Section — Marc, Institutiones Morales
§ 2. On the Procuring of Abortion
St. Alphonsus, III, 394; ed. G., I, p. 644; H. Ap., VIII, 22; Lupellus, de Castit., I, p. 348; Antonelli, Med. past., II, de 5 Praec., de Bapt., de Usu Matrim.; Eschbach, disp. III and IV, in the work Disput. physiol.-theol.; Berardi, Capellmann, Olfers, Surbled, and many others.
Things to be noted beforehand. 1. Conception of the fetus. According to physicians, ordinarily conception by no means concurs with copulation; indeed most often it occurs with several hours or days intervening. - 2. Animation of the fetus. That the fetus from the beginning of conception, or at least after some days, is informed by a rational soul, St. Alphonsus already taught (VI, 124), and today it is commonly admitted.2 Yet the matter is not proved by an altogether certain argument. Cf. Antonelli, Eschbach, l. c. - 3. Viability of the fetus. The fetus after the seventh month of pregnancy is, as they say, viable, so that, without proximate danger of destroying it, it can be drawn forth to light. In the case in which they use artificial incubation, couveuse artificielle, the fetus could be drawn forth from the completed sixth month without proximate danger. It belongs to the physician to judge concerning viability in individual cases. - 4. Ectopic being of the fetus. Although ordinarily the fetus lives in the uterus of the mother, sometimes it can happen that pregnancy occurs outside the maternal uterus: then ectopic fetuses are had. - 5. Life of the fetus. It is established by experience, and because of reasons taken from embryology it must be admitted, that the fetus in the uterus of a dead mother can live for some time.
(2) The opinion concerning instantaneous animation of the fetus by a spiritual soul fits better with the present sense of the Church. - The ancients judged the fetus to be animated after 40 days from conception, if it was male; after 80 days, if it was female. Today, the distinction between an animated and non-animated fetus having been omitted, penalties are enacted simply against those who procure abortion. In the treatise on irregularity alone the opinion of the ancients still appears, certainly to be removed from new codes.
- Definition. Abortion is the ejection from the uterus of an immature fetus. Thus in the Constitution Effraenatam of Sixtus V.
Division. Abortion, by reason of imputability, is voluntary or casual. Voluntary is direct or indirect. Abortion is procured directly if deliberately, from whatever operation, an immature fetus is expelled; but indirectly, if a cause is posited acting of itself on the mother, but from which detriment can arise for the fetus, for example a bath, venesection, a remedy by which the health of the mother is consulted. All these things can produce contractions in the muscular coverings of the maternal uterus.
Note. Physicians directly procure abortion for several causes: if, the mother being ill, birth is foreseen as difficult; if, although the mother is healthy, she cannot give birth because of narrowness without danger, etc. Sometimes also through diverse operations, concerning which below, they directly attack the life of the fetus, afterward intending to expel it lifeless. It is plain that that very evil mode of acting cannot be called abortion properly so called, although, as regards the gravity of the crime, it is not less than abortion; see Nouv. Rev. Theol., 1911, vol. 43, p. 599.
- Principles. I. Direct abortion is never licit. The reason: homicide, whether real or attempted, will never be licit. But if the fetus is animated, real homicide is committed, and indeed the more atrocious because soul and body at once are cast into ruin. But if the fetus is said not yet animated, this always remains: that there is danger lest a man truly endowed with spiritual life be killed. Therefore attempted homicide is had. Therefore Innocent XI rightly condemned the 34th proposition: "It is licit to procure abortion before the animation of the fetus, lest a girl detected as pregnant be killed or defamed." Cf. Response of the Holy Office, 4 May 1898, ad 2, where the Decree of 25 July 1895 concerning the illicitness of abortion is confirmed. Nouv. Rev. Theol., vol. 31 (1899), p. 276; Anal., VI, 277.
Hence: 1. They are guilty of homicide: a) Those who so strike or terrify a pregnant woman that abortion follows. - b) Likewise pregnant women who, with grave imprudence, posit a proximate cause of abortion in various ways, say by washing the feet in cold water, carrying heavy burdens, indulging a violent commotion of mind, etc.3
Probably an oppressed woman does not commit sin who at once expels the seed emitted while she resisted. Cf. Lehmkuhl, I, n. 1013. - St. Alphonsus (III, n. 394; ed. G., I, p. 647; VI, n. 954) holds the contrary opinion. But there he supposes as certain what moderns often and more often think to be little probable: namely that conception happens immediately after emission. Indeed it cannot be denied that conception can happen at once, and therefore an unmarried woman who sinned voluntarily cannot expel the seed; but for the woman invaded the right of repelling aggression prevails.
