Catholic Medical Quarterly Volume 64(3) August 2014
Preterm Induction and Abortion
Dr Michael Jarmulowicz
Anthony McCarthy’s response to critics (May 2014) of his original paper on pre-viability induction (Feb 2014) displays some illogicality in his thinking. In his original article he uses the analogy of being pushed off a lifeboat, and argues against Dr Gerrard’s criticism of his use of this analogy by in effect admitting the imperfect nature of analogy and admitting that he used it to highlight one aspect of his argument. So it seems strange that he finds my use of the analogy of an ITU on fire ‘alarming’. The definition of analogy is a comparison to things that are different to clarify / explain a concept in terms of familiar things. Of course an analogy is not a perfect comparison but a literary device to help make a point. And I hope readers recognise that my defence of the MaterCare position in not dependent entirely on this analogy!
He finds my letter disturbing because I mention of the use of methotrexate in ectopic pregnancy. I was careful not to say that I agreed with its use in ectopic pregnancy, but mentioned it only to highlight that there are difficult moral issues which orthodox moral theologians find difficulty agreeing on. Many years ago I wrote to Rome, as an officer of the Guild of Catholic Doctors, seeking clarification on the use of methotrexate in ectopic pregnancy, and never received a direct reply. Instead I was told informally that this was an unresolved issue. It is interesting that a fairly recent edition of the Linacre Quarterly (the USA Catholic Medical Association Journal) carries a review of the arguments on both sides of the debate. (The Ethics of Ectopic Pregnancy: A Critical Reconsideration of Salpingostomy and Methotrexate. Linacre Quarterly. 76(3):265-282;2009). My introduction of this issue was only to highlight that medicine confronts difficult ethical situations and there are times when sound, well informed Catholics using well-argued reasons arrive at differing conclusions. The rapidly evolving clinical picture in septic pregnancies makes decision making very difficult – clinically never mind ethically. We must be careful not to be too judgemental of an individual’s position in these situations.
Anthony McCarthy interprets directive 45 of the 2009 USCCB ‘Ethical and Religious Directives for Catholic Health Care Services’ as an absolute prohibition of pre-viability induction. I disagree; the context of the USCCB document addresses the problems facing Catholic Hospitals in the secular environment, and that the use of the word “abortion” and the phrase “directly intended termination of pregnancy” (“45. Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted.”) is in the context which we all understand in common usage as ending an unwanted pregnancy. Anthony’s absolutist interpretation cannot be justified otherwise how can you interpret directive 47 which gives the circumstances under which treatment, fatal for the fetus, can be given before viability? The exact words of the directive 47 are:- “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.” Most would argue that induction of a child prior to viability in the context of inevitable septic miscarriage fits perfectly into that category. The crucial aspect here, and what underpins the double effect argument, is intention. In such case there is absolutely no intention to kill the child, but a sad recognition of the inevitability of its death.
Dr Michael Jarmulowicz