§ II. On the Procuring of Abortion

Abortion is the expulsion of an immature fetus from the womb of the mother; but a fetus is called mature when, with no other danger supervening, it can live by itself, even if it comes forth into the light before the ninth month.

I say 1st. It is never licit directly to procure abortion, even if the fetus were supposed to be still inanimate. The reason is that if it is animated, it is homicide properly so called; but if it is not animated, it is anticipated homicide, because an inanimate fetus is ordered from its own nature to forming a man. - Cf. St. Alphonsus, n. 394. - Lacroix, n. 823. - Kenrick, tract. 3, n. 127. And this which we say concerning the expulsion of an immature fetus from the womb is likewise to be said concerning the extraction of an immature ectopic fetus from the cavity of the mother.

The placenta, as must be noted, together with the umbilical cord, is the organ of nutrition of the fetus in the cavity of the mother. Any expulsion separating the fetus from the placenta and umbilical cord destroys the anatomical relations necessary for the very existence of the fetus; for the placenta can be considered as a certain intimate union between the vascular system of the mother and of the fetus. To destroy this union is to destroy the fetus itself.

To expel the fetus is not only to put it in another place, but is to destroy the marvelous mechanism which makes, between the fruit of the mother and the mother, an internal vital communication, and therefore to kill the infant itself. Nor should you say, in fact it will die; you say rightly, but this does not give the right to kill it. - Cf. Besson., Nouvelle Rev. Theol. v. 45, p. 154, where he sets forth the argument excellently.

I say 2nd. Sometimes it is licit indirectly to procure abortion, or better to permit it, namely by supplying to a mother laboring under a grave disease remedies harmful to the fetus, if the following conditions concur, namely: 1st. that it concern a lethal disease; 2nd. that the remedies, harmful to the fetus, be of themselves directly and immediately efficacious for curing the disease of the mother; 3rd. that the administration of the remedies not impede the conferral of baptism, because the spiritual life of the fetus prevails over the temporal life of the mother. - Cf. St. Alphonsus, ibid. Lacroix, n. 826. - Kenrick, tract. 3, n. 128.

Question 1. What is to be said of the craniotomic operation, which many physicians nowadays employ to save the mother?

Response. An operation of this kind is true homicide, and accordingly always and intrinsically evil. For if, according to St. Thomas, "a man ought not to kill the mother in order to baptize the child," a fortiori the child ought not to be killed so that the temporal life of the mother may be saved.

Nor should you say that an obliquely positioned fetus, or one presenting too large a head, can be compared to an aggressor, at least materially unjust; for the response is that it is so disposed by the sole course of nature and accordingly can in no way be called an aggressor. Otherwise both the mother herself, in relation to the fetus, and those who labor under a contagious disease, in relation to those who are well, would have to be called aggressors, and accordingly it would have to be lawful to kill them.

Nor should you appeal to authority, because if this was hitherto doubtful and slight, now it certainly will be none in Catholic schools, since the Sacred Congregation of the Holy Office, on May 31, 1884, declared that the liceity of craniotomy cannot be safely taught. But recently, namely Aug. 19, 1889, it was signified to the professors of the medical faculty of the Catholic University of Lille: "In Catholic schools it cannot safely be taught that the surgical operation which they call craniotomy is licit ... and any surgical operation directly killing the fetus or the pregnant mother." Cf. St. Thomas, p. 3, q. 68, art. 11, ad 3. Kenrick, tract. 3, n. 128. - Analecta jur. Pont., fascicle 133, p. 547, May 1876. - Ciarmadori, Opusculum de craniotomia. - Nouvelle Revue Theologique, vol. 17, p. 13; vol. 16, pp. 95 and following; pp. 62 and following; pp. 293 and following; vol. 22, p. 74. Amer. Eccl. Review, vol. 9, pp. 360 and following, and vol. 23, pp. 128 and following.

Question 2. Whether at least it is licit to accelerate birth when otherwise the life of the mother would be brought into danger?

Response 1st. If this acceleration takes place after the seventh month, it is entirely licit; indeed by many it is said also to be worthy of praise; for it profits not only the mother, but also the fetus, which can then be judged mature. - Cf. O'Kane, n. 213. - Dublin Review, No. 87, art. Obstetric. Morality, p. 118.

Response 2nd. But if birth is accelerated during that period of gestation in which the fetus can in some way be cast forth alive, yet necessarily must afterward die because it has not yet arrived at substantial maturity, it must be said that such acceleration scarcely, or not even scarcely, differs from craniotomy, and therefore is altogether to be condemned. For in that case to extract the fetus from the womb, or from the cavity of the mother if the conception is ectopic, is an action killing by its own nature, not otherwise than withdrawing air from an adult.

