Question Four: Concerning Embryotomy, or Concerning Incisions Which Injure the Fetus

I. Operations which kill the fetus and are called by the general name embryotomy (which is a surgical operation by which the infant is cut up in the uterus and, having been cut up, is extracted in parts) consist in the reduction or division of various parts of the fetus, which are afterward gradually extracted one by one, when, on account of excessive narrowness of the pelvis or excessive size of the head, the extraction of the fetus is possible in no other way.

These operations are performed in various ways, according as the fetus presents the head, the pelvis, or the trunk:

a) craniotomy (verbrijzeling van den schedel), by which the cranium of the infant is perforated and the cerebral mass is extracted; this having been done, the uterine contractions lessen the volume of the head, and the infant is more easily expelled or extracted by hand or instrument;¹

¹ Craniotomy was already known by Hippocrates, Celsus, and the Arabian physicians.

b) cephalotripsy (samendrukking van het hoofd), by which the infant's head is compressed until the cerebral mass and blood overcome the resistance of the bones and skin of the head;²

² It was also known by the ancients.

c) cephalotomy (verbrijzeling van het hoofd), by which the head is divided lengthwise into two parts;

d) sphenotripsy (σφήν, cuneus; wigbeendoorboring), by which the base of the head is perforated in several places;

e) embryulcia, by which the head is separated from the trunk (decollation, onthoofding), or the breast or vertebral column is cut by suitable forceps (embryothlasis, verbrokkeling der vrucht in de moeder), which has place when the fetus presents the trunk; for then extraction cannot be done in another way, and the fetus is cut into several parts;

f) evisceration (eventration; uithaling der ingewanden), by which, after perforation of the abdomen or breast, the viscera of the belly and thorax are extracted; then, through suitable instruments exerting mechanical force upon the vertebral column, the vertebral column is bent and extraction is made. It is employed when expulsion becomes possible by none of the operations indicated above; and otherwise, after decollation has been performed, the remainder of the fetus cannot be expelled, because the body is ordinarily larger, or the liver and kidneys are too much developed.

II. Embryotomy under whatever form is intrinsically evil, and all the aforesaid actions are illicit and unjust, even if on the one hand provision is made for the salvation of the infant by baptizing him in the uterus of the mother, and on the other hand there is no other means of preserving the mother, so that if the operation is omitted the mother and infant are certainly going to perish. For these actions are always of themselves and directly destructive, since the good effect does not proceed equally immediately, but only through the mediation of the evil effect; and therefore the death of the infant is necessarily willed as a means for saving the mother. Thus the Holy Office, 28 May 1884, concerning craniotomy, and 14 August 1889, concerning every operation directly destructive of the mother or infant.³

³ Do not wonder that the Holy Office only said that this cannot safely be taught, and not that it is illicit. For it did so because it responded to the question: can it safely be taught? Moreover, afterward it also explicitly said that it is illicit, 24 July 1895. Concerning embryotomy and abortion, the following can be consulted: L. Hubert, De l'avortement medical, 1852; Capellmann, De Occisione foetus, 1875; Eschbach, L'embryotomie au point de vue theologique et morale, 1876; Illustrious Lord Waffelaert in Nouvelle Revue Theologique, T. XVI and XVII; E. Hubert, Discussion sur le feticide (Annales de la Societe Scientifique, 1902-1903); Vermeersch, Discussion sur le feticide medical (Annales de la Societe Scientifique, 1902-1903); Treub, Van Oppenraay, and Vlaming, Het levensrecht der ongeboren vrucht, 1901; Van Gennep, Over medischen abortus, 1916; Meuleman, Het levensrecht der geboren vrucht, 1917; Daels, Het Bakersboek, 1919; Moeder en Kind; Salsmans, Geneeskundige plichtenleer, 1920; Dictionnaire Apolog. de la Foi cathol., art. "Feticide"; Dictionnaire de Theologie Catholique, art. "Embryotomie"; Cathol. Encycl., art. "Abortion" (Coppens). Likewise manuals of Moral Theology, such as Noldin, Tanquerey, Prummer, and Vermeersch.

They object:⁴

⁴ Cf. Prummer, Th. Mor., t. II, n. 134. Formerly certain theologians, such as Ballerini, Avanzini, and Constantini, stood for the liceity of feticide.

