Craniotomy and similar operations

Craniotomy, or any other similar operation which has for its immediate and direct effect the destruction of the life of the foetus, is a direct killing of the innocent, and is never allowed. If the child is already dead, there is of course no difficulty in permitting craniotomy or embryotomy, but if it is still alive it is not lawful to kill it, even if otherwise both child and mother were certain to die. Evil must not be done that good may come of it. The end does not justify the means. Some medical men consider the foetus, until it is born, as a portion of the mother which may be destroyed to save her life. This view is not in keeping with Christian principles, according to which the child has a soul of its own, and has its own independent right to live.

Some theologians used to think that such operations were lawful if the mother’s life could not otherwise be saved, because the child might be considered a materially unjust assailant of its mother’s life, and so be lawfully killed; or because when there is a conflict of rights the stronger right should prevail. However, in no sense can it be allowed that the child is an unjust assailant of its mother’s life; it is where nature placed it, through no fault of its own, and it has a right to be there and to be born. If either is an unjust assailant of the other’s life, it is the mother, who voluntarily undertook the obligations of motherhood. In the same way, when the stronger of two conflicting rights prevails, this is due to the fault of the other party, and such fault is out of the question in this case. This doctrine is now theologically certain after the repeated declarations of the Holy See that no operation which tends directly to the destruction of the life of the foetus is lawful.

When the child cannot be born in the natural way, and the life of both mother and child is in danger, Caesarian section or some similar operation may be, and should be, performed, by which the lives of both may very probably be saved. The operation which takes its name from Dr. Porro, and which consists in removing the uterus together with the foetus, requires some special reason to make it lawful, for such mutilation of the mother is only allowed when it is necessary in order to save life.

In all operations which involve danger to the life of the child, Catholic parents should be careful to have the living foetus baptized, which may be done by the doctor or nurse while it is still in the womb. But according to Canon 746 this should not be done as long as there is any hope of the child being born alive.

I. Embryotomy - from Greek embryon = fetus and temno = I cut - to which craniotomy - kranion = skull - and cephalotripsy - from kephale = head and tribo = I crush - pertain; embryotomy, I say, and similar operations, are gravely illicit. For they contain killing, and that direct killing (n. 731). There are added the responses of the Holy Office,¹ which declare that in Catholic schools it cannot safely be taught that craniotomy and any surgical operation directly killing the fetus or the pregnant mother are lawful.

¹ May 28, 1884 (Collect., n. 1618) and August 14, 1889 (Collect., n. 1716).

IV. Extraction of an ectopic or extra-uterine fetus¹ is to be judged as follows:

1. If, considering the time elapsed from conception, provision can be made for the offspring, it is lawful,² indeed it even obliges if otherwise the fetus cannot certainly be baptized.

2. If provision cannot be made for the offspring, it is not lawful to extract it from the body of the mother, because the act of extracting is assumed as a means insofar as it is killing, that is, insofar as it tears the offspring away from the mother. Nevertheless it is lawful to extirpate a tumor infected with cancer or lethal on another count, even if the fetus is cut out at the same time, because the act of extirpating is not assumed as a means insofar as it is killing, that is, extirpative of the offspring itself.

3. If there is doubt whether or not a true fetus is had, the same solutions have force. Others judge that in the case an ectopic fetus can be extracted from the mother's body, even if provision cannot be made for its life, because, they say, the certain right of the mother must be preferred to the uncertain right of the offspring. But these things are not pleasing, because, to use again the words of St. Alphonsus, "it is intrinsically evil positively to expose an innocent person to danger of direct death" (III, 394), or because it is illicit to place an act which probably is directly killing an innocent person.

¹ Namely, sometimes it happens that conception occurs outside the natural place, that is, outside the maternal uterus; in that case birth cannot occur in the natural way. Moreover, a threefold ectopic pregnancy is distinguished, namely tubal, ovarian, and abdominal, of which tubal, which takes place in the oviduct, seems more frequent.

² Cf. Holy Office, May 4, 1898 (Collect., n. 1997); likewise May 5, 1902; yet the latter decree lacks pontifical approval.

V. Acceleration of birth (n. 733) is lawful for a proportionate cause, as if the safety of the mother is hoped for from accelerated birth, or if it is feared that the woman cannot give birth to a more developed fetus. Hence the Holy Office¹ declared that acceleration of birth is not per se illicit, provided it is performed for just causes, and at that time and by those methods by which, according to ordinary contingencies, provision is made for the lives of the mother and fetus.

¹ May 4, 1898 (Collect., n. 1997).

What is abortion? Abortion is commonly defined: the ejection of an immature fetus. Immature, that is, not yet fit for vital birth, in such circumstances of the time of gestation that the fetus, although still living when it comes forth into the light, nevertheless must necessarily die soon. Therefore abortion is not really the same thing as mere acceleration of birth. In acceleration of birth the fetus is not immature, and although it comes forth into the light before the completed time of gestation, nevertheless it can naturally live. Abortion properly has place in the first seven months of gestation; in the remaining two months it is mere acceleration of birth, commonly speaking and according to the general rule. The ejection of the fetus; hence abortion is properly distinguished from any action which is not per se primarily ejective of the fetus, but injurious to that same fetus, such as that surgical operation which is called craniotomy and embryotomy, because it is the cutting of the cranium of the infant, or fetus, in order to extract him from the mother's womb.

E. M. According to the general rule. Absolutely speaking, the fetus can live outside the womb after six months, six and a half months, and even before this term, if extraordinary means for nourishing the fetus are present. But in order that the moral danger of the death of the fetus be excluded, the term of seven months must be awaited. Cf. here 663.

Is direct procurement of abortion lawful? - In no case ever, or for any cause, is it lawful directly to procure abortion, even if the fetus were supposed still unanimated. Proof: For if the discussion is about direct procurement of abortion improperly so called, namely through means or medicines by which one tends directly to injuring and killing the fetus or infant, as, for example, when physicians with the help of forceps crush the cranium of the little infant in the mother's very womb, in order afterward violently to extract the dead fetus, there is had a very true homicide, directly intended and directly exercised, which is never lawful.

If the discussion is about direct procurement of abortion through means or medicines which directly cause only premature acceleration of birth, from which the offspring, necessarily, by the very laws of nature, must succumb to death, "after animation this would be directly to kill the infant, which is never lawful"; for by a positive action to eject an immature infant outside the womb is positively to withdraw from him the means instituted by nature itself for the conservation of his life, which is directly to kill someone. "But before animation it is not lawful directly to procure this either, just as it is not lawful to procure the emission of seed even to save life, in which case Tertullian seems to speak in Apol. cap. 3; for he gives a universal reason: he who will be a man is a man, he says, for the fruit is in the seed." Lugo de Iust. et Iure d. 10, n. 130. Therefore, since even the non-animated fetus is ordered to forming a man, its ejection is anticipated homicide. Hence Ithur. Cas. 21, n. 5 says, "it is most certainly always infected with grave malice, direct procurement of abortion."

There are indeed grave and many doctors, whom Sanchez de Matr. l. 9, d. 20, n. 9 and Struggl tr. 7, q. 3, n. 16 follow and report, who judge that directly procured abortion, where nevertheless the matter concerns only the mere premature ejection of a non-animated fetus, is not so intrinsically unlawful that at least in the case of preserving the life of the mother, extremely endangered from present disease, it is not lawful. Indeed doctors are not lacking who defend the direct procurement of abortion even of an animated fetus in the aforesaid case, "which opinion once the illustrious D'Annibale judged not improbable," p. 2, n. 284, ed. 4. But this opinion is altogether excluded by the Decrees of the Holy Office concerning the unlawfulness of craniotomy. Indeed, between the killing which is had through craniotomy and abortion of this sort there is in fact no difference. For who would deny that he equally kills a man who pierces him through, and who casts him down from a tower, and who drowns him in the sea? Besides, that opinion is rejected by the Decree of the Holy Office, 24 Jul. 1895, by which the unlawfulness of abortion itself is expressly declared. E. M.

Hence it is clear that laparotomy also is unlawful for extracting from the bosom of the mother ectopic or extrauterine fetuses, still immature. On the contrary, necessity compelling, laparotomy is lawful for extracting from the bosom of the mother ectopic conceptions, provided that the lives both of the mother and of the fetus are seriously and suitably cared for, as much as can be done. Since they cannot be born, they often carry death with them also for the mother. E. M.

To n. 742 ff. -

1. The doubt having been proposed by the Archbishop of Lyons: "Whether it can safely be taught in Catholic schools that the surgical operation which they call Craniotomy is lawful, namely when, if it is omitted, the mother and infant are going to perish, but if it is admitted, the mother is to be saved while the infant perishes?", the S. C. U. I. on 28 May 1884 responded: "All things having been weighed long and maturely, with account also taken of those things which, in this matter, were written by expert Catholic men and transmitted by Your Eminence to this Congregation, they judged that it must be answered: It cannot safely be taught. Which response, our Most Holy Lord fully confirmed." Immediately when a response of this sort of the Holy Office was published, doubt began concerning its value, namely whether it in reality settled the controversy and truly condemned the opinion concerning the lawfulness of that surgical operation. For there were not lacking, nor are lacking, grave theologians who thought and still think that that decree has no other value except merely disciplinary, and does not render improbable the opposite opinion concerning the lawfulness of craniotomy. Wisely, they say, the S. C. judged that it should be responded thus, both because each opinion is not without its own probability, and especially because in practice abuse would perhaps happen very frequently. At another time perhaps it will become probable which now is held as improbable or as slightly probable. For slight or light probability is more than sufficient, so that it can be said of an opinion of this sort, especially when the matter concerns so great harm to a third party: it cannot safely be taught. Therefore it will not be displeasing to students of moral matters briefly to weigh the force of the aforesaid decree.

2. The preceding Response can be declared by a twofold consideration, extrinsic and intrinsic. Let us begin from the first. A similar question was proposed to the S. R. U. I. concerning Ontologism, namely: "whether the following propositions can safely be handed down": there follow seven noted propositions concerning Ontologism. The Sacred Congregation, Wednesday, 18 Sept. 1861, wrote back: "The Eminent and Reverend Lords, with the vote of the Lord Consultors having been had beforehand, after maturely weighing all and each of the propositions enunciated above, responded to the proposed doubt: Negatively," namely: that they cannot safely be handed down.

3. By this decree theologians and philosophers themselves understood a true condemnation and proscription of the doctrine. Wherefore those who defended Ontologism attempted to show that in those seven condemned propositions there was not contained the doctrine of Ontologism which they themselves were defending, but another doctrine well diverse. Cf. the little work of the most learned philosopher and theologian Joseph Kleutgen, L'Ontologismo e le sette tesi censurate dalla Sacra Inquisizione, Rome, with the types of the "Civilta Cattolica," 1867, p. 10 ff.

4. Nor only did private and public Professors interpret that decree in this way, but also the Roman Congregations themselves understood that decree in this sense, namely of true condemnation and proscription. These things are read in the decree transmitted by His Eminence Cardinal Patrizi to His Eminence the Cardinal Archbishop of Mechelen concerning the philosophical books of G. C. Ubaghs, dean doctor in the University of Leuven. "Moreover, what already, as from my letters given to the individual Bishops in Belgium on 11 Oct. 1864, the aforesaid Cardinals had reserved to themselves to do, they undertook to examine other doctrines which are contained in the more recent editions of the works of the same author. And indeed they had to perceive that in those books doctrines fully similar to some of the seven propositions are handed down ... which the Supreme Congregation of the Holy Office on 18 Sept. 1861 judged could not safely be handed down; ... hence it will be altogether necessary that not only those books and those similar to them be kept away from the Catholic University and from all schools, but also," etc. Rome, 2 Mar. 1866. Cf. the cited little work, p. 84 ff.

5. After the decree reported in the preceding number, new doubts arose on the part of the defenders of Traditionalism and Ontologism. For they said that the decisions given were disciplinary, not doctrinal; that they could not teach, but could keep in heart, those things which before were handed down; and that these were still probable and lawful. When these things had been denounced to the Supreme Pontiff by His Eminence the Cardinal Archbishop of Mechelen and the other Bishops of Belgium, in letters given 1 Aug. 1866^†, His Eminence Patrizi, in the name of the Most Holy Father, wrote these things back to them: "In the letters ... given to the Most Holy Pius IX, judgment is sought from the Apostolic See concerning certain doubts raised ... about the responses of the sacred Congregations of the Holy Office and of the Index, sanctioned by the authority of the Supreme Pontiff both in the year 1864 and in this year 1866. But these are not such doubts as require a new interpretation and declaration of a matter already defined; for to dissolve these thoroughly, there is more than enough through the very responses of the Sacred Congregations. Indeed, it was heard not without wonder that doubts of this sort had been proposed.... Now Catholic men, but much more ecclesiastics, have this duty, that they subject themselves fully, perfectly, and absolutely to the decrees of the Holy See, with contentions removed from the middle which would obstruct the sincerity of assent." Rome, 30 Aug. 1866. Cf. the cited little work, p. 86-89.

