The Deacon's Bench

The Deacon's Bench


“Direct abortion” vs. a “medical procedure”

posted by jmcgee

Wednesday, the bishops released a document clarifying the difference between a “direct abortion” and a “medical procedure” — evidently, in connection with the much-covered case in Phoenix.

Catholic News Service offers a summary:

The committee’s statement quoted directive 45: “Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.”

Therefore, the committee’s statement said, “Direct abortion is never morally permissible. One may never directly kill an innocent human being, no matter what the reason.”

The committee’s statement also quoted directive 47: “Operations, treatments and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”

In explaining the distinction, the committee offered two examples involving an unborn child not old enough to survive outside the womb.

The first involves a pregnant woman who is experiencing problems with one or more of her organs, apparently because of the added burden of pregnancy. In this case, the doctor recommends an abortion to protect the woman’s health.

In the second example, a pregnant woman develops cancer in her uterus. In this case, the doctor recommends surgery to remove the cancerous uterus as the only way to prevent the cancer from spreading. Removing the uterus also will result in the death of the unborn child.

The committee said the first case is an example of a direct abortion. The surgery, the committee explained, does not directly address the health problem of the woman by repairing the organ that is malfunctioning.

“The surgery is likely to improve the functioning of the organ or organs, but only in an indirect way, i.e., by lessening the overall demands placed upon the organ or organs, since the burden posed by the pregnancy will be removed,” the committee’s statement said. “The abortion is the means by which a reduced strain upon the organ or organs is achieved.”

In the second example, the committee explained, “an urgently needed medical procedure indirectly and unintentionally … results in the death of an unborn child.”

The surgery directly addresses the woman’s health problem by removing a malfunctioning organ and, the committee’s statement continued, “does not directly target the life of the unborn child … the death of the child is an unintended and unavoidable side effect and not the aim of the surgery.”

“There is nothing intrinsically wrong with surgery to remove a malfunctioning organ,” the doctrine committee’s statement said. “It is morally justified when the continued presence of the organ causes problems for the rest of the body.

“Surgery to terminate the life of an innocent person, however, is intrinsically wrong. There are no situations in which it can be justified,” the committee added.

There’s much more at the link.



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Eugene Pagano

posted June 23, 2010 at 9:40 pm


I am generally pro-life, but this distinction between a direct abortion and an indirect one makes little sense to this lawyer who has left the RCC (for the Episcopal Church). It means that the mother must die unless the danger to her life can be removed if an organ can be removed, with the fetus incidentally going along with the rest of the removed tissue — but that the mother and fetus must both die if it is not possible to end the threat to the mother’s life by removing some tissue other than the fetus, with the fetus being removed incidental to the removal to the other tissue. Pro-life principles reach a reductio ad absurdum when their application results in the death of two persons instead of one.
If the pregnancy itself creates the threat to the mother’s life, why not consider the placenta the diseased organ that can licitly be removed with the fetus being removed as an incident to the removal of the placenta?



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Chris Sullivan

posted June 23, 2010 at 10:42 pm


The full USCCB statement is clearer and is online at http://usccb.org/doctrine/direct-abortion-statement2010-06-23.pdf
The issue the statement addresses is not the morality of removing the child to save the mothers life in this particular case but the USCCB’s concern over wide misreporting that direct abortion is supported by the Church. As the USCCB statement puts it :-

The position that Church teaching supports the direct taking of unborn life has been widely reported at the national level by media outlets, which has caused some confusion among the faithful as to what the Church teaches regarding illegitimate and legitimate medical procedures used in cases where the mother’s health or even life is at risk during a pregnancy.
In order to clarify doubt regarding the Church’s teaching on this important matter, the Committee on Doctrine, following its mandate to provide expertise and guidance concerning the theological issues that confront the Church in the United States, offers the following observations on the distinction between medical procedures that cause direct abortions and those that may indirectly result in the death of an unborn child.

What the statement does not address is the issue of whether removing the baby is not a direct abortion.
While it may clarify an apparent misreporting that the Church supports direct abortions, it doesn’t really help much in the Phoenix case for the USCCB to observe that a direct abortion is, in fact, a direct abortion. Everyone knew that already.
The real issue is what can be done to save the life that can be saved without directly killing the baby.
I submit that removing the baby without directly killing it meets all the moral criteria. That’s exactly what we’d do if the baby was old enough to survive outside the womb and no one would think to call such an operation an abortion.
God Bless



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cathyf

posted June 24, 2010 at 1:25 am


“There is nothing intrinsically wrong with surgery to remove a malfunctioning organ,” the doctrine committee’s statement said. “It is morally justified when the continued presence of the organ causes problems for the rest of the body.