Nor should you say that the death of the fetus follows only indirectly, from the fact that it itself is not touched but only the membranes by which it is enveloped are torn, or the fibers are relaxed, or from the fact that such expulsion is not intended as an end: for the response is that someone is directly killed whenever his death is taken up as a means, whatever may be the kind of action by which it is procured.

Nor should you say that the weight of authority can be brought in favor of this acceleration; for although St. Alphonsus says: "it is licit, with cold water, if another cannot be had, to baptize a child soon about to die, even if it were feared that from this death would be accelerated," he permits this only because "such an action does not tend to killing but to ablution." But other Doctors speak either of a drug given directly for curing the disease of the mother, as Cardinal de Lugo, or of an inanimate fetus which, erroneously indeed, some thought to be as a part of the viscera of the mother. - Cf. St. Alphonsus, de Sacram. Baptis., n. 106. Lugo, de just. et jur., disp. 10, n. 133. - Salmant., tract. 13, cap. 2, n. 60. - Crolly, vol. 3, nn. 118 and following. - This solution, which has always been certain to us, receives special strength from the notable Response of the Holy Office, which has itself thus:

"Stephen Mary Alphonsus Sonnois, Archbishop of Cambrai, most devotedly prostrate at the feet of Your Holiness, most humbly sets forth what follows:

"Titius, a physician, when he was called to a pregnant woman lying gravely ill, commonly observed that no other cause of the lethal disease was present except the pregnancy itself, that is, the presence of the fetus in the womb. Therefore, in order to save the mother from certain and imminent death, one way was at hand for him, namely that of procuring abortion or the expulsion of the fetus. He was accustomed to follow this way, yet using means and operations which, of themselves and immediately, indeed did not tend to this, that they should kill the fetus in the maternal cavity, but only that, if it could be done, it should be brought forth alive into the light; although very soon to die, since it was still altogether immature.

"Now indeed, after reading what the Holy See wrote back to the Archbishop of Cambrai on August 19, 1889: 'it cannot safely be taught that any operation directly killing the fetus is licit, even if this would be necessary for saving the mother,' Titius remains doubtful concerning the liceity of the surgical operations by which not rarely he had hitherto procured abortion, in order to save gravely sick pregnant women.

"Wherefore, that he may consult his conscience, Titius suppliantly asks whether he can safely undertake the stated operations in the aforementioned repeated circumstances.

Wednesday, July 24, 1895.

"In the General Congregation of the Holy Roman and Universal Inquisition, the above-written petition having been proposed, the Most Eminent and Reverend Lord Cardinals, General Inquisitors in matters of faith and morals, the vote of the Reverend Lord Consultors having first been had, decreed that the response should be: Negative, according to the other Decrees, namely of May 28, 1884 and August 19, 1888.

"But on the following Thursday, July 25, in the audience granted to the Reverend Father Lord Assessor, Our Most Holy Lord approved the resolution of the Most Eminent Fathers reported to Him.

L. + S. J. Mancini Can. Magnoni

Notary of the Holy Roman and Universal Inquisition."

And the subsequent decree solves various doubts concerning the liceity of acceleration of birth, of the Caesarean operation, and of laparotomy.

"The Bishop of Sinaloa, prostrate at the feet of Your Holiness, humbly asks the resolution of the following doubts:

"I. Will acceleration of birth be licit whenever from the narrowness of the woman the exit of the fetus at its natural time would become impossible?

"II. And if the narrowness of the woman be such that not even premature birth is judged possible, will it be licit to provoke abortion or to perform the Caesarean operation at its own time?

"III. Is laparotomy licit when it concerns extrauterine pregnancy, or ectopic conceptions?

Wednesday, May 4, 1898.

"In the General Congregation held by the Most Eminent and Most Reverend Lord Cardinals, General Inquisitors against heretical depravity, the above-written doubts having been proposed, and the vote of the Reverend Lord Consultors having first been had, the same Most Eminent and Most Reverend Fathers judged that it should be written back:

"To I. Acceleration of birth is not illicit of itself, provided it is performed for just causes and at that time and in those modes by which, according to ordinary contingencies, provision is made for the lives of the mother and the fetus.

"To II. As to the first part, negatively, according to the decree of Wednesday, July 24, 1895, concerning the illiceity of abortion: but as to the second, that nothing stands in the way that the woman in question be subjected to the Caesarean operation at its own time.

"To III. When necessity compels, laparotomy is licit for extracting ectopic conceptions from the cavity of the mother, provided that provision be made seriously and opportunely for the lives of both fetus and mother, as far as can be done."

"But on the following Friday, the 6th day of the same month and year, in the usual audience granted to the Reverend Father Lord Assessor of the Holy Office, a report concerning all these things having been made to Our Most Holy Lord Leo XIII, Pope by Divine Providence, His Holiness approved the responses of the Most Eminent and Most Reverend Fathers.

