Caesarean Section and Other Incisions

Besides Caesarean section, symphysiotomy, pubiotomy, and combined operations are distinguished.¹

¹ Cf. Antonelli, Medicina pastoralis, I, n. 308 and following; Capelmann-Bergmann, Pastoral-Medizin, p. 57 and following.

I. Notions. 1. Caesarean section is an operation by which, the maternal womb having been cut, the fetus is extracted from the womb. It is called Caesarean section from Julius, who was brought into the light by cutting and thence was called Caesar. Now Caesarean section can be done either on a living mother or on the body of a mother recently dead.

2. Symphysiotomy is an operation by which the cartilage, the symphysis, which joins the two pubic bones, is cut, whereby it happens that the width of the pelvis is increased and the fetus can more easily come forth into the light.

3. Pubiotomy is an operation by which one or both pubic bones are cut, and in that way the exit of the fetus is rendered easier.

4. Combined operations are constituted by symphysiotomy together with artificial premature delivery.¹

¹ Cf. Antonelli, loc. cit.

II. Morality. 1. Caesarean section or another incision of the living mother, according to the circumstances:

a) Is licit if there is a well-founded hope of saving both the mother and the offspring, and by the section the hope of baptizing the offspring is increased.¹ It is said:

1. If there is a well-founded hope of saving both the mother and the offspring; for otherwise the section would involve homicide. "Evils are not to be done," says St. Thomas, "that goods may come, as is said in Romans 3:8; and therefore a man ought not to kill the mother in order to baptize the child" (III, q. 68, a. 11, ad 3; St. Alphonsus, VI, 106). Now hope of saving the offspring is not present except after 28 weeks from conception; before that he is not viable. For the rest, observe that hope of performing the operation with a happy outcome is present today much more easily than formerly because of the progress of surgical art.²

2. And by the section the hope of baptizing the offspring is increased. For it is licit for the mother to expose herself to danger of death so that the spiritual salvation of the offspring may be better provided for.

b) It is obligatory, that is, it must be sustained by the mother, if: 1. there is a well-founded hope of saving the mother and the offspring; and 2. by the section the hope of baptizing the offspring is notably increased. The reason is that the mother is bound to prefer the eternal life of the offspring to her own temporal life. Now since the infant can commonly be baptized either in the womb of the living mother, or after, the mother being dead, he has been cut out, therefore section of the living mother will very rarely be obligatory. If the case obtains, prudence will commonly require that the section be urged upon the mother rather than imposed.

2. Section on the body of a dead mother:³

a) Is laudably done whenever there is even the least hope of extracting a living fetus. Now some hope is already had about the fortieth day from conception, indeed even before, since they narrate that it has happened that fetuses have been extracted alive at the assigned time.⁴

b) Is obligatory, and indeed under grave obligation, whenever there is probable hope of extracting a living fetus. Now probable hope seems to be present after about the completed fourth month from conception.⁵ But the obligation once begun "perseveres until the morally certain death of the offspring... How long life can be preserved for infants in the womb of a deceased mother cannot be determined: this depends much on the character of the illness from which the pregnant mother died; but there is no doubt that a fetus can survive the mother for an hour, indeed for several."⁶

¹ It suffices practically to note this; for there are also other cases in which the section is licit, for example if not only is there a well-founded hope of saving the mother and the offspring, but by the section the hope of saving the mother is increased, while the hope of baptizing the offspring is not diminished, etc.; but these cases cause no difficulty.

² Nederlandsche Katholieke Stemmen, 1907, p. 15.

³ Note that the death of the mother is not certainly established unless the first signs of putrefaction are present.

⁴ Cangiamilla, Embryologia sacra, book II, chapter 5.

⁵ Cf. Capelmann-Bergmann, op. cit., p. 62.

⁶ De Smet, De Sacramentis, n. 313. Cf. Ferreres, Mort reelle et mort apparente.

III. By whom is it to be performed? 1. Section of a living mother, as is clear, belongs only to an expert; one who is not an expert would become guilty of homicide.

2. Section of a mother not certainly dead, but perhaps only apparently dead:

a) If revival, as it is called, is held as possible, the section should be done by an expert if one is present, because otherwise the operation would expose the life of the mother to graver danger without sufficient reason. If an expert is lacking, generally whoever is sufficiently skilled is bound, or at least one who has hope of extracting the fetus; because then there is sufficient reason for admitting the graver danger. Now revival is held as possible if the mother succumbs after a crisis of the nerves, whether induced by vehement pain or by another cause.

b) If revival is held as impossible, namely if the mother is seen to succumb after longer pains, the section again belongs primarily to an expert, who can admit the danger of accelerating death if it is present. If an expert is lacking, generally another is bound, as was said above.

