Abortion to Save the Life of the Mother — The "Double Effect."

       The very rare cases of pregnancy that pose a real and immediate threat to the mother's life — including uterine cancer and ectopic pregnancies — are a source of great confusion, especially among Catholics.
       It is absolutely true that the Catholic Church bans direct abortion to save the life of the mother. However (and this is an extremely important point) the mother's life may be saved by a surgical procedure that does not directly attack the preborn baby's life.
       The most common dysfunctions that may set a mother's life against that of her preborn child's are the ectopic pregnancy, carcinoma of the uterine cervix, and cancer of the ovary. Occasionally, cancer of the vulva or vagina may indicate surgical intervention.
       In such cases, under the principle of the "double effect," attending physicians must do everything in their power to save both the mother and the child. If the physicians decide that, in the case of an ectopic pregnancy, the mother's life can only be saved by the removal of the Fallopian tube (and with it, the preborn baby), or by removal of some other tissue essential for the preborn baby's life, the baby will of course die. But this kind of surgery would not be categorized as an abortion. This is all the difference between deliberate murder (abortion) and unintentional natural death.
       The principle of the twofold, or double effect, states that it is morally allowable to perform an action that will produce both good and bad effects as long as the following conditions are all met. The example shown is for the treatment of an ectopic pregnancy, where the preborn child is developing in the Fallopian tube. If the child continues to grow there, the tube will eventually rupture and will probably cause the death of both the mother and the child.[13]

(1) The object of the action to be performed must be good in itself or at least morally neutral. In this case, the object of the surgery is to remove a pathological organ which presents a threat to the life of the woman. By contrast, the object of surgical or chemical abortion is simply to kill the preborn child ["object" is the end toward which an action tends, and does not connote the intention(s) of the operator, as does the word "objective"].

(2) The good effect must not come about as a result of the evil effect, but must come directly from the action itself. In this case, the good effect (saving the mother's life) is not caused by the bad effect (the death of the preborn child). By contrast, in the case of direct abortion (surgical or chemical abortion), the death of the child is wrongly considered to be the "good" effect.

(3) The evil effect must not be desired in itself but only permitted. In the case of the removal of an ectopic pregnancy, the surgeon does not intend or want to kill the baby; his death is an unintended and unwanted side effect of the surgery. By contrast, the intent of abortion is to kill the preborn child.

(4) There must be a sufficiently grave reason for permitting the evil effect to occur. In this case, the reason is to save the life of the mother, a good that is greater than or equal to the evil effect of the baby's death. Pro-abortion groups often stretch this principle to absurd lengths, going so far as to justify all abortions under the principle of the double effect because, as they allege, all abortions threaten the life of the mother.[14]

(5) Sometimes a fifth condition is added, implicit in (4), above, namely, that there is no other alternative available to solve the problem at hand. If there are alternatives other than the intervention that offer better possibilities to save both mother and preborn child, these of course must be used.
       In fact, this last condition is the one that most clearly distinguishes the "indirect abortion" case (the case under the double effect principle) from the "therapeutic" abortion case. "Therapeutic" abortion is direct abortion, and therefore is always gravely evil. It is the abortion committed with the (supposed) intention of saving the mother's life, but where one or more of the above conditions are not met. Basically, the doctor in this case does have alternatives to save both mother and preborn child, but chooses abortion as the most expedient way to solve the problem at hand. The phrase "therapeutic abortion" is in fact an oxymoron, since no direct abortion is therapeutic, i.e. it does not "cure" anyone of an illness, but instead kills an innocent human being.
       It is perhaps a sign of the times that abortionists see pregnancy itself as a disease, and abortion as the "cure" for this dreaded malady. At an Association of Planned Parenthood Physicians conference, Willard Cates compared the miracle of pregnancy to a venereal disease when he said that "Unwanted pregnancy is transmitted sexually, is socially and emotionally pathologic ... and has many other characteristics of the conventional venereal diseases. The incubation time, defined as the period between exposure (mid-cycle coitus) and the development of initial symptoms (usually missed menses), averages approximately two weeks."[15] Barbara Roberts said that "It's obvious, therefore, that unwanted pregnancy is the most common venereal disease ... This disease is associated with immense suffering. Seeking to be cured of this disease, women from time have risked pain, mutilation, and death in numbers that really stagger the imagination."[16] And late-term abortionist Warren Hern has said that "[Pregnancy] is an episodic, moderately extended, chronic condition ... defined as an illness ... treated by evacuation of the uterine contents. ... The relationship between the gravid female and the feto-placental unit can be understood best as one of host and parasite. Pregnancy should be seen as a biocultural event in the context of other human illnesses."[17]
       The promotion of "therapeutic" abortion by pro-abortionists in countries where abortion is illegal is a strategy they use to not only legalize abortion in these cases, but also to eventually legalize abortion on demand. Exceptions to direct abortion are not only evil in themselves, they also and always lead to abortion on demand.