6. After the preceding letter had been received, His Eminence the Cardinal Archbishop of Mechelen and the other Bishops of Belgium, on 17 Dec. 1866, gave letters to the Rector and Professors of the University of Leuven, in which, speaking of the resolution of both Congregations, of the Holy Office and of the Index, of 2 March 1866, cf. above n. 5, they assert these things: "These decisions are so clear that the cause is to be regarded as definitively decided. But we know that the most firm will of the Most Holy Lord is that, errors having been removed, all think the same. Therefore, so that all dissensions may remain extinguished forever, and in a question long agitated and now defined nothing may remain to be wished for or awaited, we send the formula of letters to be subscribed by all who either handed down the reproved doctrines, or in some way adhered to the same." But in the formula it is said: "I subject myself fully, perfectly, and absolutely to the Decisions of the Holy Apostolic See of the day 2 March and 30 August of this year 1866, cf. above n. 4, 5, and from my soul I acquiesce. And therefore from my heart I reprove and reject any doctrine opposed," etc. Cf. the cited little work, p. 90, 91.

7. Retraction of Ontologism, by force of the condemnation pronounced by the Holy Office, was required from Rev. D. Ugonin, when he was proposed for the Episcopate. This was the formula of retraction: "Since I, the undersigned, have received from His Eminence and Most Reverend Lord Archbishop of Myra, Apostolic Nuncio in France, that the doctrine which I set forth in my philosophical work on Ontologism (Etudes philosophiques, Ontologie) is disapproved by the Holy Apostolic See, as one which especially, whether explicitly or implicitly, favors those propositions which the S. R. and U. I. decreed in the year 1861 cannot safely be handed down; I myself, with no delay interposed, freely and spontaneously declare that I hold and disapprove the aforesaid doctrine in exactly the same way as the Holy See judged, as deviating more or less from the sound principles of philosophy; and at the same time I promise that, as far as is in me, I will take care in the future that it no longer be handed down in schools. Given at Paris on 13 Oct. 1866." The cited little work, n. 15. Cf. also the Letter of Leo XIII, Litteris ad te, 1 June 1889, concerning the forty Propositions of Rosmini condemned by the Holy Office.

8. Therefore if craniotomy was condemned by the Holy Office in the same way as Ontologism was condemned, if parity stands for both condemnations, certainly it appears how great is the force of that juridical censure concerning craniotomy, it cannot safely be taught. Nor indeed may it be objected that proscriptions and decisions intervened not once, but several times, against Ontologism on the part of the Sacred Congregations and of the Holy See itself, which has not yet been had against craniotomy. For those repeated proscriptions and decisions do nothing other than inculcate and confirm that first condemnation of the Holy Office on 18 Sept. 1861, by force of which His Eminence Cardinal Patrizi, in his Letter and Decree of 2 March 1866, pronounces books infected by that doctrine to be kept away from the University of Leuven and from all schools; and the Most Reverend Bishops of Belgium regard the cause as definitively decided; and the cause was also concerning Ontologism; and, errors having been removed, they exhort all to subscribe to sound doctrines. But that Decision of 28 May 1884 was again confirmed by the Holy Office on 19 Aug. 1889^†. Cf. Enchirid. Moral., ed. 4, p. 99.

9. Let us now make a step to the intrinsic consideration of the matter. That is called safe which is without danger. Therefore an opinion which cannot safely be taught is an opinion which cannot be taught without danger. And thus in the cited Decree of 2 March 1866, given through His Eminence Patrizi, after it had been affirmed that in the philosophical books of G. C. Ubaghs "doctrines plainly similar to some of the seven propositions are handed down ... which the Supreme Congregation of the Holy Office on 18 Sept. 1861 judged could not safely be handed down," it is then said that in the same books doctrines or opinions are found which cannot be handed down without danger.

10. Now this danger is danger of error, if we wish to understand the aforesaid decision of the Holy Office in its proper and obvious sense. For it is said that it cannot safely be taught, and danger in teaching some opinion properly and in the obvious sense is nothing other than danger of error. Wherefore that Decree is not merely a certain disciplinary prohibition of teaching or handing down that opinion in public schools or even private schools; but it is a true doctrinal judgment concerning the truth and falsity of the same opinion, which consequently can no longer be handed down in all schools, but must be kept altogether away from them.

11. Nor indeed should it be said that this danger is to be understood from the subject matter, which is a certain practical matter. For the matter with which it is concerned is practical and most practical, but it is a matter not regarding ecclesiastical and positive discipline, but regards morals and touches the natural law itself. Wherefore from consideration of the subject matter it does not follow that that decree is merely disciplinary, but that it is doctrinal in the matter of morals. For that decree involves this in other words: that opinion concerning craniotomy cannot be taught without danger of error in the matter of morals. Nor should one press by saying that it can very well happen that that opinion cannot safely be taught, even speaking speculatively, because practically someone could easily abuse it, by applying it badly to practical cases, and by not rightly distinguishing the cases in which it can lawfully be given to execution from the cases in which this is altogether illicit. This insistence is not valid; for this confusion of a case of lawful application and a case of illicit application is impossible, and therefore that danger is not this danger, of badly applying the aforesaid opinion practically, and of confusing case with case. Truly the opinion concerning craniotomy in the abstract, considered according to itself and generally, was not condemned; but the opinion concerning craniotomy in the concrete, according to determinate circumstances, and considered in particular, was condemned. For the question proposed, which the Sacred Congregation resolved by its decision, is not: "Whether it can safely be taught in Catholic schools that the surgical operation which they call Craniotomy is lawful," thus generally, but in that peculiar and determinate case concerning which there was question and controversy among theologians, "namely when, if it is omitted, the mother and son are going to perish; but if it is admitted, the mother is to be saved while the infant perishes." Certainly in this case the doctrine concerning craniotomy is declared dangerous. Therefore the very application to the determinate case is declared a dangerous doctrine; it cannot safely be taught. Therefore that danger is not the danger of practical abuse, the danger of illicit application, but is the danger of error in the opinion enunciating the lawfulness of craniotomy in that aforesaid case.

12. But it is still objected that the aforesaid opinion could well be called not safe, although determined to that peculiar case concerning which there was question, on account of the very practical danger of discerning the case of true necessity: namely that, if craniotomy is omitted, the mother and son truly are going to perish, but if it is admitted, the mother truly is to be saved while the infant perishes. This cannot reasonably be objected. For that case of necessity is supposed certain in that proposition concerning the lawfulness of craniotomy. Only in such a hypothesis was the question being made by Theologians and proposed to the Sacred Congregation, and the Sacred Congregation certainly understood it in this sense; for it says in its Response, "with account also taken of those things which, in this matter, were written by expert Catholic men and transmitted by Your Eminence to this Congregation." Besides, this objection would then have force, when in reality that case of necessity would be difficult to know; but where the matter concerns craniotomy the matter is most clear and subject to no difficulty, unless the Surgeon is wholly stupid, which is per accidens and is not attended to in the condemnation of a general proposition. For the matter is considered per se.

13. One danger is intrinsic, another extrinsic; likewise one is proximate, another remote. The danger of error in asserting the lawfulness of craniotomy cannot be from a circumstance extrinsic to craniotomy itself, insofar as it is employed in such circumstances of things as render it illicit. For, as was just observed, the lawfulness of craniotomy in general is not condemned, but the lawfulness of craniotomy in the aforesaid circumstance of the death of the mother and son if that operation is omitted, and of the safety of the mother and death of the son if it is done. Now if any circumstance can be imagined which could render craniotomy lawful, certainly it is no other than the one just enunciated, when without that operation neither mother nor son is saved, but with it employed, the son is not constituted in a worse condition and the mother is saved. But the Holy Office, in this very case, declares that it is dangerous to teach the lawfulness of craniotomy. Therefore the danger of error is intrinsic to craniotomy itself, namely because it is the direct killing of an innocent. The danger of error is intrinsic to the very complex, that is, to craniotomy clothed with the aforesaid circumstance; for in that complex craniotomy remains with its whole nature, which is by no means changed by that most favorable circumstance. Now if the danger of error is intrinsic, namely by force of craniotomy itself, that danger of error consequently cannot be remote, but is proximate and most proximate; for nothing is more proximate to some thing than its intrinsic and intimate nature. Therefore the lawfulness of craniotomy cannot be taught without proximate and intrinsic danger of error.

14. An action which is a danger of sin is an action distinct from the very action of sin, and it is sin not properly and strictly speaking by reason of itself, but by reason of that action sinful in itself with which it is connected. Likewise an opinion containing danger of error is an opinion distinct from another certain and unshaken doctrine against which that opinion contains the danger of erring, and thus it is connected with it insofar as it is opposed to it. Therefore generally, and speaking per se, an opinion which cannot safely be taught, or which contains danger of error, is an opinion which, although in itself it is not error, nevertheless is connected with error; at least insofar as of itself and in the obvious sense, and not per accidens from mere lack of consideration, it labors under equivocation between error and truth in such a way that it easily turns toward error rather than toward truth, and he who adheres to it is judged indeed to embrace error, not truth. Yet when, from the subject matter, a proposition is so determined that no way lies open to truth, although it is defined merely as not safe, and by reason of the note or censure itself cannot be held except as merely dangerous, or containing danger of error, nevertheless consequently that proposition is to be held as error, namely by reason of legitimate deduction. And hence it is easily explained why, although those seven propositions of Ontologism were not marked with another censure than that they cannot safely be handed down, nevertheless in the Schools they were commonly held as altogether improbable after that Decision of the Holy Office. The same seems to happen in our case. For no true sense can be imagined, since in the most favorable case itself it is said that it cannot safely be taught. Wherefore it does not appear how craniotomy can still be probably defended.

15. That adverb safely can be declared in another way; but the conclusion is almost the same. That adverb can be resolved into an adjective, and then the understood substantive is to be sought. Now this substantive, which can be thought of more favorably in the present matter, is conscience; so that it cannot safely be taught is the same as it cannot be taught with a safe conscience. This interpretation, which pertains especially to a moral and practical matter, seems altogether to agree with the decision of the Holy Office of which we treat; for in it the matter concerns a moral and practical thing. Now in Moral matters, that opinion is called safe in the merely speculative order which someone can hold in mind and externally teach to others without danger and fear of erring against some certain law or precept. In our case that certain and unshaken law is the law, Thou shalt not kill. Wherefore that craniotomy cannot safely be taught in that case set forth above is the same as that craniotomy cannot be taught without danger and fear of error against the law, Thou shalt not kill. But this danger and fear of error would then, on the part of the thing, remain a mere danger of error and would not consequently become error, if a case could be given in which in reality the law Thou shalt not kill would not be broken. But this case cannot be given. For if this case were given, it would be no other than the proposed case itself. But that proposed case would then, on the part of the thing, remain a mere danger of error and would not become error directly against that law Thou shalt not kill, since it would not already be ultimately determined by every favorable circumstance, and could still be determined further. Therefore, although by force of the condemnation that opinion is only a not safe doctrine, nevertheless in reality by force of the matter that opinion becomes altogether improbable.

16. But someone will ask why then the Holy Office negatively said that opinion was not safe, and did not positively say that it was erroneous, if not safe is in reality the same as erroneous? First it is answered: it did not say this, because this was not being asked, but that; and the Sacred Congregations respond to proposed doubts with customary formulas, nor in their brief responses are they accustomed to make a treatment of the matter in question, so as to set it forth and explain it. Secondly it is answered: although the not safe opinion in our case, by reason of the matter, by legitimate conclusion, falls back in reality into an erroneous or false opinion, nevertheless that theological censure, not safe, is not the same as another censure: erroneous or error, which is a far graver censure. We contend the former, not the latter. But we say erroneous or false, also to narrow the signification of error, since strictly speaking error and false are not the same.

"From Augustine in the Enchiridion, cap. 17, and Contra Academicos, cap. 4, to err is nothing other than to approve true things as false, or false things as true. In this signification error is nothing other than a false proposition, and thus it can be found not only in the matter of faith or Theology, but also in any natural or human matter whatever; but according to the common manner of speaking, error, as though by antonomasia, in each matter is accustomed to signify not any false judgment whatever, but, by a certain exaggeration, that which is more evidently or more certainly false." Suarez, De Fide, D. 19, S. 2, n. 11. Hence the same Suarez, discoursing concerning an erroneous proposition, insofar as it is distinguished from a heretical one in theological censures, says that it is one "which is opposed to a truth certain by theological certainty, which does not attain the certainty of faith; because in no way is it immediately revealed, as is supposed; but it is a conclusion evidently inferred from one proposition of faith and another evident by the natural light.... A proposition contrary to such a proposition does not attain the grade of a heretical proposition, because it does not have the highest opposition to a proposition of faith, such as an immediate one is. But that it is erroneous is manifest, because after a heretical proposition, it has the highest repugnance with the truth of faith, namely mediate, through evident inference." l. c. n. 14. The doctrine of Cardinal Lugo is the same, De Fide, D. 20, S. 3, n. 73: "The word error, taken most broadly, can be attributed to any false proposition in any matter; for he who believes the false as true errs from the true and is deceived. Commonly, however, that word is accustomed to be restricted to the false which is opposed not only to the true, but to the evident, or certain, which among all is commonly known certainly. Nor is any false opinion in Philosophy called error, but one which is opposed to a doctrine certain and received as such among philosophers. Wherefore in Theology only that is called error which is opposed to some certain truth which among Catholics and Theologians is held as certain." But insofar as error is a special censure below heresy, according to the same Lugo, "error properly is that which is opposed not immediately, but only mediately to the doctrine of faith, insofar as it immediately denies a proposition which is not of faith, but only a theological conclusion, evidently deduced from one proposition of faith and another evident by the light of nature." l. c. n. 78.