3. If the mother is certainly dead, the things just said under b) hold.

I said above, generally he is bound, etc., because authors do not agree to what extent even a priest must, or licitly can, perform the section, or command that it be performed, that is, by ordering see to it that it is done. Now he certainly cannot proceed to the said operation if the common good stands in the way, namely if, considering the circumstances, it must be feared that by this kind of manner of acting the priest would become less capable of promoting the salvation of people, or that other inconveniences would arise from it for the faithful.¹ If danger to the common good certainly is not imminent, some judge that the priest is bound, because natural law, to which the decrees are not thought to be contrary, imposes the obligation. Others teach that he is prohibited from performing the section. They rely on decrees of the Holy Office.² The first decree indeed regards in itself circumstances in which the common good stood in the way; but the second, they say, which refers the petitioner to the first, seems to signify that a general prohibition is intended. Finally, others hold each opinion as truly doubtful, and consequently think that a priest can perform the section or command that it be performed, but is not bound. The matter seems truly doubtful to me also; but for that reason I think that natural law, as possessing priority, should prevail, or that the section is to be performed, except, of course, in the case in which danger to the common good stands in the way.

Corollary. All to whom the matter becomes known are per se bound prudently to see to it that the section is done, but especially relatives and the pastor. Therefore a surgeon should be called as quickly as possible, and meanwhile the uterus of the deceased mother should be kept warm.³ Nor should the section be omitted, even if a fairly notable time has elapsed from the death of the mother; for they narrate that it has happened that fetuses have survived the mother for 24, indeed for 48 hours and beyond.⁴ Hence a physician asserting that the fetus has certainly died should not easily be believed. Indeed Dr. Brillaud even contends: "Since medical science knows no sign by which it may be judged with certainty that the fetus is dead, the Caesarean operation after death must always be undertaken."⁵

¹ Civil laws commonly stand in the way.

² 15 February 1780 (Collectanea, n. 541) and 13 December 1899.

³ Older authors add that the mouth of the mother is to be opened; but according to physicians the infant does not breathe in the womb of the mother.

⁴ Eschbach, Disputationes physico-theologicae, p. 356.

⁵ In Eschbach, op. cit., p. 363.

IV. The manner of performing the section. 1. The section is made from the navel to the genitals or pubic bone; but lest the intestines be injured, this precaution is to be used: once a small opening has been made, the operator immediately puts into it the index finger placed beneath the back of the scalpel or knife, and in the aforesaid manner cuts first the skin, then the other coverings which cover the intestines. When this has been done, the uterus, if the pregnancy is more advanced, will appear of itself; otherwise it will be found back behind the bladder. If this is filled with urine and impedes the finding of the uterus, let it be compressed by the hand and emptied.

2. The uterus, once found, is immediately cut, proceeding from the upper and anterior part to the lower; then the afterbirth membranes also are cut or ruptured, by which the fetus is enveloped.

3. The infant or fetus is extracted, and if certain or doubtful signs of life appear, he is to be baptized at once. If nevertheless danger of death is thought or feared to be present, the fetus is to be baptized before he is extracted.

4. After Baptism has been conferred, if the infant survives with hope of preservation, the umbilical cord is cut at a distance of two or three inches from the abdomen and is strongly tied with thread at a distance of one inch from the abdomen; when these things have been done, he is handed over to be nourished.¹

Question. What should be done by a confessor who, from the confession of a sick girl, discovers that she is pregnant?

Response 1. If the girl is already pregnant from about the fourth month, she is bound under grave obligation to see to it that after her death she be cut; nor is she excused on account of the loss of reputation. Therefore let the girl reveal her condition to a prudent person either by word of mouth, or let her hand over to him a writing to be read after death, in which she declares her pregnancy and her will that after death the infant be extracted and baptized.

Response 2. If the girl is ignorant of the grave obligation, and it is feared that, once taught, she will not obey it, let the confessor proceed only by persuading.

¹ Aertnys-Damen, Theologia Moralis, II, n. 57.

68. III. On the Caesarean operation. This operation consists in this, that the membranes which cover the uterus and the uterus itself are cut, so that from it may be brought forth the infant who cannot be brought to the light by the natural way; it is called Caesarean, because by this method Julius was born, and on that account called Caesar (from the word caesus); physicians call the same thing hysterotomy.

(A) When this operation is done on a living mother, if she is robust and the physician skilled, and moreover antiseptics and other means very well known to surgeons are employed, generally both the mother and the infant are saved¹; nevertheless some danger of death remains for each. - This being posited, it is asked whether the mother is held to suffer Caesarean section, so that her offspring can receive baptism. (a) First, all confess that she is not held if the infant can be baptized in the uterus; for even if there is hope of saving the life of the mother and of the child, this is not so certain that therefore the mother is strictly held to undergo a dangerous operation; hence such an obligation is not to be urged.

¹ Eschbach demonstrates this, p. 340-344, by the testimony of physicians. - Another operation, which is called symphysiotomy, consists in the cutting of the symphysis of the pubic bones, by which the opening of the pelvis is made broader, so that the offspring can more easily pass through it; this is not free from danger, but, if in a particular case it is judged safer by a prudent physician than Caesarean section, nothing prevents its being permitted.

(b) But if the infant cannot be baptized in the uterus and Caesarean section is the only means of procuring the salvation of the infant (which today at least rarely happens), not a few teach that the mother is held to permit the operation, provided she is sufficiently robust, the physician skilled, and precautions can be employed which remove probable danger of death; for, by the law of charity, we ought to prefer the salvation of our neighbor to our own temporal good. But many say that there is no strict obligation of undergoing this, for, that we may be held to expose life for the salvation of our neighbor, it is necessary that there be certain hope of saving him; but in the case such certainty is not present, since, notwithstanding the aforesaid precautions, some danger of death remains not only for the mother, but also for her offspring. - Hence in practice the Caesarean operation can be advised, but not strictly urged².

