Moral Action in the Face of Life-Threatening Pregnancies

—by Gifford Grobien

Recent high profile events—the Gosnell trial and the septicemia of Savita Halappanavar in Ireland—have again raised the question if abortion is ever acceptable, such as in attempts to save the life of the mother.

There are at least two ways of thinking about such dilemmas in the Christian moral tradition. The first, which can be traced at least as far back as Thomas Aquinas, relies on the principle of double effect.  The second, more familiar to the Lutheran communion, is the method of casuistry, the detailed study of all the factors and circumstances of a case in order to determine the correct course of action. At root, however, both ways can be complementary. When one gives attention to the details of a moral case, he may periodically find himself in a moral dilemma, wondering which action has moral authority. The principle of double effect is one way of discerning the right action.

The principle of double effect relies on four sub-principles: 1) the act itself must not be intrinsically, morally evil; 2) a good effect is intended from the act; 3) the good effect is not produced by means of an evil effect, that is, evil is not a means to good; and 4) there is a proportionate reason for allowing the evil—there is no less harmful way to accomplish the good.

At first glance, it would seem that saving the life of the mother in cases such as an ectopic pregnancy, preeclampsia, or septicemia would violate the principle of double effect, especially points 1) and 3). Deeper consideration is necessary in these cases.

With regard to 1), we first need to distinguish between murder, killing, and death. Murder, the direct taking of (legally) innocent life, is intrinsically evil. However, killing, action which leads directly to the death of a person, is not. The execution of criminals and killing in self-defense or the defense of one’s neighbor are traditional cases in which killing is not considered morally wrong. Death itself, resulting from conditions or circumstances, is also not necessarily a moral evil, such as when a person dies from a disease or environmental factors.

Thus, not every action that could be taken to relieve a pregnant woman from a life-threatening condition, even if it results in the death of the baby, is intrinsically evil. In fact, the first choice for treating preeclampsia or septicemia is to induce labor and hopefully save both the mother and the baby’s lives. Even in the case of an ectopic pregnancy, removing the baby is not murder, as the act preserves the life of the mother while transferring the baby from a probably hostile environment to another hostile environment. In nearly all cases, the baby already exists in an environment that will lead to his death; removing the baby from the mother’s body does nothing to worsen his situation. If the baby has reached an age where there is potential for viability, every effort should be made to sustain and nurture his life. Furthermore, we should be aware that in very infrequent cases, babies and mothers may actually survive an ectopic pregnancy.

With regard to 3), that the evil effect should not be a means to the good, we must distinguish again between the actual treatment of the mother’s condition and the death of the unborn baby. When the evil effect is not actually that which treats the mother’s condition, evil is not a means to an end. Again, for example, when delivering the baby treats the mother’s septicemia or preeclampsia, the evil effect of the baby’s death is not itself necessary or a means for bringing about the mother’s health. Rather, it is the effect of the baby or the placenta leaving the mother’s body. The baby’s death is a potential (even probable) effect of delivery, but the death itself is not a direct means to the mother’s health. Rather, the mother’s health and the baby’s death (if the baby dies) are both effects of the act of delivering the baby. Again, even in the case of an ectopic pregnancy, it is not the baby’s death that protects the life of the mother but the removal of the baby from a threatening position.

Thus, from the perspective of the principle of double effect, treating the mother to preserve her life is not immoral.

We should further note that it is wrong to refer to such treatment as an “abortion to save the life of the mother.” The treatment is not anything like a clinical abortion. Inducing labor in order to the deliver the baby and keep him alive is a completely different procedure from any of the usual abortion methods: suction aspiration, dilation and curettage, dilation and extraction, or saline injection. In treating an ectopic pregnancy, a salpingostomy is also a very different procedure: one that is precise and as minimally invasive as possible. Thus it is inaccurate to say that even in the rare cases an abortion is necessary to save the life of the mother. Treatment to care for a pregnant woman whose life may be endangered may result in the death of her unborn baby. But while such a death may be unavoidable, it is not intentional nor is it procedurally similar to an abortion. For further discussion of this question, click here.

Now in the Lutheran tradition, we are generally unfamiliar with parsing moral dilemmas to such an extent. Such exercises might even appear as attempts to justify ourselves. But it is important to distinguish between trying to find the best moral option and claiming that by doing so we have excused ourselves from sin. Applying some effort to understanding the moral implications of certain actions, intentions, and circumstances is not necessarily linked to self-justification. Rather, we ought to endeavor to understand actions, intentions, and circumstances simply in order to do what is good.

Indeed, trying to do what is good and presuming to be without blame are very different things. The former is wholly Christian: “Let love be genuine. Abhor what is evil; hold fast to what is good” (Romans 12:9). Christians live in Christ and are empowered by the Holy Spirit. Christians know that the whole law is fulfilled by love. The corresponding truth then is that love expresses itself in good action that is sometimes very difficult to discern and takes effort: effort at understanding the law, effort at discerning the place of love in the circumstances and relationships, and effort in recognizing the effect of actions.

Lutherans through the age of Orthodoxy understood the importance of careful attention to moral questions, which is why they developed extensive manuals of casuistry. ((See Benjamin T. G. Mayes, Counsel and Conscience: Lutheran Casuistry and Moral Reasoning after the Reformation (Göttingen: Vandenhoeck & Ruprecht, 2011).)) Yet they also understood the pervasiveness of sin and the inability of man ever to escape sin apart from the salvation of Christ. In fact, the Christian should both seek moral rectitude while at the same time confessing one’s inadequacy to know and act without sin. This is the fullness of what it means to live as a baptized Christian: to live according to the life and love that we have in Christ, serving our neighbor with all of our power, and to live according to the forgiveness of sins that we have in Christ and on his account, the forgiveness that justifies us before our heavenly Father, quite apart from any moral or immoral action in this world.

Moral reasoning is no path to purity or self-justification. It is the effort it takes to love the neighbor.

The Rev. Dr. Gifford Grobien is Assistant Professor of Systematic Theology at Concordia Theological Seminary, Fort Wayne, Indiana.


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