Case XXXVII: Does the Performance of Craniotomy Incur Excommunication?

Applied correction from Woywod’s opening insert: Case XXXVII, page 180.—The Code makes no change in the solution of the case. Canon 2350 declares that those procuring abortion, including also the mother, fall into excommunication reserved to the bishop.

A physician confesses that he has frequently resorted to craniotomy to save the life of a mother. He adds that in his previous Confession he had been warned that craniotomy is prohibited under penalty of excommunication, but that he could not see its unlawfulness in case of necessity. How is this physician to be dealt with?

Whereas formerly some theologians, such as Ballerini and Avanzini, held that in a case of utmost necessity craniotomy might be allowed, this view has now, after repeated decisions of the Holy Office, been discarded. As early as May 28, 1884, the Holy Office answered to a query of Archbishop Caverot, of Lyons, with the direction: It cannot safely be taught in Catholic schools that the surgical operation which they call craniotomy is lawful. This decision created a great stir and much theological dispute. It was asserted that, craniotomy being a dangerous thing, Rome had intended in this decision to discourage the view that this operation were generally permitted, and that its abuse was chiefly aimed at by the prohibition. Especially was this view held by some professors at the University of Lille. The Archbishop of Cambrai, within whose jurisdiction this university is situated, therefore, proceeded to submit the details of six different cases of craniotomy to the Congregation and requested it to pass upon them. The six cases^* were supposed to include the whole variety of conditions likely to occur in such instances. It took the Holy Office three years to give its answer, which, at last, on August 19, 1889, came in the following terms: It cannot safely be taught in Catholic schools that the surgical operation which they call craniotomy is lawful, as was declared on May 29, 1884, nor that any surgical operation directly causing the death of the fetus or of the pregnant mother is lawful. This disposed finally of craniotomy as also of similar operations that destroy the life of the fetus, such as Cephalotripsia, Embryotomia, Decollatio, Exenteratio, Embryothlasia, etc. Although both answers were worded Tuto doceri non posse, this expression may not be construed so as to mean that, while its lawfulness cannot be taught, yet in single cases there may be justification. The term, Tuto doceri non posse, means in the language of the Congregation that the matter is finally and entirely condemned.^* Hence, all theologians of the present time put the ban upon craniotomy. A physician, unless exonerated by conscientia erronea, commits, without doubt, a grave sin if he performs craniotomy or a similar operation. But does such a physician fall under the censure reserved to the bishop, if he was aware of the excommunication proclaimed against the procurantes abortum effectu secuto? Theologians differ in this matter. Some,, as, for instance, Berardi (Praxis Confess. IV., n. 1094), Haine (Element. Theol. Mor., ed. 4, IV., p. 476), Genicot (Theol. Mor., ed. 5, II. 608) and others hold that craniotomy and kindred practises, while direct murder of the child, are in reality neither the procuration of premature birth nor abortion. Thus Haine: nor does craniotomy or embryotomy belong here (under abortion), because it differs from abortion not only in terminology, as is clear in itself, but also in reality, since it is not the expulsion of the fetus but rather the killing of the fetus, which is followed by the expulsion of the corpse. Moreover, in penal matters an argument from parity, and still less an argument a fortiori, is not valid. Nevertheless, the majority of theologians teach that craniotomy, and similar destroying operations, fall under the censure. A physician performing craniotomy kills the child no less than the one who produces abortion. Keeping in mind the aim of the prohibition of abortion: protection of the child life, it must be admitted that the same aim would demand the prohibition of craniotomy. Indeed, the physical action is much the same in both proceedings. Notwithstanding all this we are inclined to take the milder view of Haine, Berardi and Genicot, for the following reasons: (1) Excommunication is obviously a poena, an odiosum. Here applies the principle: In odiosis quod minimum est, tenentum est, and, odiosa sunt restringenda. Whatever does not with abso- Jute certainty fall under the excommunication must be regarded as (ecclesiastically) not liable to the punishment. Strictly speaking, however, the definition of abortion violenta et culpabilis ejcctio foetus immaturi ex utero materno, does not apply to craniotomy. For, in case of the latter, there is the mature fruit. (2) A rigidly formal interpretation of censures is customary also in the case in other matters. For instance, while the perusal of heretical books falls under the penalty of excommunication, it is the general opinion that this penalty is not incurred by those who make others read such books aloud to them. It cannot be claimed that there is any great distinction between reading such books and listening to someone else reading them. With the same right it might be said that procuratio abortus incurs the censure, but not craniotomy. (3) Since the issue of the bull Apostolicae Sedis there has been a marked tendency by ecclesiastical legislature to lessen censures and to facilitate absolution. It is very likely that the pending codification of Canon Law will work further in this direction. On the strength of these three reasons the view of the authors cited above should be supported. Hence, every confessor may (de jure communi) absolve a physician who accuses himself of having performed craniotomy. It is understood, of course, that the physician positively promises to omit such operations in the future. If the physician is still bona fide in regard to craniotomy, the confessor should be careful not to disturb this bona fides, because by such course there is usually nothing gained, and very likely much lost. In this respect we agree with Noldin, who states (Sum. Theol. Mor. II., n. 333, ed. 6a.), Yet since the demonstration by which craniotomy is shown to be unlawful from natural principles is not so plain and evident, it can easily happen that physicians practice it in good faith. Therefore, unless the confessor is expressly questioned about this matter, let him beware of disturbing their good faith. Dr. Prümmer, O.Pr.

^* Stated in full in Eschbach’s Disputationes Phys. Theol., ed. alt. pp. 464-467.

^* Compare the answer of Cardinal Patrizzi in Eschbach, l. c., p. 462.