² Sometimes the danger for the mother and her offspring can also be removed by acceleration of childbirth, which can be done without grave danger for the infant after seven months have already elapsed after conception. Concerning its liceity the Holy Office on May 4, 1898 wrote back: "Acceleration of childbirth is not illicit of itself, provided it is performed from just causes and at that time and in those modes, by which from ordinary contingencies the lives of the mother and fetus are cared for." (Acta S. Sedis, XXX, p. 704).

69. (B) But when a pregnant mother has died, there is present a grave obligation, from charity, of performing Caesarean section, whenever it is probable that the fetus has not perished, so that the offspring can be baptized and perhaps its life preserved. This obligation falls first upon physicians and surgeons; but if these are lacking, also upon others who can furnish this without danger to the infant. But it is not licit for a priest, not indeed because such an operation of itself is repugnant to priestly honor, since there is question of a soul to be saved by a legitimate means; but because of the danger of scandal which many would suffer from it; for it is a lesser evil that an infant die without baptism than that scandal be given to many adults. Hence in this sense the Holy See responded several times¹, especially December 13, 1899. But the priest ought prudently to take care with all his strength that the operation be performed by others, especially by a physician². - That the life of the infant in the uterus of the dead mother may more easily be preserved, when Caesarean section is not performed at once, the uterus is to be covered with cloths, so that it may retain heat; but it is useless to keep the mouth of the mother open, since this does not in the least help the respiration of the infant.

¹ Thus the Holy Office, Feb. 15, 1780 and Dec. 13, 1899, apud Acta S. Sedis, XXXII, p. 502-503.

² In some States no one except a physician can licitly perform such an operation.

70. Corollaries. (A) If the confessor, from the confession of a sick girl, knows that she is illegitimately pregnant, no one knowing it, he ought to admonish her that nothing is to be done which could injure the life of the infant. But if she is in proximate danger of death, he ought to induce her to disclose the matter to a discreet person, so that, after her death, the Caesarean operation can be done and the infant baptized. This the girl can furnish: (a) by writing letters, in which she declares that she wills that after death the uterus be opened and the offspring baptized; these letters, signed and closed, she will hand to a trustworthy person, to be opened only after death: for thus she will provide, insofar as can be done, for her reputation and for the salvation of the offspring; (b) if she cannot write, let her manifest the matter by living voice to a wholly discreet person, who will reveal the fact only after her death. - If nevertheless she is in good faith, and it is prudently feared that she may not acquiesce, the confessor can be silent.

71. (B) Since the eternal salvation of many infants depends on the way in which physicians and midwives put into execution the aforesaid rules concerning fetuses to be baptized, it is the office of the pastor to instruct them diligently both on the necessity and on the manner of baptizing aborted fetuses and infants in danger, whether in the mother's uterus or after birth; for thus he will perform an excellent work of charity, and will assign to the heavenly fatherland not a few of those little ones concerning whom Christ was accustomed to say: "Suffer the little children to come to me, and do not forbid them; for of such is the kingdom of God."¹

¹ Mark, X, 14.

I. The incisions which injure the organs not of the fetus but of the mother are:

a) Caesarean section (keizersnede, so called because Julius, called Caesar, i.e., cut out, was thus born), or hysterotomy (baarmoedersnede): it consists in an incision of the abdomen and of the maternal uterus in order to extract a living fetus who, on account of the narrowness of the mother or other causes, such as death, irreducible retroversion of the uterus (onherstelbare omkanteling van de baarmoeder), placenta previa,¹ cannot be brought forth by the natural way;²

¹ The placenta is called previa when it adheres over the internal mouth of the uterus or near this mouth. This occurs when the ovule descends as far as the mouth of the uterus, and there the decidua serotina and then the placenta are developed.

² You will find the manner of performing the Caesarean operation among certain theologians, such as Dens, Theol. Mechlin., Aertnijs, and in Antonelli, c. c., t. I, n. 446.

b) symphysiotomy³ (schaamboogdoorsnijding), by which the cartilage, or symphysis, which joins the two bones of the pubis is cut. This operation is done if the impossibility of birth arises from narrowness of the pelvis (bassin, bekken), provided, however, that the narrowness is not excessive; for thus the breadth of the pelvis is increased so that the fetus can pass through it more easily;

³ It is the operation which Dr. Sigault first employed, in the year 1768; it is more dangerous than Caesarean section: in the latter, indeed, the section is deeper, but in the former harder; yet, in a particular case, it can be judged safer.

c) pubiotomy (schaambeendoorsnijding), by which, for the same end, one or both bones of the pubis are cut;

d) combined operations⁴ (vereenigde behandelingen): that is, symphysiotomy together with artificial premature delivery; thus the Caesarean operation is avoided, and the mother is healed after a few days.

⁴ They are of Dr. Iacolucci, in the year 1867.

II. The aforesaid operations are not illicit, unless they are done in such circumstances in which, on account of the weakness of the mother, the inexperience of the operator, or a certain danger of infection, they appear destructive of the mother and equivalent to killing. For Saint Thomas says (III, q. 68, a. 11, ad 3): "Evils are not to be done that goods may come about (Rom. IV, 8), and therefore a man ought not to kill the mother (or the infant) in order to baptize the child"; whence Caesarean section is illicit if it brings with it, as it were necessarily, the death of the mother or of the infant.