The problem with this is that this is rarely how medicine works. Sure, sometimes you can go in and directly fix what’s broken or remove what’s malfunctioning. But most of the time what you do is go in and break something else in a way that more or less cancels out the effect of the malfunction. Especially in the case of the endocrine system, which is a series of multi-part feedback loops, which are more-or-less self-correcting.
In the case of the pulmonary hypertension, I would argue that the placenta is a malfunctioning organ, because it is overstimulating the lungs. Organs that produce stimulating hormones are supposed to be sent chemical signals to turn them off when they have stimulated their target enough, and they are supposed to respond to them by excreting exactly enough of what they excrete. Individual humans in fact vary as to their individual sensitivities to various hormones, so the actual amounts produced of mediating hormones can vary be a lot from person to person. Clearly in the pulmonary hypertension the target is being overstimulated (to the point of death) and so the placenta is sending out more lung-stimulating hormone than is proper. Whether it is because of a defect in the placenta itself that it does not pay attention to the hormones that tell it to turn off, or the lungs don’t send the “stop” signals, it is clearly sending the wrong amount of hormone out.
What is still not clear from the bishop’s statement is whether they are willing to allow the medical sense of “malfunction” which is considerably more plastic than their examples envision. It is simply not clear to me whether their examples are constructed they way that they are because they are ignorant of the complexities of the underlying biological systems (because they are expert at neither biology nor medicine) or because they really see some distinction there that I simply cannot see.



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Panthera

posted June 24, 2010 at 3:45 am


Cathyf said:
It is simply not clear to me whether their examples are constructed they way that they are because they are ignorant of the complexities of the underlying biological systems (because they are expert at neither biology nor medicine) or because they really see some distinction there that I simply cannot see.
end quote
Cathyf, I think this is the great challenge any institution which decides what is right and wrong for everybody has.
One must be expert in all fields necessary to reach, first, a proper understanding of the matter in order to, second, pronounce upon the matter such that similar matters may be resolved deductively and not inductively.
The more these discussions arise on the culture war topics, the more those suffering pain and hurt are failed by us Christians on both sides.



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Las Vegas Lawyer

posted June 24, 2010 at 7:02 am


Talk about abortion; it is kind of murder. You generally take life of person even birth does not come. Every child has the right to live, to have proper education, d to be loved. Let’s stop abortion if it is not necessary for life threatening situations.



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Klaire

posted June 24, 2010 at 7:53 am


Chris, once again, your logic baffles me. I don’t think the new Bishop statement could make it any more clear: It is NEVER ok to direclty kill a baby, period. An 11 week old fetus has about as much chance of “living” after “removal” as an embryo does from jumping out of a petri dish. An 11 week old fetus is totally sustained by the life of the mother, unlike a 6 month or older baby, who COULD survive outside the womb with medical technology.
Eugene, did you consider the fact that had the mother chosen to not to allow the abortion, there was still a chance, albeit slight, that they both could have lived? It would make sense that being that the church views EVERY life as sacred, from the moment of conception, that the unborn had just as much of a right to life as the mother, all left to the hand of God, despite the enormous odds.
I think Dcn. Greg pretty well summed up this story that never seems to end on the last post. This is about as hard as our faith gets, calling us to possible martydom, all the while leaving a family of 5 behind and having enough grace to trust totally in God’s will.
I don’t think any of us who have debated this story think that the mother’s choice was “easy”, and most of the faithful DO know that it was a DIRECT killing of the baby. I still conclude that the reason this is such an unending debate, is that it forces all of us (especially faithful Catholics), to wonder IF we could ever answer the call to martydom, especially in a world that for the most part, has zero concept of it.
The good news is that God’s mercy is great. Anyone with repentence can be forgiven, the “ex commummincated” can be restored to the fullnes of the faith, as well as a mother who may have, in her humaness, said “no to martydom.”
The greatest tragedy would be not to seek God’s mercy. Even without knowing every last detail, it seems highly unlikely that Sister McBride or this dear mother made easy decisions, even if they were not in accordance with God’s will.



