Friday, March 18, 2011

Old News: Thoughts on "Life of the Mother"

For unrelated reasons, in my constant ponderings, I was looking back over an old Vox Nova post, and the comments following, about that case at St. Joseph's Hospital in Phoenix where that Sister was excommunicated for allegedly approving a "direct abortion" to save the life of the mother.

I got distracted from the main purpose of my return to that post by reconsidering the question. Though at the time my gut reaction was to side with him, I'm starting to think that Bishop Olmsted may have gotten his moral analysis wrong.

I don't know all the details, of course; maybe Bishop Olmsted knows something relevant that I don't. But, as far as I understand now from re-reading all this, the procedure ultimately preformed was to disconnect the placenta from the wall of the uterus to lower the pulmonary hypertension. In this D&C procedure, the fetus may have been physically harmed, though they tried not to (either way, it can't survive for long with the placenta detached). Afterward, the remains of dead fetus and placenta were removed in pieces.

The bishop's argument was that terminating the pregnancy was the very means for saving the mother's life, and thus could not be called a mere side-effect. Her hypertension was caused by the state of pregnancy itself (which was true). Therefore, he concluded, to save her by ending the pregnancy in this way was direct abortion, not merely an indirect side-effect of some other procedure (like removing a cancerous uterus).

However, someone on Vox Nova pointed out, basically, that the state of pregnancy and the life of the baby are not the same thing. Stillborn babies often die months before birth, but the physical state of pregnancy in the mother continues, and it is the placenta which is the source of the this state continuing (though the baby himself is dead).

Thus, it is argued, if the same procedure would be preformed whether the baby was alive or dead (and it would have been) can't really be argued that the death of the baby was the direct object of the act. Rather, it was ending the state of pregnancy that was putting too much pressure on the woman's heart. But pregnancy is not equivalent to the life of the baby, given that the state of pregnancy can exist even when the baby is already dead, and also that it can be ended without killing the baby (such as in live birth!)

This is the same conclusion reached by the theologian writing in defense of the hospital, and a few orthodox theologians she cites. And having considered this, I have to agree. I think what the bishop failed to see, but which this example makes clear, is that "terminating a pregnancy" and "killing the baby" are not the same thing. A pregnancy, after all, is also "terminated" by live vaginal birth or c-section! Also, removing the child and putting him in an artificial womb or incubator would be "terminating the pregnancy" (and yet not result in his death). Also, a stillborn pregnancy may be terminated, and yet that is not equivalent to killing the baby (as the baby is already dead in that case).

It was the state of pregnancy (whether the baby was alive or not) which was the cause of this woman's fatal hypertension, not the life of the baby in itself. As shown above, the physical state of pregnancy in the mother is very much abstractable from the question of the life of the child himself.

Detaching the placenta to end the state of pregnancy causing fatal tension on the body...would therefore not seem to be the same moral object as the death of the child as means of saving the mother, though that is a foreseen (but unintended) side effect of that act in this case. Sadly, the technology is not yet available that would have kept the baby alive outside the mother (nor even, it seems, to safely remove the baby whole in this mother's condition; he died in the womb after/when the placenta was detached, and then the remains were removed in pieces).

Arguments that the placenta is an organ of the baby and not the mother, though genetically true, do not seem morally relevant given that the placenta can continue living (and making the mother pregnant) even after the baby itself has died (as in the case of stillborn pregnancies). Therefore, to argue that acts done to the placenta are equivalent to an act done directly on the baby seem moot.

Some might say this is a slippery slope. If we allow that "terminating pregnancy" like this through detaching the placenta is different from "killing the baby" as a moral object...isn't that a slippery slope to allowing women who do not want to be pregnant to "end the pregnancy" through "merely" "removing the baby," albeit in a way that "just happens" to lead to its death?

No. Not at all. It might mean I'd admit that, in most women getting abortions, the moral object probably does not involve the death of the child in itself, but merely its removal. But that doesn't mean it's justified, as in most cases there is no proportionate reason to remove the baby early like that, the grave side-effect of the baby dying (when it would not otherwise) is not outweighed by the mere convenience of the mother. So it is still equivalent to murder.