Nevertheless, in fact it is almost always licit, if the fetus is viable,⁵ and birth cannot be obtained in any other way. Formerly it often brought great danger and was an extraordinary means; today, because of the progress of surgical art, if it is done by an expert, it often is not very dangerous, nor is it a means so extraordinary, but for the most part it includes a rather remote danger of death for the mother, especially if precautions by antiseptic means are employed; but by an inexperienced person, e.g., by a priest, while the mother is living, it cannot be done. The same is to be said a fortiori of a less dangerous incision, which they call the vaginal Caesarean operation,⁶ namely, by which the opening of the female genital canal (moederscheede) is widened, which is the natural way by which the infant is born.

⁵ It is said: "if the fetus is viable"; for, as De Smet notes (De Sacramentis, n. 316): "If the infant is in danger before mature birth, seven months, because the pregnant mother is sick even unto death, and therefore it is to be feared lest the offspring die with her, regularly the death of the mother is to be awaited, and when she has died, the fetus is to be cut out from the maternal womb... And indeed: a) there can scarcely be a question of conferring Baptism in the uterus, both because before mature birth the uterus is penetrated with greater difficulty, and because for rightly administering the sacrament the membranes enclosing the fetus would have to be perforated; and this perforation would inevitably bring with it the effusion of the amniotic fluid and the expulsion of the immature fetus; but the expulsion of a fetus not yet viable would constitute abortion, and seems gravely illicit. (See nevertheless below, II, q. 3, n. IV.) b) Regularly there will be no place for Caesarean section, inasmuch as, the weakness of the mother being supposed, it would be deadly in the case."

⁶ It is the operation of Dr. Hubert, who was professor at the University of Louvain. This is done if birth is impeded not from narrowness of the pelvis, but from closure or perverse disposition of the fleshy parts, which cannot otherwise be overcome.

III. The mother is also bound (of herself under grave obligation) to undergo an operation, even Caesarean section, if 1) she cannot give birth naturally; 2) in the judgment of an expert the infant cannot otherwise be baptized; and 3) the safety of the mother and of the infant can prudently be hoped for by means of the section; for the mother cannot be killed, nor the fetus himself, so that this latter may be baptized before he dies.

Hence there is required a) that the fetus be viable, ordinarily of seven months; otherwise he would be killed; b) that the mother be robust; c) and that there be an expert surgeon. For then, by the law of charity, the mother must, under grave obligation, prefer the eternal salvation of her neighbor, namely of the infant, to temporal good and life.

Hence generally the obligation of the mother does not exist, because a) more often the fetus survives the deceased mother, or there is serious hope that he will survive; b) generally, by means of an instrument, he can be baptized in the uterus; c) for preserving her own life, and a fortiori for preserving the life of the fetus, the mother probably is not bound to have recourse to a means which perhaps is, or at least is still reputed to be, extraordinary.

For practice, even in the case in which she is bound to undergo the incision, prudence generally forbids warning a mother who is in good faith about the grave obligation, because of the danger lest perhaps, by refusing consent, she die in the state of sin. Nevertheless, the priest, and likewise the physician and relatives, ought to exhort her to the section. The physician is obliged to perform it, if it is asked of him, and he is bound to exhort the mother to undergo it, because from justice he must employ safer means for preserving the life of the mother and of the offspring; whence the priest should induce the physician to furnish this office.

IV. When a pregnant woman has died, immediately after death the Caesarean operation is to be done, as the Roman Ritual prescribes, tit. II, c. I, n. 17: "If a pregnant mother has died, let the fetus be extracted cautiously as soon as possible, and if he is living, let him be baptized" (Can. 746 § 4; S. Off., 15 Feb. 1780). But that the life of the infant may more easily be preserved, the uterus of the deceased mother is to be covered with cloths, so that it may retain heat; however, to open the mother's mouth, lest the infant perish by lack of respiration, is of no utility, because he does not breathe through the mother.

To this section, of themselves all are bound by the grave precept of charity, because all are bound to provide for the eternal salvation of the infant even with the greatest temporal inconveniences; and, if the fetus is viable, there is added another reason, that of preserving his temporal life.⁷ They are bound, however, provided three conditions are present:

⁷ "The obligation," says De Smet (De Sacramentis, n. 313), "begins from the death of the mother, known with moral certainty, and perseveres until the morally certain death of the offspring... But how long life can be preserved for infants in the uterus of a dead mother cannot be determined: this depends much on the character of the disease from which the pregnant mother died; but there is no doubt that the fetus can survive the mother for an hour, indeed for several." Namely, in the placenta there remains a sufficiently great amount of blood that from it he can assimilate the necessities of life; and this is the greater because little suffices for sustaining that tender life.