17. Wherefore if that censure, it cannot safely be taught, is taken altogether properly and strictly by reason of itself, according to the general rule of interpreting condemned propositions, the aforesaid opinion concerning craniotomy is a dangerous opinion, which namely cannot be taught without danger of error; but consequently it is also a dangerous opinion, which cannot be reduced to practice without danger of sin. But if the censure, it cannot safely be taught, is considered in the subject matter, that same opinion concerning craniotomy is simply false, and in this sense it can also be called not safe, dangerous, in the true and proper sense; for it contains an intrinsic and proximate danger of denying an evident, certain, and universally received truth, namely Thou shalt not kill.

18. The doctrine set forth in the present Commentary can be confirmed by another Response of the Holy Office, 14 Aug. 1889, which was published after the present Commentary had been issued. It is of the following tenor: "In Catholic schools it cannot safely be taught that the surgical operation which they call craniotomy is lawful, as was declared on 28 May 1884, nor any surgical operation directly killing of the fetus, or of the mother bearing it."

19. Lastly it must be noted that if craniotomy cannot safely be taught, neither can direct procurement of abortion be safely taught in the same circumstances. This follows by legitimate reasoning. For first, the arguments by which craniotomy was defended are the same as the arguments by which direct procurement of abortion is defended. Besides, it matters little whether the infant's head is cut apart or compressed, or the infant is infected with poison, or an immature fetus, by mere ejection from the maternal womb, directly and per se is deprived of the natural element altogether necessary to him for life. It is indeed the same thing to kill a man by iron, by poison, or by throwing him into fire or immersing him in water.

1. To all moral theologians the question concerning craniotomy is known, and known is the response which concerning it came forth from the Congregation of the Eminent Fathers of the S. R. and U. I. As soon as a response of this sort was published, doubt began to arise concerning its value, namely whether it really settled the controversy, and truly condemned the opinion concerning the lawfulness of that surgical operation. For there were not lacking, nor are there lacking, grave theologians who thought and still think that that decree has no other value except a merely disciplinary one, and that it does not render improbable the opposite opinion concerning the lawfulness of craniotomy. Therefore it will not be unpleasant to students of moral matters briefly to weigh the force of the aforesaid decree.

2. The preceding Response can be explained by a twofold consideration, extrinsic and intrinsic. Let us begin from the first. A similar question was proposed to the S. R. U. I. concerning Ontologism, namely: "whether the following propositions can safely be handed down:" there follow the seven known propositions concerning Ontologism. The Sacred Congregation, Feria IV, on the day 18 Sept. 1861, rescripted: "The Most Eminent and Most Reverend Lords, the vote of the Consultors having first been had, and all and singular of the propositions above enunciated having been maturely weighed, responded to the proposed doubt: Negatively," namely: that they cannot safely be handed down.

3. By this decree theologians and the Philosophers themselves understood a true condemnation and proscription of the doctrine. Wherefore those who were defending Ontologism attempted to show that in those seven condemned propositions there was not contained the doctrine of Ontologism which they themselves were maintaining, but another doctrine quite different. Cf. the little work of the most learned philosopher and theologian Joseph Kleutgen, L'Ontologismo e le sette tesi censurate dalla Sacra Inquisizione, Rome, with the types of La Civilta Cattolica, 1867, p. 10 ff.

4. Nor did private and public Professors alone interpret that decree in this way; but also the Roman Congregations themselves understood that decree in this sense, namely of true condemnation and proscription. These things are read in the Decree transmitted through the Most Eminent Card. Patrizi to the Most Eminent Cardinal Archbishop of Mechlin concerning the philosophical books of G. C. Ubaghs, decurial doctor in the University of Louvain. "Moreover, what already, as from my letters given to the individual Bishops in Belgium on the day 11 Oct. of the year 1864 they had reserved to themselves to be done, the aforesaid Cardinals undertook to examine other doctrines which are contained in the more recent editions of the works of the same author. And indeed they had to perceive that in those books are handed down doctrines plainly similar to some of the seven propositions... which the Supreme Congregation of the Holy Office on the day 18 Sept. of the year 1861 judged could not safely be handed down; ... hence it will be altogether necessary that not only those books and those similar to them be kept away from the Catholic University and from all Schools; but also," etc. Rome, 2 March 1866. Cf. the cited little work, p. 84 ff.

5. After the decree related in the preceding number, new doubts arose on the part of the defenders of Traditionalism and Ontologism. For they said that the decisions given were disciplinary, not doctrinal; that those things which had previously been handed down could not be taught, but could be kept in the heart; and that they were still probable and lawful. When these things had been denounced to the Supreme Pontiff by the Most Eminent Cardinal Archbishop of Mechlin and other Bishops of Belgium, by letters given 1 Aug. 1866, the Most Eminent Patrizi in the name of the Most Holy Father rescripted these things to them: "In the letters... given to Most Holy Pius IX, a judgment is sought from the Apostolic See concerning certain doubts stirred up... concerning the responses of the sacred Congregations of the Holy Office and of the Index, both in the year 1864 and in this year 1866, sanctioned by the authority of the Supreme Pontiff. But those doubts are not of such a sort as to require a new interpretation and declaration of a matter already defined: for to dissolve them utterly, through the very responses of the Sacred Congregations, more than enough is done. Indeed it has been heard not without admiration that doubts of this sort have been proposed.... Moreover, Catholic men, much more indeed ecclesiastics, have this duty, that they subject themselves fully, perfectly, and absolutely to the decrees of the Holy See, contentions being removed from the midst which would obstruct the sincerity of assent." Rome, on the day 30 Aug. 1866. Cf. the cited little work, p. 86-89.

6. The preceding letter having been received, the Most Eminent Cardinal Archbishop of Mechlin and other Bishops of Belgium, on the day 17 Dec. of the year 1866, gave letters to the Rector and Professors of the University of Louvain, in which, speaking of the resolution of both Congregations, of the Holy Office and of the Index, on the day 2 March of the year 1866, cf. above n. 5, they assert these things: "These decisions are so clear that the cause must be held as definitively decided. But we know that the most firm will of the Most Holy Lord is that, errors having been removed, all think the same. And so, that all dissensions may remain extinguished forever, and that in a question long agitated and now defined there may remain nothing to be wished for or expected, we send the formula of letters to be subscribed by all who either handed down the reprobated doctrines or adhered to the same in any way." But in the formula it is said: "To the decisions of the Holy Apostolic See of the day 2 March and 30 August of this year, 1866, cf. above nn. 4, 5, I submit myself fully, perfectly, and absolutely, and from the soul I acquiesce. And therefore from the heart I reprobate and reject whatsoever doctrine opposed," etc. Cf. cited little work, p. 90, 91.

7. The retractation of Ontologism, by force of the condemnation pronounced by the Holy Office, was required from Rev. Dr. Ugonin when he was proposed for the Episcopate. This was the formula of retractation: "Since I, the undersigned, have received from the Most Eminent and Most Reverend Lord Archbishop of Myra, Apostolic Nuncio in France, that the doctrine which I set forth in my philosophical work on Ontologism (Etudes philosophiques-Ontologie) is disapproved by the Holy Apostolic See, as especially either explicitly or implicitly favoring those propositions which the S. R. and U. I. C. in the year 1861 decreed could not safely be handed down; I myself, no delay having been interposed, freely and spontaneously declare that I hold and disapprove the aforesaid doctrine in precisely the same way as the Holy See has judged, as wandering more or less from sound principles of philosophy; and at the same time I promise that, as far as will be in me, I will take care in the future that it be no longer handed down in the schools. Given at Paris on the day 13 Oct. 1866." Cited little work, p. 15.

8. Therefore, if craniotomy has been condemned by the Holy Office in the same manner in which Ontologism was condemned, if parity stands for each condemnation, it plainly appears how great is the force of that juridical censure concerning craniotomy, it cannot safely be taught. Nor indeed should it be objected that not once but several times proscriptions and decisions intervened against Ontologism on the part of the Most Holy Congregations and of the Holy See itself, which has not yet been had against craniotomy. For those repeated proscriptions and decisions do nothing else than inculcate and confirm that first condemnation of the Holy Office on the day 18 Sept. 1861, by force of which the Most Eminent Card. Patrizi, in his Letter and Decree on the day 2 March 1866, pronounces books infected with that doctrine to be kept away from the University of Louvain and from all Schools, and the Most Reverend Bishops of Belgium hold the cause as definitively decided; and the cause also concerned Ontologism; and, errors having been removed, they exhort all to subscribe to sound doctrines.

9. We now make a step to the intrinsic consideration of the matter. That is called safe which is without danger. Therefore an opinion which cannot safely be taught is an opinion which cannot be taught without danger. And thus in the cited Decree of 2 March 1866, given through the Most Eminent Patrizi, after it had been affirmed that in the philosophical books of G. C. Ubaghs "doctrines plainly similar to some of the seven propositions... which the Supreme Congregation of the Holy Office on the day 18 Sept. of the year 1861 judged could not safely be handed down" are handed down, it is then said that in the same books there are found doctrines or opinions which cannot be handed down without danger.

10. Moreover this danger is the danger of error, if we wish to understand the mentioned decision of the Holy Office in its proper and obvious sense. For it is said that it cannot safely be taught, and danger in teaching some opinion, properly and in the obvious sense, is nothing other than the danger of error. Wherefore that Decree is not some mere disciplinary prohibition of teaching or handing down in public or even private schools that opinion; but it is a true doctrinal judgment concerning the truth and falsity of the same opinion, which consequently can no longer be handed down in any schools, but must be altogether kept away from them.

11. Nor indeed should it be said that this danger is to be understood from the subject matter, which is some practical thing. For the matter about which there is question is practical and most practical, but it is a matter not regarding ecclesiastical and positive discipline, but regarding morals and touching the natural law itself. Wherefore from the consideration of the subject matter it does not follow that that decree is merely disciplinary, but that it is doctrinal in a matter of morals. For that decree involves this in other words: that that opinion concerning craniotomy cannot be taught without danger of error in a matter of morals. Nor should it be urged by saying that it can very well happen that that opinion cannot be safely taught, even speaking speculatively, because practically someone could easily abuse it, by applying it badly to practical cases, and by not rightly distinguishing the cases in which it can lawfully be given to execution from the cases in which that would be altogether illicit. This objection has no force, for that confusion of the case of lawful application and the case of unlawful application is impossible, and thus that danger is not this danger, of badly applying practically the aforesaid opinion and of confounding case with case. For indeed the opinion concerning craniotomy has not been condemned in the abstract, considered according to itself and generally; but the opinion concerning craniotomy has been condemned in the concrete, according to determined circumstances and considered in particular. For the question proposed, which the Sacred Congregation resolved by its decision, is not: "Whether it can safely be taught in Catholic Schools that the surgical operation which they call Craniotomy is lawful," thus, generally; but in that peculiar and determined case concerning which there was question and controversy among theologians, "namely when, if it is omitted, the mother and child would perish, but if it is admitted, the mother would be saved, the infant perishing." In this case, surely, the doctrine concerning craniotomy is declared dangerous. Therefore the very application to a determined case is declared a dangerous doctrine; IT CANNOT SAFELY BE TAUGHT. Therefore that danger is not the danger of practical abuse, the danger of unlawful application, but it is the danger of error in the opinion enunciating the lawfulness of craniotomy in that aforesaid case.

12. But it is still objected that the aforesaid opinion could well be called not safe, although determined to that peculiar case concerning which there was question, because of the practical danger itself of discerning the case of true necessity, namely that, if craniotomy is omitted, the mother and child truly would perish, but if it is admitted, the mother truly would be saved, the infant perishing. This cannot reasonably be objected. For that case of necessity is supposed as certain in that proposition concerning the lawfulness of craniotomy. Only in such a hypothesis was the question made by Theologians and proposed to the Sacred Congregation, and the Sacred Congregation certainly understood it in this sense; for it says in its Response, "account also having been taken of those things which in this matter were written by expert Catholic men and transmitted by Your Eminence to this Congregation." Besides, that objection would then have force when that case of necessity were truly difficult to know; but where craniotomy is concerned the matter is most clear and subject to no difficulty, unless the Surgeon is wholly stupid, which is accidental and is not attended to in the condemnation of a general proposition. For the matter is considered in itself.

13. Danger is one thing intrinsic, another extrinsic; and likewise one is proximate, another remote. The danger of error in asserting the lawfulness of craniotomy cannot be from a circumstance extrinsic to craniotomy itself, insofar as it is applied in such circumstances of things as render it unlawful. For, as has just been observed, what is condemned is not the lawfulness of craniotomy in general, but the lawfulness of craniotomy in the stated circumstance of the death of the mother and child, if that operation is omitted, and of the safety of the mother and death of the child, if it is done. Moreover, if any circumstance can be thought up which could render craniotomy lawful, this plainly is no other than the one just enunciated, since without that operation neither mother nor child is saved, while, when it is applied, the child is not placed in a worse condition and the mother is saved. But the Holy Office, in this very case, declares it dangerous to teach the lawfulness of craniotomy. Therefore the danger of error is intrinsic to craniotomy itself; namely because it is the direct killing of an innocent person. The danger of error is intrinsic to the complex itself, that is, to craniotomy clothed with the aforesaid circumstance; for in that complex craniotomy remains with its whole nature, which is not changed in the least by that maximally favorable circumstance. But if the danger of error is intrinsic, namely by force of craniotomy itself, consequently that danger of error cannot be remote, but proximate and most proximate; for nothing is more proximate to any thing than its intrinsic and innermost nature. Therefore the lawfulness of craniotomy cannot be taught without proximate and intrinsic danger of error.

