Question One: On Caesarean Section and Other Incisions Which Injure the Mother

I. There are several operations which injure the mother for this end, that the fetus may be brought forth, live, and be baptized. We indicated these in the preceding little work A, On Embryology, I, q. 3, n. I; and the best known of them is Caesarean section.¹ It can be performed while the mother is living or when the mother is dead, and concerning it the question is asked whether it is licit, or even obligatory.

¹ In what follows, we cite the first little book which we wrote On Embryology and the Ministration of Baptism under the name "little work A," while the present little book On Embryology and Sterilization comes under the name "little work B."

II. When the mother is living, Caesarean section:

1. Is per se licit, if the fetus is viable and birth cannot be obtained in any other way, unless, because of the weakness of the mother or other circumstances, for example because of infection or the inexperience of the operator, it would be lethal to the mother, as we explained in the said little work A, q. 3, n. II. This also holds for similar operations.

2. It is also obligatory, so that the mother is bound to undergo it, if the safety of the mother and infant can prudently be hoped for by means of the section; and indeed:

a. not for saving the life of the fetus, because no one is bound to expose his own life for the life of another;

b. perhaps, however, for saving her own life, because today, on account of the progress of surgical art, such an operation generally cannot be considered a very extraordinary means;

c. but certainly for conferring Baptism upon the infant, who could not otherwise be baptized; for everyone is bound to prefer the eternal salvation of his neighbor to his own temporal life, and to expose his own life for the eternal salvation of his neighbor.

Nevertheless, in practice the mother is rarely bound, because more often the infant can be baptized in another way, or at least there is a serious hope of baptizing him in another way. We explained these matters at length in little work A, q. 3, n. III.

The principles are clear, but nevertheless they have suffered a certain obscuring.

Some have written that in practice there is never an obligation for the living mother: not indeed for the temporal life of the fetus; nor even for Baptism and eternal salvation, because otherwise it would have to be certain that he could not be saved in another way, and thus that he would certainly be saved. Thus some theologians spoke more laxly: Genicot, Th. M., II, n. 144; Noldin, Th. M., II, n. 344; Cappello, De Sacramentis, I, n. 165; and certain others. Hence they deny the obligation, or at least doubt it in practice.

But a. absolute certainty is not required in this matter; rather, it suffices that it be morally certain; b. neither is it required that the infant certainly be saved by the operation, but that there be a serious probability, a probable hope, of saving him. This is according to the rules customarily handed down in the treatise on charity, where it treats of aid to be rendered in extreme spiritual necessity. Hence Fr. Schmitt corrected this in the recent twentieth edition of Noldin's work; and Fr. Salsmans, in the twelfth edition of Genicot's work, places a restriction, adding that in some extraordinary case the opinion of the many who hold that there is an obligation for the mother must be urged, namely where there would be no other probability of conferring Baptism.

Even in some little books or treatises of a practical character, written in the vernacular, which circulate also in our regions, a more lax opinion is sometimes proposed to physicians and midwives, and is spread among the people, namely that in practice the Caesarean operation is not obligatory, or is almost never obligatory; and this indeed by insisting on this one point and remaining silent about the others, as if in fact there were no obligation. Thus errors easily arise. In truth, one must not be silent, because there are cases in which a true obligation is present; and now physicians, midwives, and others would be told that no care is to be taken concerning it and that in practice it does not exist! Certainly obligations are not to be extended, nor uncertain ones imposed; but neither are obligations to be diminished or denied. It is a matter of the gravest importance, namely the eternal salvation of one's neighbor. It is certainly a great evil to be deprived of the beatific vision of God for eternity.

Therefore, they say, is the section to be imposed upon mothers? It is certainly to be counseled; but prudence generally advises that we not impose it, unless, however, the mothers ask doubtfully about their obligation: then we must acknowledge the truth. But it is one thing to say to the mother, "There is an obligation," which we prudently leave unspoken; it is another to say to physicians, midwives, and others, "There is no obligation," which is contrary to the truth.