1. the mother is morally certainly dead; whence the section is not to be done except after the testimony of an expert concerning death;

2. it is probable that the fetus is living; hence no one is bound to it at the beginnings of pregnancy, in the second or third month, because then the fetus is almost always dead, or at least it is very uncertain whether he will emerge living; nevertheless it is to be done in the fourth month, especially if the woman has perished by sudden or very rapid death, unless there are grave reasons for judging that the fetus died before the mother or with her;

3. those acting are suitable and have sufficient skill so that they can accomplish the section without danger to the fetus; nevertheless no one is bound beforehand to learn the art or manner, because, in order to satisfy a precept, no one is bound to employ remote means, namely when the precept does not yet urge. Hence:

a) the operation first falls upon the physician, who is to be induced to perform it even if he says that the offspring is already dead, because in this matter they are accustomed to proceed more lightly and to speak thus lest they perform the section; and yet there is no doubt that the fetus can survive the mother for an hour, indeed for several;

b) but if he is unwilling, let another, e.g., a midwife, who is suitable for this, approach; the priest should warn such a person concerning this, unless very grave inconveniences are feared;

c) if others are lacking, the priest is not certainly bound to this, both because of frequent inexperience, and because of indecency, and especially because of the danger of scandal and of greater evil from the hostile talk, hatred, and calumnies of the enemies of religion; for the scandal of many is to be avoided more than the salvation of one infant is to be procured (S. Off., 15 Feb. 1780; 13 Dec. 1899). Nevertheless, these reasons do not hold for all circumstances, e.g., if there is a discreet Catholic family, or in missions, the Chinese nevertheless excepted; whence, according to several authors, of himself he would be bound: although this is perhaps more probable, nevertheless it is not certain.⁸

⁸ Many teach that the priest is bound, such as Cangiamila, Debreyne, Th. Mechl., Vering, Konings, and Behmkuhl; nevertheless others deny it, such as Bouvier, Gousset, Marres, and Berardi.

V. Case. It can happen that a woman or girl illegitimately pregnant, with no one knowing it, is in imminent danger of death. Now, after the fourth month of pregnancy, there is a well-founded hope of extracting a living fetus from the uterus of the dead mother. Whence the woman has a grave obligation to disclose the matter directly to some person, so that after her death the Caesarean operation can be done and the infant baptized. She can furnish this:

a) by writing letters in which she declares that she wills that after her death the uterus be opened and the offspring baptized, which signed and sealed letters she should hand to a trustworthy person, to be opened only after death. For thus, as far as can be done, provision is made for her reputation and for the salvation of the offspring;

b) if she cannot write, or does not wish to, let her manifest the matter orally to a wholly discreet person, who will reveal the fact only after her death;

c) other things being equal, for a duty of this kind the physician is to be chosen before others, who perhaps already knows the matter under professional secrecy, who can more fittingly provide for the reputation of the mother and of the family, and who, when necessity urges, can at once proceed to the section and baptism; parents are less suitable, who perhaps, from excessive fear of infamy, will abstain from revelation;

d) the confessor himself should only with difficulty and in the last place take upon himself the burden of revealing, especially if he fears lest from this the sacrament be rendered odious to the relatives of the girl.

But the confessor should induce the penitent to this by persuading and commending, not impose it as obligatory, if he finds that the penitent will certainly refuse it; for then he would uselessly disturb good faith, which in fact would not profit the infant and would harm the salvation of the mother. If, however, she doubts and asks concerning the obligation, the confessor must acknowledge the obligation.

VI. Observations. 1) To avoid the above-mentioned incisions by preventing conception, utero-ovarian amputation (the operation of Dr. Porro), or amputation of both ovaries, is often done; it is had without great hemorrhage or suppuration, and for that reason is said to be preferable to Caesarean section. But grave mutilation⁹ of the body is licit only (and indeed with the consent of the mother supposed) for preserving the life of the whole body, which therefore cannot otherwise be preserved, because the part itself is infected by disease and, from this very fact, even apart from pregnancy, brings danger to life; as with an arm and a foot. It is illicit if it is done in order never to conceive; indeed also, because evils are not to be done that goods may come about, in order to avoid the danger of a new pregnancy or of a new Caesarean section, the more so because a new pregnancy is doubtful and the danger is not yet imminent, and the Caesarean operation is not most grave, especially in a woman who has already undergone it, and this operation is as grave as Caesarean section.

⁹ Mutilation is grave not only by reason of danger or of the dimension of the member, but also by reason of function, e.g., if it deprives one of a power or function of great importance.

2. Oophorectomy, or ovosection (doorsnijding der eileiders), i.e., resection or ligation of the tubes of the oviduct, or of the canal leading from the ovary to the womb and carrying the maternal ovule to it, is gravely illicit for the same reason, as being a grave mutilation, except in the sole case in which the part labors under grave disease and constitutes a danger to life.

3. The same must be said of vasectomy¹⁰ in the man, or resection of the vessels or canals carrying the seed to the seminal vesicles (doorsnijding der zaadleiders), by which the way to ejaculation is broken off for the seed. Namely, it is gravely illicit, as being a grave mutilation, unless by reason of health it would be necessary for the good of the body, e.g., if a part of the deferent canal were infected with gangrene; whence it is not licit for obtaining sterility or impotence, even if perhaps the integrity of the canal and the power of inseminating could be restored, as some affirm, although in practice it is difficult; likewise, it is not licit for avoiding the multiplication of offspring or a dangerous birth, indeed not even for healing a great vicious inclination of lust: for the member, by its own nature, is immediately subordinated only to the good of the body, not to the good of the soul.