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Panthe

posted June 24, 2010 at 8:35 am


Klaire,
I like you. We disagree, nearly completely on all the culture war issues, but your posts arise from a genuine committment to serve God and not from the hatred which motivates most.
That said, I must object to your last statement in this paragraph:
The greatest tragedy would be not to seek God’s mercy. Even without knowing every last detail, it seems highly unlikely that Sister McBride or this dear mother made easy decisions, even if they were not in accordance with God’s will.
end quote
I just do not see how we can claim to “know” God’s will. We can strive to learn His will, yes. But to know? The Nazis knew God’s will towards Jews and Roma and Sinti and the homosexuals.
We’ve been down that path before, except I’ve read the trial in Latin, and it’s no good – the Church doctors knew the sun circled the earth because they knew God’s mind…
I don’t know God’s mind, nor his will. I know that I am accountable to Him for my actions and inaction. I know my my salvation is dependent on His grace, not upon anything I might achieve.
But that’s just about all i know.



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Panthera

posted June 24, 2010 at 8:41 am


Well, I also know that posting before the first cup of coffee after a long night correcting term papers leaves me incapable of spelling even my own name…my apologies for the typos.
Recaptcha: “and spastic”. E tu, computatris?



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oldestof9

posted June 24, 2010 at 8:49 am


Panthera,
I know God’s will for me…
Just by questioning (discernment) myself, my actions, and God, I know that He wanted me to become an ordained deacon in the Catholic Church. I never had the feeling/revelation that it was to be any other way. If I would have, I would not have been ordained…I knew than as I know now God’s will for me.
Peace to all



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Panthera

posted June 24, 2010 at 8:57 am


Oldestof9,
I can respect a calling to serve. I do believe, however, very firmly in fact, that most of the evil done to homosexuals and Jews and Sinti and Roma was possible because of people being convinced that the “knew” God’s will on the matter.
Right now, in Uganda, many American Christians are doing their very best to pass laws which will put homosexuals to death. Quite a few of those Christians have close ties to the Catholic Church, which only very late, indeed, distanced herself from the sad affair.
If you ask them, they will tell you that they “know” God’s will is my murder.



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Klaire

posted June 24, 2010 at 9:15 am


Panthera thank you for your kind words, despite how differently we see things. I certainly agree that God’s will takes some serious discernment, however what DO KNOW a few things, because Jesus Himself taught them to us:
1. The Holy Spirit only comes to those who obey (don’t you agree it would be quite difficult to discern God’s will sans the Holy Spirit Pantherea?). Consequently, obedience is the first necessary step.
2. Keeping the commnandments, and for Catholics, living the fullness of the faith, is the first step to doing God’s will. If you google Dei Verbum, you will understand how Scripture, Tradition, and the Teaching of the Magesterium, including the Catechism, all work together, always in concert, and none ever standing “alone.”
Panthera a very holy priest once told me that if we live truly within the teachings of Christ, i.e, obedience, even if we never come to an ah ha moment of discernment to a vocation of sorts,we are for the most part, doing God’s will. The point being, it all starts with obedience. Mother Angela used to describe it as “Just keep walking through open doors.”
I suspect you and I would disagree on what obedience is, but for me Pathera, it’s living the Catholic Faith the best that I can, even when I don’t understand every why of every teaching. After all, that’s the “faith part” of it, trusting that Jesus left the one true Church, guided by the Holy Spirit, even despite the sins of many in it.
One of the things that finally brought me into the fullness of Catholicism was trying to prove the chruch wrong on any teaching of faith and morals over 2000 years. It’s impossible, has never happened, even with the most corrupt Popes (guess they were too busy sinning to define new dogma-the protection of the promised Holy Spirit). The CC may have it’s wordly problems, but it’s rock solid when it comes to the 2000 years of the immutable teachings of Jesus Christ.
God Bless you Panthera.
p.s. As for Gaileo, go to catholic.com and search under his name. The “facts” may surpise even you.



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Panthera

posted June 24, 2010 at 9:20 am


Klaire,
I’d rather spend the day discussing with you, but duty calls. Sadly, I’ve now got about 50 freshmen to flunk. None are mine, I am only doing seminars right now … which rather makes it worse.
The Galileo affair is definitely worth exploring at some future juncture.
God bless!



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Fran Rossi Szpylczyn

posted June 24, 2010 at 9:23 am


Panthera says: “Klaire,I like you. We disagree, nearly completely on all the culture war issues, but your posts arise from a genuine committment to serve God and not from the hatred which motivates most.”
Klaire responds: “Panthera thank you for your kind words, despite how differently we see things.”
A bit off topic, but I am grateful to both Klaire, Panthera and Deacon Greg for being a part of this blogging community that has healed somewhat over time. We don’t always agree, but when we are in conversation, based on our need to love and serve God and one another, we are re-membering the Body of Christ as it should be. And may we all continue to learn and grow in our faith.



