Catholic Medical Quarterly Volume 65(1) November 2015


Pre-viable induction – the debate continues

Dr Michael Jarmulowicz

Photo of authorSir,

It was very helpful to see the details of the inquest into the death of Savita Halappanavar [Nov 2014] which clearly shows that the fundamental issue was not one of abortion but a tragic death caused by a delay in diagnosis and subsequent delay in the treatment of a urinary tract infection.

However, that does not prevent discussion of the principle of pre-viable induction in septic pregnancies.  I do not wish to address each one of the points raised in Anthony McCarty’s latest letter in the Nov 2014 issue because I now feel that we have clarity on the fundamental point of disagreement in this debate.

If my understanding is correct Anthony McCarthy accepts that Directive 47 does indeed acknowledge the principle of double effect, but then he introduces what might be construed as a new condition into this double effect argument – that the pre-viable induction is of no benefit to the baby and therefore invalidates the double effect argument.  I think that he is using this terminology as a way of distinguishing between direct and indirect abortion.  I hope so, because if he does then we have a way forward.

For instance, if a pregnant woman develops breast cancer some doctors would suggest an abortion before starting chemotherapy, as the chemotherapy could potentially damage the unborn baby.  I would agree that an abortion in such a case is immoral and the double effect argument could not be used because it is a direct abortion.  However, we need to return to the debate around the use of salpingotomy / methotrexate in the treatment of ectopic pregnancies, which he accepts is a disputed question, but which I think is directly relevant to our issue under discussion. 

Examination of the various arguments by the proponents of each side in the debate hinges around whether the treatment is a direct abortion (and so morally wrong) or an indirect abortion (which can be justified by the double effect argument).  Certainly these discussions get into philosophical semantics which I would not claim to have any expertise in. But we have help from a recent article on the very issue of interpretation of the US Directives relevant to this discussion; precipitated by recent lawsuits in the USA around the treatment of obstetric complications in Catholic Hospitals. 

The issue that doctors need to address is how to respond to a clinical situation where expert bioethicists and theologians disagree on the matter, and where the magisterium has not ruled on the matter either.  Pre-viable termination in septic abortion is such a case.  The advice given by the US National Catholic Bioethics Centre in its ‘A Manual for Practitioners’ is crucially important.  It states:

“Generally, if there are two competing but contrary bodies of theological opinion about a moral issue, each held by experts whose work is in accordance with the magisterium of the Church, and if there is no specific magisterial teaching on the issue that would resolve the matter, then the decision makers may licitly act on either opinion until such time that the magisterium has resolved the question."[1] 

I don’t think that we will be able to resolve the issue in these pages of the CMQ, but healthcare workers should be reassured that they can adopt either position; in addition we should respect those who hold divergent opinions on the matter.

yours sincerely

Dr Michael Jarmulowicz

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