Saving the Life of the Mother

The Ethical Quandary of Ectopic Pregnancies and Abortion

Jackson McNeece

When the U.S. Supreme Court delivered the Dobbs v. Jackson Women’s Health Organization decision, American society was sent into an uproar. While there were many bad-faith actors, some women were genuinely fearful, mostly due to the incredible amount of disinformation circulating online. Much of this disinformation surrounded the idea that women would now face criminal charges for ectopic pregnancy and miscarriages. 

Amidst the tumult and trepidation, Christians can compassionately minister to others and step into the public square with a well-reasoned, well-articulated position that promotes the flourishing of both the child and mother. To do so, however, first requires serious thinking about both the medical and theological nature of abortion. 

Three Foundational Premises

In order to help our evaluation, it’s important to synthesize several principles from both the truths of Scripture and the facts of science that provide us with three foundational premises to acknowledge. First, from the moment an egg is fertilized by a sperm cell, a new life is conceived. Further, we know that every human life is made in the image of God (Gen. 1:26-27), and it is both a joy and a duty to protect all life, particularly the most vulnerable lives (Psa. 82:3-4). 

Second, abortion is a medical procedure with moral implications. The moral nature of abortion rests not only around the procedure itself, but around the decision as to why to abort the child. Finally, there are medical circumstances in which the physical life of the mother is at risk should she deliver the baby. This raises the question of whether there is a difference between an elective abortion and a medically necessary abortion to save the life of mother.

Defining Our Terms

According to the Oxford English Dictionary, abortion is “the expulsion or removal from the womb of a developing embryo or fetus in the period before it is capable of independent survival.” 

I contend there are two types of abortion: elective abortion and medically necessary abortion. An elective abortion is any abortion the mother and/or father chooses due to adverse circumstances, some of which being economic, a lack of desire for a child, fear of single parenthood, or the presence of disability in the child. 

Conversely, medically necessary abortions are those that are required to save the physical life of the mother. In these circumstances, a complication has arisen and the pregnancy has gone awry in such a way that the result of the pregnancy will be the death of the mother and potentially of the child. 

A pregnancy is considered ectopic when the fertilized egg implants outside the main cavity of the uterus, most often implanting in the fallopian tube of the pregnant woman. This condition is dangerous because, without medical intervention, the embryo will continue to grow, eventually causing a rupture of the site where the ectopic pregnancy is implanted. If unaddressed, the rupture can result in intra-abdominal hemorrhage that will kill the mother.1https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088

Additionally, an ectopic embryo will die before it reaches the stage of viability. It is this statistically rare—according to Hendriks, Rosenberg, and Prine, ruptured ectopic pregnancies account for 2.7% of all pregnancy-related deaths—but medically and ethically serious circumstance that invokes the Christian’s conscience to consider the ethics of abortion more thoroughly.2Hendriks, E., Rosenberg, R., & Prine, L. (2020). Ectopic Pregnancy: Diagnosis and Management. American family physician, 101(10), 599–606.

A Case Study Use on the “Rule of Double Effect” 

To assist us in answering these questions, I will use a case study so we can analyze Christian ethical principles of medically necessary abortions in a real-life context. 

Maya is a healthy, married, 28-year-old woman who has missed her period and is experiencing pain and tenderness in her midsection. She visits her primary care physician, who thinks Maya might be pregnant and orders a blood test to measure the concentration of the hormone human chorionic gonadotropin (HCG) to determine if she is pregnant. Her serum HCG levels are elevated, signaling that Maya is pregnant. Maya’s abdominal pain alongside a pregnancy raises concern for a possible ectopic pregnancy. Given that Maya is medically stable at this point in her pregnancy, her physician proceeds with performing a specific ultrasound to determine the location of the pregnancy. Unfortunately, the ultrasound confirms her doctor’s concerns: Maya’s pregnancy is ectopic. 

Both Maya and her physician are committed, orthodox Christians who believe life begins at conception. While they are desirous of pregnancies, Maya and her husband do not want her to die, so they are conflicted as to what to do.