Certainly they commit homicide who induce a falsely colored acceleration of birth, whether through puncture of the membranes or in another mode, at that time when the fetus certainly is not viable.4 For this is equivalent to direct killing, just as we are said truly to kill a fish if we draw it from the water. Thus from the grave Response of the Holy Office, 25 July 1895. After this Decree, let the controversy among authors have an end. Nouv. Rev. Theol., vol. 27, p. 599.
(3) Those are equated with homicides by canonical right who impede the natural conception or birth of the fetus through injections made to a woman before intercourse, or by poison of sterility, or in another undue mode (c. V, de Homicidio). (4) The reasons brought forward for legitimating acceleration of birth, as can be seen in the Decree, were: a) The fetus can renounce life in the mother's uterus, as in shipwreck a friend can yield a plank to a friend; indeed, it is judged really to renounce it, since through accelerated ejection it can be baptized more safely. b) Existence in the mother's uterus, since it puts into risk the life of the mother first possessing it, can be considered as something secondary, which must be overcome by the primary right possessed by the mother. Nevertheless the Holy Office declared: It cannot safely be taught that any operation directly killing the fetus is licit, even if this were necessary for saving the mother.
- II. Indirect abortion is sometimes licit.
It is said: 1. Indirect, that is, coming beyond the intention from an ambiguous action, for example by supplying to the mother a medicine indeed salutary to her, but dangerous to the offspring, as we have explained.
- Sometimes, namely if the conditions from the indirect voluntary are present, and indeed: a) the remedy is of itself and directly curative of the illness; - b) another cannot be used; - c) provision is made for the extreme spiritual necessity of the fetus, as it can be provided.
The proposition is proved: The indirect voluntary, in which we are here, under due cautions, is no sin. The two prior conditions are required of themselves. The later condition here must necessarily be expressed, since charity and piety oblige the mother to prefer the spiritual life of the offspring to the health of her own body. - Now, abortion truly does not deprive the fetus of the hope of Baptism when, the remedy having been omitted, it would certainly die with the mother, or when it is hoped that it will be brought forth alive into the light, and therefore can be baptized, or finally if in fact it can be baptized in the uterus. - It is plain besides that it is licit to take such a remedy if the danger of abortion is equal whether it is taken or not: the condition of the fetus is not made worse from it (III, 394; H. Ap., VIII, n. 26).
Note. 1. Let the physician not be too anxious as regards medicines to be furnished to mothers. For it is morally impossible, the mother perishing, that the offspring can survive for a long time, unless the mother is near birth, or the disease is very brief (Antonelli, l. c.).
Nevertheless attention must be given to the cautions which we indicated above in the case in which, so that he may consult the mother, he wishes to diminish the volume of a sufficiently mature fetus (Lehmkuhl, I, 1009).
If the fetus is only probably viable, the timorous physician will wait, insofar as can be done, for the certain maturity of the fetus. But if from delay the danger for the mother or for the offspring becomes greater, it is sufficiently probable that acceleration of birth is licit. The reason: in a desperate case it is licit to use a doubtful remedy (cf. n. 84), the more so because here there is not lacking hope of conserving the fetus alive, which otherwise would be constituted in the highest danger.
- Corollaries. In our times, so that the very intricate question of very difficult and dangerous birth may be solved, physicians have recourse to various operations, in which, from the end of the one operating, the safety of the mother alone is sought, with no or almost no respect had to the rights of the infant. Of these: 1. certain ones directly offend neither the mother nor the fetus, for example compression of the abdomen, puncture of the membranes, by which birth is accelerated; - 2. others directly touch the fetus, as craniotomy and similar ones; - 3. finally others directly touch the mother, as symphysiotomy, Caesarean section, laparotomy, the Porro operation. It is licit to designate the whole series of these operations by the name: medical abortion.
