Moral Principles and Medical Practice - Abortion [Imprimatur 1897]

[Stone]

Lecture III.: Abortion
Abortion, gentlemen, is the theme of my present lecture.

I. An important point to be determined is the precise time when the human embryo is first animated by its own specific principle of life, its human soul. It is interesting to read what various conjectures have been ventured on this subject by the learned of former ages. They were totally at sea. Though gifted with keen minds, they had not the proper data to reason from. And yet some of those sages made very shrewd guesses. For instance, as early as the fourth century of our era, St. Gregory of Nyssa taught the true doctrine, which modern science has now universally accepted. He taught that the rational soul is created by Almighty God and infused into the embryo at the very moment of conception. Still, as St. Gregory could not prove the certainty of his doctrine, it was opposed by the majority of the learned.

The Schoolmen of the Middle Ages, while condemning abortion from the time of conception, preferred the opinion of Aristotle, that the rational soul is not infused till the foetus is sufficiently developed to receive it. The embryo lived first, they taught, with a vegetable life; after a few days an animal soul replaced the vegetative principle; the human soul was not infused into the tiny body till the fortieth day for a male, and the eightieth day for a female child. All this sounds very foolish now; and yet we should not sneer at their ignorance; had we lived in their times, we could probably have done no better than they.

It was not till 1620 that Fienus, a physician of Louvain, in Belgium, published the first book of modern times that came near the truth. He maintained that the human soul was created and infused into the embryo three days after conception. Nearly forty years later, in 1658, a religious priest, called Florentines, wrote a book in which he taught that, for all we know, the soul may be intellectual or human from the first moment of conception; and the Pope's physician Zachias soon after maintained the thesis as a certainty that the human embryo has from the very beginning a human soul.

Great writers applauded Fienus and his successors; universities favored their views; the Benedictines, the Dominicans, and the Jesuits supported them. Modern science claims to have proved beyond all doubt that the same soul animates the man that animated the foetus from the very moment of conception. The "Medical Jurisprudence" of Wharton and Stille quotes Dr. Hodge of the Pennsylvania University as follows (p. 11: "In a most mysterious manner brought into existence, how wonderful its formation! Imperfect in the first instance, nay, even invisible to the naked eye, the embryo is nevertheless endowed, at once, with the principles of vitality; and although retained in the system of its mother, it has, in a strict sense, an independent existence. It immediately manifests all the phenomena of organic life; it forms its own fluids and circulates them; it is nourished and developed; and, very rapidly from being a rudis indigestaque moles, apparently an inorganic drop of fluid, its organs are generated and its form perfected. It daily gains strength and grows; and, while still within the organ of its mother, manifests some of the phenomena of animal life, especially as regards mobility. After the fourth month its motions are perceptible to the mother, and in a short period can be perceived by other individuals on close investigation.

"The usual impression," the authors add, "and one which is probably still maintained by the mass of the community, is that the embryo is perfected at the period of quickening--say the one hundred and twelfth or one hundred and twentieth day. When the mother first perceives motion, is considered the period when the foetus becomes animated--when it receives its spiritual nature into union with its corporeal.

"These and similar suppositions are, as has been already shown, contrary to all fact, and, if it were not for the high authorities--medical, legal, and theological--in opposition, we might add, to common-sense."

At present, gentlemen, there seems to be no longer any authority to the contrary. But many people, and some Doctors, seem to be several generations behind the times; for they still act and reason as if in the first weeks of pregnancy no immortal or human soul were in question.

Physicians worthy of their noble profession should strive to remove such gross and mischievous ignorance. In many of the United States the law casts its protection around an unborn infant from its first stage of ascertainable existence; no matter whether "quickening" has taken place or not, and consequently no matter what may be the stage of gestation, an indictment lies for its wilful destruction (Wharton and Stille, p. 861). "Where there has been as yet no judicial settlement of the immediate question, it may be reasonably contended that to make the criminality of the offence depend upon the fact of quickening is as repugnant to sound morals as it is to enlightened physiology" (ib.). "That it is inconsistent with the analogies of the law is shown by the fact that an infant, born even at the extreme limit of gestation after its father's death, is capable of taking by descent, and being appointed executor" (ib.). Dr. Hodge adds this sensible remark: "It is then only [at conception] the father can in any way exert an influence over his offspring; it is then only the female germ is in direct union with the mother--the connection afterwards is indirect and imperfect" (ib.). The fact, therefore, is now scientifically established that the embryo from the first moment of conception or fecundation is a human being, having a human immortal soul.