Anything short of saving a life cannot justify a death, even as a side effect.
Removing a uterus to end the pregnancy (with the side-effect of the baby dying) would not be allowed merely for convenience, yet it is allowed to save the mother's life (in the case of uterine cancer, etc). Removing a fallopian tube merely for, say, sterilizing purposes would not be allowed, but it is allowed to save the mother's life in ectopic pregnancy (even when an embryo contained within dies as a side-effect).

In fact, I'd argue now, merely removing the embryo, with its placenta, from the fallopian tube (even if it then died)...could probably be permitted rather than requiring the whole tube be removed (under the argument that the tube itself is pathological somehow). Because, of course, if that embryo could be re-implanted in the uterus itself, or in an artificial womb...removing it from the fallopian tube would not be considered abortion. It's death in se is not the means to the cure of the mother, merely its removal.

That very fact proves that the act of removing is not, in itself, equivalent to murder. The lack of technology to remove without death resulting as a side-effect of removal makes the question more grave, of course, and it is potentially equivalent to murder if there is no equally grave reason to justify such a side effect. But if the embryo is going to die either way, it seems that requiring the removal of the whole fallopian tube just to avoid "directly" acting on the child in a physical sense is silly (and has seemed so intuitively to many people, even who agree with the Church's principles).

I think the reason is because, in reality, acting on the child directly in a physical sense is fine, as long as the moral object is not saving the mother through the death of the child as a direct means. But "removing" is not the same as "killing." It is not the child's death which saves the mother in these cases, merely his non-presence in the womb. The cure, however, is indifferent to whether that non-presence leads to death or not (and, in fact, someday it may be possible to keep even very young embryos alive after removal in artificial wombs). The death does not seem, then, to be the direct means in these cases. Rather, the removal is (the death is just a side-effect of the removal).

Though every effort should be made, of course, to remove the child (even if death as a side-effect is inevitable) in the manner least painful for him, and most in keeping with his dignity...what I've said about "removing" for the sake of saving the mother being a different moral object than "killing" would probably even be true if the means of removal acted directly on the child's body even in a gruesome manner (and Grisez seems to agree). Though I'm not claiming that these are cases of self-defense, the analogy can be made to self-defense where the goal is self-preservation, and the action on the aggressor is chosen only as a means of save your own life (yet that life-saving cannot be willed through the other person's death as a direct means, even if it results from that defensive action as a side effect).

To use another analogy, there are several virgin martyrs who leaped to their deaths off roof-tops after being pursued by would-be rapists. Given that rape does not forfeit theological virginity, some people find these stories odd, even seemingly saying death is better than being raped. However, if their concern is interpreted as concern for the soul of the rapist, they might make more sense (though intending an act is morally equivalent to completing it, still...there does seem to be something more harmful to the soul, if not more culpable, about actually following through with it successfully).

Nevertheless, the point is that these Saints did not commit suicide. They leaped from the roof to avoid capture. Their deaths were a side-effect justified by the spiritual purpose. Nevertheless, their deaths in themselves were not the means to this spiritual purpose, their escape was, even if their death was a side-effect of the thing done to escape. Presumably, though, they wouldn't have minded if there had been a trampoline underneath and they had survived the fall, just so long as they escaped; their escape was not dependent on their death, which proves it was just a side-effect. "Jumping off a roof" to escape pursuers is not the same moral object as suicide, where escape from suffering in life is willed directly by means of death. Even so, if the former case is foreseen to lead to death, you had better have a very good reason for it!

Well, I can't really see how a "pathological" pregnancy in the case of hypertension is any different than all these cases. It seems pregnancy can be a medical issue, even a fatal one, that might be terminated through removal of the child for proportionate reason. That does not mean, however, that the moral object is the death of the child, however, as "pregnancy" and "the life of the child" do not seem equivalent. The moral object is saving the mother through the neutral action of removing the child; even if death is a foreseen result of that removal, the saving of the mother is not dependent on the death, the death is not the direct means to it in any sense, and as such (especially in cases where the baby is going to die either way) it is not in any sense part of the moral object chosen.

