The Life of the Mother

Regarding my question about Nicaragua's total abortion ban, Georgetown philosophy prof Karen Stohr explains:

Without knowing the details of the law, I'm guessing that they are defining abortion as the intentional killing of a fetus, with the understanding that not all procedures that result in the fetus's death are properly considered to be abortions. For instance, everyone (I think!) agrees that it's permissible to treat an ectopic pregnancy by way of salpingectomy, or the excision of the fallopian tube. This of course results in the baby's death, but it's not considered intentional killing on the double effect grounds that the death is not serving as a means to treating the woman's life-threatening condition. (There is much more disagreement about whether other treatments for ectopic pregnancy constitute abortions, but that's neither here nor there.) Likewise, inducing labor prior to viability to treat a woman's life-threatening eclampsia or HELLP syndrome would not be considered abortive, even when it's known in advance that the baby cannot survive. I don't know enough about obstetrics to know whether there is always a non-abortive procedure that would save a woman's life, nor do I know whether the non-abortive procedures would ever carry significantly higher maternal health risks compared to the abortive procedures. I take it that the Nicaraguan government is assuming that the answer to the first question is "yes" and that the answer to the second question is either "no" or "doesn't matter."

Notre Dame law prof Julian Velasco explains further:

The Church would allow you to take many measures to save the mother's life even if those measures are certain to result in the unborn child's death, but you may not directly kill the child.  It's part of the principle of double effect: you cannot intend the evil as either the end or the means, but can accept it as a result.  The perfect example is the ectopic pregnancy: you cannot have an abortion, because that would be directly killing the baby, but you can remove the portion of the fallopian tube that is causing problems, even though it will result in the death of the baby.  In that case, you neither want the baby to die nor are you killing him/her.  You are merely saving the mother's life.

Here is another explanation of the distinction between "abortion" and efforts to save the mother's life that result in the fetus's death:

Catholic Theologians typically discuss the morality of three common treatments for ectopic pregnancies according to the principle of double effect.[4] One approach utilizes the drug Methotrexate (MTX), which attacks the tissue cells that connect the embryo to its mother, causing miscarriage. A surgical procedure (salpingostomy) directly removes the embryo through an incision in the fallopian tube wall. Another surgical procedure, called a salpingectomy, removes all of the tube (full salpingectomy) or only the part to which the embryo is attached (partial salpingectomy), thereby ending the pregnancy.

The majority of Catholic moralists reject MTX and salpingostomy on the basis that these two amount to no less than a direct abortion. In both cases, the embryo is directly attacked, so the death of the embryo is not the unintended evil effect, but rather the very means used to bring about the intended good effect. Yet, for an act to be morally licit, not only must the intended effect be good, but also the act itself must be good. For this reason, most moralists agree that MTX and salpingostomy do not withstand the application of the principle of double effect.

I'll admit to absolutely no expertise in this area, but I'll also admit that this seems like hair-splitting to me.  Maybe it's important hair-splitting, but to tell a mother whose life is in peril that she cannot simply remove the embryo, but must instead remove a portion of the tube in which the embryo is located, seems to verge on putting principle above prudence, particularly if this increases the risk to the mother or lessens her chances of becoming pregnant in the future (I don't know if it does either of these).

In thinking of "life of the mother" exceptions more broadly, I'm reminded of Eduardo's "burning house" hypothetical.  I realize that there is moral significance to the act/omission distinction in not rescuing vs. removing from the tube.  At the same time, if my choice is between saving my adult wife, on whom several children depend for love and care, and saving an embryo in its earliest stages, that's not a particularly difficult question for me.  (It's a heart-breaking question, but not a difficult one.) And I will presume that it's not a difficult question for the vast majority of Americans.  Is this simply a case where Church teaching is so far removed from the current state of public opinion that it's not worth talking about in our legal and political discourse?  Or do we need to talk about it more because we have a nation of improperly formed consciences (including my own, perhaps)?

Rob