Question Seven: Concerning Ectopic or Extrauterine Fetuses

I. Extrauterine pregnancy is treated by many physicians as a tumor, and consequently they judge that the cyst is at once to be extirpated by laparotomy, or the fetus to be killed by electric fluid or an injection of morphine. Not rightly, because if the fetus is there, his life, according to the law of justice, is to be protected as far as can be done. Hence:

1. if the woman presents an internal tumor whose nature cannot be known, it is necessary first of all that the physician do nothing and await the time in which it will more easily be diagnosed.¹ But if it is a fetus, the time at which he is viable is to be awaited for performing the operation of laparotomy (S. Off., 4 May 1898), for otherwise, without any cause of necessity, the operation would tend to the harm of the fetus.

¹ From the fifth month, by means of the stethoscope, ordinarily the pulsation of the heart can be perceived.

2. If, by awaiting the time at which the fetus is viable, danger to the life of the mother is greatly feared, and the presence of the fetus is not yet known through the pulsation of the heart, perhaps laparotomy can probably seem licit, because the presence of the fetus is only slightly probable and very doubtful, and the danger of the mother is certain. Whence the cyst perhaps can be considered as a tumor, and then there is not directly intended the killing of the fetus, but directly the removal of the tumor, from which there follows directly the cessation of the mother's danger and afterward the death of the infant, if nevertheless he exists.²

² Thus, for example, Genicot and Noldin; likewise Antonelli, who holds this to be all the more licit because in ectopic pregnancies ordinarily the fetus dies before he reaches his proper development, or is not capable of living when the cyst is ruptured, o. c., t. I, n. 453.

3. On the contrary, if the existence of the fetus is even only truly and solidly probable, it is illicit to act upon the cyst by electric fluid or morphinic injection, because by these operations there follows directly and of itself the certain death of the infant, and through that the safety of the mother, and no relief is directly offered to the mother, even if there were nothing but a tumor. Besides, the Baptism of the infant is rendered impossible.

4. If the presence of a living fetus is certain and the rupture of the cyst is proximate, bringing the death of each, excision of the cyst is licit if there is hope of preserving the fetus because he is viable or probably viable; otherwise it is illicit. In the first case the good effect follows immediately: to repel the danger of the mother, and indirectly the infant can perish; in the other case the infant is directly killed and the danger of the mother is mediately turned away. Thus the Holy Office, 5 May 1902, concerning a fetus when the sixth month has not been completed, applying the decree of 4 May 1898.

5. It could be said otherwise if some organ of the mother were corrupted, or a tumor independent of the fetus and not formed from him brought danger to the mother; these could directly be removed even if by accident they at the same time indirectly brought with them the expulsion of the fetus. In that case Baptism would have to be conferred upon the fetus immediately, since he will die quickly.

II. Corollaries. 1. Therefore the same principle holds concerning ectopic fetuses and concerning others.

2. Nor can the ectopic fetus be considered as an unjust aggressor; not an aggressor, because he does nothing: for he does not act upon the mother, but is acted upon by the mother; not unjust, because he does not transgress the paths of right. Whence he is no more an aggressor than a uterine fetus who cannot be brought forth into the light.

3. This principle is already consecrated by the responses of the Holy Office indicated above; whence we are unable to understand how certain theologians have still remained hesitating or have spoken more benignly or equivocally. They said, e.g., that excision is prohibited only outside the present necessity of the mother, or when it is equivalent to direct killing; but, by the general rule, even "when necessity compels," it is prohibited "unless provision is made seriously and opportunely for the lives of the fetus and mother," because otherwise precisely it is equivalent to direct killing. Others said that it is licit, for saving the mother, provided there is the very slightest hope of saving the fetus; but how is this composed with the decree affirming that no extraction is licit, "unless it is performed at a time and in ways by which, according to things ordinarily happening, provision is made for the lives of mother and fetus"? Therefore it is no wonder if more recently the language has already begun to become more rigorous.

4. Hence also the same rules as those which hold for a fetus certainly living are equally to be applied to a fetus probably living; nor in the case can the principle be maintained that the certain right of the mother prevails over the probable right of the infant,³ as Genicot placed it in the first editions (Th. M. I, 376), and Noldin repeats neither approving nor disapproving (Th. M. II, 341), to which Prummer also somewhat yields (Th. M. II, 136). Namely, it is illicit to expose oneself even to the probable danger of killing; whence in the new, tenth, edition of Father Genicot's work this was already deleted and changed.

³ The principle is rightly applied when the certain preservation of life in the mother and probable danger to life for the infant arise equally immediately, as a twofold effect, from the same action or placing of the same cause; in the present matter it does not hold because the danger introduced to the life of the infant would be the means of preserving the life of the mother, that by which provision would be made for the mother.

5. Likewise, in extrauterine pregnancy, because of the abnormal position harmful to the mother, the fetal sac cannot be equated with a corrupted organ or lethal tumor which can be removed even if it contains the fetus, in the same way as we have said concerning the diseased uterus. This indeed is taught by P. Salsmans, after Lehmkuhl and Antonelli; but the last, in the second edition (1906), changed his opinion. And rightly, for if it were true, it would almost always be licit to excise thus, which does not agree with the Roman responses. Nor can the fetal sac be held as a tumor or sick organ of the mother, but it is something of the fetus. Whence this can be defended as licit only if there are other true lethal tumors joined with the fetus, or a true tumor which would not proceed from the fetus but in which the fetus would by chance be found with his coverings, as others more rightly say.⁴

⁴ Thus Capellmann-Bergmann, o. c., ed. 18; and in the same sense we understand those things which Aertnijs-Damen, Th. Mor., I, 583, and Prummer, Th. Mor., II, 146, have.

III. Observation. In establishing the indicated rules, as in all the preceding ones, the principle must be held high: that human life is, as it were, sacred, which it is not licit directly to take away, and for which, whether it is of the fetus or of the mother, serious provision must be made as far as possible. The Church, history bears witness, has always protected human life; and just as formerly, against the tyrannical cruelty of fathers or masters, she protected the life of the infant or slave, so now she protects the life of the fetus against the cruel sensuality of our age and more lax theologians.