The operations of the first genus we have already called back under the scales. Concerning others, some things. The hinge of the question is in this, that we see whether these operations can or must be reduced to direct or indirect abortion.
I. CRANIOTOMY, or EMBRYOTOMY. It consists in the perforation of the skull of the infant, and extraction of the cerebral mass. - Supposing that the fetus is not certainly dead, it is a most grave sin, even if it appears as the only remedy of saving the mother. For it is an action of itself and directly killing, and, since it is inflicted on an innocent person, intrinsically evil; nor can it ever be made honorable by the intention of saving the mother. Nor let it be said: only the death of the infant, otherwise certainly about to die, is accelerated; for is not this acceleration of death, willed in itself, although not for itself, true homicide? - Nor let the fetus be equated with an unjust aggressor: for one who from the sole natural course of things, for example a man infected with plague, becomes the cause of death to another cannot be held as an unjust aggressor. Whence, on 19 August 1889, the Holy Office declared: in Catholic schools it cannot safely be taught that the surgical operation which they call craniotomy is licit, as was declared on 28 May 1884, and any surgical operation directly killing the fetus or the mother carrying it. These things were confirmed by the Decree of the same Holy Office on 25 July 1895. Cf. A. S. S., vol. 17, p. 601.
Note. To this operation must be assimilated and therefore condemned the mode of acting of those who attempt directly to extinguish an ectopic fetus, concerning whose presence there is certainty, by injection of morphine or by applied electrical force (Lehmkuhl, I, n. 1011).
II. CAESAREAN OPERATION. It consists in incision of the uterus, to this end that the fetus can be drawn out. This operation, which formerly they named difficult, barbarous, today is often performed by physicians, and indeed happily, while the mother is living, so that more or less 90 percent of mothers are saved. Cf. the things which Antonelli, Eschbach, and Capellmann narrate in the cited works.
A double question can be posited: 1. Whether it is licit for the mother to permit such an operation? - 2. Whether the mother is held to this?
To the first one must respond thus: It is licit if on the one side, because of her robust constitution and the skill of the surgeon, the danger of death becomes only remote, and on the other side hope shines out that the life of the offspring, both temporal and spiritual, can be consulted. But it is not licit if the danger of death as regards the mother appears proximate or truly probable, because such a danger must be equated with death (VI, 106; ed. G., III, p. 84). See the cited Response of the Holy Office, year 1898, ad 2 and 3.
To the second it must be said that if there is present a founded hope of drawing out the infant viable, of itself, from the precept of well-ordered charity, the mother is obliged to undergo the operation, which in our times, as we said, no longer remains an extraordinary means (cf. Lehmkuhl, I, n. 758, note, where he cites St. Alph., II, n. 26, 27); and even if it is supposed extraordinary, is not the eternal salvation of the infant worth so much? (cf. above n. 483). Yet let the prudent confessor see whether, with the natural horror of the mother toward such operations standing, the intimation of this obligation can be urged.
Note. a) What we said concerning the licitness of this operation can equally and under the same cautions be affirmed of SYMPHYSIOTOMY, by which narrowness of the pelvis must be removed through the cutting of the cartilage joining two bones. - For the rest, Antonelli adds (II, n. 94) that this operation and another similar one are not approved so commonly by surgeons.
b) The same must be said concerning LAPAROTOMY, by which a tumor is cut out so that an extrauterine fetus can be drawn out, or concerning the PORRO OPERATION, by which the uterus and ovaries are cut out. The Holy Office declared, 4 May 1898, that all these things are licit, provided that serious and opportune provision is made for the lives of both the fetus and the mother (Nouv. Rev. Theol., vol. 31, p. 276). The Holy Office confirmed these previous Decrees on 5 May 1902 (ibid., vol. 45, p. 161).
c) The pregnant woman having died, nothing prevents the Caesarean operation from being performed. In this case a strict obligation urges. But whatever some have said, it is certain that the priest is not obliged to this. The Holy See expressly declared that on 15 Dec. 1899, confirming the things which it had already prohibited on 15 Feb. 1780 (A. S. S., vol. 32, p. 503). Cf. Antonelli, II, n. 103.