¹⁰ Concerning vasectomy, Nouvelle Revue Theologique 1910, p. 420; Revue Ecclesiastique de Liege, VI, 1910, p. 203; and Collationes Brugenses, XVII, 1912, p. 533, can usefully be read.

But public authority, since it does not have direct dominion over the life, liberty, and members of subjects, cannot take these away from them, and therefore cannot impose vasectomy upon innocent citizens, even the sick; to punish criminals in this way is incongruous, since it is not a suitable punishment, because the operation is little painful; finally, to use this means lest they harm others or lest, by entering marriage, they transmit disease by heredity, is not licit, because an evil means is not to be used for a good end, and also because other means are not lacking by which provision can be made for these things, e.g., prohibition by law under penal sanction, confinement, or abstinence from marriage.

It can also be noted that marriage, in the case of perpetual vasectomy, contracted, is invalid because of the impediment of impotence; but if the potency can be restored, it would also have to be restored when the consort demands it, yet then the end intended by authority would no longer be obtained. Moreover, bodily good is not the greatest common good of society; to this also pertains preserving human dignity, to which every species of animal selection is repugnant.

4. Likewise it is illicit to use the so-called X-rays or Roentgen rays, which, directed more intensely and with a greater dose upon the ovaries or testicles, can produce sterility, yet not always efficaciously and with fruit. For this is to be judged a grave mutilation, since it deprives one of a function of greater importance.

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.

130. On Caesarean section¹⁶⁸ and other similar surgical operations. It is necessary to distinguish whether Caesarean section is performed while the mother is living or dead.

a) Must Caesarean section be performed while the mother is living?

Because baptism can with moral certitude be validly conferred upon an infant in the maternal womb, the mother now does not seem to have a strict obligation to undergo Caesarean section for the sake of conferring baptism upon the infant. For Caesarean section almost always causes the mother a grave danger of death, which she is not bound to undergo, since the spiritual salvation of the infant can be sufficiently secured in another manner, namely, through baptism in the maternal womb. For the bodily salvation of the offspring, however, the mother is not bound to expose her own life to the greatest danger. Nevertheless, the mother can sometimes licitly permit Caesarean section to save the infant and to render his baptism more secure, unless, however, most grave disadvantages would arise for the husband or for other offspring already born from the death of the mother which might follow.

b) Must Caesarean section be performed when the mother is dead: a) in order to baptize the fetus; b) in order to save the bodily life of the infant?

It is answered to a): If a physician is present who can and wills to perform this operation, it certainly must be performed in order to save the soul of the infant. Otherwise, however, so many and so great inconveniences are accustomed to arise from civil laws and other circumstances that a priest is not bound to urge it. The Holy Office, when asked concerning this obligation on December 13, 1899, ordered that a response already issued on February 15, 1780,¹⁶⁹ be given, in which it is stated: "Although this extraction of the fetus from the womb of a pregnant and deceased mother is to be disclosed and urged, nevertheless His Holiness expressly guards against and forbids missionaries, in particular cases, to involve themselves in ordering the section, much less in performing it." Moreover, if the infant is near to delivery, he can be baptized by means of some instrument without Caesarean section, as was said above. In the first four months, however, neither conception itself is certain, nor a fortiori is it certain that a fetus still living exists, since it is morally certain that so tender a fetus does not survive its dead mother. Therefore, at that time there is no grave obligation to perform Caesarean section with great inconvenience.

It is answered to b): If a truly well-founded hope of preserving the life of the offspring is present, this surgical operation certainly is to be performed, since the order of charity requires this. Such a hope is present, however, a) if the offspring has already been conceived for seven months; b) if the mother has not been consumed by a long and protracted disease; and c) if the section is performed immediately after the death of the mother has occurred. For from the seventh month the offspring is viable, as they say; but a long disease of the mother is accustomed also to harm the offspring and cause his death in the maternal womb.¹⁷⁰

¹⁶⁸ What Caesarean section is was already stated above, II, n. 133.

¹⁶⁹ Collectan. de Prop. Fide, nn. 541 and 2073.

¹⁷⁰ Cf. above, II, n. 135.

S. Th. III, q. 68, a. 11.

153. State of the question. - By unborn are understood fetuses enclosed in the womb of the mother, or at least not yet perfectly brought forth. These, on account of grave illness or the condition of the mother, or because of difficult birth, can be in danger, so that it may be necessary to baptize them before birth. Now for those who are already partly brought forth, if they put forth the head, Baptism conferred upon it is certainly valid; if they put forth another member, Baptism conferred upon it is doubtful, according to what was said in n. 124. But concerning those who are entirely enclosed in the womb, there is a twofold opinion of theologians:

The first opinion, of almost all the older writers, denies that Baptism can validly be conferred upon them, both because no one can be reborn before he has been born (John III, 5), and because the one to be baptized must be a distinct member of human society, and consequently it does not suffice to wash the mother; but the infant himself is enclosed in the womb, as for centuries the Roman Ritual, t. 2, c. 1, n. 16, used to say after St. Thomas, q. 68, a. 11 and in IV Sent., d. 6, q. 1, a. 1. Yet this reason does not hold, because it supposes that the infant cannot be touched directly and immediately, which today is false: for commonly he can be touched by an instrument; - but the first reason has only slight probability: for a man is already said to be born in the womb, as is read in Mt. I, 20: "That which is born in her is of the Holy Spirit."