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Chris Sullivan

posted June 24, 2010 at 11:04 am


Klaire,
And the baby in the cancerous uterus example the USCCB statement used has equally as little chance of surviving after its removal.
The point is that removal is not direct killing and therefore not an abortion.
What kills the baby is not the removal. What kills isn’t what’s necessary to save the mother. What kills is our current lack of the technology to keep alive an 11 week old baby outside the womb. Let’s hope and pray we one day have that technology so we can save both lives.
In the meantime let’s remember that the fifth commandment “thou shalt not kill” requires us to save the life we can.
Panthera,
You make an excellent point of the need to be circumspect about knowing the will of God. Thank you for that.
God Bless



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Klaireadams

posted June 24, 2010 at 11:51 am


QUOTE FROM CHRIS:
Klaire,
And the baby in the cancerous uterus example the USCCB statement used has equally as little chance of surviving after its removal.
I agree with the “little chance of survival” Chris, but as the Bishops clearly explain, “necessary treatment” is permitted as long as it isn’t DIRECT killing, as in “Kill baby first”, which it clearly was in Phoenix, despite the agonizing circumstances. Also, the baby in the case of the overian cancer would NOT be removed while it was alive, only after it has ceased to live sometime after the chemo. Maybe that’s the source of your confusion Chris, as it isn’t “Chemo and abortion” all in one swope. The baby would STILL die a natural death, albeit a result of necessary life sustaining treatment for the mother. And of course, miracles are always possible!
Fran thanks for your comment. IMO at least, the essence of good blogging is honest disagreement, albeit always civil. It actually would be pretty boring if we all agreed. I learn a lot from this blog!
I don’t doubt Chris’s sincerity for a minute, just couldn’t disagree more with his logic.



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pagansister

posted June 24, 2010 at 1:49 pm


All this is as clear as trying to answer the question of old: “How many angels can dance on the head of a pin?”
Each case will be different and probably not totally clear cut, even with the definitions given, in order to supposedly clairify things.



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Chris Sullivan

posted June 24, 2010 at 3:22 pm


klaireadams,
The USCCB statement says:-

In the second scenario, a pregnant woman develops cancer in her uterus. The doctor recommends surgery to remove the cancerous uterus as the only way to prevent the spread of the cancer. Removing the uterus will also lead to the death of the unborn child, who cannot survive at this point outside the uterus.

[This] second scenario describes a situation in which an urgently-needed medical procedure indirectly and unintentionally (although foreseeably) results in the death of an unborn child. In this case the surgery directly addresses the health problem of the woman, i.e., the organ that is malfunctioning (the cancerous uterus). The woman’s health benefits directly from the surgery, because of the removal of the cancerous organ. The surgery does not directly target the life of the unborn child. The child will not be able to live long after the uterus is removed from the woman’s body, but the death of the child is an unintended and unavoidable side effect and not the aim of the surgery.

In other words, it is quite licit to remove the baby in the uterus and that is NOT an abortion.
It seems to me that doing the same thing is exactly the medical solution in the Phoenix case. Especially if Cathy is right about the placenta posing a threat to he mother analogous to the cancerous uterus.
God Bless



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Chris Sullivan

posted June 24, 2010 at 3:26 pm


I’d also point out that we don’t know for sure whether what was done in Phoenix actually was a direct abortion. Given the confusion between medical procedures necessary to save a mothers life and direct abortions, not to mention the political context, that doesn’t surprise me.
God Bless



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cathyf

posted June 24, 2010 at 4:31 pm


The bishops’ statement has no mention of chemo:

The second scenario describes a situation in which an urgently-needed medical procedure
indirectly and unintentionally (although foreseeably) results in the death of an unborn child. In
this case the surgery directly addresses the health problem of the woman, i.e., the organ that is
malfunctioning (the cancerous uterus). The woman’s health benefits directly from the surgery,
because of the removal of the cancerous organ. The surgery does not directly target the life of
the unborn child. The child will not be able to live long after the uterus is removed from the
woman’s body, but the death of the child is an unintended and unavoidable side effect and not the
aim of the surgery.