III. DOUBTFULLY PROHIBITED OPERATIONS. Three very difficult cases are especially given, in which the licitness of the operation is not established: 1. The uterus of a pregnant woman sometimes prolapses and cannot be reduced except through puncture of the covering, so that the amnion flows. But from this abortion certainly follows. 2. Sometimes also the very uterus of a pregnant woman is so infected by malignant tumors, or in a healthy uterus such tumors are formed, that the health of the mother can be restored only by removal of the whole uterus. But removal of the uterus, in the case, unhappily draws with itself the extraction of a fetus perhaps immature. 3. Finally sometimes, in the case of extrauterine conception, the tumor will cast the mother into highest risk, and, if the organs rupture, into certain death; which seems to render removal of the tumor necessary.
Concerning the three aforesaid cases, there is no consensus of authors. There are not lacking those who think that puncture, removal, in the case in which the fetus is immature, is not licit, according to the Decree of the Holy Office, 5 May 1902, in which the Eminent Fathers refer themselves to the Response of 4 May 1898 cited above. But others judge that discussion of direct abortion cannot be instituted here, but of abortion which is procured only indirectly; and that the excusing cause is the highest and certain risk of life in which the mother is placed. Nevertheless all agree in this, that these things are in no way licit as long as true and certain danger for the mother does not exist. Cf. Lehmkuhl, I, n. 1011, who says the Response of the Holy Office of 1902 lacks pontifical approval; Nouv. Rev. Theol., vol. 44 (1912), p. 590; vol. 45 (1913), p. 154; Antonelli, II, n. 110.
- CONCERNING PENALTIES IMPOSED ON THOSE PROCURING ABORTION. I. From canonical right they are the following: 1. Papal excommunication reserved to the Ordinary (cf. n. 1349). Nevertheless those do not incur this who commit the crime of craniotomy. Cf. Noldin, de Poenis eccl., n. 93; Linz. Quart. Schr., 1910.
- Irregularity, if nevertheless the fetus is animated (cf. n. 1946). 3. Inability for ecclesiastical titles, which is incurred ipso facto, but probably can be removed by the Bishop. 4. Privation of benefice, office, etc., but after a sentence declaratory of the crime (III, 395-397).
II. From civil right this crime is punished with grave imprisonment. Cf. French Penal Code, a. 317; Italian, a. 381; German, a. 218, 219, 220; Spanish, a. 425-428. It happens more and more often that physicians indiscriminately consider all those things which happen in birth, for rescuing the mother from certain death, as necessary consequences of their function.1
Practical rules. 1. Good faith can be given concerning the licitness of medical abortion, whether in parents, or in mothers, or in physicians. The confessor, if he is not asked, should speak prudently concerning these matters: for his admonition, for the most part useless, indeed frequently harmful to those to be admonished, will become so, since it draws with it danger of formal sin. Asked by a physician, let him reprove the operation as illicit, yet without always making mention of the prohibition of the Church. - Asked by a mother, in many cases he will satisfy his function if he exhorts her that she herself say to the surgeon, in the best mode by which she can, that the life of the infant must be consulted. Let him not impose on the mother without consultation that she refuse the operation, nor indiscreetly manifest the prohibition of the Church. Yet sometimes, for example if a physician not very scrupulous advises a falsely colored acceleration of birth for avoiding inconveniences that are not grave, the confessor cannot be silent (Card. Gennari, Cons. mor., t. I, n. 77; cf. Nouv. Rev. Theol., vol. 45, 1913, p. 160 seqq.). 2. Physicians, especially if they are called unexpectedly, often are placed in a state of perplexed conscience. Therefore they must be judged according to the rules fitting this state, and, if fruit is hoped, admonished and instructed. 3. Sisters of Charity, if some hospital proper to them exists, are held to choose truly upright men. If the manner of acting, on the part of the physician, is less conformable to the Decrees of the Holy See, they are not held to resist his work, unless in the case in which his intention of prevaricating would evidently disclose itself (S. Poen., 7 July 1911; Nouv. Rev. Theol., vol. 44, 1912, p. 35 and Rev. Eccl. de Metz, 1911, p. 588).
(1) Yet there are not lacking those who enter a sounder way. For example, Prof. Schauta writes (Realenzyklopedie der Heilkunde, art. Kaiserschnitt): "(Perforation of the fetus) this most foul plague must altogether be cut out from obstetrical art."