Conclusions

I. Therefore, in practice:

1. If a woman exhibits an internal tumor whose nature cannot be known, first of all the physician must do nothing and await the time when it can more easily be diagnosed. But if it is a fetus, the time when he is viable must be awaited in order to perform the laparotomy; otherwise, without any cause of necessity, the operation would tend toward injury to the fetus.

2. If the presence of a living fetus is certain and rupture of the cyst is near, perhaps bringing the death of mother and fetus, excision of the cyst is licit if there is hope of saving the fetus who is certainly or probably viable; otherwise it is illicit. In the first case a good effect immediately follows, namely, to repel the danger to the mother, and indeed probably to the offspring also, although the infant could perish indirectly. In the other case the infant is immediately and directly killed, and the danger to the mother is mediately averted. Thus it would be if excision were performed before the completion of the sixth month after conception.

3. If, however, some organ of the mother were diseased or infected, or a tumor independent of the fetus and not formed from him brought danger to the mother, these could be directly removed even if per accidens or indirectly they brought with them the expulsion of the fetus. In that case Baptism would immediately have to be conferred upon the fetus, since he might soon die.

4. On the contrary, if the existence of the fetus is even only truly and solidly probable, it is illicit to act upon the cyst, for example, by removal, electrical current, or morphine injection, because from these operations the certain death of the infant follows directly and per se, and only through it the safety of the mother. Moreover, the Baptism of the infant is rendered impossible.

5. If, by waiting until the fetus is viable, danger to the life of the mother is greatly feared, and the presence of the fetus is not yet known by ordinary indications, nor are there any positive or probable signs of his presence, nor are there means for resolving this doubt, laparotomy could perhaps appear probably licit, because the presence of the fetus is in no way probable but only negatively doubtful, while the danger to the mother is certain. For even in these grave circumstances we are not bound to attend to altogether slight probabilities, or mere possibilities or hypotheses, but a negative doubt, as founded upon nothing, is to be disregarded.¹ Hence the cyst then appears capable of being considered as a mere tumor which proceeds from another cause; and thus it is not directly intended to injure the fetus, of whose presence no sign is or can be had, but directly to remove the tumor, from which the cessation of danger to the mother follows immediately, although the death of the infant could follow indirectly and afterward, if he nevertheless exists.

¹ In this sense are to be understood those things which we proposed less clearly in little work A, I, q. 7, n. I, 2.

II. How the physician is to proceed.² The procedure is watchful waiting. So long as the cyst, by growing normally and regularly, affords signs of life, or so long as this is probable, one must wait until the normal term of nine months, or until the term when the fetus is certainly viable, in order to extract him. But let the waiting be accompanied by vigilance, so that, in a case of premature rupture, the physician is prepared to intervene. For this purpose the mother can be instructed concerning the indications of this rupture, or, better, she can be placed under observation in a hospital or clinic. Thus an unnecessary operation would not be performed in a case in which the fetus dies or is resorbed; at the same time the viable fetus is preserved and there is a possibility of bringing him to maturity; finally, the danger is reduced to a minimum because the mother remains under the vigilance of the physician or is even placed under observation. For in a case of rupture, hemorrhage rarely brings death to the mother if it is diagnosed in time; hence there is no compelling necessity to forestall or prevent hemorrhage.

² Cf. Capellmann-Bergmann, op. cit., 19th French ed., p. 54; Dr. Vincent, in Dr. Clément, Le droit de l'enfant à naître, pp. 69–71.

III. Observations.

1. Judgment concerning the opportuneness or necessity of the operation in the concrete pertains to the physician, given the liceity of the operation; but judgment concerning the liceity of the operation, even in the concrete, and concerning the necessity of this operation in order that it can be licit, pertains to the theologian.

2. In the question of the ectopic fetus, as in the matter of abortion, the principles have suffered a certain obscuring, both because of a less clear and less firm manner of proposing doctrine, and because of the laxer manner of thinking of certain theologians. From a desire to reduce obligations to a minimum, to excuse, or to permit many things and leave as much liberty as possible to physicians, so that their conscience may remain in tranquillity, they remain silent about the doctrine, or do not urge it, or propose it as somewhat doubtful, or even attempt to treat it as a matter of opinion. But this occurs to the detriment of truth and morality. Moreover, judgment concerning liceity and morality is not to be left to physicians; indeed, it pertains to the good of physicians that the matter not depend upon their own judgment, but, so that they may be able to resist depraved solicitations, they must be able to oppose to them the conscience of an honorable man and the immutable prohibition of the moral law.

3. Let physicians remember that their office is to preserve life and to heal, not to destroy, and indeed the life of the infant as well as of the mother; each has an equal right, equally to be preserved.

4. In the preceding pages we rejected several solutions without formally saying that they are unsafe in practice. Do not conclude from this that they are not certainly false or improbable, and therefore can be put into practice, as someone has thought.³ On the contrary, by the fact that we opposed sound reasons and sufficiently responded to the contrary arguments, the probability of the impugned solution of itself thereby vanishes, and it follows that it is not secure and is not to be employed in practice, unless the contrary is expressly noted.

³ Payen, op. cit., ch. XVIII, §3, n. 4.