Patients with ectopic pregnancies

I have a job related question. I’m a nurse and I just got a new job at a large hospital in my community in a department where my tasks are consuiting physicians from outside smaller hospitals to physicians in my larger hospital, and arranging patient transport to make sure that patients are getting transferred to the appropriate department. I’m not having any patient contact at all. My job is a desk job in which I’m basically on the phone with physicians for my entire shift. So I’m not at the bedside providing patient care.

My question is this. For patients with ectopic pregnancies, which is a medical emergency, the only moral treatment is to remove the total fallopian tube. However many times the treatment is methotrexate or, only removing the baby from the tube (which would be immoral because thsee treatments are abortion). Keep in mind that when I’m on the phone I have no say over what treatments the doctor will prescribe for a patient, also sometimes the doctors do not say what treatments they will provide.

Is it immoral for me to arrange transport for patients with ectopic pregnancies to physicians who may or may not prescribe an abortive treatment for their ectopic pregnancy? Morally would that be helping someone to procure an abortion?

Contact he experts - those that Catholic Answers Staff refer to (one will find various ideas on this forums but some may lead one down the wrong road…please this this kind of thing contact the experts):

ncbcenter.org/

One would call them and ask to speak with an ethicist. Such as Fr. Tad who appears on CA all the time.

Just do the job you are paid to do. It is not your job to make moral judgements.

Ectopic pregnancies are not viable pregnancies. I have never heard a Catholic authority say that one particular treatment is more moral than another treatment.

Whether you remove then entire fallopian tube or not, the fetus dies. If you do nothing the fetus dies, and the mother may die as well.

I cannot see how assisting in this emergency is immoral.

I’m a Catholic not a machine…I’m not a mindless drone. Pardon me for trying to remain faithful to the teachings of the church. And trying to clarify appropriate actions on my part that could potentially place me in mortal sin and possibly excommunicate me from the church…or maybe my concerns are unfounded and there isn’t a moral issue here that I’m seeing. I just have questions regarding the morality of the situation that I could potentially be placed in. Your advise is basically telling me to just do my job and shut up…which isn’t helpful at all. God gave me a brain, and a conscience, and the church…when Im confused about a moral question why can’t I use what God has given to me (ie the church, or my fellow catholics) to help gain clarity on this situation?

@bookcat–thank you for your advice. I sent them an email.

The Church says that removing the fallopian tube in the case of an ectopic pregnancy is a legitimate medical procedure due to an abnormality of the tube: the emplanted embryo. It’s the principle of double effect: something bad results from a good thing, in this case the bad, unintended effect is the death of the embryo, the good is the removal of the diseased fallopian tube.

The Church also says that a treatment for ectopic pregnancy that only targets the embryo either surgically (removal from the tube) or chemically (dissolving the embryo with methotrexate) is abortion and forbidden. No double effect here, the intended action is the killing of the embryo.

I agree with Emily 2014. Do your job. It is not your place to make a decision for a patient.
The church uses the term double effect with removing the diseased tube which also happens to remove the embryo. It opposes killing the embryo outright with methotrexate while saving the tube which may not actually be diseased. This rule can only be binding on Catholics and you should not tell a patient what treatment to follow based on your beliefs. Either way, the embryo is going to die.

It seems like you did not read my initial post. I am not at the patient bedside, I’m not providing direct patient care, I’m not talking to any patient, or giving them advise on any moral matters. I do not see their face…I’m at a desk on a phone, in a cubicle, speaking and providing patient consultations between two Doctors…those are the people that I talk to, I work with them to arrange appropriate admissions into the hospital for treatment, and also arrange for patient transport.

My concern is a lack of clarity for myself personally on the churches teaching, regarding ectopic pregnancies and how I’m able to follow church teaching and my conscience…and still be able to do my job regarding ectopic pregnancies.
Canon law 1398 states:
“a person who procures a successful abortion incurs an automatic (latae sententiae) excommunication.”
EWTN states: This means that at the very moment that the abortion is successfully accomplished, the woman and all formal conspirators are excommunicated…Conspirators who incur the excommunication can be defined as those who make access to the abortion possible. This certainly includes doctors and nurses who actually do it, husbands, family and others whose counsel and encouragement made it morally possible for the woman, and those whose direct practical support made it possible (financially, driving to the clinic etc.).
ewtn.com/expert/answers/abortio2.htm

My job will include consulting with physicians who potentially have a patient with an ectopic pregnancy…these physicians may or may not decide to destroy the embryo using abortive treatment…and it will be my job to arrange the transfer of these patients into this physicians care and also arrange transport for this patient into the hospital to meet with the physician to receive the treatment of the physicians choice.

Continued…

My question is will my helping and arranging for physicians to care for patients with ectopic pregancies potentially lead to my excommunication from the church, if the doctor decides to use an abortive treatment…Am I understanding Canon Law correctly?

Scott and Emily…I understand that both of you think that I should just do my job. But, unfortunately, I’m not a mindless drone. Yes, it is possible that you are right and I am wrong, and I’m being scrupulous…and there is not a moral issue here. But, can you please offer me some clarity on your position and why I’m wrong. Can you please use theology and church teaching, to help offer me guidance, (this is the reason why I brought this issue to the Moral theology section of Catholic Answers)…Besides just telling me to “Just do your job, and don’t make any moral judgements”

Honestly, I’m just trying to seek out clarity

You are not being scrupulous, you are practicing your faith the best way you know how. However, your job as a nurse is separate from that. You should speak with a priest who knows about these issues. You may need to change your position at work so you don’t have to compromise your beliefs.

I was unaware that there was even a controversy.

