Case VIII: Concerning the Procuring of Abortion

A physician was called to a case of antepartum eclampsia, and was informed that the patient had had three convulsions. Four hours - after he was called the patient had a fourth terrible convulsion. The physician at this stage contemplated calling a second physician and causing the child to be delivered by operation. There was no question, of course, of craniotomy, etc., but only of accelerating the delivery. However, the attending physician decided not to send for another doctor, nor did he attempt the operation. Medicinal treatment was resorted to. The mother thereupon became conscious, and was delivered in the natural way. The child was born alive and was immediately baptized, and it lived for ten minutes after.

Would it have been permitted for this attending physician to accelerate delivery by operation? In replying, kindly say a few words on this question of accelerating birth—Inquirer.

Answer.—Eclampsia is a very grave complication of pregnancy, characterized by convulsions and coma. If delivery is effected during these convulsions, the convulsions will cease immediately or soon after, and the maternal mortality is then about 11 per cent. If the expectant treatment is used in convulsive cases, about 28 per cent. of the mothers die. The condition is one of the most dangerous found in pregnancy.” (‘“Past. Med.,” O’Malley—Walsh.)

If pregnancy ends in the emptying of the uterus before the sixteenth week of gestation, the condition is called an abortion; if this happens between the sixteenth and the twenty-eighth weeks, it is miscarriage; if the child is born after the twenty-eighth week, but before the full term, the birth is premature. Physicians commonly use the term abortion for both abortion and miscarriage. The moralists call any delivery of an unviable child an abortion, while the delivery of a viable child is called a premature birth. If the abortion is brought about by natural causes, without artificial interference, it is called spontaneous; if the abortion is caused by outside interference, it is styled artificial. If the delivery takes place before the seventh month of gestation, or before the twenty-eighth week, it is called an abortion, because the child is not viable before the end of the seventh month. On the contrary, if the delivery takes place after the seventh month, but before term, that is, between the twenty-eighth and the thirty-sixth week, it is called a premature birth, because it is possible for a twenty-eight weeks' child to live outside the mother's womb.

1. It is lawful, for a grave cause, to bring about, artificially, a premature birth. First, we say that it is lawful, because a child, after the seventh month of gestation, is capable of living outside its mother's womb, and therefore to remove it from its mother's womb is not equivalent to killing it, since the mother's womb is not an absolute condition of its living. Secondly, we say that it is not lawful, except for a grave cause, to remove the child, even after the twenty-eighth week. The reason is because removing a viable child from its mother before the full term of gestation has been reached, is to expose the child's life to very serious danger, not alone of dying, but if it should live, of being weak and undeveloped. It is not lawful, however, to expose the child to this risk, except to ward off some graver evil, namely, the death of the mother or of the child.

2. It is never allowed directly to remove, or to cause to be removed, an unviable child from its mother, not even though it be the last hope of saving the mother's life.

Nunquam licet directe procurare abortum. An abortion is the removing from the mother of a child that is not yet viable, i. e., before the seventh month of gestation has been completed.

It is never allowed, because such a removal is tantamount to killing the child, and it is never permitted directly to cause the death of an innocent person. Even though the unviable foetus could be delivered alive and baptized, and thus its soul's salvation procured at the same time that the mother's life is preserved, it is strictly forbidden by the Holy See. The end cannot justify the means. A child that is not seven months cannot live outside its mother's womb. To remove it thence is to kill it. To kill it is to kill the innocent without justification. That is murder. Therefore there is a long list of prohibitions by the Holy See declaring the unlawfulness of directly procuring abortion, even though it be the only means of saving the mother's life, and the unborn child is doomed to die by nature in any case. Both the mother and child must be left to die, since it is not lawful to save the mother by destroying the child.

In the latest edition of his Moral Theology, 1910, Father Lehmkuhl says concerning this matter: "In former editions I endeavored to bring forward reasons that might probably justify the violent invasion of the unviable foetus and its vital element as a last resort for saving the mother's life. And although I proposed the matter as doubtful, not trusting to my own judgment in so grave a matter, still I thought that the considerations which I presented might have some weight in rendering less sure an obligation that created the very greatest hardships both for physicians and mothers. The reasons I advanced were these: The unviable foetus has a right to its vital element, namely, to dwell in its mother's womb, since nature has created this element for the child. But when special circumstances arise (as, for instance, when the mother's life is in jeopardy), the child's right to dwell in its mother's womb must give way to a prior right, namely, to the mother's right to preserve her own life. In this conflict of rights the child may be supposed to waive its right in favor of its mother. Living in its mother's womb is a condition extrinsic (bonum vitae extrinsecum) to the real life of the child, and therefore, for just and sufficient reasons, the child may sacrifice it, as a shipwrecked man may waive his right to a plank in favor of his friend, and trust himself to the waves, which speedily swallow him up. Indeed, it may be affirmed that the child does, in as far as it can, waive its right to dwell in its mother's womb, since the right has become wholly worthless, owing to circumstances, and not being necessary as a condition for procuring the child's baptism, since the child's baptism will be surer in the event of an abortion. And if dwelling in the mother's womb be considered as an intrinsic part of the child's life, bonum vitae intrinsecum, still any attack on the child's existence in the womb does not seem to be an attack on the child itself, but rather an attack on something common both to mother and child, to which the mother has as much right as the child, and in this dilemma the child yields its precarious right to its mother, just as one person might yield to another, where there is not air enough to keep both alive."

These were some of the considerations that led Father Lehmkuhl to say, in the earlier editions of his Moral Theology, that it was not clearly and beyond all doubt immoral to cause a premature delivery of an unviable child, when the same held out the only possible hope of saving the mother's life.

But all this notwithstanding, the Holy Office has repeatedly declared that artificial premature delivery, or abortion, is the same as craniotomy, is a direct killing of the child, and always and under all circumstances forbidden by the law of God. And Father Lehmkuhl admits that the reasons he brought forward in favor of artificial abortion speciosiores sunt quam veriores (Theol. moral. L, n. 1007).

In regard to the case under discussion, it is quite evident that if the woman was already past the seventh month of her pregnancy, artificial delivery might be resorted to to save the mother's life.

"When the grave complications enumerated above occur in the early months of pregnancy before the foetus is viable, the Catholic physician, since by the natural law and the decisions of the Holy Office he is forbidden to induce artificial abortion, must withdraw from the case. If there is no other physician to attend to the woman, he must let her die. He cannot withdraw without explanation, and in many cases the explanation of the condition will promptly result in the calling in of a physician who has no scruple in inducing this abortion, no matter how reputable he may be. The universal medical doctrine is to induce abortion in cases where abortion will save the mother's life, and the foetus is 'too young to amount to anything.' This is looked upon as legitimate abortion by the very best men that do not recognize the authority of the Holy Office; they deem the position of the Catholic physician in these cases as altogether erroneous, or even criminal" ("Past. Med.," p. 54, O'Malley & Walsh).

To resume, if the eclampsia occurred after the twenty-eighth week of gestation, an operation to hasten the delivery would have been lawful, since a seven months' child is viable, even though the chances are greatly against the child's living. If the child dies after being delivered, its death is not a necessary result of the operation, since many children live although prematurely delivered.

If the eclampsia occurs before the twenty-eighth week of gestation, it is not lawful to empty the uterus, though that is the only means of saving the mother's life, because such a procedure is a direct killing of the child. And what is said here of an operation holds equally well in regard to the administration of medicine. If the direct effect of the medicine is to empty the uterus, it is not lawful to administer it, except after the seventh month of gestation.