II. Now we come to the direct study of abortion. Abortion, or miscarriage, strictly means the expulsion of the foetus before it is viable, i.e., before it is sufficiently developed to continue its life outside of the maternal womb. The period of arrival at viability is usually after the twenty-eighth week of gestation. When birth occurs later than that period, and yet before the full term of nine months, it is called premature birth, which is altogether different from abortion; for it may save the life of the child, which abortion always destroys. "Premature labor is frequently induced in legitimate medical practice, for the purpose of avoiding the risks which in some cases attend parturition at term . . . . The average number of children saved by this means is rather more than one-half of the cases operated upon," say Wharton and Stille ("Parturition," p. 96). But they caution the physician against too ready recourse to this treatment; for, they add very truly, "The sympathetic phenomena of pregnancy are often more alarming in appearance than in reality, and will rarely justify any interference with the natural progress of gestation. In all cases the physician should consult with one or more of his colleagues before inducing premature labor; in this manner his humane intentions will not expose him, in case of failure, to reproach, suspicion, or prosecution."

The first time my attention was practically called to the case of a child in danger of dying before the time of delivery occurred over twenty years ago, when the mother of a highly respected family, then in my spiritual charge, was wasting away with consumption during her state of pregnancy. You know that we Catholics are very solicitous that infants shall not die without Baptism, because we believe that heaven is not promised to the unbaptized. I therefore directed the lady's husband to consult their family physician on the prospects of the case, and take timely precautions, so that, if death should come on the mother before her delivery, the infant might be reached at once and be baptized before it expired. The physician, a learned and conscientious practitioner, answered that we should not be solicitous; for that Nature had so provided that mothers in such cases rarely die before the child is born. He was right. The child was born and baptized; the mother died a few hours later; the little one lived several weeks before it went to join the angels in heaven. I learned from that occurrence the lesson which Wharton and Stille inculcate that "the phenomena of pregnancy are often far more alarming in appearance than in reality, and we are rarely justified in interfering with the natural progress of gestation."

To return to our subject. Abortion, or miscarriage, is often, as you know, gentlemen, the result of natural causes beyond human control; at other times it is brought on by unintentional imprudence on the part of the mother or her attendants. It is the duty of the family physician, when occasions offer, to instruct his pregnant patients and other persons concerned on the dangers to be avoided. A good Doctor should be to his patients what a father is to his children; very important matters are confided to him, and therefore grave responsibilities rest on his conscience.

III. We are now ready to consider the chief question of this lecture, namely, whether there can be any cases in which a physician is justified in bringing about an abortion, or in prescribing a treatment from which he knows an abortion is likely to result.

1. It is evident that, if he acts with due prudence, and yet, from some cause which he did not foresee and could not have been foreseen, his treatment brings about a miscarriage, he cannot justly be held accountable for what he could not help.

2. But what if he foresees that a drug or treatment, which, he thinks, is needed for the mother's health, may perhaps bring on a miscarriage? Can he still administer that drug or prescribe that treatment? Notice the question carefully. It is not supposed that he wants to bring on the miscarriage. He does not; he will do all he can to prevent it. Nor will his treatment or drug directly destroy the life or the organism of the embryo; but it is intended to affect favorably the system of the mother, and it is applied to her own organism. Still the Doctor knows that the prescription may indirectly bring about abortion. Can he prescribe the drug or treatment from which he knows the death of the foetus may indirectly result, the direct purpose being to remove an ailment of the mother's?

There is a sound moral principle bearing on such cases; it is universally admitted in Ethics and Jurisprudence, and its application is so extensive that it well deserves careful study. It is this: "He who wilfully puts a cause is answerable for the effect of that cause," causa causa est causa causati. Therefore, if the effect is evil, he is answerable for that evil. This, however, supposes that he could foresee the danger of such evil effect.

That evil effect is said to be indirectly willed; for it follows from a cause which is directly willed. If, then, you should give a dose to a pregnant mother which is intended to stop her fever or other ailment, but may also bring on abortion, the stopping of her fever is directly intended, and the abortion is said to be indirectly intended or willed. Those are the received terms in moral science. It were more correct to say that the abortion in this case is an effect not intended at all, but only permitted. That, then, which is permitted to result from our acts is said to be indirectly willed.

