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The Linacre QuarterlyVolume 15 | Number 3 Article 4July 1948Direct and Indirect AbortionCatholic Physicians' GuildFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationCatholic Physicians' Guild (1948) "Direct and Indirect Abortion," The Linacre Quarterly: Vol. 15: No. 3, Article 4.Available at: http://epublications.marquette.edu/lnq/vol15/iss3/418 THE LINA C IlE Q U AIlTEIlLY DIRECT AND INDIRECT ABORTION Question: W ill you pl e a s e explain the difference between .. direct" and .. indirect" abortion? Also, plea se explain why the former is never allowed, whereas the latter is sometimes licit ? The questions are timely, as the a nswers involve principles that a re of frequent application in medico-moral problems. Moreover, those who fail to grasp these principles are apt to think that some distinc-tions made by Catholic moralists are mere words, subtleties that have no place in deciding issues that involve life or death. Illustrative Problems Our discussion of principles will be clearer if we first cite a number of sim ple illustrative problems. 1. A man who knows nothing about the effects of strong liquor takes a large quantity of whisky, with the result that he becomes intoxicated and severely injures himself and several others. Is he responsible befor e God _for the . effects of his drinking? 2. A doctor who has made a ll reasonable efforts to di scover whether a woman is pregnant, and who has concluded that she is not pregnant, performs an operation which kills a living fetus. Is he morally responsible for the death of the fetus? 3. A married woman who has tried to prevent conception fail s in this immoral effort and becomes pregnant. To avoid the burden of caring for . children, she takes a drug which is supposed to induce an abortion. Is she morally justi-fied in indUcing the abortion? 4. A pregnant unmarried woman wishes to have an abor-tion in order to protect her good na me. Is this permissible? 5. To check a severe hemor-rhage in a threatened abortion, the doctor wishes to use a tampon. He realizes , however, that this may bring about the expulsion of the inviable fetus . Is he justified in resorting to this procedure? 6. Having frUitlessly tried all other means of removing the dis-astrous effect of hyp e remesis gravidarum , the doctor wishes to empty the uterus, even though it contains a living inviable fetus. Is this procedure licit as a last resort? 7. An operable cancer of the cer-vix is discovered early in preg -nancy. May the radical operation be performed at that time in order to save the life of the mother? 8. While driving his car at a reasonable speed, a man sees a pedestrian a short distance ahead of him. He puts on his brakes, but the brakes fail to hold, and the result is that he kills the pedes-trian. Up to this time there had been no reason for suspecting faulty brake s . I s the driver morally responsible for the death of the pedestrian? Principle of Imputability All the problems just cited deal with an action or procedure that produces or is likely to produce a harmful effect. Concerning such problems , the firs t question that arises in the mind of the moralist is this : when is a person morally responsible (that is : responsible before God) for such harmful effects? To answer th is question , Catholic moralists have formulated the follOWing principle: " A man is responsible for the evil effects of his actions, if these three conditions a re verified: (1) he realizes that the evil effect may take place ; (2) he is able to avoid the action that produces the evil effect; and (3) he is conscious of 'l'HE LINA C RE Q U ARTERLY 19 an obligation to refrain from plac~ ing the action lest this effect fol-low. If anyone of these conditions is not verified, a man is not guilty before God for causing the evil effect. " The first of the conditions is surely the plainest kind of com-mon sense, and it explains why the man in problem 1 cannot be said to be morally gUilty of drunken-ness or morally responsible for the harm done while intoxicated . For in taking the whisky he did not even suspect its power. And the same is to be said of the doctor in problem 2. When he operated he was reasonably certain that the , woman was not pregnant; the death of the fetus was merely an unfortunate accident, as far as he was concerned. The second condition is also common sense; and it surely re~ quires no proof for one who un-derstands the meaning of moral responsibility . For the very basis of human responsibility is freedom; and one who cannot avoid a harm-ful action is not free . I do not know whether this condition can be aptly illustrated by any type of medical or surgical case; but prob~ lem 8 seems to