J. C. Mancini, Notary of the Holy Roman and Universal Inquisition."

To the Question: "Whether it is sometimes licit to extract from the cavity of the mother ectopic fetuses still immature, before the sixth month after conception has been completed?" the Holy Office responded on March 5, 1902:

"Negatively, according to the Decree of May 4, 1898, by virtue of which provision must be made seriously and opportunely, as far as can be done, for the lives of the fetus and mother; but as to the time, according to the same Decree let the Orator remember that no acceleration of birth is licit unless it is performed at a time and in modes by which, according to ordinary contingencies, provision is made for the lives of the mother and the fetus."

Question 3. What is to be answered practically to those who question confessors about this matter?

Response. The whole truth must be manifested with a courageous spirit, if the question is made in good faith, and the person who questions is foreseen to wish to acquiesce; otherwise it is better to be silent and to permit only the material evil.

Question 4. Is it licit for a girl, immediately after fornication, to take a drug for expelling an inanimate fetus, lest she be killed by her father or lose her reputation?

Response. Negatively, altogether, both because this would be directly to procure abortion, and because it was condemned by Innocent XI in prop. 34, which has itself thus: "It is licit to procure abortion before the animation of the fetus, lest a girl, detected as pregnant, be killed or disgraced." - But those women who immediately after freely had copulation wash themselves to expel the semen lest they conceive, although they do not seem to be condemned for abortion, both because semen as soon as it is received cannot be called a fetus, and because that means does not seem efficacious, nevertheless would sin most gravely by another kind of sin, namely of onanism, or of frustrated nature.¹

¹ Cf. Addenda, p. 1087, n. 4.

Question 5. Would women violated by force be condemned in the same way if they attempted immediately and altogether, without any interval at all, to reject the received semen by washing themselves?

Response. Negatively, at least probably, and the reason is that it is licit to repel force unjustly inflicted as long as the infliction itself morally perseveres. - Cf. Lehmkuhl, vol. 1, n. 849.

Question 6. What if the very uterus of the pregnant mother is infected with a lethal disease?

Response. It is licit, as it seems to us, to remove the uterus, and although by that very fact the fetus dies, nevertheless the extraction itself of the uterus has a double effect, a good one, the health of the mother, and an evil one, the death of the infant. It is like the case of procuring indirect abortion, which, as we have seen, is licit under given conditions.

Question 7. Is it licit in any case to place an action having death alone as its effect, e.g., to kill a fetus by an electric needle?

Response. Negatively: for such an action is intrinsically evil. And hence for this reason it is not licit to destroy an ectopic fetus.

Question 8. What is to be said in doubt whether that which a woman carries is a fetus or rather a tumor, e.g., in ectopic cases?

Response. It seems it must be said that if the physician, truly and sincerely, after investigation has been made, doubts, and the mother is placed in danger of life, it is licit to remove that thing. For the mother is in possession; her right is certain, nor would men, with the principles of natural law considered, force this mother to undergo this death; in other words, it is not known whether that thing is the subject of a right, and it seems cruel to prefer it to the pregnant woman. But if it is established that a fetus is present, its right must be held equally certain, nor is it licit to perform the operation until it is morally known that death has occurred. In judging all these operations, the principle often stated must be kept before the eyes, namely concerning an indifferent or good action with a double effect, good and evil. - Cf. above, n. 8. Evils are not to be done that good things may come about. Finally: nor are means to be employed which tend directly to the killing of the fetus, and by which, when they have been employed, the evil effect, in certain cases, has the good as its immediate effect. - Cf. Response of the Holy Inquisition, July 24, 1895, concerning Titius, the Physician, n. 273.

You Will Resolve. - A pregnant woman is at the point of becoming blind, insane, or paralytic; pregnancy is the cause of the insanity, etc.; the fetus is not viable. A surgeon cannot advise abortion, nor does he have the right of extracting the fetus from the cavity of the mother. In the same circumstances a non-viable fetus is at the point of dying, indeed has entered into agony. There is besides a danger lest the infirmity of the mother become incurable, or there is some other grave motive. It is not licit for the surgeon to perform an operation by which the death of the infant is more quickly induced for improving the condition of the mother: i.e. the quicker death of the fetus is not to be employed as a means for the safety of the mother: the infant will die, but this does not give the right to kill him.

A woman carries her fruit, but the fetus is extrauterine. While the physician performs a grave operation upon her, he notices the abnormal seat of the pregnancy. He also understands that the fetus is viable. It seems to us that it must be said that the surgeon can licitly, for grave causes in this case, extract that viable extrauterine fetus, even if it has not yet attained the normal term of fetal life, provided that, using the operation begun for another end, he does not perform upon the fetus any death-dealing act.