14. An action which is a danger of sin is an action distinct from the action itself of sin, and is sin not properly and strictly speaking by reason of itself, but by reason of that action sinful in itself with which it is connected. Likewise an opinion containing danger of error is an opinion distinct from another certain and unshaken doctrine against which that opinion contains the danger of erring, and thus is connected with it insofar as it is opposed to it. Therefore, generally and speaking in itself, an opinion which cannot safely be taught, or which contains danger of error, is an opinion which, although it is not in itself error, nevertheless is connected with error; at least insofar as of itself and in the obvious sense, and not accidentally from mere inconsideration, it so labors under equivocation between error and truth that by an easy way it turns aside toward error rather than toward truth, and one who adheres to it is judged to embrace error indeed, not truth. Nevertheless, when from the subject matter a proposition is so determined that no way lies open to truth, although it is defined merely as not safe, and by reason of the note itself or censure cannot be held except as merely dangerous, or containing danger of error, consequently that proposition must nevertheless be held as error, namely by reason of legitimate deduction. And hence it is easily explained why, although those seven propositions of Ontologism were not marked with any other censure than that they cannot safely be handed down, nevertheless in the Schools they have commonly been held as altogether improbable after that Decision of the Holy Office. The same seems to happen in our case. For no true sense can be thought up, since in the very case most favorable it is said that it cannot safely be taught. Wherefore it does not appear how craniotomy can still be defended probably.

15. That adverb, safely, can be explained in another way; but the conclusion is nearly the same. That adverb can be resolved into an adjective, and then the substantive understood under it is to be sought. Moreover this substantive, which can be thought up more favorably in the present matter, is conscience; so that it cannot safely be taught is the same as it cannot be taught with a safe conscience. This interpretation, which pertains most greatly to a moral and practical matter, seems altogether to agree with the decision of the Holy Office which we are treating; for in it there is question of a moral and practical matter. Moreover, in Moral matters, that opinion is called safe which someone can follow practically without danger and fear of violating some precept or some law. Likewise in a moral matter an opinion is called safe in the merely speculative order which someone can hold in the mind and teach externally to others without danger and fear of erring against some certain law or precept. In our case that certain and unshaken law is the law, Thou shalt not kill. Wherefore that craniotomy in that case set forth above cannot safely be taught is the same as that craniotomy cannot be taught without danger and fear of error against the law, Thou shalt not kill. But this danger and fear of error would then remain on the part of the thing a mere danger of error, and would not consequently become error, if a case could be given in which the law Thou shalt not kill was in reality not infringed. But here this case cannot be given. For if this case were given, it would be no other than the proposed case itself. But that proposed case would then on the part of the thing remain a mere danger of error, and would not become error, directly against that law Thou shalt not kill, since it would not yet be ultimately determined by every favorable circumstance, and could still be further determined. Therefore, although by force of the condemnation that opinion is only a doctrine not safe, nevertheless in reality by force of the matter that opinion becomes altogether improbable.

16. But someone will ask why then the Holy Office negatively said that sentence was not safe, and did not positively say that it was erroneous, if not safe is in reality the same as erroneous? It is responded, first: it did not say this, because this was not asked, but that; and Sacred Congregations respond with customary formulas to proposed doubts, nor are they accustomed in their brief responses to make a treatment of the matter about which there is question, so as to set it forth and explain it. It is responded, secondly: although the sentence not safe in our case falls back in reality, by reason of the matter, by legitimate conclusion, into an erroneous or false sentence, nevertheless that theological censure, not safe, is not the same as the other censure: erroneous or error, which is a far graver censure. We contend for the former, not the latter. But we say erroneous or false also to restrict the signification of error, since strictly speaking error and false are not the same. "From Augustine, in the Enchiridion, ch. 17, and Contra Academicos, ch. 4, to err is nothing other than to approve true things for false, or false things for true. In this signification error is nothing other than a false proposition, and so it can be found not only in the matter of faith or Theology, but also in any natural or human matter: but according to the common manner of speaking, error, as it were by antonomasia, is accustomed in each matter to signify not just any false judgment, but, by a certain exaggeration, that which is more evidently or more certainly false." Suarez, De Fide, D. 19, S. 2, n. 11. Hence the same Suarez, discoursing on an erroneous proposition, as it is distinguished from a heretical one in theological censures, says that it is one "which is opposed to a truth certain by theological certitude, which does not attain the certitude of faith; because it is in no way immediately revealed, as is supposed, but is a conclusion evidently inferred from one proposition of faith and from another evident by the natural light.... A proposition contrary to such a proposition does not attain the grade of a heretical proposition, because it does not have the highest opposition with a proposition of faith, such as immediate opposition is: but that it is erroneous is manifest; because after a heretical proposition, it has the highest repugnance with the truth of faith, namely mediate through evident inference." l.c., n. 14. The doctrine of Cardinal Lugo, De Fide, D. 20, S. 3, n. 73, is the same. "The word error, taken most broadly, can be attributed to any false proposition in any matter; for he who believes the false as true errs from the true and is deceived. Commonly, however, that word is accustomed to be restricted to the false which is opposed not only to the true, but to the evident or certain, which among all is commonly known certainly. Nor in Philosophy is just any false opinion called error, but one which is opposed to a certain dogma and received as such among philosophers. Wherefore in Theology that will not be called error unless it is opposed to some certain truth which is held as certain among Catholics and Theologians." But insofar as error is a special censure below heresy, according to the same Lugo, "error properly is that which is not opposed immediately, but only mediately to the doctrine of faith, insofar as it immediately denies a proposition which is not of faith, but only a theological conclusion, evidently deduced from one proposition of faith and another evident by the light of nature." l.c., n. 78.

17. Wherefore if that censure, it cannot safely be taught, is taken altogether properly and strictly by reason of itself, according to the general rule of interpreting condemned propositions, the aforesaid opinion concerning craniotomy is a dangerous opinion, which namely cannot be taught without danger of error; consequently, moreover, it is also a dangerous opinion, which cannot be reduced to practice without danger of sin. But if the censure, it cannot safely be taught, is considered in the subject matter, that same opinion concerning craniotomy is simply false, and in this sense can also be called not safe and dangerous in the true and proper sense; for it contains an intrinsic and proximate danger of denying a truth, evident, certain, received by all; namely, Thou shalt not kill.

18. Finally it must be noted that if craniotomy cannot safely be taught, neither can the direct procurement of abortion in the same circumstances be safely taught. This follows by legitimate reasoning. For first, the arguments by which craniotomy was defended are the same as the arguments by which the direct procurement of abortion is defended. Besides, it matters little whether the infant's head is cut or compressed, or whether the infant is infected with poison, or an immature fetus by mere ejection from the maternal womb is directly and of itself deprived of the natural element altogether necessary to it for life. It is surely the same thing to kill a man by steel, poison, or projection into fire, or immersion into water.

72. IV. On abortion and craniotomy². It is known that voluntary destruction of the fetus flourished among the Pagans; but the Christian religion, zealous for human life and the salvation of infants, strictly prohibited it as true homicide. Yet in our days not a few physicians have attempted to make honorable abortion and embryotomy or craniotomy (i.e., the destruction of a living fetus)³, at least in the case in which the life of the mother otherwise cannot be saved. Now as regards abortion, the violent ejection of an immature fetus, at the time when it cannot live outside the uterus, must be distinguished from acceleration of childbirth, which takes place when the fetus, already conceived for seven months, can live outside the uterus. - These things being posited, we set forth the responses of the Congregations on this matter:

² Eschbach, op. cit., pp. 273-286; 381-476; Surbled, op. cit., vol. II, p. 184-258; Dissez, Craniotomy from the theological point of view.

³ Embryotomy etymologically means the cutting of the embryo, craniotomy the cutting of the skull or head.

73. (A) On craniotomy. In the year 1884, on May 28, the Holy Office recalled for examination the doubt proposed by Cardinal Caverot: "Whether it can safely be taught in Catholic schools that the surgical operation which they call craniotomy is licit, namely when, it being omitted, the mother and son would perish, but on the contrary, it being admitted, the mother would be saved, the infant perishing"; it judged that it must be answered: that it cannot safely be taught⁴. But when there was dispute concerning the sense and extension of this decree, especially in the Catholic Faculty of Lille, the Archbishop of Cambrai proposed new doubts concerning certain surgical operations akin to craniotomy; after three years, the Holy Office, on August 14, 1889, confirmed the first response, and declared that it cannot safely be taught that "any surgical operation directly killing the fetus or the pregnant mother" is licit⁵.

⁴ Apud Eschbach, op. cit., p. 461-462; Acta S. Sedis, XVII, p. 556.

⁵ Eschbach, p. 464-467; Acta S. Sedis, XXII, p. 748.

c) Medical science has devised certain artificial means for saving the life of both mother and child, or at least that of the mother, in cases where, on account of some physical obstruction, normal delivery is impossible. Such means are: medical abortion, artificially produced premature delivery, perforation, the Cesarian section, laparotomy, and symphyseotomy.¹²

¹² On these operations, see A. O’Malley, The Ethics of Medical Homicide, passim, N. Y. 1919.

The S. Congregation of the Penitentiary, on Nov. 28, 1872, replied evasively to the question whether “the operation called craniotomy, or a similar operation aiming directly at the killing of the child in its mother’s womb were ever permissible,”¹³ but the Holy Office declared on May 28, 1884, that the permissibility of craniotomy “tuto doceri non posse,” i. e., cannot be safely taught in Catholic schools or practiced without danger of sin. This decision was followed by two others of the same S. Congregation, dated respectively, Aug. 13, 1889, and July 29, 1895, by which this prohibition was extended so as to include “all surgical operations aiming directly at the killing of the fetus or the mother.”¹⁴ The S. Congregation in making this decision had before it a case in which craniotomy (perforation) was the sole means of saving the mother.¹⁵ Hence the following principles must guide us in the moral appraisal of this obstetrical operation:¹⁶

¹³ S. Poenitentiario, decree of 28 Nov., 1872: “Having maturely considered the propositions, he answered: let approved authors, whether old or more recent, be consulted, and let it be done prudently.”

¹⁴ Denzinger-Bannwart, n. 1889 sq.; Cfr. Chas. Coppens, S. J., Moral Law and Medical Practice, ed. Spalding, N. Y. 1922, pp. 58 sqq.

¹⁵ “When, namely, if it [craniotomy] is omitted, mother and child are going to perish, but if it is admitted, the mother is to be saved while the infant perishes.”

¹⁶ Capellmann, Medicina Past., 5th ed., Aix-la-Chapelle 1893; B. M. Bergervoort, Direkter Abortus und Kraniotomie und deren Erlaubtheit, Munich 1896; F. Guermonprez, L’Assassinat Médical et le Respect de la Vie Humaine, Paris 1904; Chas. Coppens, S. J., Moral Law and Medical Practice, ed. Spalding, New York 1922; Stöhr-Kannamüller, Handbuch der Pastoralmedizin, 5th ed., pp. 461 sqq.; Antonelli, Medicina Past., Vol. II, 3rd ed., pp. 55 sqq.; A. Klarmann, The Crux of Pastoral Medicine, New York 1920.

α) Artificial or medical abortion (abortus medicinalis), i. e., the ejection from the womb of an immature fetus or a fertilized but not yet viable embryo,¹⁷ is direct homicide and, therefore, a grievous crime against the fifth commandment. Abortion is, moreover, a more or less dangerous attack upon the life of the mother, and therefore an attempt upon two lives at once. Modern gynecology knows of but two diseases in which abortion may be indicated as a last resort.¹⁸ The causes of the first may be removed by the administration of chloroform, while the second (hyperemesis gravidarum), usually the result of hysteria, is of rare occurrence and as a rule not only ceases about the middle of the gestation period, but can be cured by rational therapy. Hence the first duty of the physician in such cases is to endeavor to remove the underlying causes. Abortion should be avoided for the additional reason that it is a very doubtful means, to say the least, of saving the life of the mother.

¹⁷ O’Malley, The Ethics of Medical Homicide, pp. 91 sqq.

¹⁸ J. P. Gury, Comp. Theol. Mor., Vol. I, n. 414: “Sometimes it is permitted indirectly to procure or permit abortion, namely, by administering to a mother suffering from a serious disease remedies harmful to the fetus, if the following conditions occur: 1. That it be a matter of a fatal disease; 2. That the remedies harmful to the fetus be directly and immediately efficacious of themselves for curing the disease; 3. That there be no hope of procuring eternal life for that fetus through Baptism. . . . It is permitted for physicians to give a pregnant woman suffering 18 suffering from most remedies customarily used for various diseases, although abortion can sometimes follow. The reason is that experience shows that abortion very rarely follows from most properly directed remedies.”—Ibid., n. 415: “It is not permitted for a pregnant mother, even in certain danger of death, to take, or even to give her, a medicine which by its own force is directed to the ejection of the fetus, although the death of both would certainly occur if it were not administered, and on the contrary she would certainly or probably be saved if it were administered. The reason is that abortion would be directly procured. . . . It is permitted for a physician to administer a remedy directed of itself to curing the mother’s disease, if it is certain that, if the remedy is not given, both the mother otherwise destined to die and the fetus will perish without Baptism, because thus both mother and fetus are assisted in the best way possible; but very rarely will there be certainty about both. But if the danger of abortion is equal whether the remedy is taken or not, it is lawful to take it, because the mother’s life is cared for without greater danger to the fetus.”

