The ethics of ectopic pregnancy: A critical reconsideration of salpingostomy and methotrexate

Linacre Quarterly

Volumn 76, Issue 3, 2009, Pages 265-282

  Kaczor, Christopher ^a  

^a LOYOLA MARYMOUNT UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84055169283     PISSN: 00243639     EISSN: None     Source Type: Journal    
DOI: 10.1179/002436309803889106     Document Type: Article

References (40)

1. On February 7, 2007, a version of this paper was presented, with the title, "Ectopic Pregnancy and the Catholic Hospital," to a group of 170 bishops and ten cardinals from the U.S., Canada, Mexico, Central America, the Caribbean, the Philippines, India, and Europe at a conference titled "Urged on by Christ: Catholic Health Care in Tension with Contemporary Culture," the twenty-first bishops workshop, Dallas, Texas.
2. Kelly Bowring, "The Moral Dilemma of Management Procedures for Ectopic Pregnancy," in Life and Learning, vol. 12, Proceedings of the Twelfth University Faculty for Life Conference at Ave Maria Law School 2002, ed. Joseph W. Koterski, S.J. (Washington, D.C.: University Faculty for Life, 2003), 101.
3. Pope John Paul II wrote: "by the authority which Christ conferred upon Peter and his successors, in communion with the bishops-who on various occasions have condemned abortion and who in the aforementioned consultation, albeit dispersed throughout the world, have shown unanimous agreement concerning this doctrine- I declare that direct abortion, that is, abortion willed as an end or as a means, always constitutes a grave moral disorder, since it is the deliberate killing of an innocent human being." Pope John Paul II, Evangelium vitae (Vatican City: Libreria Editrice Vaticana, 1995), n. 62.
4. John Rock, TeLinde's Operative Gynecology (Philadelphia: Lippincott-Raven Publishers, 1992), 420.
5. Some authors hold that salpingostomy is not intentional abortion, see, for example, Germain Grisez, Abortion: The Myths, the Realities, the Arguments (Cleveland/New York: Corpus Books, 1970), 340-341;
6. Albert Moraczewski, "Managing Tubal Pregnancies: Part I," Ethics and Medics 21.6 (June 1996): 1-4.
7. Other authors believe that salpingostomy is intentional abortion, see, for example, Peter A. Clark, "Methotrexate and Tubal Pregnancies: Direct or Indirect Abortion?" Linacre Quartery 67.1 (2000): 7-24;
8. Bowring, "The Moral Dilemma of Management Procedures for Ectopic Pregnancy," 116.
9. For a discussion of this once-debated case, see John Connery, Abortion: The Development of the Roman Catholic Perspective (Chicago: Loyola University Press, 1977), 295-300.
10. L. Shettles, "Tubal Embryo Successfully Transplanted in Utero," American Journal of Obstetrics and Gynecology 163 (1990): 2026.
11. C.J. Wallace, "Transplantation of Ectopic Pregnancy from Fallopian Tube to Cavity of Uterus," Surgery Gynecology, and Obstetrics 24 (1917): 578-579. I have heard both cases explained in terms of heterotopic pregnancy, one tubal pregnancy and the 9 William May writes: "I contend that it is morally imperative today to make every effort possible to discover and transplant into the uterus those unborn babies who have, unfortunately, implanted in the fallopian tube or other ectopic sites and not in the uterus where they belong
12. May, "The Management of Ectopic Pregnancies: A Moral Analysis," in The Fetal Tissue Issue: Medical and Ethical Aspects, eds. Peter J. Cataldo and Albert S. Moraczewski, O.P. (Braintree, MA: The Pope John Center, 1994), 146.
13. In his book, Catholic Bioethics and the Gift of Human Life, 2nd ed. (Huntington, IN: Our Sunday Visitor Publishing, 2008), William May reverses his previous position on the use of methotrexate to treat ectopic pregnancy. He no longer views its use as intentional killing of the embryo. Eugene F. Diamond writes: "The long-term hoped-for solution to the dilemma will be the development of successful techniques for the transplantation of fetuses growing in ectopic location into the uterine cavity
