[Question:]{.underline} Does the Church approve of surgery for an ectopic pregnancy?
[Answer:]{.underline} It is never permitted to directly kill an infant (or any other person for that matter, with the exception of self defense, just war and capital punishment), and so consequently, it is immoral to perform an abortion in the case of an ectopic pregnancy, even to save the life of the mother. This is immoral, whether it is done surgically or chemically. There are now available medications (such as methotrexate, or just recently RU-486) that are commonly used for tubular pregnancies, and that directly cause the living fetus to be aborted. This is always immoral.
However, if it can be established that the fetus is already dead (by ultrasound examination, for example), then clearly the surgical removal of the already dead fetus for the health of the mother is entirely permissible.
The difficulty arises when the fetus is still alive. The mother’s life is endangered through internal hemorrhage at that time. The moral theologians hold different opinions as to whether it is permissible to intervene surgically to remove the ectopic pregnancy before the death of the foetus. Some say that surgical intervention directly kills the foetus, which is immoral. Others say that it is not direct killing at all, but it is the removing of a mass of tissue (including the placenta) which has fixed itself in the wrong place (the fallopian tube instead of the uterus), in such a way as to cause a tumor invading the mother’s fallopian tube, rather like a malignant tumor. Just as it is possible to operate on a tumor of the mother, (e.g. in treatment of uterine cancer) even if as a consequence and indirectly the child will die, so also it is moral, they say, to surgically remove this abnormal mass of tissue, which contains the fetus. It is an indirect and unfortunate, though necessary, consequence that the fetus will die, but this is not willed in itself.
The principle used in this second opinion is the application of the principle of double effect, or the indirect voluntary. This is moral, provided that the bad effect, in this case the death of the unborn child is not directly willed in itself, and that there is a proportionate reason (such as saving the life of the mother), and that the good effect, namely saving the mother’s life does not directly come from the bad effect, the death of the child. The understanding of this solution depends upon the grasping of the gravity of the proportionate reason. The fetus that lodges in the fallopian tube cannot survive in any case, and if the mother is not treated she may very well hemorrhage to death, and moreover her fallopian tubes can be so damaged by the ectopic pregnancy left untreated that she might never be able to conceive again.
Since there are opinions on both sides of this question, both can be safely followed in conscience. Consequently, it is permissible to have surgery to remove the ectopic pregnancy, since it is not a direct abortion, but the removal of invasive tissue.
Answered by Father Peter Scott, SSPX.