Thursday, October 15, 2009

Catholic Bioethics and the Dignity of Women - Ectopic Pregnancy

This week, the Catholic Herald printed one of those columns that presents the kind of Catholic bioethical argument that makes me see red. The author, Father Tad Pacholczyk, is Director of Education at the National Catholic Bioethics Center. He is a priest with a PhD in Neuroscience. The column is on management of ectopic (tubal) pregnancies -- a condition that, according to standard medical opinion, is potentially life threatening if left untreated. While an estimated half of such pregnancies end in a spontaneous natural abortion, leaving the pregnancy in place puts the woman at risk for life-threatening complications such as rupture with massive internal bleeding. This is why doctors usually intervene surgically.

In the interest of full disclosure, I must add that one of the reasons this column struck a nerve is that one of my best friends was rushed to the emergency room following the rupture of an ectopic pregnancy that she was not aware she was carrying. The rupture occured as she was driving with her teenage daughter who, fortunately, had the presence of mind to get help for her mother. Thanks to her daughter and the prompt actions of the EMTs and doctors, my friend is alive today but the episode heightened our sensitivity to how dangerous this can be.

There are three common types of medical treatment for ectopic pregnancies, which Fr. Pacholczyk outlines: 1. Administering methotrexate early in the ectopic pregnancy to disrupt the growth of the developing embryo causing the cessation of pregnancy; 2. A salpingostomy, wherein only the part of the Fallopian tube containing the pregnancy is cut out and the tube is repaired so as to preserve the woman's fertility; 3. A salpingectomy, wherein the entire Fallopian tube is removed thereby reducing the woman's future fertility.

Fr. Pacholczyk argues that option 3 is the only morally acceptable approach, even though all three interventions end in the death of the embryo. "In this situation, the intention of the surgeon is directed towards the good effect (removing the damaged tissue to save the mother's life) while only tolerating the bad effect (death of the ectopic child). Importantly, the surgeon is choosing to act on the tube (a part of the mother's body) rather than directly on the child. Additionally, the child's death is not the means via which the cure occurs...It is tubal removal, not the subsequent death of the baby, which is curative for the mother's condition." Option 3 would be the last option that doctors would recommend due to the consequence of reduced fertility but in Fr. Pacholczyk's opinion, this is a secondary consideration.

This is the kind of bioethical teaching we get when the Catholic Church's bioethics are determined by celibate men. Given that we do not yet have the capability of saving an ectopic pregnancy, would not a loving God want everything possible to be done to preserve the mother's (the couple's) ability to have children so that we don't end up with two tragic outcomes -- the loss of the child AND the loss of fertility?

As a woman, I find this kind of teaching an affront to my dignity. My fertility doesn't matter as much as a philosophical argument about whether I "intend" or "don't intend" the end of a pregnancy that will not end in a live birth no matter which option I choose. If I make a treatment choice that preserves my option to have more children, that choice is morally problematic according to the Church. Will we get to the point where we will be debating how many centimeters of Fallopian tube on either side of the embryo have to be removed before we will not be considered to be targeting the child?

I wish that Fr. Pacholczyk could witness the anguish of women who suffer infertility, something we have seen in the charismatic healing Masses where many women come to ask for prayers for this condition. Why, in God's name, would the Church recommend to a woman a treatment choice that would decrease her ability to conceive a child when other options are available? This is making an idol out of an embryo, not reflecting the compassion of a loving God.

This is why we need voices like Sr. Teresa Forcades in the Church -- a woman with both medical and theological training who can inject some common sense into these debates.

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