be a clear example of inability to stop the harm-pro-ducing action . A driver with use-less brakes is a very ' helpless per-son in a crisis . The moralists' headache comes in explaining the third condition. Common sense, of course, tells us that we are not obliged to abstain from all actions that produce harm-ful results; otherwise life would be an almost intolerable burden. But common sense will not even suggest a practical rule for judg-ing when such actions must be omitted and when they may be performed. This practical rule must be arrived at by a careful analysis of the third condition . The analysis can be expressed by the following series of questions: a) Will the contemplated action produce some good effect? If the only effect of the action is evil. then one who foresees this cannot perform the action without at the same time willing the evil. For example, in problem 3, the only effect of the drug is to induce the abortion; hence the taking of the drug cannot be morally justifiable. b) Is the person who places the action sincerely seeking the good effect, and not the evil effect? None of the problems explicitly illus-trates this point; yet it is an im-portant one in medico-moral prob-lems. For example, it might hap-pen that certain procedures such as that mentioned in problem 5 (" using a tampon to stop hemor-rhage) could be justifiable; yet even in these cases the doctor could render his action morally culpable by wishing to kill the child. c) Is the good effect produced by means of the evil effect? Both sound reason and divine revelation teach us that we must not do evil in order to obtain good . This prin-ciple is violated in problems 4 and 6, for in both these cases the in-viable fetus is expelled as a means of obtaining the good results. The woman's reputation (problem 4) is saved only by getting rid of th e fetus ; and the vomiting (problem 6) is stopped only by the empty-ing of the uterus. On the other hand , in problems 5 and 7 we have examples of good effects caused by the procedures themselves. It is the packing, not the abortion , that stops the hemorrhage; and it is the removal of the cancer, not the death of the fetus , that saves the mother 's life. d) Is the good effect of sufficient value to compensate for the harm-ful effect? The general idea here is not difficult to grasp. But the actual estimate of relative values in concrete cases is often very dif-ficult. For example , in problem 5 20 Till> LINA C RI> Q UA Il'l'ICIlLY the justification for using the tam-pon and risking an abortion would depend on whether some other simpler treatment would produce the desired result of saving the mother. And in problem 7, the justification of performing the radical operation would depend on the possibility of waiting until the fetus reaches viability and still sav-ing the mother. Principle of Double Effect I have gone to some length in explaining and analysing the gen-eral principle of moral imputability for evil effects, because this expla-nation and analysis contain all the raw materials for another, and slightly different, principle which is often used by moralists, espe-cially in their solution of medico-moral problems. I refer to the so-called " principle of the double effect." In formulating this partic-ular principle, the moralists put in capsule form all the points that I explained in my analysis of the third condition referred to in the principle of imputability. In brief form, the prinCiple of the double effect may be stated as follows : .. It is licit to perform an ac tion which has good and ba d effects provided: (a) that the action it-self is not morally bad ; (b) that the evil effect is Sincerely not de-sired, but merely tolerated ; (c) that the evil is not the means of obtaining the good effect; and (d) that the good effect is sufficiently important to balance or outweigh the harmful effect." . I might add here that, though it is often necessary to test the licit-ness of medical and surgical pro-cedures by applying the principle of the double effect, this is not always the case. For example, in ordinary mutilations such as the removal of the appendix or gall bladder or the amputation of an infected limb. there is no need of resorting to this principle; for these organs have a natural subordina-tion to the entire body, and man has a na tural right to mutilate or remove them when this is neces-sary for the good of the whole body. In such cases, therefore , the principle that evil may not be done in order to obtain some good result does not apply. The evil may be desired and caused in order to ob-tain some proportiona te benefit for the whole body. But when there is question of procedures w hich cause evil effects that are outside the scope of man 