1. The infant is the cause of death to the mother, and therefore an unjust aggressor.

Resp. a) Not unjustly, because without any act and will he is there as in a place proper to himself and conducts himself passively, but, using his own right, only by the natural course of things becomes the cause of death to the mother, just as a man infected with plague can be a cause of death; not an aggressor, because ordinarily the difficulty of birth comes from the mother, on account of the narrowness of the pelvis, and the danger is from the action of the uterus, which, although it is not voluntary, is nevertheless the mother's. Since, therefore, the fetus exists by the will of the mother, since expulsion is the action of the mother, since the greater difficulties are from the mother, the infant is not the aggressor, but rather the mother. But even if the infant were called an aggressor, nevertheless he would not be objectively unjust.

2. In a collision of rights the right of the mother is prior and stronger; and therefore the infant is judged, indeed reasonably is bound, to yield his right.

Resp. Since man is in possession of his own right, the human person and life are ordered to their own proper end, and are not subordinated as a means to the life of another; and therefore a) a direct attempt against the life of an innocent person is never licit, and never does the right of one so prevail that, in order to obtain that one's good, the killing of an innocent person becomes licit; b) although indirectly someone can yield the right of his life, insofar as he exposes himself to the danger of death, nevertheless he cannot directly yield the right to life, since he is not master of his own life, and can never permit the direct killing of himself. Therefore no more can a right be given to kill the infant in order to save the woman than to kill the woman in order to save the infant.

3. It is not killing, but only the hastening of death certainly going to follow, and a slight shortening of life.

Resp. Indirect hastening, from a cause which of itself and immediately produces another effect while this one follows accidentally and is merely permitted, can be licit; but the hastening of death, willed in itself and directly, is true killing. Direct killing, however, is illicit, even if it is only the hastening of death certainly going to follow, just as it is illicit to kill a wounded man that he may be freed more quickly from pains.

4. Between two evils the lesser is to be chosen; but the death of the infant alone is a lesser evil than the death of the mother and infant.

Resp. The greater evil is to be avoided, if it can be done without an intrinsically evil action; but it is illicit to avoid it through an intrinsically evil action, for evils are not to be done that goods may come about, not even to save the whole world. The end does not justify the means; and therefore it must not be seen to what the action is ultimately terminated, but first of all what is immediately done. This, in the case, is intrinsically evil, and therefore a greater evil, as being moral, to be avoided rather than the physical evil of death. Moreover, as even the more celebrated physicians themselves today acknowledge, it is almost always possible to save the mother, since it very rarely happens that embryotomy is the sole means for this; for frequently Caesarean section itself, or symphysiotomy, or combined operations, are possible.⁵

⁵ Thus, e.g., Dr. Pinard, professor of Paris: "To have to sacrifice the child in order to save the mother is an imaginary case; never does the accoucheur find himself before so poignant an alternative," cited in Bull. von den Bond tegen de ontvolking, 1913; likewise, Dr. E. Hubert, Le devoir du medecin; likewise Murphy, British Medical Journal, 25 Aug. 1893; Treub, Aertzliche Rundschau, 1900; likewise Dr. Guermonprez, in Eschbach, p. 389: "To kill the fetus under pretext of favoring delivery is to misunderstand the certain resources of modern obstetrical surgery; it is to be behind the times"; and Dr. Franck: "Scientific methods had so developed that saving the child's life is also the best method for saving the mother's life" (Schutzengel oder Würgeengel?, Cologne, 1922).

III. Observations. 1. Embryotomy is illicit, even if it is only probable and likely that the fetus is still living,⁶ because justice forbids exposing oneself even to a merely probable danger of killing an innocent person.

⁶ We do not say: that a fetus be obtained who will live and continue to live; for such a formula would be equivocal and could be badly understood.

2. The physician who in a particular case is going to perform embryotomy is not to be warned by the priest, if fruit is not hoped for; but even if fruit is not hoped for, he is to be warned if he frequently acts thus and there is scandal to the faithful, or if he is not in good faith, as if he asks the priest about this, or when the silence of the priest would be equivalent to approval. The mother, if she is in good faith, is not, from prudence here and now, to be warned concerning the gravity of her obligation, lest, by refusing consent, she die in the state of sin. The same holds concerning the procuring of abortion.

3. In the case in which the mother does not wish or is not able to undergo Caesarean section or some similar operation, nothing remains except to await her death; and then to perform the Caesarean operation for baptizing the fetus, if there is a possibility that the fetus is living.