O\u27Donnell, Thomas J.

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The Linacre QuarterlyVolume 24 | Number 3 Article 7August 1957The Falk ProcedureThomas J. O'DonnellFollow this and additional works at: http://epublications.marquette.edu/lnqRecommended CitationO'Donnell, Thomas J. (1957) "The Falk Procedure," The Linacre Quarterly: Vol. 24 : No. 3 , Article 7.Available at: http://epublications.marquette.edu/lnq/vol24/iss3/7THE FALK PROCEDURE Thomas J. O'Donnell, S.J.Regent. Georgetown University School of MedicineTHE FALK procedure is de- The operation as described ascribed as a cornual resection ·d I d of the fallopian tubes in the pres-ev1 ent y oes not envisage JVe the ac­her its e f suppression of the gerierat1·ve nee o recurrent salpingitis due to ulty, precisely as generative, erecurr."' .tly. exacerbating gonor-rheal ir.. ·ct10n. The infection is im-as a means or as an end, sine planted rrom below, invading by sole purpose is to divide the I th­ind ·ayre-f J way of a migratory infection, way o t, ·. cervix and reaching the its proph I t· I t b b d Y ac 1c va ue is in no u es Y 1r, �t extension along the h d endometrium of the uterus, and it ::lt�nce by its contraceptiv(is believed to be self-limited in the tubal area. The purpose of the Falk procedure. therefore, is to break the. uterine-tuba] pathway, thus permitting the healing of the t�bal inflammation and at the same time blocking the avenue of any recurrent gonorrheal infection in­sofar as the tubes ,'re concerned. This procedure, moreover, by leav­ing the tube in situ, is designed to conserve the ovarian blood supply. Disa_greement among physicians regarding the advisability of the Falk pr?cedure1 has not helped the theologians arrive at a clear cut anal_ysis of the morality of the op­eration.2 The question is an in­triguing one since it represents what to date seems to be the only c�se of tubal ligation which is not · directly contraceptive sterilization. f .'TeGLinde. M.D .. Richard W .. Oper­a we ynecolog ( 2 d d p 1953 J B L· . Y n e ·· hiladelphia, ' · · •ppmcott Co.) pp 539 ff 2Kelly, SJ G . . . p bl V · ·• erald, Medico-Moral 1-[° ems • ( St. Louis, 1954 Catholic osp1tal Association of the Unlted States and Canada) p. 33 and also in Theolo i­cal Studies, 17, 3 ( September 1956) g 339. p. 90 Moreover, the fact that the ro­cedure is designed immedi, ely merely to limit the field of grc vth of the disease presents no IT ,ral problem, since this can prop rly be done even in the case of ti. sue whic� is not itself diseased, to say nothing of tissue which is itse•f a pathological site of infection. l'ius XII. in his address to the 26thAnnual Convention of the ItalianSociety of Urologists, said: f It can also happen that the rem,,val of a healthy organ and the suppre.s,ion f its n�rmal functioning will removellld a disease, cancer for example. ils .e of growth. or, in any case, e�sen­!Jally change the conditions of its exisl­e?ce. If there is no other means at our i•sirsal, surgical intervention on the ea thy organ is permitted in both cases.'i . It is precisely the last sentence m the above quotation which seems � pinp.oint the moral obscurity i 30ne could envision a tubal resection, ° v,ef of the partially occluded condi­. ;on f the tube, to prevent the possibil-1 y o subsequent tubal pregnancy This would clearly be a case of direct ·sterili­zat1on. 19;fOsservatore Romano, October 10, LJNACRE QUARTERLY which has arisen in the matter of the Falk operation. The fact that a therapeutic pro cedure is accompanied by a fore­seen but unintended contracepti" effect, and can be thus essentiall• fitted into the framework of th• principle of double effect does nc immediately tell us that the pro ct dure is permitted. The other very important consideration of the r L • quired proportion between th,­good effect and the evil elk t. plus the consideration of whethet or not the good effect can be rea­sonably achieved in some oth(·" way, without the concomitant e\ ii effect, must be given careful scru­tiny. For the consideration of the pro­portion between the good effect and the evil effect, one must re­member that gonorrheal infection of the cervix accounts for about 60% of all acute pelvic inflamma­tory disease.5 Moreover, it seems that reinfection by no means de­pends on renewed sexual contact, but the gonorrheal focus can be a constantly smouldering infection in the cervix, with periodic flare up into endometritis. As the infection again travels along the uterine en­dometriu!Jl and into the tubal area. one is not confronted with just an infected set of fallopian tubes, but the angry tube becomes occluded and distended, and the purulent exudate may escape from the distal end, giving rise to acute pelvic peritonitis and pelvic abscess, as well as adhesions at the site of the adjoining pelvic structures, or be-6Novak, M.D., Emil and Novak, M.O., Edmund, Textbook of Gynecology (5th �d., Baltimore, 1956, Williams and Wil­kins) p. 397. AUGUST, 1957 ,ween these and the small intestine, ,igmoid, and rectum. In such a situation the tube is so occluded that the patient nearly always is, or soon will be, sterile; and still subject to further pelvic devastation by the recurrent infec­tion. Since the therapeutiei..and pro­phylactic effect of the FAik proce­dure is to isofate the infected tubal area, allowing the self-limited in­fection to subside and breaking the pathway to reinfection, and since whatever contraceptive result there may be (if the lumen of the tube still has any patency) will only be anticipating a soon to be ex­pected sterility due to infection­occlusion; there is evidently an ac­ceptable proportion between the good effect and the evil effect, from the moral viewpoint. As regards the other require­ment of the principle of double ef­fect: that the good effect cannot be reasonably achieved in some other way, without the conco�i­tant evil effect; it must be pointed out that antibiotic therapy has not been dramatically effective against the sophisticated gonococcus. Anti­biotic therapy, in the circumstances described above, would be, to say the least, a much less effective and secure way of combating the par­ticular situation; while adding little or no hope for sufficient patency of the tubal lumen to achieve fertility.' In view of these considerations we would say that the Falk proce­dure is definitely not a directly contraceptive sterilization and that when it is gynecologically indicat­ed the surgeon may safely pro­ceed, from a moral viewpoint, un­der the principle of double effect. 91 ' . . .  

The Falk Procedure

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The Falk Procedure

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