Indirect abortion, on the other hand, is permissible in certain cases, i. e., if it results accidentally from the application of remedies which are per se intended and apt to cure the mother. It is permissible, therefore, in the treatment of pregnant women who are suffering from a disease, even if there is no immediate danger of death, to employ internal or external remedies which, in the common experience of the medical profession, are necessary or apt to cure the disease from which the mother is suffering, even though they may accidentally cause abortion.¹⁹

¹⁹ Gury, Comp. Theol. Mor., Vol. I, n. 415, 2: “It is not permitted for physicians or midwives, when a woman is pregnant, to kill the fetus in order to free the mother from death.”

When there is immediate danger of death, such means may be used as will be necessary to cure the mother, even though it were certain or highly probable that abor- tion would follow, provided there is no other effective remedy to save the mother and all possible precautions are taken to prevent abortion.

β) It is lawful to induce premature delivery by artificial means as soon as the fetus is viable, i. e., so far developed that it can live outside the womb. However, this operation may endanger the lives of both mother and child, and should, therefore, be resorted to only in urgent cases. Such an emergency would arise if the birth of the child at the end of the full period would necessitate a still more dangerous operation, or if the mother were suffering from a serious illness that could probably be cured by inducing a premature delivery. Though the latter process may not entirely comply with the final object of delivery, i. e., to bring into the world a fully developed and healthy child, it at least involves no direct destruction of life and makes possible the administration of Baptism in case the child should die.

γ) Obstetrical operations that result in the destruction of the life of the child (craniotomy, cranioclasy, cephalotripsis, embryotomy [decapitation or exenteration]) are directly homicidal and therefore absolutely forbidden. Though the resultant death of the mother is not attributed to the operation, but to the disease which the operation was designed to cure, there is always involved a certain danger to the mother from the careless use of instruments or some other accident. If the fetus is dead, there is no objection to craniotomy. In case of doubt whether the fetus is dead or alive, the physician may operate if the mother’s life is in danger. In this extremely delicate question the principle of self-defense in the strict sense cannot be invoked in favor of the mother. However, the physician may consider himself in a state of perplexity from which he can extricate himself only by choosing the safer side, i. e., by saving the certain life of the mother. Besides he would make himself liable to prosecution if he omitted to use the means prescribed for such cases in the current text-books on obstetrics.²⁰

²⁰ P. A. Finney, C. M., Moral Principles in Hospital Practice, St. Louis, Mo., 1922; O’Malley, The Ethics of Medical Homicide, pp. 92 sqq.; Coppens, Moral Principles and Medical Practice, pp. 62 sqq.

δ) The so-called Cesarian section (sectio caesarea), which consists in cutting open the womb (incisio ventris) to extract a fetus that cannot be delivered in the natural way, is in itself an immediate attack upon the life of both mother and child but its technique has been so perfected that it is no longer as hazardous as it used to be and may, therefore, be permitted, provided the danger to the mother is not so immediate that the operation would mean almost certain death. All possible precautions must moreover be taken to safeguard the lives of both mother and child.²¹ Note, however, that the favorable results referred to have for the most part been achieved in a comparatively small number of hospitals and clinics and that the percentage of mortality still remains rather high. The ordinary practitioner, according to Dr. O’Malley, is utterly unfitted to do a Cesarian section of any kind.²²

²¹ S. C. Offic., d. d. 4 May 1898: “1. Is acceleration of delivery permitted whenever, because of the narrowness of the woman, the exit of the fetus at its natural time would become impossible? 2. And if the woman’s narrowness is such that even premature delivery is judged impossible, will it be permitted to provoke abortion or to perform a Caesarean operation at the proper time? 3. Is laparotomy permitted when the case concerns extrauterine pregnancy or ectopic conceptions? Reply to 1: Acceleration of delivery is not in itself unlawful, provided that it is performed for just causes and at the time and in the ways by which, according to ordinary contingencies, provision is made for the life of the mother and fetus; to 2: As regards the first part, negatively, according to the decree of Wednesday, July 24, 1895, concerning the unlawfulness of abortion. As regards the second, nothing stands in the way, since the woman in question may be subjected to a Caesarean operation at the proper time; to 3: Under compelling necessity laparotomy is permitted for extracting ectopic conceptions from the mother’s womb, provided that, so far as possible, serious and timely provision is made for the life of both fetus and mother.”—Cfr. Knapp, Theologie und Geburtshilfe, pp. 70 sqq.

²² The Ethics of Medical Homicide, p. 138.

Porro’s operation, so-called, consists in the removal of the uterus after a Cesarian section to prevent further conceptions, and is altogether unjustifiable.²³

²³ O’Malley, Essays in Pastoral Medicine, p. 59.

As regards the Cesarian section, a mother is, broadly speaking, not obliged to submit to it and should be counseled to do so only in view of the eternal salvation of her child. This consideration must not, however, always be urged in praxi, because it might lead to the commission of a mortal sin and consequently bring about the eternal loss of the mother.

If a mother dies in the state of pregnancy, the Cesarian section should, if possible, be performed on the corpse, to save the eternal and perhaps also the temporal life of the child.²⁴

²⁴ Rit. Rom., tit. II, c. 1, n. 17: “If a pregnant mother has died, the fetus should be carefully extracted as soon as possible and, if it is alive, baptized.”—S. C. Offic., d. d. 13 Dec., 1899.—Cfr. Stöhr-Kannamüller, Handbuch der Pastoralmedizin, 5th ed., pp. 473 sqq.; Antonelli, Medicina Past., Vol. II, 3rd ed., pp. 71 sqq.

ε) Symphyseotomy (sectio symphyseos) is a cutting of the maternal pelvic girdle through the symphysis pubis, the rigid joint at the front middle part of the pelvis, thus letting the bony girdle dilate. It has latterly been replaced by hebosteotomy or pubiotomy (a sawing through that joint to effect the dilation) because the rate of mortality is somewhat lessened by the latter method.²⁵ Both operations are to be judged in the same light as the Cesarian section, that is to say, they are licit only when they do not involve direct homicide.

²⁵ O’Malley, The Ethics of Medical Homicide, p. 135.

Gentlemen:—In my first lecture I proved to you the existence and the binding power of a higher law than that of human legislators, namely, of the eternal law, which, in His wisdom, the Creator, if He created at all, could not help enacting, and which He is bound by His wisdom and justice to enforce upon mankind.

We are next to consider what are the duties which that higher law imposes upon the physician. In this present lecture I will confine myself to one duty, that of respect for human life.

A duty is a bond imposed on our will. God, as I remarked before, imposes such bonds, and by them He directs free beings to lead worthy lives. As He directs matter by irresistible physical laws, so He directs intelligent and free beings by moral laws, that is, by laying duties or moral bonds upon them, which they ought to obey, which He must require them to obey, enforcing His commands by suitable rewards and punishments. Thus He establishes and enforces the moral order.

Now the duties He lays upon us are of three classes. First, there are duties of reverence and honor towards Himself as our sovereign Lord and Master. These are called the duties of Religion, the study of which does not belong to Medical Jurisprudence. The other classes of duties regard ourselves and our fellow-men, with these we are to deal in our lectures.

I. Order requires that the meaner species of creatures shall exist for the benefit of the nobler; the inert clod of earth supports vegetable life, the vegetable kingdom supplies the wants of animal life, the brute animal with all inferior things subserves the good of man; while man, the master of the visible universe, himself exists directly for the honor and glory of God. In this beautiful order of creation, man can use all inferior things for his own benefit.

This is what reason teaches concerning our status in this world; and this teaching of reason is confirmed by the convictions of all nations and all ages of mankind. The oldest page of literature that has come down to us, namely, the first chapter of the first book of Holy Writ, lays down this same law, and no improvement has been made in it during all subsequent ages. Whether we regard this writing as inspired, as Christians and Jews have always done, or only as the testimony of the most remote antiquity, confirmed by the acceptance of all subsequent generations, it is for every sensible man of the highest authority.

Here is the passage: “God said, Let us make man to our image and likeness; and let him have dominion over the fishes of the sea, and the fowls of the air, and the beasts, and the whole earth, and every creeping creature that creepeth upon the earth.” And later on in history, after the deluge, God more explicitly declared the order thus established, saying to Noe and his posterity: “Every thing that moveth and liveth shall be meat for you; even as the green herbs have I delivered them to you.” But He emphatically adds that the lives of men are not included in this grant; they are directly reserved for His own disposal. “At the hand of every man,” He says, “will I require the life of man.”

All things then are created for man; man is created directly for God, and is not to be sacrificed for the advantage of a fellow-man. Thus reason and Revelation in unison proclaim that we can use brute animals as well as plants for our benefit, taking away their lives when it is necessary or useful to do so for our own welfare; while no man is ever allowed to slay his fellow-man for his own use or benefit: “At the hand of every man will I require the life of man.”

II. The first practical application I will make of these general principles to the conduct of physicians is this: a physician and a student of medicine can, with a safe conscience, use any brute animal that has not been appropriated by another man, whether it be bug or bird or beast, to experiment upon, whatever specious arguments humane societies may advance to the contrary. Brute animals are for the use of man, for his food and clothing, his mental and physical improvement, and even his reasonable recreations. Man can lawfully hunt and fish and practise his skill at the expense of the brute creation, notwithstanding the modern fad of sentimentalists. The teacher and the pupil can use vivisection, and thus to some extent prolong the sufferings of the brute subject for the sake of science, of mental improvement, and intelligent observation. But is not this cruelty? and has a man a right to be cruel? No man has a right to be cruel; cruelty is a vice, it is degrading to man’s noble nature. But vivisection practised for scientific purposes is not cruel. Cruelty implies the wanton infliction of pain: there are people who delight in seeing a victim tortured; this is cruelty or savagery, and is a disgrace to man. Even to inflict pain without benefit is cruel and wrong; but not when it is inflicted on the brute creation for the benefit of man, unless the pain should be very great and the benefit very small. Certainly it is right to cultivate habits of kindness even to animals; but this matter must not be carried to excess.

The teaching of humane societies condemning all vivisection is due to the exaggeration of a good sentiment and to ignorance of first principles. For they suppose that sufferings inflicted on brute animals are a violation of their rights. Now we maintain that brute animals have no rights in the true sense of the word. To prove this thesis we must explain what a right is and how men get to have rights. A right is a moral claim to a thing, which claim other persons are obliged to respect. Since every man has a destiny appointed for him by his Creator, and which he is to work out by his own acts, he must have the means given him to do so. For to assign a person a task and not to give him the means of accomplishing it would be absurd. Therefore the Creator wants him to have those means, and forbids every one to deprive him of those means. Here is the foundation of rights. Every man, in virtue of the Creator’s will, has certain advantages or claims to advantages assigned him which no other man may infringe. Those advantages and claims constitute his rights, guaranteed him by the Creator; and all other men have the duty imposed on them to respect those rights. Thus rights and duties are seen to be correlative and inseparable; the rights lodged in one man beget duties in other men. The same Creator that assigns rights to one man lays upon all others duties to respect those rights, that thus every free being may have the means of working out its Heaven-appointed destiny.

Thus it is apparent that rights and duties suppose free beings, persons; now an irrational animal is not a person; it is not a free being, having a destiny to work out by its free acts; it is therefore incapable of having duties. Duties are matters of conscience; therefore they cannot belong to the brute animal; for it has no conscience. And, since rights are given to creatures because of the duties incumbent on them, brute animals are incapable of having rights. When a brute animal has served man’s purpose, it has reached its destiny.

III. But it is entirely different with man: there is what we may call an infinite distance between man and brute. Every man is created directly for the honor and service not of other men, but of God Himself: by serving God man must work out his own destiny—eternal happiness. In this respect all men are equal, having the same essence or nature and the same destiny. The poor child has as much right to attain eternal happiness as the rich child, the infant as much as the gray-bearded sire. Every one is only at the beginning of an endless existence, of which he is to determine the nature by his own free acts. In this infinite destiny lies the infinite superiority of man over the brute creation.

That all men are equal in their essential rights is the dictate of common-sense and of sound philosophy. This truth may not flatter kings and princes; but it is the charter of human rights, founded deeper and broader in nature and on the Creator’s will than any other claim of mankind. As order requires the subordination of lower natures to higher, so it requires equality of essential rights among beings of the same nature. Now all men are of the same nature, hence they have all the same essential rights.

If any people on earth must stand by these principles, certainly the American people must do so; for we have put them as the foundation-stones of our civil liberty. There is more wisdom than many, even of its admirers, imagine in the preamble to our Declaration of Independence; upon it we are to base the most important rights and duties which belong to Jurisprudence. The words of the preamble read as follows: “We hold these truths as self-evident, that all men are created equal; that they are endowed by their Creator with certain inalienable rights; that among these are life, liberty, and the pursuit of happiness.” I feel convinced, gentlemen, and I will take it for granted henceforth, unless you bring objections to the contrary, that you all agree with me on this important point that every man has a natural right to his life, a right which all other men are solemnly bound to respect. It is his chief earthly right. It is called an inalienable right; by which term the fathers of our liberty meant a right which under no circumstances can be lawfully disregarded. A man who takes it upon himself to deprive another of life commits two grievous wrongs: one towards his victim, whose most important right he violates, and one towards God, who has a right to the life and service of His creatures. “Thou shalt not kill” is a precept as deeply engraven on the human heart by reason itself as it was on the stone tables of the Ten Commandments by Revelation.

