Pre-viability inductions, are they morally permissible?

Dr Michael Jarmulowicz

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Anthony McCarthy (CMQ - Feb 2014) sets out his arguments against the MaterCare statement on premature delivery of a mid-trimester pregnancy (CMQ - Nov 2013) in the case of a severe threatened septic abortion in order to save the life of the mother. After giving a number of complex arguments, some of which I feel are of dubious relevance, my understanding of the essential element of his argument is that the principle which is violated is that the baby has a right to be in the womb at this stage of pregnancy, and that the mother has an unconditional duty, ‘till death [birth] do us part’ to keep the baby in the womb until it can survive outside the womb independently.

I don’t see how the various extracts of church teaching he quotes address the issue of the case. I feel that there are several occasions where he equates the expected / anticipated death of the baby as secondary to the induced premature labour in septic abortion with an intention of bringing about the death of the unborn baby; eg the induction of a pre-viable baby with use of the morning after pill.
A scenario that is better to consider is a fire in an intensive care unit. The patient’s life depends on being connected to the various life support equipment. Do you therefore leave the patient in ITU to burn to death or do you bring him out knowing that he will die?

There are the well-argued cases, justified by the double effect argument, where it is permissible to perform a hysterectomy for uterine cancer even if the woman is pregnant, or a salpingectomy for ectopic pregnancy. Surely these cases are very similar in moral reasoning to the Irish case of threatened septic abortion? But there are differences and so maybe a more relevant example is the use of methotrexate for the treatment of early ectopic pregnancy. Here there is a direct attack on the developing fetus. This treatment will preserve the tube as well as avoid surgery; untreated death is likely to occur. My understanding is that the Vatican has been asked to rule on the ethical acceptance of this procedure, but has declined to give a definitive ruling because ethicists and moral theologians of good standing have been unable to come to an agreement.

In modern medicine there are cases where there are conflicting principles, and this is where conscience has to come into play – in essence it must be for the treating clinician to ask themselves:- ‘In the specific circumstances of this case, in the face of conflicting principles, which is the right course of action to take?’ In pregnancy we have two lives, both of equal value.

I feel Anthony’s arguments have placed the value of the unborn above that of the mother; neither has a greater value, they are equal. Earlier in my medical career I was in the Royal Navy. The military, and now secular medicine, has a clear system of triage, to deal with situations where the presence of many wounded exceed the capacity of the medical services to treat all; so who do you treat? Cases of severe threatened septic abortion, or even the separation of conjoined twins with a single vital organ, come into this category; there comes a time where you cannot save both, but there is a likelihood of saving one, so what do you do? I support the MaterCare approach.

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