Catholic Medical Quarterly

The Journal of the Catholic Medical Association (UK)

Building knowledge. Building faith. Protecting the vulnerable.

Catholic Medical Quarterly Volume 64(2) May 2014

Pre-viability inductions, are they morally permissible?

Dr Ian Jessiman

Photo Ian JessimanSir,

Although I did not feel that the Obstetricians of Matercare had argued their case very well (CMQ Nov 2013 pp 11-12) I had been taught (even, I believe, as a student in the 1950s) that what they proposed was morally acceptable. It is not my recollection that the principle of double effect formed any part of the argument in those days.

On the other hand I was greatly dismayed by Anthony McCarthy’s severely rigorist approach (CMQ 2014(1)13-17) which is precisely the position (though it was reached by default rather than by reasoned argument) which led in the index case to the loss of the mother’s life, the pillorying of several doctors, and an attempt to liberalise the Irish Law.

Sepsis in the womb, leading to a situation such as we are discussing, can result from spontaneous miscarriage or from interference.  The situation is, or rapidly becomes, that of inevitable miscarriage. Matercare explain (p 12) that this is “imminent, cannot be prevented, and is characterised by bleeding, uterine cramps, ruptured membranes, cervical dilation, presentation of the foetus at the cervical os” (signs of early labour) and also [the] infection.

In short, the process of abortion is already under way.  It is misleading of the obstetricians to speak of inducing abortion. They are not intending to terminate a normal pregnancy but to assist, facilitate or encourage a natural (if pathological) process already begun (albeit possibly ‘arrested’). (I exclude instrumental delivery unless the miscarriage is already incomplete and the foetus is dead).   The outlook for the foetus is grave in any event – and given that estimating dates is not a precise science – one might even entertain the hope that its prospects are slightly better if delivered and appropriately treated than if left in situ.  At least this would allow for baptism (though this is never, in itself, a reason for termination). The removal of the septic tissues (placenta, amniotic fluid, etc.) is essential for the survival of the mother.

I believe the obstetricians are morally justified in adopting the course they describe.

Dr Ian Jessiman is a retired GP

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