       As medical science advances, surgeons might be able to save the preborn child despite even these serious medical problems. If we ever arrive at the point where the lives of both mother and child can be saved in all cases, the principle of the double effect would not apply.[18]
       The principle of the "double effect" also applies to sexual sterilization. If a non-pregnant woman must have a hysterectomy to remove a dangerously cancerous uterus, this will result in her sterilization, but is not a sinful act (provided the above conditions are met). However, if the purpose of the operation is not to heal or safeguard health, but to directly sterilize, then that act is intrinsically evil and is always a mortal sin.[19]

       Statement of Intent and Principle. Pope Pius XII summarized the intent of the double effect when he addressed the Family Front Congress on November 27, 1951; "Both for the one and the other, the demand cannot be but this: To use every means to save the life of both the mother and the child."[20]
       Pius also stated the general principle of the "double effect" on October 29, 1951, at his address to the Italian Union of Midwives. This speech is codified in the Pope's Acta Apostilicae Sedis, 43(1951), page 855.
       Article 14 of the Sacred Congregation for the Doctrine of the Faith's Declaration on Procured Abortion reiterates it.
       The pertinent passage of this document reads;

Deliberately we have always used the expression 'direct attempt on the life of an innocent person,' 'direct killing.' Because if, for example, the saving of the life of the future mother, independently of her pregnant condition, should urgently require a surgical act or other therapeutic treatment which would have as an accessory consequence, in no way desired or intended, but inevitable, the death of the fetus, such an act could no longer be called a direct attempt on an innocent life. Under these conditions the operation can be lawful, like other similar medical interventions — granted always that a good of high worth is concerned, such as life, and that it is not possible to postpone the operation until after the birth of the child, nor to have recourse to other efficacious remedies.

       Yet More Silliness. As described in Human Life International's course on "Winning Pro-Life Debates," one of the most effective general tactics employed by pro-abortionists and other anti-lifers involves the assertion that "this is not a black and white question." In other words, the pro-aborts would have us believe that there is some enormous (and necessarily undefined) grey area within which many ethical questions fall.
       Of course, this concept is the ultimate red herring: According to 'Catholics' for a Free Choice and other phony 'Christians,' any abortion that any woman wants inevitably falls into this "gray area."
       As with every other ethical and moral question posed to pro-abortionists, "wanna-be" theologians stretch the 'double effect' to cover all abortions, and the effects are frequently comical. For example, John Swomley, a propagandist for the 'Religious' Coalition for Abortion Rights (RCAR, now RCRC), claims that "The Roman church argues that although the death of the fetus is foreseen, it is not intended because the intention is to preserve the health and life of the woman. Isn't it just as reasonable to assert that the intention of most women is the separation of the fetus from the woman, not the killing of the fetus, though its death may be foreseen?"[21]
       Swomley obviously is not familiar with the principle of the double effect, which requires that the act producing two effects must itself be a morally good or neutral act to begin with. The only purpose of an abortion is to kill the unborn child, and such an action can never be good or even morally neutral, regardless of the circumstances or intentions surrounding it.
       Canon law requires that the desired effect (in Swomley's example, "separation of the fetus from the woman") must be accomplished in such a way as to best assure the survival of both mother and child. Thus, the approved method to achieve "separation" would be the natural termination of pregnancy known as "birth," occurring at about nine months' gestation.
       Additionally, if the intention of most women is the "separation of the fetus from the woman," why do 1.6 million women reject adoption each year? And why do abortionists deliberately use methods designed to kill preborn babies in late abortions? It is plain that the purpose of abortion is indeed to produce a dead baby.

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Footnotes for “Abortion to Save the Life of the Mother – ‘The Double Effect’”

[13] Rev. Edward J. Hayes, et. al. Catholicism and Ethics. Norwood, Massachusetts: C.R. Publications, 1997, pages 54 to 57.

