Article I: On Removal of the Fetal Sac

I. State of the question. Some say that it is illicit to open the fetal sac and immediately extract or expel the fetus, for that is a directly lethal action and is condemned by the Holy Office; but, they say, because of its abnormal position injurious to the mother, the fetal sac can be equated with a diseased organ or lethal tumor which can be removed in urgent danger, even though it contains the fetus, in the same way as we said concerning a diseased uterus. Hence the fetus is killed not directly, but only indirectly.

Thus Lehmkuhl taught;¹ but he is suspect in this matter, because he wishes to deny the force of the decree of the Holy Office of 5 March 1902, and because he taught the liceity of direct abortion, which was called indirect solely because the physician intended the effect of Baptism. And in this matter, as regards the case of an ectopic fetus, Schmitt in Noldin, Theologia Moralis, II, n. 341; Salsmans in Génicot, Theologia Moralis, I, n. 377; recently Davis, Moral and Pastoral Theology, II, c. VI, sect. 10, n. 8; and likewise Antonelli in the first edition of Medicina Pastoralis, agree; but in the second and following editions Antonelli changed his opinion and persevered in the changed opinion.

¹ "I do not think that decree, understood in this sense, must be received as a binding law, especially since, as I have said, every approval of the Apostolic See is lacking, and much less as a universally binding law; rather, it must be restricted to those cases in which that excision is equivalent to the direct procuring of abortion. But in the proposed case I judge that there is only indirect abortion." Theologia Moralis, 12th ed., I, n. 1011.

II. Judgment. This opinion is false. For:

1. It is one and the same thing, Gemelli observes, to extract the fetus from the sac or to extract the sac containing the fetus, because the sac is formed by the fetus and is his natural covering.

2. Hence the fetal sac cannot be regarded as a tumor affecting the mother, or as a diseased organ of the mother, but is something of the fetus. Therefore, just as a direct action upon the placenta is illicit and directly lethal, so also is a direct action upon the fetal sac.

3. But if this were licit, it would almost always be licit to excise ectopic conceptions, which does not accord with the Roman responses. Moreover, they say that laparotomy is not licit for extracting them from the mother's womb unless the life of the fetus is seriously and opportunely provided for, and consequently not for extracting immature fetuses except at a time and by means whereby, according to ordinary occurrences, the life of the fetus is provided for. Whether that extraction is performed from the sac or together with the sac, it is equally harmful to the fetus and equally condemned.

4. The danger in the case arises immediately from the pregnancy; the remedy sought for the mother is removal of the pregnancy. Hence it is an abortive action, not indirect but direct, and likewise a direct killing.²

² Thus Finney in Ecclesiastical Review, 1928; Gemelli, Nouvelle Revue Théologique, 1933; and Bouscaren, Ethics of Ectopic Operations.

Therefore there is no parity between ectopic pregnancy and an infected pregnant uterus. In the latter case the danger arises from the mother's uterus, not from the fetus; in the former, from the fetus, not from an organ of the mother. In the one case the danger is removed by excision of a maternal organ; in the other, by taking away the pregnancy and the fetus.

III. Corollary. Therefore it could be licit only if other lethal tumors affecting organs of the mother were joined with the fetus and could not be removed without him. In that case it would be licit directly to remove, not indeed the fetus or his covering, but those connected tumors, from which removal of the fetus would follow indirectly.

The same is to be said if there were a lethal tumor which did not arise from the fetus, but in which the fetus was found with his coverings.

Others, namely, speak more correctly in this way;³ but it can be doubted whether the last case occurs.

³ Thus Capellmann-Bergmann, op. cit., on the Fifth Precept, n. 4; and Finney, Ecclesiastical Review, 1928.