Moral theological analysis of direct versus indirect abortion

Abstract

Cases of a vital conflict, where the lives of both the mother and child are at risk during pregnancy, have been the subject of recent vigorous debate. The basic principles put forth in the Ethical and Religious Directives are reviewed, as is the principle of double effect. An illustrative case of severe cardiomyopathy in a pregnant woman is described and it is noted that the principle of double effect would not apply. Counter arguments are noted, focusing on Martin Rhonheimer who posits that in the case of vital conflicts, such as performing a craniotomy on a baby stuck in the birth canal, taking the baby’s life does not constitute a direct abortion because moral norms do not apply in the extreme conflict situation where both mother and child will die. He states that the death of the fetus is not intentional in these cases. He overlooks “how the life is being saved” and that a choice has been made, which implies a moral act, not just a physical one. Rhonheimer wants to make his moral judgment solely on the basis of intention, prescinding from what actually occurs in the physical world of cause and effect. This is clearly against the teaching in Evangelium vitae. Ethics deal with the deliberate chosen actions in space and time of embodied human beings; it deals inescapably with material actions, with specifications of intentions. Rhonheimer states, “a killing or an abortion is ‘direct,’ not because the death of the fetus is caused in some physically direct way, but because it is willed as the means to an end.” However the death of the child cannot be excluded from the act and is therefore of necessity included in it. What the acting person chooses includes what happens physically in this act. If the action theory proposed by Rhonheimer is accepted, it could be very difficult to avoid death-dealing actions from taking place in Catholic hospitals.

Summary: This is a moral analysis of cases of “vital conflicts,” where the lives of both the mother and child are at risk during a pregnancy. It is stated by some ethicists that directly killing the baby to save the life of the mother is morally justified, even when the direct action of the doctor is to kill the baby. Examples are provided to illustrate how Catholic moral principles apply. It is concluded that direct killing, regardless of the intention, is not justified. The doctor should always work to try and save the lives of both the mother and the child. One should never be directly killed even if the intention is to save the life of the other.

Keywords:

• Direct abortion
• Vital conflicts
• Ethical and religious directives
• Principle of double effect
• Pregnancy
• Evangelium vitae

Notes

1. Extensive debate has taken place between Rhonheimer and the critics of his position on craniotomy and “direct” versus “indirect.” Many of these have taken place in the pages of The National Catholic Bioethics Quarterly. I do not want to enter into those debates, but I do call the attention of the reader to them (Rhonheimer 2009a; Austriaco 2010; Guevin 2010; Rhonheimer 2011; Colloquy 2011; Colloquy 2012).

2. The first decision is found in SCUI (1884, 556).

3. References in this essay are to the Origins document, although it was originally published as “Moral Analysis of an Intervention Performed at St. Joseph’s Hospital and Medical Center,” 21, http://www.commonwealmagazine.org/blog/wp-content/uploads/2010/12/St.-Josephs-Hospital-Analysis.pdf.

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John M. Haas

John M. Haas, Ph.D., S.T.L., M.Div., is the president of The National Catholic Bioethics Center in Philadelphia, Pennsylvania. He is a consultant to the USCCB’s Committee for Pro-Life Activities and the Doctrine Committee’s Subcommittee on Health Care. He is an Ordinary Member of the Pontifical Academy for Life and a Consultor to the Pontifical Council for Health Care Workers.