In addition to the exceptions of rape and incest, those who support abortion often claim that abortion is permissible when the mother’s life is in jeopardy.  I am asked this question a lot and I find that most people don’t understand the principles underlying the Church’s teaching.  For that reason, I think it would be instructive to discuss those principles.

That being said, there are two principles in Catholic moral theology that come into play here.  The first is that you may never willingly do evil so that good may come about.  The second is the principle of double effect.  I’ll try to explain these in light of the issue.

Let’s start with a definition of abortion.  In Evangelium Vitae (58) St John Paul II defined abortion as the “deliberate and intentional killing, by whatever means it is carried out, of a human being in the initial phase of his or her existence, extending from conception to birth.”  Abortion defined as such is “always constitutes a grave moral disorder.” (EV 62)

The key to this is the phrase “deliberate and intentional killing” or what is called “direct abortion” which means we are speaking of an abortion that is willed as an end or as a means.  So with this idea in mind, direct abortion is always wrong.

That being said, it is morally licit in the case of extrauterine pregnancy to intervene when both the Mother and Child’s life are in danger because of the pregnancy itself.  However, you still cannot perform a direct abortion in this case.  There is some question from a medical standpoint as to which specific procedures constitute a direct abortion, but the guidelines are as follows

In extrauterine pregnancy the affected part of the mother (e.g., cervix, ovary, or fallopian tube) may be removed, even though fetal death is foreseen, provided that (a) the affected part is presumed already to be so damaged and dangerously affected as to warrant its removal, and that (b) the operation is not just a separation of the embryo or fetus from its site within the part (which would be a direct abortion from a uterine appendage) and that (c) the operation cannot be postponed without notably increasing the danger to the mother.  USCCB, Ethical and Religious Directives for Catholic Health Care Facilities

The moral principle at play here is what’s called the principle of Double Effect. To begin, it is important to note that a careful moral analysis of any given human act requires that we look not just to the external act but to the underlying choice of the will.  If we must look at the underlying will then it is necessary to make a distinction in two different types of will.  Classically the distinction is made between a direct will and a permitting will.  Because most human acts are complex acts, even if the will directs some good, there can often be an evil associated with it. Man may never, morally speaking, directly will an evil.  However, they may permit it.

This serves as the foundation of a very important principle in Catholic moral teaching called the principle of double effect.  Simply stated this principle says it is morally allowable to perform an act that has at least two effects provided all four of the following conditions are met.   First, the objective act to be done must be good in itself or at least morally indifferent.  Secondly, the intent of the agent must be to achieve the good effect and to avoid the evil effect as much as possible.  The evil effect must not be directly willed but only permitted.  This is the case even if the evil effect is foreseen.  Thirdly, the good effect is proportional to the bad effect.  Finally, the good effect must follow directly from the action and not as a result of the harmful effect.

It is important to make a further distinction related to this principle that aids in distinguishing it from the notion of a “pre-moral” act that often accompanies the moral teaching of many dissenting theologians.  Morality is always concerned with voluntary human acts.  The evil effect assuming that it is only permitted is the physical effect of a moral decision.  It is not a moral effect or a “pre-moral” effect.  In and of itself it is neither moral nor immoral because it was not directly willed.

It has been suggested by some that it is only the first condition that is really essential and the remaining three are simply prudential checks to make sure this condition is actually being fulfilled.  In this way the third condition checks that the proposed intrinsically good action is not invalidated by circumstances that produce greater evils than the good that is directly intended.  This serves as a guard against those who subscribe to a proportionalist view of morality by using the third condition to support their methodology.  Likewise the second and fourth conditions serve to ensure the person intends only the intrinsically good effect.

Even if the death of the child is a foreseen but unintended side effect of a medical procedure designed to preserve the mother’s life (assuming the procedure is not morally illicit) then there is nothing morally wrong with having the procedure.

With this in mind then what about the question as to whether or not it is morally licit to have an abortion in the case where a mother has something like uterine cancer?  This is a perfect example of applying both the principles mentioned above.  One may not perform a direct abortion even if the good of saving the mother’s life is intended.  However if the mother does decide to have treatment and the treatment ends up killing the child (even if she knew this intervention was highly likely to do so) then this is morally licit.  The death of the child would fall under the principle of double effect.

I think in the coming years this issue is going to come up more and more.  One of the reasons is that Chlamydia is the most common STD today with about 3 million cases a year.  The reason why this is relevant is because one of the things that can happen is that the bacteria can attack the fallopian tubes which could to inflammation and scarring.  What this means is that the incidence of Ectopic pregnancies is rising and will continue to rise making the Church’s teaching important to understand.