Is performing/assisting with an emergency D&C immoral?

Hello everyone,

I work in an ER and intend to go to medical school to become an ER physician. I know that, on occasion, doctors must do emergency D&Cs for a mother who has miscarried but has not completely passed the remains of the child. I have a feeling that the answer to this question is “no”, but I just want to be sure: is performing/assisting during an emergency D&C immoral? Thanks.
dje101

No, it’s not immoral.

Why do you think such a D&C might not be morally permissible?

Just because its an abortion-like procedure. I recognize that there is a big difference between an emergency D&C and an elective abortion, but I just wanted to be sure. That was all.

Thanks to both of you for your input.

I think that the issue here is whether you are taking the life of the unborn child. In the case you described, the answer is clearly no. The tougher case is when a woman shows up in your emergency room and requires an abortion of a viable fetus to save her life. Then the Church has something to say.

The answer to your question is “no”. It is not immoral. However, an Emergency Medicine physician does not perform or assist in a D & C. That is something that an OB/GYN is trained to do, not an ER doctor. Assisting staff for this procedure would be RNs or surgical techs from either the general OR or the Labor/Delivery area. The only thing you might do is an exam on the mom to confirm the bleeding or order an ultrasound, but you would page/contact the OB/GYN on call to come in and evaluate the patient. It would be the decision of the OB/GYN whether to do a D & C or wait to see if the tissue passes on its own. So, no need to worry about gynecological surgical procedures if you plan on going into Emergency Medicine. You’ll have enough on your plate with all that walk through your doors or the EMS crews bring in…but you probably already know that and have seen quit a bit of interesting cases (or have heard the war stories from your colleagues). Best wishes for your career choice.

It’s my understanding that such a situation is practically non-existent - if medically necessary, the child could be delivered.

This does happen with ectopic pregnancies (tubal). see link:
cuf.org/2004/04/ectopic-for-discussion-a-catholic-approach-to-tubal-pregnancies/

Also, in regards to the original question, am I understanding correctly that the mother is having a miscarriage of a baby who has already died?

That is correct. Miscarried baby that didn’t completely pass from the mother and therefore needs to be removed from the uterus.

Also regarding the ectopic pregnancy, the ER (at least the one I work in, and as far as I know) would have nothing to do with the surgery of a patient with a tubal ectopic pregnancy, only initially stabilizing the patient and getting them transferred to the OR.

This all probably seems like a silly post to put here in the first place, but I am aware enough to know that moral theology is not quite my forte and I sometimes don’t think of alternatives to given hypothetical situations. I just wanted confirmation of what I already thought was true.

The poster I quoted specifically said a viable fetus. If the fetus is viable, labor could be induced or an emergency C-section performed. :slight_smile:

No, not immoral at all. Also, the removal of a tube during an ectopic pregnancy is not immoral, either. You are removing a defective tube, second effect is that the baby will die. I would be more concerned about having to offer “emergency contraception”.

Ah, yes. Sorry I missed that. :o

dje101

the info ou are being given is correct- nothing wrong with performing or assisting with a miscarriage, although if you do become an ER physician, you won’t be performing D+C procedures. OB/GYN physicians do that.

regarding the viable ectopic pregnancy in a fallopian tube, removing the tube (salpingectomy) is acceptable. as mentioned, loss of pregnancy is second effect. performing a salpingostomy (making an incision in the tube, and removing the pregnancy) is not acceptable if fetus is alive because you would be directly destroying life. if it is a tubal pregnancy, and non-viable fetus (fetus is dead) performing a salpingostomy is acceptable. and, again, as an ER physician, you would not be part of that surgery. An OB/GYN would

good luck on getting into medical school and becoming a physician !

It’s not always an abortion-like procedure.
Often, it’s performed to remove abnormal tissue or fibroids or to check for cancer or for excessive bleeding…and is not pregnancy-related at all.

.

dje101 said D+C for a miscarriage.

but,you are correct, a D+C can be a gynecologic procedure, not an obstetric procedure.

Am I reading this correctly? Remove the pregnancy and the foetus dies but the woman can still have children. Remove the tube and the foetus dies and the woman is left sterile.

Assuming the context is ectopic pregnancy,…not entirely sterile, one of two tubes is gone.

If one focuses on perceived consequences as the basis of morality, one concludes it must be the better course to simply end the pregnancy (= murder the child). And by that criteria, it sounds right. “Removing the pregnancy” is the same as murdering/abortion, as there is no intent to save the child].

However, intentionally killing the child breaches one of those Christisan “absolutes” - you can’t intentionally kill an innocent - or more generally, you can’t do a moral evil (i.e. Breach the negative precepts of the divine law, which murder does) in order to schieve some good. [The ends do not justify the means.]

Of course all that relies on accepting that a fetus is s human being. Some argue otherwise.

If you remove one tube due to ectopic, pregnancy is still possible from other tube- in fact, the pregnancy rates change very little for a woman with one or two functioning Fallopian tubes

Thank you. I forgot that the ER physicians don’t do the D&C procedure. However, the position that I have right now in the ER could possibly require me to assist with one (part of my initial training was how to set up the machine, instruments, and how to assist the physician), which was the other reason why I was asking. I haven’t had to assist with one yet, but if/when I do I just wanted to be sure.

:confused: Is your ED doing D & C’s right in the department? I’ve worked ED, but mostly OB and we have never performed a surgical procedure, even a simple one like a D & C, any place but the OB-OR or the regular OR. The patient was given a general by CRNA or anesthesiologist and it was RNs or CSTs that assisted in the actual procedures and set up of equipment might have been by OB Techs or OR support techs, but ED staff stayed in the ED. I would be very concerned about a surgical procedure like a D & C being done anywhere but in a fully stocked and appropriately staffed OR. There is no way that a tech who has not completed a surgical technician training program should be messing with setting up sterile instruments on the back table and assisting a physician with a surgical procedure. That’s a liability no one should be asking you to be part of. Please check with your department manager, clinical education, and even risk management at your facility to make sure you are properly trained and certified to be having your name as part of the surgical team on a patient’s chart/hospital record.

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