What About Life-Saving Abortions?

I. The Sr. McBride Excommunication
You can tell how fair CNN’s treatment of the recent Margaret McBride case was by the headline: “Nun excommunicated for approving life-saving abortion.” Or from the first paragraph, describing how it was an “agonizing decision” to have an abortion. Or from the second paragraph which describes “The problem: St. Joseph’s is a Catholic hospital and abortions are largely prohibited.” As CNN sees it, the abortion was the obviously-right thing to do, and it’s a “problem” that St. Joseph’s is a Catholic hospital and “largely” prohibits abortions.

CNN’s treatment, unfortunately, is pretty characteristic. And the comments on the article from non-Catholics are uniform: religion is stupid, because the Church “wanted” two people to die, instead of one. It’s eerie reading these things, because it shows a populace largely married to the idea of utilitarianism, to the extent that they can’t even understand the alternative, other than “it must be blind religious dogma.” The fact that this related to the already controversial issue of abortion makes it even harder to get people to think clearly. So let’s take a hypothetical that doesn’t involve abortion:

A woman and her young child are walking through the woods when they encounter a wild beast. Immediately, the beast hungrily pursues them. The woman grabs her child and begins to flee, but realizes that with the child weighing her down, it’s dramatically more likely that the beast will catch and her both her and the child. May she kill her child and throw him to the beast as bait, while running in the other direction, so that the beast will eat her child, but let her live?

The Christian answer is simple: Romans 3:8. We are not allowed to do evil so that good can come about. Feeding your child to a wild beast is evil. It doesn’t matter if the number of lives saved is greater. The utilitarian answer is equally simple: killing the child to save the mom is superior to allowing both to die, because the first option only has one bodybag.

II. The Trouble with Utilitarianism
The Christian answer is far more sane than the utilitarian alternative. If you look at just the number of people’s lives saved, or the net amount of pleasure, or some other faux-objective standard, you’re on dangerous turf. If it’s okay for a person to purposely kill his or her own child to save their own life, is it okay for the state to execute someone they know to be innocent? Let me take another example:

The Roman state apparently used to take those found guilty of chariot theft, tie them to four different chariots, and send the chariots in the four cardinal directions, ripping the person’s body into four parts. Suppose that a certain state decided to bring this back for the capital crime of first-degree murder, to replace the electric chair. Suppose further that this incredibly painful form of punishment is a relatively effective deterrent: let’s imagine that for every person executed in this way, ten other people decided against murder (it’d be impossible to quantify this, of course, but just for the sake of argument: perhaps there are really good statiticians in your state).

Finally, imagine that the day you were to sign a certain prisoner’s death warrant, condemning him to this brutal death, you, the governor, found overwhelming evidence that he was 100% factually innocent. The police had simply grabbed the wrong guy: the real guy had died a few months earlier, and going through his belongings, you found the “smoking gun,” so to speak.

You are the only person who knows about this evidence. You can easily destroy it without raising an eyebrow, and condemn the innocent man to die — no one now or in the future would ever question his guilt, since the evidence at trial was seemingly quite strong. You can also, however, refuse to sign the death warrant, and pardon the innocent man.

Pardoning him, however, will have a negative effect: the ten killers who would be deterred by his execution might instead feel confident that you’re “soft on crime,” and commit their murders.

So your choices are to intentionally cause an innocent man die, or unintentionally permit ten other innocent people to die.

The Catholic answer is clear: you are never allowed to commit evil so good can come about. Doesn’t matter how much evil or how much good. The utilitarian answer is equally clear: one person dies if you kill the innocent man, ten die if you don’t. That’s what makes utilitarianism so incredibly dangerous: its willingness to “break a few eggs to make an omelet,” to paraphrase Joseph Stalin.

In real life, of course, it’s even worse. Utilitarians don’t live in some all-seeing tower from which they can tell all of the possible consequences of two sets of actions. All sorts of biases come in: is a German life worth more than a Jewish life? A white life more than a black life? A woman’s life more than a fetus’ life? And so forth.

And once a utilitarian marries a specific ideology, look out. An orthodox Catholic deluded into thinking that they can create utopia on earth is still restricted to moral behavior: they can non-violently demonstrate to try and bring it about, they can legislate (as long as the legislation is moral), etc., but they can’t do evil. On the other hand, a deluded utiliatarian hell-bent on creating the “perfect state” can do a massive amount of evil. One need only look at the history of the twentieth century to see just how much evil they did. Millions of people died because some ruler believed that this evil would bring about the ultimate Good, a paradise on Earth.

III. A Defense of Sister McBride
The popular defense of Sr. McBride, that what she did was okay because fewer people died in the end, is wrong and dangerous. But that doesn’t mean she is without defense. In fact, she has a solidly Catholic defense. Michael Liccione explained it in First Things, but I’d like to try my hand. The USCCB’s Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition has two important directives on point.

The first is Directive 45, which prohibits abortion (as the Church defines abortion). Here’s the first half of the directive (the relevant half):

Abortion (that is, the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus) is never permitted. Every procedure whose sole immediate effect is the termination of pregnancy before viability is an abortion, which, in its moral context, includes the interval between conception and implantation of the embryo.

