicaraguan government is assuming that the answer to the first question is "yes" and that the answer to the second question is either "no" or "doesn't matter."
Notre Dame law prof Julian Velasco explains further:
The Church would allow you to take many measures to save the mother's life even if those measures are certain to result in the unborn child's death, but you may not directly kill the child. It's part of the principle of double effect: you cannot intend the evil as either the end or the means, but can accept it as a result. The perfect example is the ectopic pregnancy: you cannot have an abortion, because that would be directly killing the baby, but you can remove the portion of the fallopian tube that is causing problems, even though it will result in the death of the baby. In that case, you neither want the baby to die nor are you killing him/her. You are merely saving the mother's life.
Here is another explanation of the distinction between "abortion" and efforts to save the mother's life that result in the fetus's death:
Catholic Theologians typically discuss the morality of three common treatments for ectopic pregnancies according to the principle of double effect.[4] One approach utilizes the drug Methotrexate (MTX), which attacks the tissue cells that connect the embryo to its mother, causing miscarriage. A surgical procedure (salpingostomy) directly removes the embryo through an incision in the fallopian tube wall. Another surgical procedure, called a salpingectomy, removes all of the tube (full salpingectomy) or only the part to which the embryo is attached (partial salpingectomy), thereby ending the pregnancy.
The majority of Catholic moralists reject MTX and salpingostomy on the basis that these two amount to no less than a direct abortion. In both cases, the embryo is directly attacked, so the death of the embryo is not the unintended evil effect, but rather the very means used to bring about the intended good effect. Yet, for an act to be morally licit, not only must the intended effect be good, but also the act itself must be good. For this reason, most moralists agree that MTX and salpingostomy do not withstand the application of the principle of double effect.
I'll admit to absolutely no expertise in this area, but I'll also admit that this seems like hair-splitting to me. Maybe it's important hair-splitting, but to tell a mother whose life is in peril that she cannot simply remove the embryo, but must instead remove a portion of the tube in which the embryo is located, seems to verge on putting principle above prudence, particularly if this increases the risk to the mother or lessens her chances of becoming pregnant in the future (I don't know if it does either of these).
In thinking of "life of the mother" exceptions more broadly, I'm reminded of Eduardo's "burning house" hypothetical. I realize that there is moral significance to the act/omission distinction in not rescuing vs. removing from the tube. At the same time, if my choice is between saving my adult wife, on whom several children depend for love and care, and saving an embryo in its earliest stages, that's not a particularly difficult question for me. (It's a heart-breaking question, but not a difficult one.) And I will presume that it's not a difficult question for the vast majority of Americans. Is this simply a case where Church teaching is so far removed from the current state of public opinion that it's not worth talking about in our legal and political discourse? Or do we need to talk about it more because we have a nation of improperly formed consciences (including my own, perhaps)?
Rob
Thursday, October 26, 2006
Today Nicaragua's legislature voted to ban all abortions, even when the mother's life is in danger. Is this justified -- much less mandated -- under the Church's teaching? My understanding is that an intentional abortion is never morally permissible, but a procedure intended to save the mother's life is permissible even if it is certain to result in the unborn child's death. Unless I'm missing something, I assume that such procedures would be prohibited under a total ban (unlike South Dakota's law, which contains an exception for saving the mother's life). What's the argument in favor of a total ban and why is the Church in Nicaragua reportedly calling for one?
Rob
Wednesday, October 25, 2006
Dale Carpenter has concerns about the New Jersey Supreme Court's same-sex marriage decision:
It’s significant that no other gay-marriage case (with the possible and instructive exception of Vermont, where the court adopted similar reasoning) has been brought in a state with as favorable a public policy toward gays as this one was: a broad set of antidiscrimination laws, domestic partnerships, second-parent adoptions, a hate crimes law, and so on. In this environment – where the state was committed to protecting gay people, sustaining gay couples, and facilitating gay parenting – it was both logically and practically difficult to hold on to the procreation and child-rearing rationales. The state had nothing left in defense of the rights gap except an unadorned “tradition” that the state itself had steadily undermined in its public policy. . . .
[T]he New Jersey court’s quotation from Justice Brandeis’ famous dissenting opinion praising the states as “laboratories” to “try novel social and economic experiments” is a bit ironic. The New Jersey court now holds that once the state substantially experiments with gay equality it must go all the way, ending the experiment.
While the result in this case is surely a good one for gay families, it may chill experiments in other states where legislators might fear that they cannot move incrementally toward equality for gay couples without surrendering the judicial basis for any remaining distinctions. I doubt that’s really a great danger in most states, where courts tend to be less aggressive than New Jersey’s and where the standard rational-basis test should allow legislatures to proceed incrementally, but this opinion will surely be cited as a reason not to grant any rights to gay couples.
Rob
The New Jersey Supreme Court has held:
Denying committed same-sex couples the financial and social benefits and privileges given to their married heterosexual counterparts bears no substantial relationship to a legitimate governmental purpose. The Court holds that under the equal protection guarantee of Article I, Paragraph 1 of the New Jersey Constitution, committed same-sex couples must be afforded on equal terms the same rights and benefits enjoyed by opposite-sex couples under the civil marriage statutes. The name to be given to the statutory scheme that provides full rights and benefits to same-sex couples, whether marriage or some other term, is a matter left to the democratic process.
Rob