14. Diamond, "Moral and Medical Considerations in the Management of Extrauterine Pregnancy," Linacre Quarterly 66.3 (1999): 11.
15. Bowring writes: "This [transplantation technique] needs to be reconsidered and pursued, especially with the certainty that it is not just plausible, but possible. Convincing the medical field to focus on re-implantation is the true moral imperative in the issue of managing ectopic pregnancy today." Bowring, "The Moral Dilemma of Management Procedures for Ectopic Pregnancy," 118.
16. William E. May, "Methotrexate and Ectopic Pregnancy," Ethics and Medics 23.3 (1998).
17. For his more recent position, one that accepts the use of methotrexate and salpingostomy, see May, Catholic Bioethics and the Gift of Human Life, 201-202.
18. Thomas Aquinas, Summa theologiae, II-II, q. 64, a. 7.
19. See, John C. Ford, S.J., "The Morality of Obliteration Bombing," Theological Studies 5 (1944): 261-309.
20. United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services, 4th ed. (Washington, D.C.: USCCB, 2001).
21. Statistic cited by Charles E. Cavagnaro III, M.D., in "Treating Ectopic Pregnancy: A Moral Analysis (Part II)," NaProEthics Forum 4.2 (1999): 4.
22. R.J. Morlock et al. "Cost-Effectiveness of Single-Dose Methotrexate Compared with Laparoscopic Treatment of Ectopic Pregnancy," Obstetrics and Gynecology 95 (2000): 407-412.
23. Physicians Vicken Sepilian and Ellen Wood write: "A bhCG level of greater than 15,000 IU/L, fetal cardiac activity, and free fluid in the cul-de-sac on US (presumably representing tubal rupture) are contraindications [for MXT]." Sepilian and Wood, "Ectopic Pregnancy" (2007), http://www.emedicine.com/med/topic3212.htm.
24. Sepilian and Wood, note: "embryonic cardiac motion can be observed 3.5-4 weeks postconception, about 5.5-6 weeks after the last menstrual period
25. Seplian and Wood, "Ectopic Pregnancy
26. Connery, Abortion, 162. As a reviewer helpfully noted, Raynaud himself thought the ectopic fetus was an unjust aggressor and that the distinction between "direct" and "indirect" was not relevant in such cases. Nevertheless, the colorful example does illustrate the general principle that neither the certainty of the effect nor acting upon the body of another entails that a lethal effect which follows from the action must be intended.
27. Albert Moraczewski, "Managing Tubal Pregnancies: Part II," Ethics and Medics 21.8 (August 1996): 4.
28. I argue this point further in my book, The Edge of Life: Human Dignity and Contemporary Bioethics (Dordrecht: Springer, 2005), ch. six.
29. A version of this chapter can also be found in "Moral Absolutism and Ectopic Pregnancy," Journal of Medicine and Philosophy 26 (2001): 61-74.
30. John Finnis, Germain Grisez, and Joseph Boyle, "'Direct' and 'Indirect': A Reply to Critics of Our Action Theory," Thomist 65 (2001): 20.
31. William E. May, "Methotrexate and Ectopic Pregnancy," Ethics & Medics 23.3 (March 1998): 1-2.
32. May, "Methotrexate and Ectopic Pregnancy," 3.
33. These matters have been debated in other contexts as well. See, Christopher Kaczor, "Intention, Foresight, and Mutilation: A Response to Giebel," International Philosophical Quarterly 47 (2007): 481-486.
34. Bowring, "The Moral Dilemma of Management Procedures for Ectopic Pregnancy," 109.
35. For example, Cavagnaro speaks of "the shared maternal-fetal organ of pregnancy- the placenta," in "Treating Ectopic Pregnancy: A Moral Analysis (Part II)," 4.
36. Connery, Abortion, 300.
37. Finnis, Grisez, and Boyle, "'Direct' and 'Indirect,'" 28-29.
38. Kaczor, "Moral Absolutism and Ectopic Pregnancy," 61-74.
39. D. Alan Shewmon, "The Dead Donor Rule: Lessons from Linguistics," Kennedy Institute of Ethics Journal 14 (2004): 293-295.
40. John F. Tuohey, "The Implications of the Ethical and Religious Directives for Catholic Health Care Services on the Clinical Practice of Resolving Ectopic Pregnancies," Louvain Studies 20 (1995): 46.