The Bioethics of High-Risk Pregnancy
Jacopo da Pontormo, The Carmignano Visitation 1528-1530.
Two lives are frequently in danger in high-risk pregnancies, making the right ethical course of action difficult at times to see. Respect for the equal dignity of all human beings leads Catholic bioethicists and the Church to strive for solutions that rescue mother and child while acknowledging difficult circumstances where it is not possible to save both. Here there is a marked contrast to much secular and utilitarian thinking that frequently defaults to prioritizing protecting the life of the person who can most easily be preserved, usually the mother. Prior to viability outside the womb, the extreme vulnerability of preborn babies makes killing them frequently the easiest path to follow in terms of what is least medically risky.
Let us look at these problems from the perspective of the culture of death to give the “devil his due,” so to speak. There is a logic to the proposition that when the child cannot survive without the mother, and the pregnancy is putting her life at risk, one should minimize the danger of both dying by sacrificing the life of the baby. One can even speak of a duty to preserve one’s own life in a form of “self-defense,” particularly when the continued pregnancy is the cause of a grave danger of death.
What makes the pro-abortion reasoning flawed, however, is the leap to justifying the commission of a grave injustice, the direct killing of an innocent human being. Intentions, circumstances and, very importantly, the objective nature of what is being done, matter greatly in the moral evaluation of our actions. In an earlier essay, I reflected on the fundamental proposition held by the Church, and brilliantly defended by Saint John Paul II, that some acts are intrinsically evil. Direct abortion falls in that category of acts we can never commit ethically.
Some will immediately object that it is absurd to allow both a mother and baby to die when an abortion would allow the woman to live. Catholics hold the deepest reverence for the right to life, but we affirm that committing evil is too high a price to pay to preserve a person’s physical life. A spiritual and supernatural perspective that includes eternal life makes the Catholic position more intelligible. It is therefore understandable that atheists and agnostics are sometimes baffled and even angrily reject the Church’s challenging teachings in this area.
Where there should be more convergence in thinking is the way that Catholic bioethics strives to find ethical solutions to grave dilemmas short of doing evil. Making very fine ethical distinctions is possible. This should not degenerate into a quest for finding clever ways to justify bad actions but should always be an honest search for determining the limits of what can be done ethically.
Ectopic pregnancy is an example of a tragic situation where Catholic ethics permits actions to safeguard the health of the mother. These are not direct abortions but do result in the death of the child. Directive 47 of the Ethical and Religious Directives for Catholic Health Care Services states:
Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman 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.
An example is salpingectomy, the surgical removal of a part or all of the fallopian tube in the dangerous situation where the newly conceived embryo implants in the tube rather than the uterus. The moral reasoning relies on the ethical principle of double effect. What is crucial is that a salpingectomy is not a direct attack on the life of the child but rather a removal of the tube whose rupture would lead to dangerous hemorrhaging. If it were possible to reimplant the baby in the womb, that would be what we would do, but what is impossible cannot be required.
Other actions that resolve an ectopic pregnancy by directly dismembering the human embryo, or drugs, like methotrexate, that kill the embryo directly, cross the line into the intrinsic evil of direct abortion in the opinion of the NCBC. Some ethicists claim that methotrexate acts primarily on the trophoblast, or embryonic placenta, and not directly on the main body of the preborn child, so it might be permissible. This is an area where a definitive pronouncement by the Magisterium of the Church would be very helpful to the faithful and health care professionals.
It should be clear from directive 47 that the claim made by some abortion activists that the Church requires a mother to sacrifice her life for her child when there is a maternal/fetal vital conflict is false. It is true that some mothers have heroically prioritized the preserving of their preborn babies’ lives, such as Saint Gianna Beretta Molla and many others. There is a world of difference, however, between admiring the courage and self-sacrifice of some and saying this is morally required for all.
The fundamental point is that all human beings are precious, and one may never commit an intrinsic evil, such as a direct abortion, even to save a person’s life. There are some tragic circumstances, after all other options have been explored, where it is ethical to take a course of action to save one person’s life even if it leads to the foreseen but not willed death of another so long as there is no direct attack on the innocent party. I always come back to the basic orientation of reverence for human life and doing everything one can morally to safeguard people in danger. Abortion is not the ethical answer to high-risk pregnancies.
