Abortion, The Mother’s Life, And The Principle of Double Effect

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One of the bulwarks used to defend abortion is that sometimes it is necessary to save the life of the mother—the “therapeutic” abortion.  At first blush, this is a compelling argument and has led many people to support a procedure they would otherwise oppose.  But is this argument correct?  Is abortion ever really necessary to save the life of the mother?

Imagine a pregnant woman diagnosed with uterine cancer and the only treatment alternative is a hysterectomy which would likely save her life, but surely end in the death of the child.  Absent any action, both are expected to die.  In such an instance, is the loss of the child permissible?  The answer is simple, but the logic is worth understanding well.

The answer lies in the distinction between intentionally killing the child (which is never licit) and removing the uterus with child from his mother, so that her life might be saved, and then doing all things possible to save the child’s life as well.  In both instances, the child doesn’t survive, but in the first, the physician directly kills him; in the second, the physician permits his death, an indirect effect of extracting a sick organ where no alternative exists.  The distinction is enormous.

Situations wherein from one act, two effects can arise, one good and one bad, occur frequently in medicine.  Another example is the giving of morphine to someone with a terminal illness.  The morphine mitigates pain but also provokes respiratory failure.

Under what conditions are such acts permissible?

The Principle of Double Effect

When an intervention has two effects, one good and one bad, before it can be undertaken it must meet the following four conditions:

  1. The action itself must be good, or at least indifferent.  It is never licit to perform an evil act, even for a good effect.  The action must also be the only possible alternative to attain the good effect.  If there is another action that does not imply a secondary bad effect, it must be chosen.
  2. The immediate or primary effect must be the good one.  The bad effect must be a consequence of the good effect, or at least simultaneous to it.  The bad may never precede the good.
  3. The good effect must be the only one desired, and the bad effect must be only tolerated.  The bad effect is permitted because it is absolutely inseparable from the good effect, but in itself it is not sought.
  4. The good effect must be proportionally greater than, or at least equal to, the bad effect.

So how do we apply these principles in the case of our mother above?

  1. Saving the life of the mother is good, and in this instance, a hysterectomy is the only possible means of doing so.
  2. Saving the mother is the first act, the likely death (killing) of the child is a consequence of the good act.
  3. The only desired effect is saving the life of the mother, which is the good that is possible.  The likely death of the child must be sadly tolerated as the two are inseparable.
  4. Saving one life is proportional to the loss of the other’s life.

It is worth noting a few things here:

  1. If the cancer could be treated with means that would not be harmful to the child, or if treatment could be delayed until after the birth, or even closer to full term, this must be done.
  2. If the mother’s illness were not life-threatening and the operation were only motivated by her health, such good effect would not be proportional to the bad effect of ending the life of the child and the procedure would not be permissible.

In accordance with the Principle of Double Effect, when the child’s death (killing) comes about as a foreseen but unintended and unwanted consequence, a consequence of an unavoidable therapeutic intervention aimed at saving the mother’s life, then in itself it is not directly abortive, and is thus morally legitimate.  Tolerating the ending of a life, as an indirect effect where no other choice exists is vastly different from taking a life.  As we have said before, and say again here, there is no such thing as a therapeutic abortion.

Keep in mind that everything possible should be done to save both lives.  It is the doctor’s duty to fight for life, and he should call on every possible therapeutic intervention to accomplish both goals.

We will end with one final example.  Imagine a woman who, even while using an IUD—a device intended to abort embryos by preventing their attachment to the uterine wall—actually has an embryo attach and continue to develop.  Should the IUD be left in place or removed?  If it becomes clear that the device is threatening the life of the child, then accepting the risk of abortion by removing the device is licit.  If, however, the device is only affecting the child’s health (e.g. risking malformation but not death) and the risk of abortion is greater in removing the device, then the device must be left in place.

Some may view risking malformation as cruel, but they forget one thing.  Life, even when imperfect (as if a perfect life were possible) is a gift, and the ultimate good.

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Dr. Pilar Calva