How are ectopic pregnancies supposed to be dealt with according to the Catholic Church?

Question

The Catholic Church is against abortion in all cases, except, I've heard, where the life of the mother is at serious risk and the child has no chance of survival. A good example of this would seem to be the case of an ectopic pregnancy, where the human embryo implants in the mothers fallopian tube.

But some actual forms of abortion would seem to violate respect for the human person, forming in the wrong place by no fault of his or her own. So, in the end what means are licit for dealing with ectopic pregnancies?

Answer 1

The Catholic Health Association of the United States (CHA) is a voluntary association of Catholic hospitals. In 2014, Ron Hamel, the senior ethicist for the CHA, published an article on their website which deals with this question among others. His conclusion is this:

Treatment of ectopic pregnancy can take three forms — expectant management, surgical, and medical....

Expectant management, consists in simply monitoring the situation to see if the tubal pregnancy resolves on its own. Most women are not candidates for expectant management. Surgical treatment can take two forms. One consists in the partial or complete removal of the fallopian tube, which also contains an embryo (salpingectomy). The other involves slitting the fallopian tube and "stopping the destructive activity of the trophoblast by removing the invasive trophoblastic cells along with the damaged tubal tissue." The embryo is also necessarily removed in the process (salpingostomy). The third form of treatment, medical, consists in the administration of the drug methotrexate which prevents the trophoblastic cells from continuing to divide and doing damage to the tube that could result in severe hemorrhaging. The embryo also eventually dies.

(quote from Albert S. Moraczewski, OP, "Ectopic Pregnancy: B. Arguments in Favor of Salpingostomy and Methotrexate," in Edward J. Furton et. al., eds., Catholic Health Care Ethics: A Manual for Practitioners.)

Dr. Hamel comments that "virtually all theologians agree that "salpingectomy constitutes an indirect abortion and so is morally licit. The demise of the embryo is foreseen, but not intended." In other words, the primary purpose of the operation is to save the life of the mother, although as this happens, the embryo must die. It is not directly killed. The other two possibilities, he says, are more ambiguous.

Among Catholic theologians and ethicists, there is disagreement regarding [salpingostomy and administration of methotrexate]. Some see them as a direct attack on the embryo and, so, a direct abortion, while others see them as aimed at removing pathological tissue — the trophoblast — which unavoidably results in the death of the embryo. They judge this to be an indirect abortion.

Dr. Hamel comments

The magisterium has not resolved this controversy. Hence, neither Church teaching nor the ERDs [ethical religious directives, which given what Catholic hospitals may do in order to call themselves Catholic] forbid [these two approaches] (so long as these approaches can legitimately be argued as not constituting direct abortions). ... Given the ongoing debate, it is permissible for Catholic hospitals to employ both salpingostomy and methotrexate.

Answer 2

Ectopic pregnancies are a classic application of the principle of double effect:

The principle that says it is morally allowable to perform an act that has at least two effects, one good and one bad. It may be used under the following conditions:

1. the act to be done must be good in itself or at least morally indifferent; by the act to be done is meant the deed itself taken independently of its consequences;

2. the good effect must not be obtained by means of the evil effect; the evil must be only an incidental by-product and not an actual factor in the accomplishment of the good;

3. the evil effect must not be intended for itself but only permitted; all bad will must be excluded form the act;

4. there must be a proportionately grave reason for permitting the evil effect. At least the good and evil effects should be nearly equivalent. All four conditions must be fulfilled. If any one of them is not satisfied, the act is morally wrong.

An example of the lawful use of the double effect would be the commander of a submarine in wartime who torpedoes an armed merchant vessel of the enemy, although he foresees that several innocent children on board will be killed. All four required conditions are fulfilled:

1. he intends merely to lessen the power of the enemy by destroying an armed merchant ship. He does not wish to kill the innocent children;

2. his action of torpedoing the ship is not evil in itself;

3. the evil effect (the death of the children) is not the cause of the good effect (the lessening of the enemy's strength);

4. there is sufficient reason for permitting the evil effect to follow, and this reason is administering a damaging blow to those who are unjustly attacking his country.

See Summa Theologica II-II q. 64 a. 7 or §2.5 "Moral Norms Especially Relevant to Health Care" of Health Care Ethics: A Theological Analysis.

In the case of ectopic pregnancy, neither the death of the child nor of the mother is intended. Curing the ailment may have the unintended side-effect of the death of the child, though, but this does not make curing her morally forbidden.

See:

1. Fr. T. Lincoln Bouscaren, Ethics of Ectopic Operations, (Milwaukee, Wis.: The Bruce Publishing Company, 1944).

2. Gerald Kelly, Medico-Moral Problems, 1958.
   ch. 14 The Morality of Ectopic Operations, p. 105