As pastor of a Southern Baptist church, Maya’s husband has an interest in the early church fathers, and recalls that St. Thomas Aquinas (1225-1274) proposed a moral framework to guide Christians through the question of whether or not it is appropriate to provide self-defense. He pulls his copy of Summa Theologica from the shelves and finds the section on the “Rule of Double Effect.” 

 The Rule of Double Effect (II-II, Qu. 64, Art.7) can be summarized in this way:

  1. The act itself must be morally good or at least indifferent.
  2. The agent performing the act must not desire the bad effect, but may allow it to occur. Further, if it were possible to obtain the good effect without the bad, then that should be pursued. 
  3. 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. The good effect must be sufficiently desirable to compensate for the allowing of the bad effect.

Though Aquinas developed the Rule of Double Effect for the purpose of navigating self-defense, Maya and her husband believe their situation is analogous because her body is, in a sense, attacking itself. Pursuing a medically-necessary procedure would resolve a grave threat to Maya’s life. They used Aquinas’ rule to prayerfully think through their situation. 

  1. The act—intending to save Maya’s life—is itself morally good.
  2. The agent, Maya’s surgeon who would perform the potential operation, may not desire the bad effect—the death of the prenatal child—but may permit it. If her physician could attain the good effect without the bad effect, she should do so. There is, however, no other option to save Maya’s life, so a medically necessary abortion is the only option in this circumstance. 
  3. The surgery to remove the embryo from the fallopian tube immediately saves Maya’s life.
  4. The survival of the mother is desirable, especially compared to the inevitable death of both the mother and the embryo should no action be taken. 

In summary, the intention of the procedure is to save Maya’s life, not to kill the embryo. By applying the Rule of Double Effect to their situation, Maya and her husband believe it is ethically permissible to undergo a medically necessary abortion. They consult with their physician who agrees and recommends a pro-life OBGYN to perform the abortion. 

By thinking critically about the issue at hand with the assistance of Aquinas’ framework, we can determine the proper course of action not only for Maya, but for medically necessary abortions broadly. Further, the tool Aquinas provided allows Christians seeking proper decisions in precarious situations the ability to understand not only why this procedure can be medically necessary and ethically permissible in select circumstances, but also why there is a categorical difference between an elective and medically necessary justification for abortion. 

 When applying the Rule of Double Effect to elective abortion, each justification for choosing abortion fails at least one of the four criteria set forth. For instance, should a mother elect abortion due to their financial circumstance (one of the most cited reasons for abortion according to The Guttmacher Institute), the justification cannot satisfy the first criteria, being that abortion is not a morally good or indifferent action.3https://www.guttmacher.org/journals/psrh/2005/reasons-us-women-have-abortions-quantitative-and-qualitative-perspectives Further, elective abortion would fail to satisfy the third criteria because choosing abortion due to financial instability does not alleviate the mother’s broken economic realities, it only maintains her economic destitution. This ethical framework helps Christians properly differentiate between elective and medically necessary abortions.

In a fallen world, we will be faced with precarious and heart-wrenching ethical situations when it comes to medical complications and abortion. When faced with these types of challenges, the work of Christians of the past like Aquinas enables us to honor the Lord in the choices we make and prepares us to speak with greater confidence, clarity, and compassion as we defend and promote the flourishing of human life from conception to natural death. 

Jackson McNeece is a Master of Divinity student from Oklahoma City, OK. In May of 2020, Jackson graduated from Baylor University with a degree in Medical Humanities. Throughout his studies at Baylor, he developed an intense curiosity for medical ethics, particularly within a health care setting. While studying at Duke Divinity, Jackson hopes to continue to cultivate his fascination with medical ethics, learn to ground medical ethics within a theological context, and develop an understanding of what it means to serve in a pastoral capacity in medicine.

Article 12: The Future of AI

We affirm that AI will continue to be developed in ways that we cannot currently imagine or understand, including AI that will far surpass many human abilities. God alone has the power to create life, and no future advancements in AI will usurp Him as the Creator of life. The church has a unique role in proclaiming human dignity for all and calling for the humane use of AI in all aspects of society.

