Abortion

Any procedure that terminates a pregnancy at a certain gestational age or by any means that precludes the survival of a fetus. Under the U.S. Supreme Court ruling in Roe v. Wade, the human fetus is considered only a potential person and is not accorded any civil rights under the Constitution. However, the question upon which the morality of abortion depends within Catholic teaching is not that of personhood but of when human life begins, since all human life is considered sacred and deserving of respect and protection. The question of when human life begins is a scientific question, not a theological or philosophical question. According to the 1981 report of the Subcommittee on Separation of Powers to the U.S. Senate Committee on the Judiciary and the unanimous testimony of 57 witnesses including geneticists, biologists and physicians, human life begins at conception, the time when the process of fertilization is complete. The implication recognized in Catholic teaching, then, is that the zygote, the blastocyst, the embryo, and the fetus (all of which are merely different stages in the early development of a human life) are deserving of protection. In other words, the sanctity of life and the right to life apply to all human beings at any stage of their development. It follows that all directly intended abortions are a grave offense against human life and wrong regardless of circumstances (i.e., intrinsically evil). They are therefore prohibited in Catholic health care facilities. [See 1974 Vatican Declaration on Procured Abortion and Donum Vitae.]

This prohibition against abortion applies to any and all direct abortions, that is, any procedure in which the immediate purpose (either as an end in itself or as a means to some other good) is to terminate the pregnancy by destroying the developing human fetus at any stage after conception or to expel it before it is viable. In the moral context, this includes the interval between conception and implantation. Church teaching, however, permits indirect abortions in those cases in which the conditions of the principle of double effect are met. Indirect abortions are those procedures in which the termination of the pregnancy is not the immediate purpose of the procedure, but merely a foreseen and tolerated "side effect" (i.e., a concomitant effect) of a medical intervention whose immediate purpose is the cure of a serious pathology of the pregnant woman (see Ethical and Religious Directives for Catholic Health Services, Part Four, n. 47). In the case of a pregnancy that is complicated by the presence of a serious pathology, the moral status of any procedure that may involve the termination of the pregnancy must be evaluated via the principle of double effect.

The Church’s prohibition against direct abortions applies to all direct abortions no matter what good clinical or therapeutic outcomes may be intended. For example, in the case of a pregnant woman that has hyperemesis gravidarum (excessive vomiting accompanied by weight loss, dehydration, and acidosis) that is not responsive to other methods of treatment, an abortion would be considered illicit because the immediate purpose of the procedure is to destroy the developing fetus as a means of bringing about a good consequence. The abortion is direct and not indirect in this case because the death of the fetus is not merely a foreseen and unintended side effect of a therapeutic intervention, but the death of the fetus is intended as the precise means of relieving the pregnant woman of her pathological condition. In the case of a pregnancy involving a cancerous uterus, on the other hand, the removal of the uterus--even though it would mean the termination of the pregnancy--is permissible if the direct intent is to remove the pathology (the cancer residing in the uterus) and is the only reasonable means by which the pathology can be eradicated. In this case, the abortion is indirect and justifiable under the principle of double effect.

These examples illustrate clear cases of direct and indirect abortions. However, whether or not a specific procedure constitutes a direct or indirect abortion and is justifiable under the principle of double effect is not always clear. For example, some moralists disagree about the status of treatments intended to terminate an ectopic pregnancy. According to some, the surgical removal of the fallopian tube (a Salpingectomy) or the dissolution of the trophoblast via methotrexate entails a direct intent to cause the death of the fetus as a means to protect the mother. Others have argued to the contrary that, while detaching a fetus from its normal site of implantation would be a direct abortion, to detach it from an abnormal site in which it constitutes a serious pathology involves only the indirect destruction of the fetus. The central distinction between these two arguments is that in the latter argument, the direct intent is understood to be the treatment of a pathological condition in the mother by freeing her fallopian tube of an abnormal infiltration by the placental villi, whereas in the former argument the direct intent is understood to be the destruction of the fetus. Both of these analyses are relevant to cases of ectopic pregnancy treated by either salpingectomy or methotrexate. Other cases of treating serious pathologies involving the destruction of a fetus, such as induction for chorioamnionitis, are similarly ambiguous from a moral perspective. Such difficult cases need to be assessed in light of the requirements of moral certitude and following one’s conscience. In similarly ambiguous cases, both patients and providers in Catholic-sponsored facilities should make their own determinations in accord with the dictates of moral certitude and following their conscience. Within appropriate moral parameters set by hospital policy, individual patients and physicians should be supported in their decisions. Hospital policies should be consistent with the Ethical and Religious Directives nn. 45, 46, 47, 48 and 49. [Sources: Ashley, B. and Kevin O’Rourke, Healthcare Ethics: A Theological Analysis (Washington, DC: Georgetown University Press, 1997), 252-254; Griese, O., Catholic Identity in Healthcare: Principles and Practice (Braintree, MA: The Pope John Center, 1987), 94-99 and 266-299.]

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