Case 4. Ectopic Gestation

Titius, a young Catholic physician, asked Paul, his confessor, whether he could safely follow the doctrine commonly handed down in medical schools concerning the manner of treating ectopic fetuses. For sometimes a fetus is conceived outside the uterus and begins to grow, and it cannot always be distinguished from a tumor. Its growth, however, constitutes a grave danger to the mother, especially when the enclosing membrane is ruptured. According to the doctrine handed down in medical schools, an electric fluid is introduced into the cyst, and thus the fetus, if any is present, is deprived of life, ceases to grow, and the mother’s life is saved. Titius therefore wished to know whether it is lawful to act thus, and, if it is not lawful, what must be done when the mother’s life is endangered by a tumor which probably is an ectopic fetus, or which certainly is an ectopic fetus. Hence Paul asks:

1. What is an ectopic fetus, and why is it dangerous?

2. How are the direct and indirect killing of a human being distinguished, and when is it lawful?

3. What is to be said of the case?

1. What is an ectopic fetus and why is it dangerous? The proper place for the fecundated ovulum to settle and grow to maturity is the uterus, but sometimes it remains in the ovaries, sometimes in the Fallopian tubes, sometimes it falls into the abdominal cavity, and in these cases it is c called ectopic or extrauterine. An ectopic fetus can not be delivered in the ordinary way, and its growth becomes a serious danger to the life of the mother, chiefly on account of blood vessels being ruptured in the mother’s body by the continual growth of the ectopic fetus.

2. The first part of this question is answered above, p. 226.

Direct homicide is lawful by public authority in punishment of crime, or in a just war, and by private authority in self-defence. Indirect homicide may be permitted for some object of great importance.

3. The case. It is obvious that if an ectopic fetus is living, it will be direct and unlawful homicide to kill it with electricity. If it is uncertain whether a cause of danger to a woman is an ectopic fetus, or a tumor, or some other growth, laparotomy may be performed and the cause of danger removed as soon as the danger becomes imminent. For in that case the certain danger of the woman must be considered and guarded against in preference to the danger to the life of a fetus which is only probable and perhaps non-existent. Even when the danger certainly comes from the presence of an ectopic fetus, the same operation may probably be performed when its growth causes the danger to the mother to be imminent and the fetus is already viable.¹

1 See Antonelli, Medicina pastoralis, vol. i, n. 338; Lehmkuhl, Theol. Mor., vol. i, n. 1011, ed. 11.

On the other hand, when abortion is procured directly, the fetus is killed directly, and this is never lawful.