In plain English, directly intending the killing of an unborn child is forbidden, from conception onwards. It doesn’t matter if you directly intend it because you don’t want a child, or because continuing the pregnancy is dangerous. If you directly intend to kill an unborn child for any reason, it’s always and everywhere evil, and without defense. But there’s another directive on point, as well, which explains why directive 45 specifies “direct intent.” Directive 47 says:

Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.

In other words, a non-evil procedure to save a mother’s life may be undergone, even if there’s no way to perform that procedure without the child dying.

At first brush, this seems to contradict Directive 45, but it doesn’t at all. Let’s bring it back to the first hypothetical, about a mother and child fleeing from a beast. It would be gravely sinful for the woman to kill her child and feed him to the beast. I think (and hope) that just about everyone intuitively recognizes this. On the other hand, however, it wouldn’t be gravely sinful for the woman, realizing there was no way to save the child, and knowing that continuing to do so would mean they both died, to set him down so that she can run faster. Tragic, yes. Sinful, no. She doesn’t want him to die, she’s not trying to kill him, she’s just incapable of saving him.

Again, this is something which most people intuitively understand as correct. There are frequently cases where someone is trapped underwater and rescuers can’t save them: where their thrashing and kicking forces the rescuers to let them go. The rescuers know full well that the person will die, and did all that they could to stop it. Continuing to struggle would be in vain, and would only result in the rescuers’ own deaths.

So there’s, perhaps surprisingly, a world of difference between throwing a child to the beast, and setting him down knowing that the beast will eat him. All of this, which I think most of us would naturally recognize as correct, is built into the Catholic principle of double effect.

IV. The Principle of Double Effect, the Death Star, and Indirect Abortions
The Stanford Encyclopedia of Philosophy quotes page 1021 of the older Catholic Encyclopedia for these four conditions for applying the principle of double effect:

1. The act itself must be morally good or at least indifferent.
2. The agent may not positively will the bad effect but may permit it. If he could attain the good effect without the bad effect he should do so. The bad effect is sometimes said to be indirectly voluntary.
3. The good effect must flow from the action at least as immediately (in the order of causality, though not necessarily in the order of time) as the bad effect. In other words 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.

Nowhere is this clearer than in the context of war. Take the destruction of the second Death Star at the end of Return of the Jedi. Luke & co. blow up the Death Star while it is under construction, meaning that there are countless innocent people who died as a result. However, it meets all four conditions:

1. The act itself is morally good. It’s morally right to prevent evil and morally right to punish evil. Although it’s arguable whether they had the authority to punish, they certainly were permitted to stop evil.
2. They aren’t trying to kill the innocent workers. Presumably, if there was a way to get the innocent workers off the Death Star and then blow it up, they would have done so.
3. The good effects of stopping evil flow from the act (blowing up the Death Star), not the bad effects (the death of the construction workers). If they’d blown up the construction workers’ last project (knowing that it would prevent the building of the Death Star), that would have been evil. The good (stopping the Death Star) would have flowed directly from the bad effects.
4. The destruction of the Death Star was “sufficiently desirable to compensate for” these collateral deaths. This fourth prong is a bit vague, but the point of it is that we can’t just start nuking Afghanistan and Pakistan in the hopes one of our bombs will kill Osama Bin Laden.

But let’s take a more serious example. In the case of an ectopic pregnancy, as I understand it, a woman conceives a child outside of her uterus. The child cannot survive, and will likely kill the woman by growing in her fallopian tubes. The Church’s response is completely consistent with everything I’ve mentioned above. The woman may not purposely kill the child, but may have her fallopian tubes removed (knowing that this removal will in turn lead to the child’s death). Directive 48 says that, “In case of extrauterine pregnancy, no intervention is morally licit which constitutes a direct abortion.”

Directly killing the child would violate at least the first three of the four prongs above. She’d be performing a morally evil act (murder), positively willing the same morally evil act, and the good effect would flow directly from the murder. On the other hand, removing her fallopian tubes meets all four requirements:

1. The act is the removal of an organ which would otherwise result in her death: it’s a life-saving procedure and a morally good act.
2. The bad effect of the child’s death isn’t intended: the woman isn’t going in for an abortion because she doesn’t want a kid. If there was a way to remove the child alive, she’d do so.
3. The good effect is produced directly by the action (the removal of the tubes) and not by the bad effect (the death of the child). In other words, if the child miraculously survived after the operation, the woman’s life would still be saved, because the child’s growth would no longer be in a place where it would result in her death.
4. The good effect here is sufficiently desirable, since her life is worth equal value to her child’s.

The tubal operation isn’t an abortion, as Catholics understand it: that is, it’s not “the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus,” any more than chemotherapy is a “hair removal operation.” It’s just a tragic side effect. The woman killing her child to escape a beast is morally equivalent to a doctor killing a woman’s child to save her; a woman setting down her child to run faster to escape a beast is morally equivalent to a doctor removing fallopian tubes which contain a child. That’s also the case if a woman has cancer. Chemotherapy also results in the death of unborn children. But it’s not intended to do so, and its effectiveness isn’t premised on it doing so.

So the question in the Sr. McBride isn’t the one everyone asking, “one bodybag or two?” Instead, it’s whether the procedure directly killed the child, or inadvertantly killed the child. The answer to that question requires a lot more knowledge about the specifics of the procedure: what was done and why. If the procedure works by directly killing the child, Sister McBride is automatically excommunicated. If it’s inadvertant, she didn’t do anything wrong.