So far we have chiefly considered murder as a violation of man’s right to his life. We must now turn our attention to God’s right, which the murderer violates. It may indeed happen that a man willingly resigns his right to live, that he is tired of life, and longs and implores for some one to take it away. Can you then do it? You cannot. His life does not belong to him alone, but to God also, and to God principally; if you destroy it, you violate God’s right, and you will have to settle with Him. God wills this man to live and serve Him, if it were only by patient endurance of his sufferings.

For a man may be much ennobled and perfected by the practice of patience under pain and agony. Some of the noblest characters of history are most glorious for such endurance. The suicide rejects this greatness; he robs God of service and glory, he rebels against his Creator. Even Plato of old understood the baseness of suicide, when he wrote in his dialogue called “Phædon” that a man in this world is like a soldier stationed on guard; he must hold his post as long as his commander requires it; to desert it is cowardice and treachery; thus, he says, suicide is a grievous crime.

This being so, can a Doctor, or any other man, ever presume to contribute his share to the shortening of a person’s life by aiding him to commit suicide? We must emphatically say No, even though the patient should desire death: the Doctor cannot, in any case, lend his assistance to violate the right and the law of the Creator: “Thou shalt not kill.”

I have no doubt, gentlemen, that some of you have been saying to yourselves, Why does the lecturer insist so long upon a point which is so clear? Of course, none of us doubts that we can in no case aid a patient to commit suicide. My reason for thus insisting on this matter is that here again we are dealing with a living issue. There are to-day physicians and others who deny this truth, not in their secret practice only, but, of late, to justify their conduct, they have boldly formulated the thesis that present apparent expediency can lawfully be preferred to any higher consideration. Here is the fact. At a Medico-Legal Congress, held in the summer of 1895, Dr. Bach, one of its leading lights, openly maintained it as his opinion that “Physicians have the moral right to end life when the disease is incurable, painful, and agonizing.”

What his arguments were in support of his startling proposition, I have not been able to learn. But I know that a cry of horror and indignation has gone up from many a heart. Many have protested in print; but unless, on an occasion like this, moralists raise their voice against it with all the influence which sound principles command, the saying of Dr. Bach may at least shake the convictions of the rising generation of physicians. The only argument for Dr. Bach’s assertion that I can imagine—and it is one proceeding from the heart rather than the head—is that it is cruel to let a poor man suffer when there is no longer hope of recovery. It is not the Physician that makes him suffer; it is God who controls the case, and God is never cruel.

He knows His own business, and forbids you to thwart His designs. If the sufferer be virtuous, God has an eternity to reward his patient endurance; if guilty, the Lord often punishes in this world that He may spare in the next. Let Him have His way, if you are wise; His command to all is clear, “Thou shalt not kill.”

One rash utterance, like that of Dr. Bach, can do an incalculable amount of harm. Why, gentlemen, just think what consequences must follow if his principle were, admitted! For the only reason that could give it any plausibility would be that the patient’s life is become useless and insupportable. If that were a reason for taking human life away, then it would follow that, whenever a man considers his life as useless and no longer supportable, he could end it, he could commit suicide. That reasoning would practically justify almost all suicides. For, when people kill themselves, it is, in almost all cases, because they consider their lives useless and insupportable. Whether it results from physical or from moral causes that they consider their life a burden, cannot, it seems to me, make any material difference; grief, shame, despair are as terrible sufferings as bodily pains. If, then, we accept Dr. Bach’s principle, we must be prepared for all its baneful consequences.

IV. But are there no exceptions to the general law, “Thou shalt not kill”? Are there no cases in which it is allowed to take another’s life? What about justifiable homicide? There are three cases of this nature, gentlemen; namely, self-defence, capital punishment inflicted by the state, and active warfare. With only one of these can a physician, as such be concerned or think himself concerned. He is not a public hangman executing a sentence of a criminal court; nor is he acting as a soldier proceeding by public authority against a public foe. As to the plea of self-defence, it must be correctly understood, lest he usurp a power which neither human nor divine law has conferred upon him.

1. Self-defence. It is a dictate of common-sense, already quoted by Cicero as a universally received maxim of Jurisprudence in his day, that it is justifiable to repel violence by violence, even if the death of our unjust assailant should result. In such a case, let us consider what really takes place. A ruffian attempts to take away my life; I have a right to my life. I may, therefore, protect it against him; and, for that purpose, I may use all lawful means. A lawful means is one that violates no law, one that I may use without giving any one reasonable ground of complaint. Suppose I have no other means to protect my life than by shooting my aggressor; has he a right to complain of my conduct if I try to do so? No, because he forces me to the act; he forces me to choose between my life and his. Good order is not violated if I prefer my own life: well-ordered charity begins at home. But is not God’s right violated? It is; for God has a right to my life and to that of my assailant. The ruffian who compels me to shoot him is to blame for bringing both our lives into danger; he is responsible for it to God. But the Creator will not blame me for defending my life by the only means in my power, and that when compelled by an unjust assailant, who cannot reasonably find fault with my conduct.

But it may be objected that no evil act may be done to procure a good result, that a good end does not justify a bad means. That is a correct principle, and we will consider it carefully some other day. But my act of necessary self-defence is not evil, and therefore needs no justification; for the means I employ are, under the circumstances, well-ordered and lawful means, which violate no one’s rights, as has just been shown. Of course the harm I do to the aggressor is just only in as far as it is strictly necessary to defend the inalienable right I have to life or limb or very valuable property. Hence I must keep within the just limits of self-defence. To shoot an assailant, when I am in no serious danger, or when I can free myself some other way, or when I act through malice, would not be self-defence, but unjustifiable violence on my part.

2. The principles that make it lawful for a man to defend his own life with violence against an unjust assailant will also justify a parent in thus defending his children, a guardian his wards; and in fact any one may forcibly defend any other human being against unjust violence. A parent or guardian not only can, but he is in duty bound to, defend those under his charge by all lawful means. Similarly the physician would be obliged to defend his patient by the exercise of his profession in his behalf.

Now the only case in which the need of medical treatment against unjust aggression could become a matter for discussion in Jurisprudence is the case of a mother with child. Is the child under those circumstances really an unjust aggressor? Let us study that important case with the closest attention. Let all the rays of light we have gathered so far be focussed on this particular point. Can a physician ever be justified in destroying the life of a child, before or during its birth, by craniotomy or in any other manner, in order to save its mother’s life, on the plea that the child is an unjust assailant of the life of its mother? Put the case in a definite shape before you. Here is a mother in the pangs of parturition. An organic defect, no matter in what shape or form, prevents deliverance by the ordinary channels. All that medical skill can do to assist nature has been done. The case is desperate. Other physicians have been called in for consultation, as the civil law requires before it will tolerate extreme measures. All agree that, if no surgical operation is performed, both mother and child must die. There are the Cæsarian section, the Porro operation, laparotomy, symphysiotomy, all approved by science and the moral law. But we will suppose an extreme case; namely, the circumstances are so unfavorable for any of these operations—whether owing to want of skill in the Doctors present, or for any other reason—that none can safely be attempted; any of them would be fatal to the mother.

In this extreme case of necessity, can the Doctor break the cranium of the living child, or in any way destroy its life with a view to save the mother? If three consulting physicians agree that this is the only way to save her, he will not be molested by the law courts for performing the murderous operation. But will the law of nature and of nature’s God approve or allow his conduct? This is the precise question under our consideration. We have seen that the infant, a true human being, has a right to live, as well as its mother. “All men are created equal, and have an equal right to life,” declares the first principle of our liberty. The Creator, too, as reason teaches, has a clear right to the child’s life; that child may answer a very special purpose of Providence. But whether it will or not, God is the supreme and the only Master of life and death, and He has laid down the strict prohibition, “Thou shalt not kill.”

Now comes the plea of self-defence against an unjust aggressor. If the child is such, if it unjustly attacks its mother’s life, then she can destroy it to save herself, and her physician can aid the innocent against the guilty party. But can it be proved that the infant is an unjust aggressor in the case? There can be no intentional or formal guilt in the little innocent babe. But can we argue that the actual situation of the child is an unjust act, unconsciously done, yet materially unjust, unlawful? Thus, if a madman would rush at me with a sharp sword, evidently intent on killing me, he may be called an unjust aggressor; though, being a raving maniac, he does not know what crime he is committing, and is formally innocent of murderous intent. Materially considered, the act is unjust, and I can defend myself lawfully as against any other unjust assailant. Such is the common teaching of moralists. But can the innocent babe be classed in the same category with the raving maniac? Why should it? It is doing nothing; it is merely passive in the whole process of parturition.

Will any one object that the infant has no right to be there at all? Who put it there? The only human agents in the matter were its parents. The mother is more accountable for the unfortunate situation than the child. Certainly you could not, to save the child, directly kill the mother, treating her as an unjust assailant of her child’s life? Still less can you treat the infant as an unjust assailant of its mother’s life.

The plea of self-defence against unjust aggression being thus ruled out of court in all such cases, and no other plea remaining for the craniotomist, we have established, on the clearest principles of Ethics and Jurisprudence, that it is never allowed directly to kill a child as a means to save its mother’s life. It would be a bad means, morally evil; and no moral evil can ever be done that good may come of it; the end cannot justify an evil means. In theory all good men agree with us that the end can never justify the means. But in practice it seems to be different with some of the medical profession. Of late, however, the practice of craniotomy and all equivalent operations upon living subjects has gone almost entirely out of fashion among the better class of physicians.

Allow me, gentlemen, to conclude this lecture with the reading of two extracts from articles of medical writers on the present state of craniotomy in their profession. You will find them in accord with the conclusions at which we have arrived by reasoning upon the principles of Jurisprudence.

Dr. W. H. Parish writes (“Am. Eccles. Review,” November, 1893, p. 364): “The operations of craniotomy and embryotomy are to-day of relatively infrequent occurrence, and many obstetricians of large experience have never performed them. Advanced obstetricians advocate the performance of the Cesarian section or its modification—the Porro operation—in preference to craniotomy, because nearly all the children are saved, and the unavoidable mortality among mothers is not much higher than that which attends craniotomy. Of one hundred women on whom Cesarian section is performed under favorable conditions and with attainable skill, about ninety-five mothers should recover and fully the same number of children. Of one hundred craniotomies, ninety-five mothers or possibly a larger number will recover, and of course none of the children. The problem resolves itself into this: Which shall we choose—Cesarian section with one hundred and ninety living beings as the result, or craniotomy with about ninety-five living beings?”

Even if a liberal deduction be made for unfavorable circumstances and deficient skill, the results, gentlemen, will still leave a wide margin in favor of Cesarian section. My second extract is from an article of Dr. M. O’Hara, and it is supported by the very highest authorities (ib. p. 361): “Recently [August 1, 1893] the British Medical Association, the most authoritative medical body in Great Britain, at its sixty-first annual meeting, held at Newcastle-upon-Tyne, definitely discussed the subject before us. In the address delivered at the opening of the section of Obstetric Medicine and Gynecology, an assertion was put forth which I regard as very remarkable, my recollection not taking in any similar pronouncement made in any like representative medical body. The authoritative value of this statement, accepted as undisputed by the members of the association, which counts about fifteen thousand practitioners, need not be emphasized.

“Dr. James Murphy (‘British Medical Journal,’ August 26, 1893), of the University of Durham, made the presidential address. He first alluded to the perfection to which the forceps had reached for pelves narrowed at the brim, and the means of correcting faulty position of the fœtus during labor. He then stated: ‘In cases of great deformity of the pelvis, it has long been the ambition of the obstetrician, where it has been impossible to deliver a living child per vias naturales, to find some means by which that child could be born alive with comparative safety to the mother; and that time has now arrived. It is not for me to decide,’ he says, ‘whether the modern Cesarian section, Porro’s operation, symphysiotomy, ischiopubotomy, or other operation is the safest or most suitable, nor yet is there sufficient material for this question to be decided; but when such splendid and successful results have been achieved by Porro, Leopold, Saenger, and by our own Murdoch Cameron, I say it deliberately and with whatever authority I^† possess, and I urge it with all the force I can master, that we are not now justified in destroying a living child; and while there may be some things I look back upon with pleasure in my professional career, that which gives me the greatest satisfaction is that I have never done a craniotomy on a living child.’”

You will please notice, gentlemen, that when this distinguished Doctor said, “We are not now justified in destroying a living child,” he was speaking from a medical standpoint, and meant to say that such destruction is now scientifically unjustifiable, is a blunder in surgery. From a moral point of view it is not only now, but it was always, unjustifiable to slay a child as a means to save the mother’s life; a good end cannot justify an evil means, is a truth that cannot be too emphatically inculcated. This is one of the most important subjects on which Medical Jurisprudence has been improved, and most of its text-books are deficient. The improvement is explained with much scientific detail in an address of the President, Samuel C. Busey, M.D., before the Washington Obstetrical and Gynecological Society (“Am. Journal of Obstetrics and Diseases of Women and Children,” vol. xvii. n. 2).

I. Operations which kill the fetus and are called by the general name embryotomy (which is a surgical operation by which the infant is cut up in the uterus and, having been cut up, is extracted in parts) consist in the reduction or division of various parts of the fetus, which are afterward gradually extracted one by one, when, on account of excessive narrowness of the pelvis or excessive size of the head, the extraction of the fetus is possible in no other way.