Whence the other opinion, which is of a few of the ancient writers but now morally of all the more recent writers, rightly affirms that Baptism is conferred validly upon infants in the mother's womb: for one who has contracted original sin and is man as wayfarer is capable of Baptism (Council of Trent, sess. 5, can. 4), provided he can be touched.

154. Principles. - I. "No one enclosed in the mother's womb is to be baptized until there is probable (in the proper sense, namely likely) hope that, duly brought forth, he can be baptized" (can. 746, § 1).

For outside a case of necessity it is not fitting to baptize in the womb, all the more because Baptism, on account of the difficulty of certainly washing the head of the infant, easily becomes doubtful; but to minister a doubtful sacrament is not licit outside necessity.

II. If probable hope is lacking that the infant can be duly brought forth:

1. "If the infant has put forth the head and danger of death is imminent, let him be baptized on the head; nor afterward, if he escapes alive, is he to be baptized again under condition.

2. "If he has put forth another member, let him be baptized on that member, if danger is imminent, under condition (if you are capable, or if I can); but then, if once born he lives, he is again to be baptized under condition (if you are not yet baptized)" (can. 746, § 2 and 3).

Since the principal member, namely the head, has been put forth, the infant is already considered born, because the chief part has been born, and therefore Baptism is certainly valid; on the contrary, if another member has been put forth, Baptism is not sufficiently certain. Hence theologians conclude: if, when some member has been put forth and Baptism has been conferred on it, danger of death persists, and another member much nobler or very near to the head is put forth, let him be baptized again under condition: if you are capable and are not yet baptized.

III. When danger of death is wholly imminent, an infant enclosed in the womb is, as far as possible, to be baptized under condition.

For in the case, before all else care must be taken for the eternal salvation of the infant. For this the membranes in which the infant is enclosed are to be broken, so that he may be washed immediately with water. The cutting of the membranes can easily be done by means of an instrument in instant danger of death during the last periods of gestation, when the fetus is at least probably viable; but in the earlier periods, very rarely, on account of the great danger brought upon the birth, the infant, and the mother from the destruction of the membranes; whence it is not to be attempted unless it is certain both that the fetus is living and that its life is being diminished: for then before all else the soul of the infant seems to have to be saved.

It is no obstacle that cutting the membranes in the first months is equivalent to direct killing, which can never be licit, not even for conferring Baptism. For in the case there is an action which immediately has a twofold effect: one good, the other evil. For the very perforation of the membranes does indeed take away an element necessary for the temporal life of the infant, namely the amniotic fluid, whose outpouring it causes; but just as immediately it confers an element necessary for spiritual life: the possibility of touching the infant and conferring Baptism. Namely, this possibility follows immediately from the very perforation, and not by means of the consequent outpouring of the fluid, and would subsist even if that fluid were not poured out.

Indeed it takes away extreme spiritual necessity by perforating the membrane which is the obstacle to Baptism, although in this way at the same time it places the infant in extreme temporal necessity, from the consequent loss of the fluid.¹

¹ Do not conclude from this that the cutting of the membranes can also be done for procuring the safety of the mother. For parity is lacking; because the possibility of saving the mother would not be obtained immediately, but only by means of harm to the infant, namely by means of the outpouring of the fluid.

IV. "A fetus baptized in the womb, after birth must again be baptized under condition (if you are not yet baptized)" (can. 746, § 5).

The reason is both because Baptism is in itself somewhat doubtful, on account of the probability, although slight, of the opinion asserting that no one can be reborn before he has been born; and because it is very difficult to know whether someone has sufficiently touched the head. Thus Benedict XIV and S.C.C., July 12, 1794 and March 16, 1897.

155. Question: Must a fetus be extracted from the womb of the mother so that it can be baptized? - St. Thomas says, ad 3: "Evils are not to be done so that goods may come, and therefore a man ought not to kill the mother in order to baptize the child." Whence Caesarean section, or incision of the mother's abdomen and uterus for extracting a living fetus, is illicit if it quasi-necessarily brings about the death of the mother.

A. While the mother is alive, the operation is licit, and of itself the mother is bound to undergo it, with these conditions given: if 1. the mother cannot give birth naturally; 2. the safety of the mother and infant can prudently be hoped for by means of the section, for neither the mother nor the fetus himself can be killed so that the latter, before he dies, may be baptized; and 3. in the judgment of an expert the infant cannot otherwise be baptized. For then by the law of charity the mother is bound under grave obligation to prefer the eternal salvation of the neighbor, namely the infant, to the inconvenience and danger of her own temporal life.

And so it is required that 1. the fetus, for the present circumstances, be viable, otherwise by extraction from the maternal womb he would be killed; 2. the mother be robust; 3. and the surgeon be expert: for then, on account of the progress of surgical art, the danger of death for the mother is commonly sufficiently remote.