I say all this not because I want to be liberal when it comes to these very grave life issues, but rather because I feel like this could get the Church out of a lot of bad PR when it comes to situations that seem to, basically, require the mother to die for the sake of abstract theory (even if the child will also die) when she could be saved, a situation which always seemed morally fishy to me. And yet, on the other hands, I definitely agree that the ends can't justify the means! As that theologian's article in the Vox Nova post says, I think a lot of this trouble is due to an overly physicalist notion of the moral object.

So, it seems, making this crucial distinction between saving the mothers life through "terminating pregnancy" (by removing the child) and "killing the baby" (even if that is often a foreseen side-effect of removing the child, especially by certain methods) as moral objects...could very possibly eliminate many arguments in favor of direct abortion on the grounds of "life of the mother." Not by forsaking the life of the mother, but by conceding that in cases where both would die if nothing is done, it is not really "direct abortion" at all in the first place, morally speaking.

Because I cannot imagine any case where the mother's life would be threatened by the very life of the baby itself. By the fact of the pregnancy, yes, possibly. But terminating pregnancy doesn't have to mean directly killing the baby in the moral sense. This is something I point out to people who argue for abortion based on a claim that the mother has a right to not be pregnant. I say to them, "Even if we admitted that, after viability 'not being pregnant' and 'killing the baby' are two very different things." It could be birthed live if possible, if old enough, and then cared for in an incubator, for example.

Cases where it is not currently possible to save the baby once removed (or where it might be, but where a method of removal that results in death is used) would require proportionate justification for the side-effect of death (and only saving another life could be proportionate to the loss of a life). And if that justification were not present, it would be equivalent to murder. But it does seem to me that "terminating the pregnancy" through removing the baby (even if that leads to death) is not equivalent to direct abortion, to killing the baby, to willing something through its death specifically (as opposed to just its removal).

Again, in cases where there was no proportionate reason for doing so, the side-effect would not be outweighed, and so it would still be equivalent to murder (through preforming an unnecessary act foreseen to cause death). But in cases where it was necessary, where it was proportionate (ie, for the life of the mother, especially in cases where the baby is going to die either way) seems like this would, for me, provide an ethical "out" that could finally resolve the seeming absurdity of demanding that they both die, yet without admitting that the ends justify the means or any heretical school of proportionalism.

At the very least, I think it can be admitted that this side has a very good argument and shouldn't face excommunication.

1 comment:

Yellowed said...

Hmm. Two things:

"I'd admit that, in most women getting abortions, the moral object probably does not involve the death of the child in itself, but merely its removal. But that doesn't mean it's justified[...]it is still equivalent to murder."

What then do you think of the moral object of the abortionist himself, as opposed to the mother??

"Though every effort should be made, of course, to remove the child (even if death as a side-effect is inevitable) in the manner least painful for him, and most in keeping with his dignity...what I've said about "removing" for the sake of saving the mother being a different moral object than "killing" would probably even be true if the means of removal acted directly on the child's body even in a gruesome manner (and Grisez seems to agree)."

I'm a little uncomfortable with this. If, say, the fetus is removed by dismemberment, can we really say that death is merely a "side effect" of removal. It would seem to me that dismemberment is equivalent to death, and in such a case dismemberment would not seem to be merely a side effect, but the direct means of the "removal."

I suppose you could argue that "the death really wouldn't matter" or that "if it were possible to save someone after dismemberment, they would."

But then I think of examples like, say, cannibalism. If I'm starving on a desert island with an infant, can I cook the baby for nutrition and then claim the death was a "side effect"?? That I don't really care about his death, that "If possible, I'd get nutrition from him alive." That seems facetious; cooking and eating someone is equivalent to his death. The death may not be the nutritive end willed, but it is a direct means for achieving the nutrition given that you simply cannot conceptually separate eating someone from killing them.

Likewise, I think of organ donation. Many Catholic theologians argue that the removal of vital organs (common in hospitals) when the patient is merely brain-dead (but not actually dead) constitute direct murder. Yet by your analysis, we could take organs from a living person (dying themselves or not) in order to save others, because the direct means of our moral object would be merely "removing the organs," abstracted from the person's death. But I'm not sure you can sincerely abstract the two...