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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.