's direct rights, the principle of the double effect must be applied. For example, the generative function , as such. is a social function and is not directly subordinated to the good of the individual; hence pro-cedures that induce sterility must be tested by the principle of the double effect. Similarly, the principle of the double effect must be applied to all procedures that are designed to benefit the mother but which also involve the danger of abortion or of some other harm to the child; for the life and well-being of the child are not subordinated to the life a nd well-being of the mother. This point brings us to the ques-tions asked at the beginning of our discussion. Direct and Indirect Abortion By abortion I mean the inter-ruption of a pregnancy before the fetu s is viable. The supposition is tha t the fetus is still alive and that the placenta is still attached to the mother. To expel a dead fetus is not an abortion ; nor is it an abortion to remove from the uterus a fetus which is already completely detached from the mother. An abortion is said to be direct when the interruption of the preg-nancy is intended either as an end in itself (as in problem 3) or as THE L1NA CRE QU ARTERLY 21 a means to some other end (as in problems 4 and 6) . In such cases the procedure is precisely directed to the interruption of the preg~ nancy; hence the life of the fetus is directly attacked. Such pro-cedures, even when euphemistically labeled "therapeutic," are never licit. Note the following strong words of Pius XI on this point : "As to the 'medical and thera ~ peutic indication ' to which , using their own words , We have made reference, Venerable Brethren , however much We may pity the mother whose health and even life is gravely imperiled in the per~ formance of the duty allotted to her by nature , nevertheless what could ever be a sufficient reason for excusing in any way the direct murder of the innocent? This is precisely what we are dealing with here. Whether inflicted upon the mother or upon the child it is against the precept of God and the law of nature : 'Thou shalt not kill.' The life of each is equally sacred, and no one has the power, not even the public authority, to destroy it." An abortion is said to be indirect when the interruption of the preg~ nancy is the undesired but un~ avoidable effect of a procedure which is immediately directed to some other good purpose (e.g. the stopping of hemorrhage, as in problem 5, or the removal of can-cer, as in problem 7) . Granted that an abortion is merely indirect , it may be permitted for a suffi~ ciently serious reason (e.g . when the procedure is really necessary to save the life of the mother), beca use in this case all the condi~ tions of the principle of th e double effect are applicable. References For a good discussion of direct and indirect abortion and uf the use of the principle of the double effect, see Cronin, The Science of Ethics, II (ed. 1939), 687 ~90. This volume of the 1939 edition con~ tains a brief, but excellent, appen~ dix on medico~moral problems. The publishers would do us a great service if they would publish this appendix in pamphlet form. On the same topics, it will also be profitable to consult Bouscaren , Ethics of E ctopic Operations (2nd ed. , Bruce, Milwaukee, 1944), 3-64. Father Bouscaren is dealing primarily with ectopic operations, but he incorporates into his dis~ cussion many points about abor-tion and the principle of the double effect. A brief. illuminating statement and explanation of the principle of the double effect may also be found in the booklet edition of the Catholic Moral Medical Code of the Diocese of Toledo, prepared by Msgr. Robert A. Maher, pp. 17 ~ 18. Several of the articles already published in this section of Hos~ pital Progress have dealt with mutilations of the rep rod uctive organs. See "Suppression of Ovarian Function to Prevent Me~ tastasis ," April , 1948, pp. 147-48 ; "Problems Concerning Excessive Uterine Bleeding ," June, 1948, pp. 221-24 ; and "Orchidectomy for Carcinoma of Prostate," August, 1948 , pp. 296-97. In these articles I did not explicitly refer to the principle of the double effect. but I repea tedly insisted that the ster-ility induced by the various pro~ cedures must always be a merely tolerated result. It should not be the express object of the proced-ure , nor should it be the precise cause of the good effect aimed at by the procedure. This is the same as saying that the prinCiple of the double effect must be applied to any operation or treatment that induces sterility. 

Direct and Indirect Abortion

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Direct and Indirect Abortion

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