From what I have been able to discern, the Church has made no direct ruling on the treatment of ectopic pregnancies.

The U.S. conference of Catholic Bishops has said:

In the case of extra-uterine pregnancy, no intervention is morally licit which constitutes a direct abortion.[2]

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.[3]

According to this article, most Catholic ethicists, believe the Bishops’ opinion means that salpingectomy is permitted, and salpingostomy and methotrexate are not permitted.

cuf.org/2004/04/ectopic-for-discussion-a-catholic-approach-to-tubal-pregnancies/

The second two treatments are clearly a direct abortion. The second two treatments also have a direct purpose to treat a serious (life threatening) condition of a pregnant woman.

This what Catholic people who actually work in hospitals do from my observation. They ask their priest if there is time. If there is not time, they ask another Catholic in the same medical profession what he / she thinks. They do not ask non-clergy or people who are not health care workers.

ncbcenter.org/page.aspx?pid=940

I will look up further what the us catholic bishops say about this. Thank you for that idea.
–I have asked catholic ethicists, according to bookcats suggestion. I am waiting for their response.
—I will ask my priest.
—and as far as asking any other Catholic medical professionals. I personally don’t know any. I don’t work with practicing Catholics…I do know a couple of people who were raised Catholic and have left the faith…they are also pro choice and have heard them speak of the pro-life belief system as being immoral. I don’t have any catholic medical professionals to bounce questions off of. Which is why I tried to seek out other Catholics on Catholic answers for my question.

Thank you for your suggestions

Yes, in your heart AND brain you know as a medical professional that a woman having her tube removed to save her life or even using medications to reach the same result is in no way against Church teachings. If you find yourself suffering from scrupulosity then please speak with a Catholic psychologist so this doesn’t snowball. I’ll pray for you to find peace in your heart.:slight_smile:

I agree with bookcat. In this particular topic you need an expert opinion. I see that you already contacted the ncb center which is great. They will give you the right answer and of course is always a good idea to talk to your priest.

No, that’s not the point. Even in the latter case, the intended effect is to save the mother, NOT to kill the baby. It’s possible to surgically remove an unviable baby without intending to kill a baby.

The Principle of Double Effect, however, says that we may not do evil so that good may result. We may not save a mother BY killing a baby. We may only do something to save a mother that has the unintended effect of killing a baby. The thing that we do to save the mother cannot be (fundamentally) a killing of innocent life.

When a doctor surgically removes an unviable baby, the most straightforward way to explain his action is that he is killing an (already doomed) child – albeit for a good reason. This would appear to be “doing evil so that good would result”, although some Catholic ethicists have reasonable disagreements on this point.

It should be uncontroversial, though, that removing a fallopian tube is an action whose intended result is the salvation of the mother, and whose unintended and non-instrumental consequence is killing the child. Such an action is permissible.

As for your situation, OP, consider this: would it be morally permissible to drive Harry Truman to the place where he could decide whether to bomb Hiroshima? I think it would. The decision still lies in the hands of Truman, and you have no particular reason to assume Truman will do the wrong thing – even if he does do the wrong thing.

No, it will not, you are not providing “formal support” for an abortion. Nor is an ambulance driver, or the hospital receptionist, who checks in a patient.

The action is what the doctor does, not the reason why he does it. The action is the surgery or administration of the drug. The reason for doing it does not come into play. Again, you can’t do an evil (deliberately killing the embryo by removing it from the tube or injecting a drug) even if the result is going to be good (saving the life of the mother). You can do a good (removal of a diseased fallopian tube) even if it has the effect of killing the embryo contained within it.

By your logic it would be OK to kill the Son of Sam at birth because your intent is to save the life of all those he later killed.

You totally misunderstood what I was saying. I said the doctor had good intentions, yes. But I did not say those intentions justified his actions. I’m not sure where you got the idea that I believed such a thing. :confused:

In principle, the surgical removal of just the embryo need not have the intention or the effect of killing the embryo. We are able today, in rare cases, to save babies with only 22 weeks of gestation - something that was unthinkable 100 years ago. It is not out of the question that 100 years from now there may be a way to provide for the full development of an embryo removed from an ectopic pregnancy, either by providing an artificial womb, or by transplanting the embryo into the uterus of the same woman. Certainly in that case the surgical removal of the embryo would not constitute abortion, even if some or most of the embryos died in the process. The key point is that the death of the embryo is not deliberate or intended. The death of the embryo is not necessary to treatment of the mother. It is clearly an unintended side effect of the removal.

Methotrexate, on the other hand, is a completely different situation. The means by which the tube is cleared is by killing the embryo. If the dosage of methotrexate is not high enough, and the embryo does not die, then the operation is a failure and the woman remains untreated. So in that case the intention is clearly to kill the embryo, because without the death of the embryo, the treatment does not work. This is unlike the surgical removal of just the embryo because the death of the embryo, while probably inevitable, is not essential to the treatment. It is possible to imagine a successful treatment without the death of the embryo, even if such a treatment is currently out of reach of present technology.

But what about today, when no such technology exists? Does the absence of that technology change the intention of the removal? I don’t think so. Unless the doctor wantonly carves up the embryo and takes it out in pieces, the operation can appear the same as if the advanced technology existed. And when such an operation is compared with the (licit) removal of the section of tube, the operations appear very similar, except that in one case the embryo is surrounded by a section of tube and in the other case he isn’t. But that tube is not keeping him alive. What is the difference between the two procedures with regard to the intention of the doctor?

DISCLAIMER: The views and opinions expressed in these forums do not necessarily reflect those of Catholic Answers. For official apologetics resources please visit www.catholic.com.