Are we then always responsible for evil effects permitted or indirectly willed? The principle laid down seems to say so. But then that principle admits of important exceptions. If we could never do an act from which we know evil consequences may follow, then we could scarcely do anything of importance; a young man could certainly not become a physician at all, for he is almost certain to injure some of his patients in the course of his professional life. But if we had no Doctors, such a loss would be a much greater evil to mankind than their occasional mistakes. Here then we seem to be in a dilemma, with evil on both sides of us. And then we are reminded of that other principle of which we spoke before, that we may never do evil at all that good may come of it. What shall we do? The solution is this: we should never do evil, but we are often justified in permitting evil to happen; in other words, we can never will evil directly, but we can often will it indirectly: we can do what is right in itself, even though we know or fear that evil will also result from our good act.

This conduct requires four conditions: 1. That we do not wish the evil itself, but make all reasonable effort to avoid it. 2. That the immediate effect we wish to produce is good in itself. 3. That the good effect intended is at least as important as the evil effect permitted. 4. That the evil is not made a means used to obtain the good effect.

Now let us apply these principles to the case in hand.

1. If the medicine is necessary to save the mother's life, and it is not certain to bring on abortion, though it is likely to do so, then the good effect is greater and more immediate or direct than the bad effect; then give the medicine to save the mother, and permit the probable death of the child.

2. If the medicine is not necessary to save the mother's life, though very useful, for the sake of such an advantage, you cannot justly expose the child's life to serious danger.

3. But if the danger it is exposed to is not serious but slight, and the remedy, though not necessary, is expected to be very useful to the mother, you may then administer the medicine; for a slight risk need not prevent a prudent man from striving to obtain very good results.

4. But what if the drug is necessary to save the mother, and as dangerous to the child as it is beneficial to her; can you then give the medicine with the moral certainty that it will save her and kill her child? When we know principles clearly we can apply them boldly. I answer then with this important distinction: you can give such medicine as will act on her system, her organs, in a manner to save her life, and you may permit the sad effects which will indirectly affect the child; but you cannot injure the child directly as a means to benefit her indirectly; that would be using a bad means to obtain a good end.

Suppose, then, what is said to be a real case of occasional recurrence in obstetrical practice, namely, that a pregnant mother is seized with violent and unceasing attacks of vomiting, so that she must die if the vomiting be not stopped; and you, as well as the consulting physician called in, can discover no means of relieving the vomiting except by procuring an abortion, by relieving the womb of its living burden. Abortion is then the means used to stop the vomiting. Are you justified in using that means? Abortion is the dislodging of the child from the only place where it can live and where nature has placed it for that purpose. Therefore abortion directly kills the child, as truly as plunging a man under water kills the man. Can you thus kill the child to save the mother? You cannot. Neither in this case nor in any other case can you do evil that good may come of it.

You notice, gentlemen, that I lay great stress on this principle that the end can never justify the means. It is an evident principle, which all civilized nations acknowledge. Its opposite, that the end justifies the means, is so odious that the practice of it is a black stamp of ignominy on any man or any set of men that would be guilty of it. The Catholic Church has, all through her course of existence, taught the maxim that the end cannot justify the means. She has impressed it on the laws and hearts of all Christian peoples. She inculcates it in the teachings of all her theologians and moral philosophers and in all her channels of education. And since we Jesuits are among her leading educators and writers, we have maintained that thesis in thousands of printed volumes, as firmly as I am maintaining it before you today. No Jesuit ever, nor any Catholic theologian or philosopher, has taught the contrary. And yet even such pretentious works as the "Encyclopaedia Britannica " have carried all over the earth the slander that we teach the opposite maxim, that the end does justify the means, and the odious term Jesuitry has been coined to embody that slander.

Is it not strange then, very strange, that they who thus falsely accuse us are often the very men who will procure an abortion to save the mother's life, who will do wrong that good may come of it? And you find such men maintaining the lawfulness of abortion on the plea that the operation, whether licit or not, is a necessary means to obtain a good end.

IV. Gentlemen, if once you grant that grave reasons would justify abortion, there is no telling where you will stop in your career of crime. To-day, for instance, you are called to attend a mother, who, you think, must die if you do not bring on a miscarriage. You are urged to do it by herself and her husband, and perhaps by other physicians. There are money considerations too, and the possible loss of practice. Will you yield to the temptation? The next day you are visited by a most respectable lady; but she has been unfaithful to her marriage vow. The consequences of her fall are becoming evident. If her husband finds out her condition, he may wreak a terrible vengeance. Her situation is sadder than that of the sick mother of the preceding day. You can easily remove the proof of her guilt, we will suppose, and spare a world of woes. Will you withstand the temptation? The third day comes a young lady, a daughter of an excellent family; bright prospects lie before her; her parents' lives and happiness are wrapped up in that girl. But in an evil hour she has been led astray. Now she is with child. She begs, she implores you to save her from ruin, and her parents from despair. If you do not help her, some other Doctor or a quack will do it; but you could do it so much better. If you should have yielded on the two former occasions, if you have already stained your heart with innocent blood, will you now refuse? Where are you going to draw the line?