We deny that AI will make us more or less human, or that AI will ever obtain a coequal level of worth, dignity, or value to image-bearers. Future advancements in AI will not ultimately fulfill our longings for a perfect world. While we are not able to comprehend or know the future, we do not fear what is to come because we know that God is omniscient and that nothing we create will be able to thwart His redemptive plan for creation or to supplant humanity as His image-bearers.

Genesis 1; Isaiah 42:8; Romans 1:20-21; 5:2; Ephesians 1:4-6; 2 Timothy 1:7-9; Revelation 5:9-10

Article 11: Public Policy

We affirm that the fundamental purposes of government are to protect human beings from harm, punish those who do evil, uphold civil liberties, and to commend those who do good. The public has a role in shaping and crafting policies concerning the use of AI in society, and these decisions should not be left to those who develop these technologies or to governments to set norms.

We deny that AI should be used by governments, corporations, or any entity to infringe upon God-given human rights. AI, even in a highly advanced state, should never be delegated the governing authority that has been granted by an all-sovereign God to human beings alone. 

Romans 13:1-7; Acts 10:35; 1 Peter 2:13-14

Article 10: War

We affirm that the use of AI in warfare should be governed by love of neighbor and the principles of just war. The use of AI may mitigate the loss of human life, provide greater protection of non-combatants, and inform better policymaking. Any lethal action conducted or substantially enabled by AI must employ 5 human oversight or review. All defense-related AI applications, such as underlying data and decision-making processes, must be subject to continual review by legitimate authorities. When these systems are deployed, human agents bear full moral responsibility for any actions taken by the system.

We deny that human agency or moral culpability in war can be delegated to AI. No nation or group has the right to use AI to carry out genocide, terrorism, torture, or other war crimes.

Genesis 4:10; Isaiah 1:16-17; Psalm 37:28; Matthew 5:44; 22:37-39; Romans 13:4

Article 9: Security

We affirm that AI has legitimate applications in policing, intelligence, surveillance, investigation, and other uses supporting the government’s responsibility to respect human rights, to protect and preserve human life, and to pursue justice in a flourishing society.

We deny that AI should be employed for safety and security applications in ways that seek to dehumanize, depersonalize, or harm our fellow human beings. We condemn the use of AI to suppress free expression or other basic human rights granted by God to all human beings.

Romans 13:1-7; 1 Peter 2:13-14

Article 8: Data & Privacy

We affirm that privacy and personal property are intertwined individual rights and choices that should not be violated by governments, corporations, nation-states, and other groups, even in the pursuit of the common good. While God knows all things, it is neither wise nor obligatory to have every detail of one’s life open to society.

We deny the manipulative and coercive uses of data and AI in ways that are inconsistent with the love of God and love of neighbor. Data collection practices should conform to ethical guidelines that uphold the dignity of all people. We further deny that consent, even informed consent, although requisite, is the only necessary ethical standard for the collection, manipulation, or exploitation of personal data—individually or in the aggregate. AI should not be employed in ways that distort truth through the use of generative applications. Data should not be mishandled, misused, or abused for sinful purposes to reinforce bias, strengthen the powerful, or demean the weak.

Exodus 20:15, Psalm 147:5; Isaiah 40:13-14; Matthew 10:16 Galatians 6:2; Hebrews 4:12-13; 1 John 1:7 

Article 7: Work

We affirm that work is part of God’s plan for human beings participating in the cultivation and stewardship of creation. The divine pattern is one of labor and rest in healthy proportion to each other. Our view of work should not be confined to commercial activity; it must also include the many ways that human beings serve each other through their efforts. AI can be used in ways that aid our work or allow us to make fuller use of our gifts. The church has a Spirit-empowered responsibility to help care for those who lose jobs and to encourage individuals, communities, employers, and governments to find ways to invest in the development of human beings and continue making vocational contributions to our lives together.

We deny that human worth and dignity is reducible to an individual’s economic contributions to society alone. Humanity should not use AI and other technological innovations as a reason to move toward lives of pure leisure even if greater social wealth creates such possibilities.

Genesis 1:27; 2:5; 2:15; Isaiah 65:21-24; Romans 12:6-8; Ephesians 4:11-16

Article 6: Sexuality

We affirm the goodness of God’s design for human sexuality which prescribes the sexual union to be an exclusive relationship between a man and a woman in the lifelong covenant of marriage.