In practice: a) The obligation of the mother rarely exists, because more often the fetus survives the dead mother or there is serious hope that he will survive, and because generally by means of an instrument he can be baptized in the womb; yet it would be erroneous to say that the mother is never obligated.²

² Some practically deny the obligation, or doubt concerning it, such as Genicot, Th. M., II, n. 144; Noldin, Th. M., II, n. 344; Cappello, op. cit., n. 165; because it ought to be certain that the infant cannot be saved in another way, and that he would certainly be saved by the operation. - But 1. in this matter absolute certitude is not required, but it suffices that this be morally certain; 2. also it is not required that the infant be certainly saved by the operation, but that there be probable hope of this: thus according to the rules handed down in the treatise on Charity, where it treats of help to be brought in a case of extreme spiritual necessity. Whence Fr. Schmitt emended the doctrine in this matter in the 20th edition which he gave of Noldin's work.

b) Even in the case in which she is bound to undergo the incision, generally prudence forbids admonishing the mother, if she is in good faith, concerning the grave obligation, on account of the danger lest perhaps, by denying consent, she die in the state of sin; nevertheless the priest, likewise the physician and relatives, ought to exhort her to the section.

c) The physician is bound to perform the section if it is sought from him, and is bound to exhort the mother that she undergo it, because by justice he is bound to employ the safer means for preserving the life of the mother and of the offspring; whence the priest should induce the physician to render this office.

d) By one not expert, for example by a priest, the section cannot be done while the mother is alive.

B. When a pregnant mother is certainly dead, immediately after death a Caesarean operation is to be performed, as the Ritual prescribes, tit. 2, c. 1, n. 20: "If a pregnant mother has died, the fetus, extracted by those whom it concerns, if he certainly lives, is to be baptized absolutely; if doubtfully, under condition" (can. 746, § 4).

The obligation arises from the grave precept of charity, by which we are bound to take counsel for the eternal salvation of the neighbor, in the case the infant, even with the greatest temporal inconveniences; and if the fetus is viable, there is added another reason of preserving his temporal life.

The section is to be done provided three conditions are present:

1. that the mother be morally certainly dead, whence, in doubt, it is not to be done except after the testimony of an expert concerning death;

2. that it be probable that the fetus lives; hence no one is bound to it in the beginnings of pregnancy, in the first six weeks, or according to others, in the second or third month, because then the fetus is almost always dead, or at least it is very uncertain whether he will come forth living; yet it is to be done in the fourth month, especially if the woman has perished by sudden or very rapid death, unless grave reasons are present for thinking that the fetus died before the mother or with her;

3. that a suitable person be present who has sufficient expertise to complete the section without danger to the fetus; yet no one is bound to learn the art or mode, because to satisfy the precept no one is bound to employ means remotely, namely when the precept is not yet urgent.

The obligation a) first regards the physician or surgeon, who is to be induced to do it even if he says the offspring is already dead, because in this matter they are accustomed to proceed rather lightly and to speak in this way so that they may not do the section;

b) but if he refuses or cannot be present, let anyone else suitable for this approach, as for example a midwife: for the precept of charity in extreme necessity of itself obliges all; concerning which therefore the priest should admonish, unless very grave inconveniences are feared;

c) but upon others, especially relatives, it is incumbent to take care that the section be done;

d) if others are lacking, the priest does not seem certainly bound to perform the section, both because of frequent lack of expertise, and because of indecency, and especially because of danger of scandal and of a greater evil from the slanders, hatred, and calumnies of enemies of religion: for the common good must be cared for, and the scandal of many avoided, more than the salvation of one infant procured (Holy Office, December 13, 1899); for which reason missionaries should abstain among the Chinese from demanding and carrying out the section (Holy Office, February 15, 1780). Yet these reasons do not hold for all circumstances, for example if the Catholic family is discreet, or in the missions, nevertheless with the Chinese excepted; whence, according to many, the priest would of himself be bound: although this may seem truer, nevertheless we do not dare to say that it is certain.³

³ Many teach that the priest is bound, such as Cangiamila, Debreyne, the Theologia Mechliniensis, Vering, Konings, Lehmkuhl; yet others deny it, such as Bouvier, Gousset, Marres, Berardi. The mode of doing the Caesarean operation is indicated in Dens, Theol. Mechl., Aertnijs, and in Antonelli, Medicina pastoralis, I, n. 446.

It should be noted that there is no doubt that the fetus can survive the mother for an hour, indeed for several hours. But so that the life of the infant may more easily be preserved, the uterus of the deceased mother is to be covered with cloths, so that it may retain warmth; but to open the mother's mouth, lest the infant perish from lack of respiration, is of no utility, because he does not breathe through the mother.

156. Observations. - 1. Baptism in the womb of the mother, the membranes first having been broken if this is possible, is conferred by means of some irrigating instrument, for example a small siphon full of water, or with some sponge, but with the other hand one must investigate whether the water touches a part of the infant; - but if these means are lacking, it is conferred by the moistened hand alone, although that mode is easily doubtful (Holy Office, December 14, 1898). Warm or tepid water should be used, because cold water would harm the mother; indeed, when from pure water a true danger of death in the mother is to be feared, it can be mixed with corrosive mercuric bichloride, one part of this chloride dissolved in a thousand parts of water, as we know from the response of the Holy Office, August 21, 1901.

2. The ministry is ordinarily to be performed by a physician, or, if he is lacking, by a midwife, who is to be taught by a physician or by the pastor.

3. The pastor is to be informed concerning Baptism conferred in this way (can. 778).