To the overwhelming majority of activists in the pro-life movement, a life of the mother exception is a given in proposed laws against abortion. Prior to Roe v. Wade, almost every state had this exception, and there was no concerted action to remove it by churches or other groups. However, there is and has been a consistent minority opinion held by some of the most sincere and highly motivated pro-life people that this exception is not needed. In this brief space, allow me to explain why, even though I don’t think it’s needed; nevertheless, it is needed.
First, let me call your attention to a recent report from Ireland. Over a decade, three major hospitals in Dublin report the delivery of 223,000 babies with only two maternal deaths, deaths that abortion would not have prevented. The head of Obstetrics stated that he saw no reason to ever do an abortion because the life of a mother was threatened. This is a remarkable achievement, and a medically legitimate one. In my travels I have rarely been given a clinical history that indicates to me that an induced abortion done for life-saving reasons was in fact necessary.
Emergency Premature Delivery
We must first exempt cases of necessary premature delivery, which sometimes is confused with abortion. Let’s take the two most common problems that necessitate this 1) toxemia of pregnancy and 2) severe diabetic crisis. In both of these cases there can come a time when, if the pregnancy is allowed to continue, it is quite possible that the mother will die and take her baby with her. In such cases, by reputable obstetric judgment, the uterus must be emptied, and this will resolve the maternal problem. What’s important to recognize here is that these occur in the third trimester of pregnancy when the baby is usually well enough developed to be able to survive. In this case, separation of the baby from the mother is an emergency measure to stop the maternal deterioration. It does deliver a
premature baby, who usually will survive, but who would inevitably die if allowed to stay inside of the mother. We do not list this type of an activity as an abortion. This is clearly an emergency premature delivery, and the goal is to save both of them. Let’s not confuse the issue.
I’ve been a knowledgeable physician in this area for 52 years. When I was in training, we were given a number of reasons for therapeutic abortion, that is an abortion to save her life. I have watched through the years as, one by one, it was shown that these were not necessary or no longer necessary to save her life. Many became quite treatable, and in a couple of cases it was shown to be more dangerous to abort than to allow her pregnancy to continue.
In a Third World culture where good medical care is not available, there are so many things that can jeopardize a woman’s life and health that it is extremely difficult to make a judgment in this area. Accordingly, let’s look at this in a fairly typical, sophisticated, medical climate in the Western world. Here we ask, Is there a maternal condition that necessitates induced surgical abortion of the developing baby? I speak of conditions where there is a reasonable certitude that if the induced abortion is not done, the mother will die. Commenting on this, I can only say that I don’t think such a case exists today.
Assuming that this is true, it would then seem that we would not need the life of the mother clause in a statute forbidding abortion. However, there is another major consideration.
Mother or Baby?
The classic case here is a tubal or ectopic pregnancy. This occurs when the embryonic baby, instead of planting in the nutrient lining of the womb, rather, plants in the thin wall of the fallopian tube. As this new occupant sinks his roots into the wall and begins to grow, left alone, this causes a rupture of the tube, internal hemorrhage into her abdomen, death of the embryonic baby and sometimes also death of the mother. Planting in the tube is simply incompatible with further development of the child. Medical management of this has always been emergency surgery, removal of the damaged tube, blood transfusions if needed, etc. In this case, the baby was already dead, or if not, was in a position of absolutely guaranteed imminent demise. The tube, which was damaged is removed. On some occasions, there was yet a living embryonic baby inside of the tube, but, with removal of the tube, death occurred quickly. The ethical reasoning here has always been consistent in every religious and ethical judgment. Yes, the procedure did cause the death of this baby, but the reason for doing the surgery was to save the mother’s life. The death of the baby was not directly intended; rather, it was an unfortunate, secondary effect. In theology this is known as primary and secondary effect. You desire the primary, and you reluctantly accept the secondary. So, in ethical terms, this is truly not an induced abortion.
Modern scientific developments have complicated this relatively straightforward ethical issue. We now have ultrasound and in many, if not most of these situations, the diagnosis is now made before rupture of the tube. We now have laparoscopes, which are easily inserted into the abdominal cavity. Through it, the surgeon can locate the lump in the tube. It is then relatively easy to incise the lump and suck out the contents (the live baby). How does one evaluate this?
From a purely medical viewpoint, such a procedure is the least mutilating to the mother. She does not sacrifice a tube, as it may heal over and be able to transport another embryonic baby to the uterus. She does not undergo the post-operative pain and complications of an abdominal operation. It is less expensive, and she may leave the hospital the next day. These are clearly positives. But there are negatives for this is now not an indirect, but a direct assault upon a living human being. This, in fact, is what some would consider a direct suction abortion, however, done within the abdomen. This is a direct killing of this embryonic child. Even so, left alone, with nature taking its course, we would have the tragic result of a tubal rupture and the loss of one or possibly even both of these lives. Obviously, if this tiny embryo could be transplanted from its present pathologic location into a uterus, that would be morally required, but such technology is not available to us yet. While the above is held out by most as the procedure of choice, at the least it is troubling, and to many sincere ethicians it is highly questionable.
Another example would be that the mother has developed a cancer. It is judged that she must have treatment radiation, chemotherapy, etc. If she does not, she might proceed to a fatal ending. However, if she does, the treatment might kill her baby. The ethician approaches this again as a primary and secondary effect. Yes, she may have the cancer treatment because the primary effort here is to cure the cancer and save her life. Secondarily, the child may be harmed, or even killed, but that is an unfortunate and non-willed result.
I scrubbed in on a case during my training where a gunshot wound of the lower abdomen had carried away part of the wall of a woman’s uterus. During surgery, it was found that there was still a living embryonic baby comfortably ensconced in the remaining part of her uterus. Clearly, the life-saving procedure was to remove the uterus. Just as clearly, in removing it that tiny life was lost. This offers no ethical dilemma. The necessary surgery was the primary need. The secondary loss of this new life was not willed, but an unfortunate, unavoidable result.
Why labor with the above concerns? Some would say that these cases are not abortions because the intent is not to abort. However, lawmakers don’t all look at it this way. To the lawmaker, this woman could have died. This procedure saved her life and killed the baby. To most lawmakers and judges, this is killing the baby to save the mother. However indirect that demise may be, this procedure terminated that tiny life, and the law sees it as no different from an abortion.
So, when making laws to stop abortions, it certainly would be unanimously agreed that treatment of the above conditions should not be forbidden. In the world of law, the reasoning of moral theologians on the primary intent of the action takes a second place to the pragmatic actuality of causing the death of the baby. This pragmatic actuality says that there must be an exception in the law forbidding abortion an exception that allows for saving the life of the mother.
Finally, one bit of semantics. An exception to save her life has been interpreted to allow abortion to prevent a threatened suicide. This is a perversion of the wording. Nevertheless, the Supreme Court in Ireland used it effectively a few years ago. Accordingly, our legal advice, going back almost 30 years, has been to prefer the wording, to prevent the death of the mother. If we use this phrase, it cannot be misinterpreted to justify abortion for a suicide threat.
We should add to this, while doing everything possible to save them both.
While I do not think that in modern medical practice there ever exists a need to do a surgical abortion to save the life of the mother, nevertheless in passing laws there needs to be a clause permitting abortion to prevent the death of the mother, while doing everything possible to save them both.