We deny that the pursuit of sexual pleasure is a justification for the development or use of AI, and we condemn the objectification of humans that results from employing AI for sexual purposes. AI should not intrude upon or substitute for the biblical expression of sexuality between a husband and wife according to God’s design for human marriage.

Genesis 1:26-29; 2:18-25; Matthew 5:27-30; 1 Thess 4:3-4

Article 5: Bias

We affirm that, as a tool created by humans, AI will be inherently subject to bias and that these biases must be accounted for, minimized, or removed through continual human oversight and discretion. AI should be designed and used in such ways that treat all human beings as having equal worth and dignity. AI should be utilized as a tool to identify and eliminate bias inherent in human decision-making.

We deny that AI should be designed or used in ways that violate the fundamental principle of human dignity for all people. Neither should AI be used in ways that reinforce or further any ideology or agenda, seeking to subjugate human autonomy under the power of the state.

Micah 6:8; John 13:34; Galatians 3:28-29; 5:13-14; Philippians 2:3-4; Romans 12:10

Article 4: Medicine

We affirm that AI-related advances in medical technologies are expressions of God’s common grace through and for people created in His image and that these advances will increase our capacity to provide enhanced medical diagnostics and therapeutic interventions as we seek to care for all people. These advances should be guided by basic principles of medical ethics, including beneficence, non-maleficence, autonomy, and justice, which are all consistent with the biblical principle of loving our neighbor.

We deny that death and disease—effects of the Fall—can ultimately be eradicated apart from Jesus Christ. Utilitarian applications regarding healthcare distribution should not override the dignity of human life. Fur- 3 thermore, we reject the materialist and consequentialist worldview that understands medical applications of AI as a means of improving, changing, or completing human beings.

Matthew 5:45; John 11:25-26; 1 Corinthians 15:55-57; Galatians 6:2; Philippians 2:4

Article 3: Relationship of AI & Humanity

We affirm the use of AI to inform and aid human reasoning and moral decision-making because it is a tool that excels at processing data and making determinations, which often mimics or exceeds human ability. While AI excels in data-based computation, technology is incapable of possessing the capacity for moral agency or responsibility.

We deny that humans can or should cede our moral accountability or responsibilities to any form of AI that will ever be created. Only humanity will be judged by God on the basis of our actions and that of the tools we create. While technology can be created with a moral use in view, it is not a moral agent. Humans alone bear the responsibility for moral decision making.

Romans 2:6-8; Galatians 5:19-21; 2 Peter 1:5-8; 1 John 2:1

Article 2: AI as Technology

We affirm that the development of AI is a demonstration of the unique creative abilities of human beings. When AI is employed in accordance with God’s moral will, it is an example of man’s obedience to the divine command to steward creation and to honor Him. We believe in innovation for the glory of God, the sake of human flourishing, and the love of neighbor. While we acknowledge the reality of the Fall and its consequences on human nature and human innovation, technology can be used in society to uphold human dignity. As a part of our God-given creative nature, human beings should develop and harness technology in ways that lead to greater flourishing and the alleviation of human suffering.

We deny that the use of AI is morally neutral. It is not worthy of man’s hope, worship, or love. Since the Lord Jesus alone can atone for sin and reconcile humanity to its Creator, technology such as AI cannot fulfill humanity’s ultimate needs. We further deny the goodness and benefit of any application of AI that devalues or degrades the dignity and worth of another human being. 

Genesis 2:25; Exodus 20:3; 31:1-11; Proverbs 16:4; Matthew 22:37-40; Romans 3:23

Article 1: Image of God

We affirm that God created each human being in His image with intrinsic and equal worth, dignity, and moral agency, distinct from all creation, and that humanity’s creativity is intended to reflect God’s creative pattern.

We deny that any part of creation, including any form of technology, should ever be used to usurp or subvert the dominion and stewardship which has been entrusted solely to humanity by God; nor should technology be assigned a level of human identity, worth, dignity, or moral agency.

Genesis 1:26-28; 5:1-2; Isaiah 43:6-7; Jeremiah 1:5; John 13:34; Colossians 1:16; 3:10; Ephesians 4:24