These operations are performed in various ways, according as the fetus presents the head, the pelvis, or the trunk:

a) craniotomy (verbrijzeling van den schedel), by which the cranium of the infant is perforated and the cerebral mass is extracted; this having been done, the uterine contractions lessen the volume of the head, and the infant is more easily expelled or extracted by hand or instrument;¹

¹ Craniotomy was already known by Hippocrates, Celsus, and the Arabian physicians.

b) cephalotripsy (samendrukking van het hoofd), by which the infant's head is compressed until the cerebral mass and blood overcome the resistance of the bones and skin of the head;²

² It was also known by the ancients.

c) cephalotomy (verbrijzeling van het hoofd), by which the head is divided lengthwise into two parts;

d) sphenotripsy (σφήν, cuneus; wigbeendoorboring), by which the base of the head is perforated in several places;

e) embryulcia, by which the head is separated from the trunk (decollation, onthoofding), or the breast or vertebral column is cut by suitable forceps (embryothlasis, verbrokkeling der vrucht in de moeder), which has place when the fetus presents the trunk; for then extraction cannot be done in another way, and the fetus is cut into several parts;

f) evisceration (eventration; uithaling der ingewanden), by which, after perforation of the abdomen or breast, the viscera of the belly and thorax are extracted; then, through suitable instruments exerting mechanical force upon the vertebral column, the vertebral column is bent and extraction is made. It is employed when expulsion becomes possible by none of the operations indicated above; and otherwise, after decollation has been performed, the remainder of the fetus cannot be expelled, because the body is ordinarily larger, or the liver and kidneys are too much developed.

II. Embryotomy under whatever form is intrinsically evil, and all the aforesaid actions are illicit and unjust, even if on the one hand provision is made for the salvation of the infant by baptizing him in the uterus of the mother, and on the other hand there is no other means of preserving the mother, so that if the operation is omitted the mother and infant are certainly going to perish. For these actions are always of themselves and directly destructive, since the good effect does not proceed equally immediately, but only through the mediation of the evil effect; and therefore the death of the infant is necessarily willed as a means for saving the mother. Thus the Holy Office, 28 May 1884, concerning craniotomy, and 14 August 1889, concerning every operation directly destructive of the mother or infant.³

³ Do not wonder that the Holy Office only said that this cannot safely be taught, and not that it is illicit. For it did so because it responded to the question: can it safely be taught? Moreover, afterward it also explicitly said that it is illicit, 24 July 1895. Concerning embryotomy and abortion, the following can be consulted: L. Hubert, De l'avortement medical, 1852; Capellmann, De Occisione foetus, 1875; Eschbach, L'embryotomie au point de vue theologique et morale, 1876; Illustrious Lord Waffelaert in Nouvelle Revue Theologique, T. XVI and XVII; E. Hubert, Discussion sur le feticide (Annales de la Societe Scientifique, 1902-1903); Vermeersch, Discussion sur le feticide medical (Annales de la Societe Scientifique, 1902-1903); Treub, Van Oppenraay, and Vlaming, Het levensrecht der ongeboren vrucht, 1901; Van Gennep, Over medischen abortus, 1916; Meuleman, Het levensrecht der geboren vrucht, 1917; Daels, Het Bakersboek, 1919; Moeder en Kind; Salsmans, Geneeskundige plichtenleer, 1920; Dictionnaire Apolog. de la Foi cathol., art. "Feticide"; Dictionnaire de Theologie Catholique, art. "Embryotomie"; Cathol. Encycl., art. "Abortion" (Coppens). Likewise manuals of Moral Theology, such as Noldin, Tanquerey, Prummer, and Vermeersch.

They object:⁴

⁴ Cf. Prummer, Th. Mor., t. II, n. 134. Formerly certain theologians, such as Ballerini, Avanzini, and Constantini, stood for the liceity of feticide.

1. The infant is the cause of death to the mother, and therefore an unjust aggressor.

Resp. a) Not unjustly, because without any act and will he is there as in a place proper to himself and conducts himself passively, but, using his own right, only by the natural course of things becomes the cause of death to the mother, just as a man infected with plague can be a cause of death; not an aggressor, because ordinarily the difficulty of birth comes from the mother, on account of the narrowness of the pelvis, and the danger is from the action of the uterus, which, although it is not voluntary, is nevertheless the mother's. Since, therefore, the fetus exists by the will of the mother, since expulsion is the action of the mother, since the greater difficulties are from the mother, the infant is not the aggressor, but rather the mother. But even if the infant were called an aggressor, nevertheless he would not be objectively unjust.

2. In a collision of rights the right of the mother is prior and stronger; and therefore the infant is judged, indeed reasonably is bound, to yield his right.

Resp. Since man is in possession of his own right, the human person and life are ordered to their own proper end, and are not subordinated as a means to the life of another; and therefore a) a direct attempt against the life of an innocent person is never licit, and never does the right of one so prevail that, in order to obtain that one's good, the killing of an innocent person becomes licit; b) although indirectly someone can yield the right of his life, insofar as he exposes himself to the danger of death, nevertheless he cannot directly yield the right to life, since he is not master of his own life, and can never permit the direct killing of himself. Therefore no more can a right be given to kill the infant in order to save the woman than to kill the woman in order to save the infant.

3. It is not killing, but only the hastening of death certainly going to follow, and a slight shortening of life.

Resp. Indirect hastening, from a cause which of itself and immediately produces another effect while this one follows accidentally and is merely permitted, can be licit; but the hastening of death, willed in itself and directly, is true killing. Direct killing, however, is illicit, even if it is only the hastening of death certainly going to follow, just as it is illicit to kill a wounded man that he may be freed more quickly from pains.

4. Between two evils the lesser is to be chosen; but the death of the infant alone is a lesser evil than the death of the mother and infant.

Resp. The greater evil is to be avoided, if it can be done without an intrinsically evil action; but it is illicit to avoid it through an intrinsically evil action, for evils are not to be done that goods may come about, not even to save the whole world. The end does not justify the means; and therefore it must not be seen to what the action is ultimately terminated, but first of all what is immediately done. This, in the case, is intrinsically evil, and therefore a greater evil, as being moral, to be avoided rather than the physical evil of death. Moreover, as even the more celebrated physicians themselves today acknowledge, it is almost always possible to save the mother, since it very rarely happens that embryotomy is the sole means for this; for frequently Caesarean section itself, or symphysiotomy, or combined operations, are possible.⁵

⁵ Thus, e.g., Dr. Pinard, professor of Paris: "To have to sacrifice the child in order to save the mother is an imaginary case; never does the accoucheur find himself before so poignant an alternative," cited in Bull. von den Bond tegen de ontvolking, 1913; likewise, Dr. E. Hubert, Le devoir du medecin; likewise Murphy, British Medical Journal, 25 Aug. 1893; Treub, Aertzliche Rundschau, 1900; likewise Dr. Guermonprez, in Eschbach, p. 389: "To kill the fetus under pretext of favoring delivery is to misunderstand the certain resources of modern obstetrical surgery; it is to be behind the times"; and Dr. Franck: "Scientific methods had so developed that saving the child's life is also the best method for saving the mother's life" (Schutzengel oder Würgeengel?, Cologne, 1922).

III. Observations. 1. Embryotomy is illicit, even if it is only probable and likely that the fetus is still living,⁶ because justice forbids exposing oneself even to a merely probable danger of killing an innocent person.

⁶ We do not say: that a fetus be obtained who will live and continue to live; for such a formula would be equivocal and could be badly understood.

2. The physician who in a particular case is going to perform embryotomy is not to be warned by the priest, if fruit is not hoped for; but even if fruit is not hoped for, he is to be warned if he frequently acts thus and there is scandal to the faithful, or if he is not in good faith, as if he asks the priest about this, or when the silence of the priest would be equivalent to approval. The mother, if she is in good faith, is not, from prudence here and now, to be warned concerning the gravity of her obligation, lest, by refusing consent, she die in the state of sin. The same holds concerning the procuring of abortion.

3. In the case in which the mother does not wish or is not able to undergo Caesarean section or some similar operation, nothing remains except to await her death; and then to perform the Caesarean operation for baptizing the fetus, if there is a possibility that the fetus is living.

I. Embryotomy, by a general name, designates all surgical operations which cut up the infant in the uterus and divide him into parts so that he can be extracted.

These operations can be performed in various ways and by different procedures, which we indicated in the earlier little work A, On Embryology, I, q. 4, n. I.

We inquire here concerning their liceity.

II. History of the question of feticide. Formerly, when it was generally thought that the fetus was not animated from the beginning, it could more easily be doubtful to some whether it was licit to injure or expel a fetus not yet animated by a rational soul. Now, however, the difficulty is greater, because many hold that he is animated in this way from the beginning. This indeed is not certain;¹ but even probable homicide is to be avoided. Thus, for example, one who doubts whether that which moves in the forest is a man or a wild beast cannot injure or kill it, because he cannot expose himself to the danger of killing a man. But even if the fetus certainly were not yet animated by a rational soul, it would be illicit, because the fetus is then a man in proximate potency,² and the unanimated fetus is ordered to the formation of a man; hence his expulsion or killing is equivalent homicide, for it tends to the deprivation of human life and is contrary to the nature of generation.

¹ Cf. little work A, On Embryology, II, q. 4, n. I.

² Thus according to the manner of speaking of St. Thomas, Q. D. de Malo, 15, a. 2.

Nevertheless, not only physicians but even some theologians thought that feticide was licit in certain cases, when it was not possible otherwise to save the mother, and especially when otherwise both mother and fetus would perish. To defend this, they adduced various arguments:

a. The necessity of acting in such a way in order to avoid a greater evil.

b. For in the case in which danger of death follows in the mother from pregnancy itself, the infant is an aggressor against her life, and indeed materially unjust; therefore, just as it is licit to kill a drunk or insane aggressor, so also the fetus who is the cause of death to the mother.

c. All the more because in a conflict of rights the stronger right ought to prevail; but the mother's right to life is of greater force than the infant's right, because the mother is more necessary. Hence the infant also, if he had knowledge, would yield his right, since he would reasonably be bound to do so.

d. Besides, it is not a killing but an acceleration of death, if the infant would nevertheless die with the mother. He is not killed; rather, the mother merely ceases to preserve the offspring, and the mother is not bound to preserve the fetus with danger to her own life.

e. In the case, therefore, the killing is not direct, because it is not intended, but indirect, since it is done from necessity only beyond the intention, for the defense of the mother's life.

Some theologians taught this, at least as probable: some concerning abortion, and even a few concerning embryotomy, for example Ballerini,³ Avanzini, Constantini, and certain others, especially in Italy. But by far the greater number held the contrary.

³ See Annotations on Gury, I, nn. 402–403, where he notes various things; and Work of Moral Theology, II, n. 910 ff.

The Holy Office, having been questioned concerning this matter, responded on 28–31 May 1884 that the liceity of craniotomy could not safely be taught; and on 14–19 August 1889 it extended that response to any operation directly lethal to the fetus or to the gestating mother. But since it had said only "cannot safely be taught," responding to the question proposed to it, "whether it can safely be taught," this was restrictively interpreted by some concerning the safety of the doctrine, not concerning the liceity of the operation, because it had not said "cannot safely be done."⁴ Hence, to the question, "whether an operation of this kind can safely be undertaken," the response was: "In the negative," 24 July 1895, and indeed according to the other decrees cited above.

⁴ Safely, that is, without danger of error; but that which exposes one to error, they say, could be probable and perhaps true.

Nevertheless, physicians continue to think this licit in the sufficiently rare case in which the mother could not otherwise be saved, or if otherwise both mother and infant would die. Indeed, in practice, some physicians do it even if the mother could be saved in another way, but because it is easier. They say that it is not feticide but a medical or therapeutic indication.

Pius XI, in the encyclical Casti connubii of 31 December 1930, attacks this and refutes the arguments usually brought forward:

"As for the medical and therapeutic indication—to use their words—we have already said, Venerable Brethren, how greatly we pity the mother for whom grave dangers to health, indeed to life itself, threaten from the office of nature. But what cause can ever avail in any way to excuse the direct killing of an innocent person? For this is what is in question here. Whether it is inflicted upon the mother or upon the offspring, it is against the precept of God and the voice of nature: Thou shalt not kill!⁵ For the life of each is an equally sacred thing, and no one, not even public authority, can ever have the power to destroy it. Most ineptly is this power invoked against the innocent from the right of the sword, which avails only against the guilty; nor does any right of bloody defense against an unjust aggressor have force here (for who would call an innocent little child an unjust aggressor?); nor is there present any so-called right of extreme necessity which could extend as far as the direct killing of an innocent person. Therefore, upright and skilled physicians laudably strive to guard and preserve the life of each, both mother and offspring; on the contrary, all those would prove themselves most unworthy of the noble name and praise of physicians who, under the appearance of providing medical care, or moved by false pity, would lie in wait for the death of either."

⁵ Exod. XX, 13; cf. Decrees of the Holy Office, 4 May 1898, 24 July 1895, 31 May 1884.