The passions of men are insatiate, even in modern society; the more you yield to them, the stronger grows their craving. Let me illustrate my meaning by a fact that happened a few years ago in Russia. It is just to our point. During a severe winter, a farmer, having his wife and children with him on a wagon, was driving through a wild forest. All was still as death except the howling of wolves in the distance. The howling came nearer and nearer. After a while a pack of hungry wolves was seen following in the track of the wagon. The farmer drove on faster, but they gained on him. It was a desperate race to keep out of their reach. At last they are just back of the wagon. What can be done? The next moment the wolves may jump on the uncovered vehicle. The children, horrified, crouch near their trembling mother. Suddenly the father, driven to despair, seizes one of the little children and flings it among the pack of wolves, hoping that by yielding them one he may save the rest. The hungry beasts stop a few moments to fight over their prey. But soon they are in hot pursuit again, fiercer because they have tasted blood. A second child is thrown to them, and after a while a third and a fourth.

Human society, gentlemen, in this matter of sacrificing fcetal life is as insatiable as a pack of hungry wolves. Woe to any one of you if he begins to yield to its cravings; there is no telling where he will stop. In proof of my statement, let me read to you an extract from a lecture on Obstetrics, delivered by Doctor Hodge, of Philadelphia, to the medical students of the University of Pennsylvania: "We blush while we record the fact, that, in this country, in our cities and towns, in this city where literature, science, morality, and Christianity are supposed to have so much influence; where all the domestic and social virtues are reported as being in full and delightful exercise; even here individuals, male and female, exist who are continually imbruing their hands and consciences in the blood of unborn infants; yea, even medical men are to be found who, for some trifling pecuniary recompense, will poison the fountains of life, or forcibly induce labor, to the certain destruction of the foetus and not infrequently of the parent.

"So low, gentlemen, is the moral sense of the community on this subject, so ignorant are the greater number of individuals, that even mothers, in many instances, shrink not from the commission of this crime, but will voluntarily destroy their own progeny, in violation of every natural sentiment and in opposition to the laws of God and man. Perhaps there are few individuals in extensive practice who have not had frequent applications made to them by the fathers and mothers of unborn infants (respectable and polite in their general appearance and manners) to destroy the fruit of illicit pleasure, under the vain hope of preserving their reputation by this unnatural and guilty sacrifice.

"Married women, also, from the fear of labor, from indisposition to have the care, the expense, or the trouble of children, or some other motive equally trifling and degrading, have solicited that the embryo should be destroyed by their medical attendant. And when such individuals are informed of the nature of the transaction, there is an expression of real or pretended surprise that any one should deem that act improper, much more guilty; nay, in spite even of the solemn warnings of the physician, they will resort to the debased and murderous charlatan, who, for a piece of silver, will annihilate the life of the foetus, and endanger even that of its ignorant or guilty mother.

"This low estimate of the importance of foetal life is by no means restricted to the ignorant or to the lower classes of society. Educated, refined, and fashionable women, yea, in many instances, women whose lives are in other respects without reproach-- mothers who are devoted with an ardent and selfdenying affection to the children who already constitute the family--are perfectly indifferent concerning the foetus in utero. They seem not to realize that the being within them is indeed animate, that it is in verity a human being, body and spirit; that it is of importance; that its value is inestimable, having reference to this world and the next. Hence they in every way neglect its interests. They eat and drink, they walk and ride, they will practise no self-restraint, but will indulge every caprice, every passion, utterly regardless of the unseen, unloved embryo . . . .

"These facts are horrible, but they are too frequent and too true; often, very often, must all the eloquence and all the authority of the practitioner be employed; often he must as it were grasp the conscience of his weak and erring patient, and let her know, in language not to be misunderstood, that she is responsible to her Creator for the life of the being within her." (Wharton and Stille's Med. Jur., Parturition, p. 92.)

Dr. Walter Channing, of Massachusetts, refers to the difficulty of obtaining a conviction for abortion, and adds: "I believe there has never been one in this State, this moral State by eminence, and perhaps in none is this crime more rife" (" Boston Med. and Surg. Journal," April, 1859, p. 135).

V. We have, then, proved, gentlemen, two important and pregnant principles: 1. That we can never directly procure abortion, and 2, that we can procure it indirectly in extreme cases; or rather that we can take such extreme measures in pressing danger as may likely result in abortion against our will.