In fact, in Klaire’s scenario where chemo kills the baby first, the whole remove-the-uterus question is not any kind of abortion, direct or indirect. Once the baby is already dead, removing the dead body of the baby from the mother’s body has minimal ethical considerations. Obviously the bishops’ example assumes that the baby is still alive when the uterus is removed.
But Klaire does point out a severe problem with the bishops’ example as an example — removal is not the only treatment for uterine cancer, and chemo gives the baby a chance for survival that removal does not. There are further problems… Neither a cancerous uterus or a fallopian tube with a baby implanted in it are “malfunctioning.” The danger from cancer is that it will metastasize, and cause some other organ (one necessary to life) to malfunction and kill you. The fallopian tube is functioning completely as it should — it’s not supposed to be large enough to hold a baby.
These examples are supposed to teach us what the moral principles are. Instead, they mostly serve to teach us that the bishops’ ethics experts don’t actually understand biology.
Chris makes the assertion that “What kills is our current lack of the technology to keep alive an 11 week old baby outside the womb.” This assumes that the next technological advance will be to be able to keep very young babies alive outside of the womb. I think that is very unlikely. What is far more likely is that someone will track down the hormone(s) which the placenta is excreting which are causing the lungs to malfunction, and develop a treatment which will shut down the hormonal process without having to remove the placenta from the mother’s body. The interesting question then will be the effect of that treatment on the baby. What is most likely in that scenario is that this hormonal treatment will have some risk for the baby, but not nearly the risk that leaving the pulmonary hypertension untreated would have. And of course the risks to the mom would go way down, too. If my scenario plays out — or even if it’s plausible, which it is — then I think that this somehow makes it clearer that removing the placenta to prevent the diseased organ from killing the mother and the baby should have been considered “indirect killing” all along.



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wineinthewater

posted June 24, 2010 at 5:48 pm


cathyf,
I’m not a doctor, maybe you are and know better than I do, but from what I have been able to read, the malfunctioning organ would not be the placenta, but the heart or lungs. It seems logical to me that a placenta could produce excessive hormones, but what I read indicates that the typical case is that the normal functioning of the placenta exacerbates an existing disorder. Either way, I don’t think that we can make a blanket statement that it is the placenta that is the diseased organ.
That aside, there is the problem of the nature of the placenta itself. The uterus is the mother’s organ. However the placenta is a hybrid organ of both mother and child. To remove the placenta is to take direct action against the child.
These are considerations that must be accounted for. Honestly, just as I am no doctor, I am no moral theologian. I don’t know if the removal of the placenta can be truly distinguished from a direct abortion. I don’t know if “separating” a pre-viability child from the mother can be truly distinguished from a direct abortion. My feel is that they cannot.



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cathyf

posted June 25, 2010 at 12:27 am


I don’t know if “separating” a pre-viability child from the mother can be truly distinguished from a direct abortion. My feel is that they cannot.

wineinthewater, that’s my feel, too. The problem is that it is also my feel about both of the examples given, too — that ectopic pregnancy, uterine cancer and pulmonary hypertension are all three of the same moral class, whatever you want to call it. I’m not arguing over the definition of “direct” and “indirect”. Such arguments are ultimately pointless, because words have meaning only by people agreeing to their meanings — once people don’t agree then the words have no meanings. So call it “indirect” of whatever word you want, I’m merely claiming that if removing the baby and attached tube is allowed in an ectopic pregnancy, then removing the baby and attached placenta in pulmonary hypertension is the same thing.
This whole indirect/direct argument just seems squirrelly to me. It’s like Capt Renault in Casablanca who is “…shocked, shocked to find that gambling is going on in here!” I have this mental picture of the doctor in the operating room, proclaiming in a French accent that he is “…shocked, shocked to find that there is a baby in here!”
The part of this that I also find disturbing is that when you actually compare removing a whole chunk of tube, the attached placenta and the baby, versus when you remove some uterine lining, the attached placenta and the baby, the difference is how much damage you do to the mother’s body. As if it’s not a “legitimate” medical procedure aimed at treating a serious medical problem if you don’t do enough injury to the mother in the course of the treatment.



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Mack

posted January 24, 2011 at 2:12 am


Its really a nice and informative blog..
I wanna some information about a Medical term that is called Tubal reversal and most of women’s didn’t know about it. So here I m providing you useful information…
A tubal reversal is a procedure to reconnect the fallopian tubes in a woman who has previously undergone surgical sterilization, known as tubal ligation. For more info chk this
Tubal Reversal



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