A woman is pregnant, but the fetus is extrauterine. While the physician performs a grave operation upon her, he notices the abnormal seat of the pregnancy; the fetus is alive, but not viable. The surgeon cannot bring forth the fetus from the cavity of the mother, because this action would kill the fetus. The mother is at the point of dying from hemorrhage or eclampsia and the fetus is viable. Certainly artificial birth can be induced, provided that by this operation provision is made for the life of the mother and of the infant. But this birth cannot be so induced that the death of the infant is the natural effect of the operation and the means for removing the urgent danger of the woman in labor; i.e. it is not licit to kill the fetus in order to save the mother. The mother is at the point of dying; the fetus is viable. The mother is in agony and few moments of living remain to her, but the fetus probably will live beyond an hour. It is not licit for the surgeon, in order that the infant be brought forth into the light under better conditions, to perform an operation which by its own nature would kill the mother, so that her death would be the means of improving the condition of the infant.

The mother is at the point of dying. The proximate cause of death is hemorrhage, eclampsia, or another disease arising from pregnancy. The fetus is not viable. It is not licit to procure abortion nor to advise it. In the same circumstances, a fetus not yet viable is destined to imminent death. Besides, it has already entered into agony while several hours of probable life remain to the mother. It is not licit for the surgeon to perform an operation tending directly to the very death of the fetus, as a means for placing the mother in a better condition: in other words, it is not licit to procure abortion so that the mother may be saved.

A pregnant mother is at the point of becoming blind, or paralytic, or insane, or infirm in some other way. The cause of the blindness, paralysis, etc., is pregnancy. The fetus is viable. Certainly the surgeon can advise premature artificial birth, provided that provision is made for the lives of both mother and fetus. But in the same circumstances, on account of the imminent danger lest the infirmity of the mother become incurable, there does not belong to the surgeon the right of employing a means which by its own nature determines the death of the infant, so that premature birth may be induced.

That operation is called Caesarean by which the uterus of the mother is cut so that the infant may be extracted. Not rarely it happens that the fetus, on account of the narrowness of the mother, cannot be brought forth by the natural way; in this case either the mother is to be cut, or both she and he are to be left to the course of nature. Therefore the question is about section in these most grave circumstances. These things seem to be established. 1st. The operation is never licit if the incision would be killing of the mother, because it is not licit to kill the mother so that the infant may be baptized. 2nd. It is never licit if, while the mother is living, the infant outside the uterus probably at least could not live. For this would be to kill the offspring. 3rd. While the mother is living, it can licitly be done when these conditions have been verified: 1) that the mother cannot give birth naturally, or is about to die before birth with the greatest danger of the death of the infant before he can be baptized; and 2) that from the incision there does not arise for the mother a proximate danger of death. 4th. While the mother is living, the operation ought to be done if it is certainly established that the infant cannot be baptized unless the operation is done. But the greatest prudence is needed in imposing this obligation, lest the mother, abhorring such an incision, make shipwreck of both her own and her offspring's eternal salvation, dying in a state of mortal sin, good faith having been changed into bad faith. 5th. The mother is not bound to undergo the operation when baptism can be conferred upon the infant in the womb with solid probability, which can often be done; nor is she bound when she alone is about to perish; nor, if there is probable hope that the offspring will survive her once she has died, and therefore can be baptized; nor is the mother bound to permit the operation for preserving the temporal life of the infant; nor in uncertainty of a happy outcome. But if, 6th, the case is as it were desperate and it is certain that mother and offspring are about to die, in these most difficult circumstances the operation is licit, provided that from it there arise some probability of saving both mother and offspring; for thus provision is made for the life of both this one and that one in the best way possible.

If a pregnant mother has died, let the fetus be extracted as soon as possible, cautiously, and, if it is alive, let it be baptized: Rit. Rom. tit. II, cap. 1, n. 17. Therefore as soon as the mother is dead, the operation can licitly be done. Indeed, the mother being dead, the operation also ought to be done, for there is a grave obligation by reason of the office of assisting a neighbor placed in extreme necessity: Holy Inq., Feb. 15, 1780. The section must be done with careful solicitude, lest the mother, being only apparently dead, be killed, or lest the offspring die. What must be said concerning the duty of the parish priest or missionary is clear from the response of the Holy Inquisition given on Dec. 13, 1899, first commemorating the decree of Feb. 15, 1780: "This extraction of the fetus from the womb of the pregnant and deceased mother, although it is to be made known and urged, nevertheless His Holiness expressly cautions and prohibits that missionaries involve themselves in particular cases in ordering the section, much less in performing it. Therefore it will have been enough for missionaries to have published knowledge of it and to have taken care that those laymen who apply themselves to surgery learn thoroughly the manner of performing it; and then, when the case occurs, to have left the practice of the same to their burden and duty."