Article III: On Cleansing the Pregnant Uterus

I. State of the question. Cleansing of the uterus is the removal of all things contained in it in order to avert an imminent danger to the woman; hence, together with the others, the fetus also is removed if he is present.

It is asked whether, in a case in which a fetus is present, especially one not yet viable, an operation of this kind is licit in order to save the mother. Now there can be several diverse cases.

II. Cleansing in the case of a dead fetus. If the fetus is already dead, then there is no abortion, but a legitimate cleansing. Death, however, is not to be presumed, but must be proved; hence:

a. the embryo is supposed to be living unless the contrary is established with moral certainty, and he cannot be expelled so long as he probably lives;

b. it is illicit directly to expel a probably living but corrupted fetus, because that would be directly to accelerate his death, and therefore the good effect would follow through the evil effect. Nor can the fetus, in this case, be regarded as an unjust aggressor, since he wills nothing and does nothing, but is merely passive. That case, however, is rather hypothetical, because a corrupted fetus is ordinarily dead or soon to die; hence one can easily wait until he is dead.

III. Cleansing in the case of a fetus already separated from the uterus. If the fetus has already certainly been separated from his connection with the uterus, as can occur from a certain morbid cause, for example, through rupture of the uterus or through blood discharged into the uterus, then cleansing of the uterus does not cause abortion, because the abortion has already occurred by the separation, and the expulsion is naturally to follow. Nevertheless, it would not be licit to act directly and immediately upon the living fetus, and directly to injure or kill him.

If the living fetus has not yet been separated from the uterus, but the mother suffers from hemorrhage or hydrorrhea of the uterus, concerning this twofold case we read in Capellmann-Bergmann, op. cit., 19th ed.:¹

¹ Thus according to the German and French text.

A. "Not rarely, during pregnancy, hemorrhage occurs. In a smaller quantity it can be harmless. In that case the physician will wait and prescribe rest in bed. But if it increases, hemorrhage can notably weaken the mother; yet even then pregnancy can rather often be brought to a good end. Formerly the vagina was occluded (par tampon de ouate à pansement), but this procedure had abortion as its direct effect: the flow of blood ceased, but the occlusion secondarily brought on pains and expulsion of the fetus. Today they have renounced that method because of the danger of infection from the occlusion. But now the uterus is dilated so that it may be cleansed. Is this morally licit?

"We think so. Cleansing of the uterus is nothing except the merely local removal of the fetus, who physiologically has already been essentially separated from the maternal organs."

This can be maintained, provided that: 1. the abortion cannot be avoided; and 2. the physiological separation from the uterus has been accomplished not merely virtually but already actually.

B. "Hydrorrhea of the pregnant uterus can be judged in the same way. It is a state in which the amniotic fluid or waters continually flow. Physicians distinguish decidual and amnial hydrorrhea. In the former, the flow proceeds from the space between the two membranes of the ovum; in the latter, it proceeds from the membrane itself which properly and immediately encloses the fetus. The difference can be discerned by a microscope.... This latter case alone is dangerous, since there is an opening in the covering of the fetus himself. If the flow of the amniotic waters occurs in the third or fourth month, or even later, the pregnancy is rarely brought to term: abortion or accelerated birth occurs.

"Since the outflow of the fluid, in a certain true sense, already constitutes an incipient abortion and the fetus is by that very fact lost, cleansing of the uterus can be performed, provided that: 1. it is established that the fetus has already been physiologically separated from the maternal organs; and 2. the continuation of the pregnancy until the time when the fetus is viable or can live outside the maternal womb can in no way be hoped for; otherwise the physician is bound to await that time."

Thus, provided that these two conditions are truly established.

IV. Cleansing in the case of an irreparably disturbed pregnancy. This is a case in which the pregnancy appears irreparably disturbed, the mouth of the uterus is widely opened, abortion is shortly to follow, and danger of hemorrhage and infection together with high fever is imminent for the mother. This danger can be forestalled only by cleansing the uterus at once and at the same time expelling the fetus, who otherwise also will certainly perish.

Concerning this case Salsmans says:² The good effect does not arise directly and immediately from the expulsion of the fetus, but from the very cleansing of the uterus just as immediately as does the expulsion itself. Moreover, that operation would also be performed in the same way outside pregnancy, and it does not tend directly toward abortion, but per se tends solely to cleansing of the uterus by removing whatever it contains, such as a mole (that is, a fleshy mass) or a mucous covering, and per accidens, if he is present, also the fetus.

² Geneeskundige Plichtenleer: Deontologia medica, n. 179 bis.

This appears to us more doubtful than the case of a uterus infected with cancer; nevertheless, until the Church pronounces, we would not dare to condemn this, but, subject to a better judgment, we think that it can be held as probable, provided that:

1. the danger of abortion is not only future, but is already present here and now;

2. the danger does not arise solely from the pregnancy itself or the condition of the fetus;

3. there is no probable hope of bringing the pregnancy to the time when the fetus is viable.