Wednesday, July 21, 2010

Between a rock and a hard place (Part III - double trouble)

This is part 3 of a series of posts on whether abortion is justified "to save the life of the mother" (here are part I and part II). In the first two posts we covered some popular cases involving pulmonary hypertension and cancer. I introduced "double effect" in the second post. I'd like to explain that in more detail, and then get into some philosophical questions.

Just to recap, despite claims in the media and government that abortion has to have a special exception in law "to save the life of the mother" this is simply not true. The goal of medicine is to save lives, and in the case of a pregnant woman there are two lives at stake. In performing an abortion the doctor is destroying one life to make treatment simpler - the abortion is not part of the treatment of the condition.

At the end of the previous post I talked about uterine cancer, where there are cases where the mother and child cannot both be saved. Pro-abortion propaganda would have you believe that Catholics and other pro-lifers would leave the mother to die, but that simply is not true. The fact is, the pro-life position is just that - pro-life. Do everything possible to save both lives, but if that can't be done, at least try to save one. The only thing that's not acceptable is intentionally killing.

Ectopic pregnancy is one of those conditions under which the mother and child cannot both survive. In an ectopic pregnancy, instead of the embryo implanting in the uterine wall it implants in the fallopian tube. As the child grows the tube is stretched to the point at which it ruptures. If untreated the mother and child will both die. The treatments are to remove the affected part of the fallopian tube, or to abort the baby chemically or surgically. Any of these three methods will save the life of the mother. The removal of the affected part of the fallopian tube is morally acceptable, the abortion is not.

What's the difference, you may ask, if all three procedures have the same results (a live mother and a dead child)? The difference is in actions and intent. To put it simply, it's the difference between someone dying in an automobile accident and running someone down with your car. The outcome is the same, but your actions and intentions were different. The "technical term" is "double effect".

The double effect principle was proposed by Thomas Aquinas, in dealing with self defense. Suppose someone is attacking you, and in trying to stop them you kill them. Is it wrong to kill an attacker in order to save your life? Aquinas says that it is not, and worked out the moral principles of why it is not. The principle is called "double effect" because Aquinas notes that a single action can have more than one consequence. One consequence can be good while the other is bad. In that case, how do you decide whether the act itself is good or bad?

One way would be to balance "how good" with "how bad". Stealing a loaf of bread to keep your child from starving? OK. Killing someone to get their money? Not OK. But what if the effects are similar (life and death, for instance)?

Aquinas determined four conditions for determining under what circumstances this is justified, and his logic has withstood almost 800 years of critique. Those condition are described as follows (paraphrased from the Stanford Encyclopedia of Philosophy):
  1. [the nature of the act] The act itself must be morally good or at least indifferent.
  2. [the right intention] The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.
  3. [the means to an end] The good effect must be produced directly by the action, not by the bad effect. Otherwise the agent would be using a bad means to a good end, which is never allowed.
  4. [proportionality] The good effect must be sufficiently desirable to compensate for the allowing of the bad effect
In the case of fallopian tube removal in an ectopic pregnancy, the conditions of "double effect" are met as follows:
  1. The removal of the fallopian tube is morally indifferent. There is nothing inherently good or bad about a surgical procedure.
  2. The bad effect (the death of the child) is not the intention of the surgery. If the mother could be saved without the child dying that action would be taken.
  3. The mother's life is saved by the removal of the tube, not because of the child's death.
  4. Saving the mother's like is sufficiently good to allow for the bad effect.
In the case of abortion for an ectopic pregnancy, conditions 1 and 2 are not met:
  1. Intentionally killing an innocent human being is morally evil.
  2. The death of the child is the intention of the procedure.
Let's look at some examples of double effect that may make it even clearer. There's a well known (in some circles) ethical dilemma involving a train. In this scenario there are five children playing on the tracks, and a train is coming. The trains brakes have failed, and it cannot be stopped. The children are unaware of the train, and will be killed by it if nothing is done. You cannot get them off the track in time. Fortunately you are near the tracks and there is a switch near you that will put that train onto a side track. Unfortunately there is one child playing on that track. If you throw the switch the child on the side track will be killed. Do you throw the switch? By the principle of double effect, you should, because even though a child will be killed, you are not trying to kill him, you are trying to save the other five. But is this just a case of "the needs of the many outweigh the needs of the few"?

Consider the case of terrorists holding five children hostages. They say they will kill the hostages unless you kill someone (presumably an innocent victim). Should you do it? The outcome is he same, one life to save five, yet it is not moral to do so. Or consider a doctor with five patients, who all need organ transplants. The doctor knows a nurse who would be a tissue match. Should the doctor kill the nurse and cut him up to supply organs for the other five?

Let's say you are pro-life, and you know an abortionist kills 10 children a day. Should you murder the abortionist to save the children? Despite the claims of pro-abortion propaganda, such an act would be contrary to pro-life principles, on the following grounds, as per the double effect:
  1. Murder is an evil act.
  2. It is possible to obtain the good effect (saving the children) by another means (such as protests, education, voting, etc.).
  3. It would be using a bad act (murder) as the means to a good end (saving children).
I hope these posts have helped clear up some of the misinformation regarding Catholic and pro-life principles and abortion "to save the life of the mother". To sum up
  • Abortion by itself never saves a life, it destroys one.
  • Abortion is never necessary for other medical treatments to take place.
  • Pro-lifers do not advocate "letting the mother die", but rather trying to save both patients, mother and child.
  • In cases where a doctor cannot save both patients, abortion is still not the answer. Other medical procedures are always an option even if they have the double effect of killing the child so the mother can live.
  • The double effect principle helps us rationally choose between good and evil acts.
  • The pro-life position does not condone violence against anyone. To do so would be contrary to the very principles that make abortion wrong.


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