[14] For example, at the 1980 national convention of the National Abortion Federation (NAF), abortionist Lise Fortier said that "Each and every pregnancy threatens a woman's life. From a strict medical viewpoint, every pregnancy should be aborted" [Andrew Scholberg. "The Abortionists and Planned Parenthood: Familiar Bedfellows." International Review of Natural Family Planning, Winter 1980, page 308].

       As described in the text, one of the most ridiculous pro-abortion abuses of the "double effect" was committed by John M. Swomley of the Religious Coalition for Abortion Rights (now RCRC), of which CFFC is a member organization. Swomley claimed that "The Roman church argues that although the death of the fetus is foreseen, it is not intended because the intention is to preserve the health and life of the woman. Isn't it just as reasonable to assert that the intention of most women is the separation of the fetus from the woman, not the killing of the fetus, though its death may be foreseen?" [June 1987 propaganda pamphlet by RCAR entitled "Six Ethical Questions"].
       This is as stupid a statement as someone claiming that they only intended to push someone off a 500-foot cliff but were guilty of no crime, even though the death of the victim could be foreseen.

[15] Willard Cates Jr., M.D., et. al. "Abortion as a Treatment for Unwanted Pregnancy: The Number Two Sexually-Transmitted Condition." Address presented to the Association of Planned Parenthood Physicians Conference, Miami Beach, Florida, November 11-12, 1976.

[16] Barbara H. Roberts, M.D. "Abortion Laws Murder Women." Essay in a Women's National Abortion Action Coalition booklet entitled "Abortion is a Woman's Right: March on Washington, DC and San Francisco, November 20 [1972]."

[17] Warren Hern. "Is Pregnancy Really Normal?" Alan Guttmacher Institute's Family Planning Perspectives, January 1971, page 9; Warren Hern. Abortion Practice. Philadelphia: J.B. Lippincott Company, 1984.

[18] In some countries there currently exist advanced techniques that can save both the mother and her preborn child even in the extreme case of a tubal pregnancy. Abdominal pregnancies present a less difficult scenario insofar as saving both mother and child, because less advanced technology is required than in the case of tubal pregnancies.
       In the case where the particular medical facility does not have such technology available to save tubal babies, competent moralists and doctors affirm that with the present medical technology we can diagnose such pregnancies earlier than before, and we can also accompany expectantly (ready to act but without intervening) a woman pregnant with a tubal preborn baby until we can attempt to save him (if that is indeed possible) or until we know the tubal baby has unfortunately died, in order to then remove him or her without damage to the mother. This way of acting is more respectful towards the preborn baby and the one to be followed, and we should set aside utilitarian considerations about costs, etc. [Niceto Blázquez. Bioética Fundamental. Madrid: Biblioteca de Autores Cristianos, 1996].
       Of course, where none of the above techniques are available, the doctors will do the best they can to save both mother and child or at least one of them under the principle of the double effect.
       We must also clarify that many times doctors, when faced with what they think is a tubal pregnancy, immediately rush to intervene without the proper diagnosis. And when they do intervene, they use drugs or other means to kill the tubal baby and then remove him or her. This is gravely immoral and does not constitute a correct use of the principle of double effect but a direct abortion.
       Every effort should be made to obtain those techniques to save mother and preborn child and also to prevent ectopic pregnancies, since not enough is being done in this area. Let us keep in mind that many ectopic pregnancies are caused by promiscuity, which can result in sexually transmitted diseases (STDs) and/or the use of the intrauterine device (IUD), which is also abortifacient [see Chapter 2, "Abortifacients"].
       The case of the cancerous uterus in a pregnant woman no longer presents a problem in saving both mother and preborn child. Therefore the principle of the double effect cannot be invoked any longer in this case to justify an intervention that results in the death of the preborn baby [Blázquez, op. cit.].

[19] Pope Paul VI, Humanae Vitae (¶14), July 25, 1968, and Pope Pius XII, "Allocution to Midwives," (¶27), October 29, 1951.

[20] Pope Pius XII, address to the Family Front Congress on November 27, 1951.

[21] John M. Swomley. "Six Ethical Questions." Propaganda pamphlet by the 'Religious' Coalition for Abortion Rights, June 1987, page 3.