And yet the encyclical—who could have conjectured it?—gave occasion for a contrary interpretation. Thus Dr. Riss in the Münchener medizinische Wochenschrift, 1931: if both must perish and all other means have been employed, then it is not an intended killing, not a direct killing in the sense of the encyclical, or a killing from malevolence, because they do not lie in wait for death. Similarly Dr. Pestalozza, a celebrated professor, wrote an article in L'Osservatore Romano of 22 January 1931, Dopo l'enciclica sul matrimonio cristiano: la parole de la scienza [After the Encyclical on Christian Marriage: The Word of Science], in which certain responses of the more celebrated gynecologists of Italy to certain questions are set forth. Among them Pestalozza himself says: from the progress of medical science, soon there will no longer be a question of medical abortion; today, however, there are still most rare cases in which it is necessary, if the pregnancy necessarily and after a short time tends toward the death of the mother and fetus. In this case abortion does not fall under the Italian penal code, because malice is not present, and therefore neither is a crime. I would presume it to be so also for the Christian conscience, because in the case there is not a direct killing of the innocent, but only the liberation of the woman from a disease which would also bring death to the infant. One who acted thus would not be moved, as the Pontiff says, by false pity, but by a profound scientific conviction and the certainty of saving at least the mother.

Fr. Dr. Gemelli, rector of the University of Milan, responded to him in L'Osservatore Romano of 28 January 1931: Dopo l'enciclica sul matrimonio cristiano. Necessarie precisazioni [After the Encyclical on Christian Marriage: Necessary Clarifications]. Nevertheless, at the congress of the Italian Society di Ostetricia a Ginecologia [of Obstetrics and Gynecology], held in Milan on 18–20 October 1931, Pestalozza again defended the liceity of the operation in this case, because it does not tend to the direct killing of an innocent person, as the encyclical presumes, but has the end of saving the mother from the gravest danger, which would also draw with it the death of the infant. Gemelli again contradicted him, and in this indeed rightly.

III. Embryotomy and every operation directly lethal to the infant is intrinsically evil and unjust, so that in no case, even one of medical indication or necessity, can it be licit. This is certain. It is established:

1. From the decrees of the Church cited above, which concern precisely the case in which, if the operation is omitted, the mother and fetus will perish, and if it is admitted, the mother is to be saved while the infant perishes; and from the encyclical of Pius XI Casti connubii, which speaks explicitly about a case of indication. For a. it excludes this case altogether when it says, "What cause can ever avail in any way to excuse the direct killing of an innocent person?"; b. it affirms that the matter concerns the direct killing of an innocent person; c. it rests upon the decrees of the Holy Office which establish the same; d. it refutes the arguments of the adversaries drawn from the right of the sword, defense against an unjust aggressor, and extreme necessity. Therefore, it cannot be said that the Pontiff adds a restriction and does not condemn the operation in a case of necessity, since he is speaking precisely about it. Those who dare to affirm this insist upon one expression and neglect everything preceding it and the whole context. And although they judge themselves not to be moved by false pity nor to lie in wait for death, nevertheless that pity which is not conformable to right reason and the precepts of the natural law is in truth false; and although they do not explicitly intend to lie in wait for death, nevertheless in reality they do so.

133. Notion. Craniotomy (cephalotripsy, embryotomy, perforation, decollation, exenteration, embryothlasia) is a surgical operation by which an infant in the maternal womb is cut up and, once cut up, extracted in parts. In present times physicians sometimes perform this operation if a mature infant, on account of the narrowness of the mother or other reasons, cannot be brought forth into the light, and therefore if this operation were omitted the mother with the infant would perish.

134. Principle. Craniotomy and other surgical operations directly causing the death of the fetus are altogether illicit.

This is plain from the responses of the Holy Office on May 24, 1884, and Aug. 19, 1889. Here are the words of the prior response: "Whether it can safely be taught in Catholic schools that the surgical operation which they call craniotomy is licit, namely when if it is omitted the mother and son would perish; but if it is admitted, the mother is to be saved, with the infant perishing? - After all things had been weighed for a long time and maturely, and consideration also had been had of those things which have been written on this matter by expert Catholic men ... they [the General Inquisitors] judged that the response should be made: It cannot safely be taught." Leo XIII confirmed this response. But craniotomy not only cannot safely be taught; it is also altogether illicit, as is plain from the response of the Holy Office on July 24, 1895. - Now the reason is that craniotomy and other similar surgical operations are the direct killing of innocent offspring. But never and for no one is it lawful directly to kill the innocent, as was said above, n. 131.

Before the responses of the Holy Office it seemed to certain theologians (Ballerini, Avanzini, Constantini) that craniotomy was licit on account of the following reasons: a) Of two evils the lesser must be chosen. But it is a lesser evil to kill the child alone than the child together with the mother. Now if craniotomy is omitted, mother and infant will die. - b) From that operation only the death of the infant is hastened, who otherwise also after a brief interval will certainly die. But it is lawful to hasten death a little for the sake of preserving the safety of the mother. - c) The infant is a cause of death for the mother. Therefore he is an unjust aggressor. But it is lawful to kill an unjust aggressor if this is necessary for saving life. - d) Ordinarily a man can yield his right of living for another, as, for example, he who falls into the sea can yield his air belt to another, even if he himself is then certainly about to perish. But in the case in which, without craniotomy, the mother with the son is about to perish, it is deservedly permissible to presume that the son yields his right to life for the preservation of the mother's safety. - Although those reasons are not altogether to be spurned, nevertheless they are by no means convincing. For the first reason indeed avails ordinarily speaking, namely if the avoidance of the greater evil can be had without an intrinsically evil act. But it is never lawful to do evils that goods may come, just as it is not lawful to lie in order to save the whole world. But the direct killing of an infant through craniotomy is intrinsically evil. - The second reason avails if it is a question of indirect hastening of death, but not of direct killing. Thus, for example, it is not lawful to kill a wounded man, certainly about to die, that he may be freed from pains more quickly. - The third reason is false; for the infant is not an unjust aggressor, but dwells without any fault at all in a place proper to himself. With better right the mother could be called the unjust aggressor of the infant. For through the action of the mother the infant was conceived and placed in the womb, and now he wishes to go out, but is impeded by the bad disposition or infirmity of the mother. Therefore rather the mother ought to sustain danger of life than the infant. - Finally, the last reason avails for indirect killing, or for the free undergoing of the extreme danger of death, but not for direct killing. Hence no one can permit that he himself be directly killed in order to save another.

135. Licit ways for saving both mother and offspring. In the case in which the infant truly cannot be born in the natural way, the physician can licitly do two other surgical operations by which the life both of the mother and of the offspring is preserved, namely either Caesarean section or symphyseotomy (hebosteotomy, pubiotomy). Certainly those two operations are sometimes more difficult than craniotomy, and also more dangerous for the mother, but on account of the difficulty or the danger arising it is not yet lawful to kill the infant. As is plain from the statistics brought forward by Bergmann,¹⁶⁸ only 2-3% of mothers die after Caesarean section has been done, provided nevertheless that the physician knows well the surgical art.

Both Caesarean section and symphyseotomy are a cutting open of the abdomen. Certainly the first is deeper, but the other, in which the bones of the pubis must be divided, is harsher. There were ancient authors, e.g., Cangiamilla, who taught that even a priest, when a physician and another fit person are lacking, ought in a case of necessity to perform this operation in order to baptize the infant. But this in our times and in our regions cannot be brought into practice for many reasons, e.g., a) because the priest lacks both the necessary instruments and sufficient skill to perform those very difficult operations, b) because he would be most gravely punished by the civil laws, c) because sinister criticisms could easily arise, greatly wounding his reputation, and finally d) because a great doubt exists whether by those surgical operations a priest could extract that fetus alive and baptize him. In places of foreign missions, when missionaries have special faculties and know somewhat the medical art, they themselves can licitly perform those surgical operations in great necessity. But when special faculties are lacking, the decree of the Holy Office on Dec. 13, 1899, must be observed: "The extraction of a fetus from the womb of a pregnant and deceased mother, although it is to be disclosed and persuaded, nevertheless His Holiness expressly guards and prohibits lest missionaries in particular cases involve themselves in ordering the section, much less in performing it."

¹⁶⁸ Medicina pastoralis 1st ed., p. 48.

136. The manner of acting with physicians in this matter. Modern physicians, even Catholic ones, are not rarely in good faith concerning the liceity of craniotomy in the case in which the life of the mother cannot otherwise be saved. For the reasons brought forward above for the liceity of craniotomy have some appearance of truth. Hence even the Sacred Penitentiary itself at first did not wish to resolve the controversy; for when it had been asked about this matter: "Whether at any time there is licit the operation which is called craniotomy, or a similar operation, which of itself directly tends to the killing of an infant placed in the womb?" on Nov. 28, 1872, after the things set forth had been maturely weighed, it had responded: "Let him consult approved authors, whether old or recent, and act prudently." - To this is added that physicians expose themselves to an urgent danger both of punishment inflicted by penal laws¹⁶⁹ and of sinister criticisms, if in extreme necessity they omit craniotomy for saving the mother. Therefore it belongs to a prudent confessor to judge whether it is better to leave the physician in good faith, provided nevertheless that baptism be conferred upon the offspring about to die. For thus the eternal salvation of the infant is procured and the life of the mother is saved. For sometimes material sins must be permitted so that formal sins may be avoided. Thus also teach Lehmkuhl,¹⁷⁰ Noldin,¹⁷¹ and others.

If in a difficult birth the fetus is already certainly dead in the womb of the mother, then indeed it can be cut up, so that it may be more easily extracted. But if the fetus is not certainly, but more probably, dead, then several authors also rightly teach that craniotomy is licit for saving the mother, because the living mother ought not to give her life for a fetus more probably already dead. - But when the mother giving birth refuses Caesarean section or symphyseotomy, the physician can now do nothing, and must permit the death both of the mother and of the offspring. For it is impossible for him by licit means to impede the death of both.

¹⁶⁹ Cf. German Penal Code § 222.

¹⁷⁰ Theol. mor. I, n. 1002.

¹⁷¹ De praeceptis n. 340.

363. Corollaries. - 1. Especially illicit are embryotomy and the direct procurement of abortion, namely, a) to kill the fetus in the womb in order to save the mother; b) to cast the fetus out of the womb, for that reason soon to die; c) to divide the fetus into parts. - For it is directly to destroy human life, or at least directly to impede it in a subject which is not an unjust aggressor.¹⁰ This, for the same reason, holds concerning ectopic or extrauterine fetuses.¹¹

¹⁰ Holy Office, 19 Aug. 1889, 24 July 1895, 31 May 1884. - Cf. our Questions on Embryology A, q. 4 and 5; B, q. 2 and 3. Some at one time judged feticide licit, such as Ballenni, Avanzini, Constantini, or abortion, as even Lehmkuhl himself.

¹¹ Holy Office, 4 May 1898 and 5 May 1902. Cf. Questions on Embryology A, q. 7; and B, q. 4. Some try to elude the responses of the Holy Office.

For it is a question of the life of an innocent person, which is equally sacred in a little infant and in an adult mother; whence no reason making the act honorable is present: neither the social power of protecting the common good against crimes, nor legitimate defense against aggression, nor the extreme necessity of the mother.

As Pius XI most recently sanctioned in the encyclical Casti connubii, 31 Dec. 1930: "What cause could ever avail in any way to excuse the direct killing of an innocent person? For this is what is at issue in this place. Whether it is inflicted upon the mother or upon the offspring, it is against the precept of God and the voice of nature: You shall not kill. For the life of each is an equally sacred thing, for the crushing of which there can ever be no faculty, not even to public authority. a) Most ineptly, moreover, is this repeated against the innocent from the right of the sword, which has force only against the guilty; b) nor does any right of bloody defense here prevail against an unjust aggressor, for who would call an innocent little child an unjust aggressor?; c) nor is there present any right of extreme necessity, as they call it, which could reach even to the direct killing of an innocent person."

2. On the contrary, abortion indirectly procured can be licit, if a) there is present in the mother a lethal disease, b) the means employed is immediately efficacious for curing the mother even when not pregnant, c) no other remedy is present, and d) provision is made for the Baptism of the infant. A fortiori, acceleration of birth can be licit if the infant can live outside the mother's womb, and a grave reason is present.

An action, namely, one bringing danger of death and directly affecting the fetus itself, or some organ or element pertaining to it, such as the placenta, the membranes enveloping it, or the amniotic fluid, cannot be legitimized by the fact that it is necessary for saving the mother, because it immediately harms only the offspring and procures the good of the mother only by means of the evil of the offspring, and thus is directly harmful and lethal; - on the contrary an action which is exercised not directly upon the fetus, nor upon any instrument or element of it, but upon the mother or an organ of the mother, say upon the uterus or tube, can be licit, provided that a) it directly procures the good of the mother, b) it is necessary here and now for saving her life, c) the danger does not proceed from the fetus alone.

3. Concerning accidental homicide, St. Thomas teaches, art. 8: He who posits an action from which, accidentally and not of itself, frequently and probably, death follows, is not guilty of homicide, provided that he has used ordinary solicitude: thus a hunter, by employing due diligence, accidentally kills a man. On the contrary, per accidens he can be guilty of homicide "who does not remove those things from which homicide follows, if he ought to remove them." This happens in two ways: a) if he is guilty of negligence, not employing due diligence, for example, by imprudently playing with a firearm, and then he sins gravely or lightly according as the negligence is grave or light: thus imprudent pregnant women, and physicians negligent in caring for the sick; b) if the action of itself is unjust and includes danger of homicide, for example, by striking a pregnant woman, or by employing dangerous materials or machines from which the life of workers is placed in great danger.