Exception: To Save the Life of the Mother

ALL About Issues June-July 1991, p. 29

EXCEPTION: TO SAVE THE LIFE OF THE MOTHER by Rev. E. M. Robinson, O.P.; copyright 1991

"Never and in no case has the Church taught that the life of the child must be preferred to that of the mother. It is erroneous to put the question with this alternative: either the life of the child or that of the mother. No, neither the life of the mother nor that of the child can be subjected to direct suppression. In the one case as in the other, there can be but one obligation: to make every effort to save the lives of both, of the mother and the child." (Pope Pius XII, Allocution to the Association of Large Families, AAS (1951), XLIII, p. 855.)

RESTRICTIONS AGAINST abortion, both moral and legal, are written in such a way that sometimes a faulty reason is offered, or at least presumed, for the exception which entitles this article. In some instances the child is looked upon as an unjust aggressor. In other cases the child's right to life is considered to be inferior to the mother's right to life. A further problem arises in the assumption that there are medically warranted situations in which the mother's life can be saved only by a direct attack upon the child-to kill the child "in order to save the mother's life."

The only ethically justified understanding of this much-celebrated exception shows that it is not an exception at all! The classical example of an ectopic pregnancy or the example of the cancerous uterus, which allow the surgeon, ethically, to remove the woman's damaged reproductive organs in order to save her life, should not be used as examples of abortion, even though a baby's life is terminated in the progress.

It is true that early medical terminology speaks of natural miscarriage as abortion, but it does not refer to the above examples by the name of abortion. In the case of the uterus, the usual name hysterectomy would be used, and the pregnancy would be noted in the pathology report. Both medically and legally, for the purposes of discussion, abortion is a direct and fatal attack upon the life of an unborn offspring of human parentage.

It becomes necessary now to see why a medical procedure, such as the excision of a cancerous, pregnant uterus, is sometimes ethically permissible and should not be called an abortion.

What is involved here are two individuals, the mother and her child, having equal, inalienable rights to continue living. If it can be established that the mother's life demands the removal of the diseased uterus, she has a right to this necessary means of preserving her own life. The surgical removal is not a direct attack upon the child, either by intention or by the nature of the procedure. Therefore, it should not be called an abortion.

The ethical principle governing this, and similar cases, is a long-standing one called the principle of double-effect. It is explained in this way: an action which terminates in two effects, one good and one evil, may be undertaken if the action, by its nature, is not evil, and if the good end is primarily intended and the first to be executed, and if the good effect is at least equal to the evil effect, and if the action is necessary and is the least harmful means for attaining the good effect. The excision of the diseased uterus is immediately necessary and is the minimum that is required to save the life of the mother. The good and evil effects are equal in magnitude, since both mother and child, as human beings, have identical rights to life. In such instances there is said to be a conflict of rights, but not a denial of the rights of either party.

One faulty assumption which is sometimes intended by the so-called exception to the prohibition of abortion claims that the child is an unjust aggressor and to kill the child would be a matter of justifiable self- defense. There is no sense in which the child can be called unjust, since this is a moral concept and requires evil intention on the part of the actor. As for being an aggressor, the child is not responsible for being in the uterus and is not, either by his or her presence or activity, injuring the mother. In the previous case, for example, it is not because of the pregnancy that the uterus is being removed.

In the present state of obstetrics there is no justification for a direct attack on the child's life as a means of saving the mother's. It is true that pregnancy may aggravate certain conditions of maternal ill-health and even be the cause of other physiological upsets in the mother. Yet, through adequate management by the obstetrician, especially in suitable health care facilities, the pregnancy need not be an unsurmountable obstacle to the mother's continued living and eventual survival. But, even if this were not so, the child may never be killed on the pretext of saving the mother's life. The human dignity of each individual does not permit that one human being may be sacrificed even to save the life of another.

In another faulty assumption, the child's right to life is said to be inferior to that of his or her mother's. From the viewpoint of existentialism, which seems to be the basis of this assumption, the greatest good is experience. The mother, experienced from many years of living, is "worth" more than the inexperienced child. But, even here, it is not the value of human rights which is being compared, but something extraneous to the right to life. Certainly, experience gained by living is something to be treasured, but it cannot be equated in value with the right to continue living!

The enactment of laws prohibiting abortion should be carefully formulated whenever the law provides the clause: "except in order to save the life of the mother." If abortion were understood in the sense stated above, there would be no need to use the exception clause. Moral and medical prudence would be sufficient, as it has been in past centuries, to guide the doctor in the performance of his duties. The pro-life people who do not accept the use of that clause could be heartened in their moral stance when the clause is used, if it clearly states that it includes only the so-called "indirect abortion," meaning, of course, cases similar to those considered above, which are conformable with the ethical principle of double-effect. These persons are correct in fearing that the clause, as stated in the title of this article, could be used to justify a direct attack upon the life of the child as a supposedly valid means of saving the mother's life. In this day of presumed "options," additional care must be taken to insure the complete and accurate legal recognition of each individual human being's right to life. In phrasing the prohibition against abortion, it would be wise to define abortion as the direct and willful killing of an unborn offspring of human parentage from the time of fertilization. To this should be added that the prohibition does not include necessary surgical procedure on the mother's body whose primary and direct purpose is to prevent her death.

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