III. When the mother is dead, Caesarean section is to be performed as soon as possible, according to the prescription of the Ritual, which for centuries has proclaimed, tit. II, c. 1: "If a pregnant mother has died, let the fetus be carefully extracted as soon as possible, and if he is living, let him be baptized." Canon 746, §4, is consonant with this.

A. The obligation urges provided that three conditions are present:

1. the mother is morally certainly dead;

2. it is probable that the fetus is living, as is generally the case from the beginning of the fourth month, especially if the mother died suddenly or quickly, unless there are grave reasons for judging that the fetus died before the mother or at the same time as she;

3. there is someone suitable who has sufficient skill to perform the section without danger to the fetus.

B. The obligation a. begins from the morally certain moment of the mother's death, and b. continues until the morally certain death of the infant. But since it is most difficult to have absolute certainty of death, mere possibilities of life or slight probabilities are not to be regarded; rather, one must act according to a prudent and likely estimation from common signs. It is certain, however, that the fetus can survive the mother not only for half an hour, but even for an hour, indeed for several hours, though rarely for days, on account of the circulation of blood being independent of the mother's circulation.

C. The obligation per se urges everyone, by the precept of charity whereby we are all bound to care for the eternal salvation of the infant even with the greatest inconvenience; and if the fetus is viable, we are also bound to care for his temporal life. It urges first of all the physician, then the midwife or another skilled person; the husband, relatives, and priest, however, must request the section and induce others to perform it.

Per accidens, the obligation does not urge:

1. If someone does not have sufficient skill. For that matter, no one is bound beforehand to acquire it or to learn the art or manner of performing the section, because no one is bound to employ means remotely in order to satisfy a precept, namely when the precept does not yet urge.

2. If there is no probability that the fetus is living. Hence the obligation does not urge during the first three months of pregnancy, because then the fetus is almost always dead, or at least it is very uncertain whether he remains alive.

3. If the greatest evils are to be feared, such as grave scandal, disparaging talk, hatred and calumnies from enemies of religion, indeed persecutions; for the grave scandal of many is to be avoided more than the salvation of one infant is to be procured. For reasons of this kind, and moreover on account of indecency and frequent lack of skill, ordinarily the priest is not bound; and in this sense the decrees of the Holy Office of 15 February 1780 and 13 December 1899 are to be understood. Nevertheless, as a rule he must admonish others about the obligation and induce them to perform it, unless graver inconveniences are to be feared.

The prohibition of the law made for persons other than physicians, even under penalty of imprisonment, does not excuse, because charity in extreme spiritual necessity obliges even with such an inconvenience; but it can be a reason for remaining silent, for not commanding, or for not inviting. In such a case, let the priest tell the relatives of the deceased mother to request or even demand the section from a physician.

This general obligation of all has also suffered obscuring among some; indeed:

1. Some even invoke the Code of Canon Law, which seems to deny that the obligation rests upon everyone, since canon 746, §4, says: "If a pregnant mother has died, let the fetus, having been extracted by those whom it concerns, be baptized absolutely if he certainly lives; if doubtfully, under condition."

Response. It is a general, indeterminate manner of speaking which the Code chooses because it does not wish to descend into particulars and define who in fact are bound. Per se, namely, all are bound; but per accidens it can happen that someone is not bound.

They say: the language of the Code indicates that not all are bound per se.

Response. The Code cannot change the natural law or the law of charity, which of itself binds all; nor is this evidently its intention. Indeed, even if its intention were not to urge this law in the external forum, the law itself would nevertheless remain in the forum of conscience. But that is not its intention; the sense of the Code can equally well be that not all are in fact bound, or that the matter does not in fact concern everyone. But the manner of speaking is somewhat equivocal and can give occasion to some hesitation or to the posing of a question.

2. Likewise, in the little books which circulate and in practical treatises, the obligation is diminished by reducing it to about half an hour after the mother's death and by counseling relatives and midwives generally to abstain from the operation. These things have been said to the detriment of truth.