While these principles are clear and undoubted, there are cases in which the right application of them is beset with great difficulties. These often occur in connection with what is called ectopic or extrauterine gestation, namely, when the nascent human form lodges in some recess not intended by nature for its abode. Of late years, Dr. Velpeau, of Paris; Dr. Tait, of Birmingham, and many other eminent physicians have shown that cases of ectopic gestation are more numerous than had been supposed; one practitioner reports that he had attended fifty cases, another eighty-five.

1. We will first suppose the case of an interior growth occurring, the nature of which cannot be determined. It may be only a tumor, yet it may be the growth of a living foetus. If no immediate crisis is feared, you will wait, of course, for further developments. If it proves to be a child, you will attempt no operation till it becomes viable at least. But suppose that fatal consequences are apprehended before the presence of a human being can be ascertained by the beating of the heart; suppose that delay would endanger the mother's life; and yet if you undertake to cut out the tumor, you may find it to contain foetal life. In such urgent danger, can you lawfully perform the operation? Let us apply our principles. You mean to operate on a tumor affecting one of the mother's organs. The consequences this may have for the child are not directly willed, but permitted. The four conditions mentioned before are hereby verified, under which the evil result, the death of the possible foetus, may be lawfully permitted; namely: (a) You do not wish its death; (b) What you intend directly, the operation on the mother's organism, is good in itself; © The good effect intended, her safety, to which she has an undoubted right, overbalances the evil effect, the possible death of the child, whose right to life is doubtful, since its very existence is doubtful; now, a certain right must take precedence of a doubtful right of the same species; (d) The evil is not made the means to obtain the good effect (see " Am. Eccl. Rev.," Nov., 1893, p. 353). This last condition would not be verified if it were proposed, not to cut out the cyst, but to destroy its contents by an electric current. Then, it would seem, the foetus itself, if there be one, would be directly attacked.

2. The case would present greater difficulties if the growth in question were known to contain a living foetus. Such a case is discussed in all its details, with remarkable philosophical acumen, and in the light of copious information furnished by prominent members of the medical profession, in the pages of the "American Ecclesiastical Review" for November, 1893, pages 331-360. The participants in this interesting discussion are writers who enjoy a worldwide reputation for keenness of intellect and soundness of doctrine in philosophical and theological learning. They are not at all agreed as to the practical conclusion arrived at, and even those who agree to the same conclusion do so for different reasons. Three of them agree that in the case of a cyst known to contain a living embryo, when a rupture most probably fatal to mother and child is imminent, the abdominal section might be performed lawfully, the cyst opened, and the child baptized before its certain death. Two of these justify this conclusion on the principle that the death of the child is then permitted only or indirectly intended; one maintains that the killing of the embryo is then directly procured, but he considers that an embryo in a place not intended for it by nature is where it has no right to be, and therefore may be treated as an unjust aggressor upon the mother's life. At least one of the disputants condemns the operation as absolutely unlawful.

The opinion that the embryo occupying a place not intended for it by nature may be treated as an unjust aggressor upon the mother's life has since been abandoned by Catholic moralists generally; and it is irreconcilable with a Roman decision of May 4, 1898, and a still more explicit one of March 20, 1902. (See the Appendix to this volume.) In Jurisprudence, reason must be our guide when it affords us evidence of the truth. But when our reason offers arguments on both sides of the question, so that we can arrive at no certain conclusion, then we act prudently by invoking the authority of wiser minds who make moral questions a specialty, and we are perfectly safe if we follow the best authority obtainable.

A Catholic physician has here a special advantage; for he has in cases of great difficulty the decisions of Roman tribunals, composed of most learned men, and renowned for the thoroughness of their investigations and the prudence of their verdicts, to serve him as guides and vouchers for his conduct. Although these tribunals claim no infallibility, yet they offer all the advantages that we look for, with regard to civil matters, in the decisions of our Supreme Court. These Roman courts have uniformly, decided against any operation tending directly to the death of an innocent child ("Am. Eccl. Rev." Nov., 1893, pp. 352, 353; Feb., 1895, p. 171).

Non-Catholics are, of course, not obliged to obey such pronouncements; yet, even for them, it cannot be injurious, but rather very useful, to know the views of so competent a court on matters of the most vital interest in their learned profession. This is the reason why the "Medical Record" has published of late so many articles on the teachings of Catholic authorities with regard to craniotomy and abortion (see vol. xlvii., nos. 5, 9, 25 ; vol. xlviii., nos. 1, 2, 3, 4).