Thursday, May 16, 2019

Analogies to ectopic pregnancy

The standard Catholic view of tubal pregnancy is that it is permissible to remove the tube with the child. The idea seems to be that the danger to the mother comes from the potential rupture of the tube, and hence removal of the tube is removal of that which poses the danger, and the death of the child is a non-intended side-effect, with the action justified by double effect. I’ve always been queasy about this reasoning, but I now have two related analogies that make me feel better about this.

Case 1: There are two astronauts on a spaceship, with no oxygen left in the air. The astronauts are wearing spacesuits with oxygen tanks. The oxygen tanks are sufficient for the astronauts to survive until they get home: 50% of the oxygen can be expected to be used up before getting home. However, one of the tanks is rigged by a malefactor with an explosive device such that if more than 20% of the oxygen is used, it will explode, killing both astronauts. The astronaut wearing that particular spacesuit is unconscious and cannot be consulted. It is not feasible to disarm the bomb or to swap tanks. The conscious astronaut removes the explosive tank from the other astronaut’s space suit and throws it into space, knowing that this will result in the unconscious astronaut dying from lack of oxygen. The intention, however, is to remove the item that will dangerously rupture if it is left in place. It is not the intention to kill the other astronaut. This is true even though it is the other astronaut’s breathing that would trigger the tank’s explosion.

The proximate source of the danger is the oxygen tank. But the more distant source is the breathing. It seems very plausible that it makes a moral difference whether the conscious astronaut shoots the unconscious astronaut to stop their breathing (wrong) or removes their tank to expel the danger (right action). This seems a legitimate case of double effect reasoning.

Case 2: Much as in Case 1, but (a) there is intense radiation outside the spaceship’s shielding, so that getting pushed into space even while wearing a spacesuit on will be fatal, and (b) there is no way to separate the tank from the astronaut. Thus, the other astronaut picks up the explosive tank, and throws it far into space. The tank is connected to the unconscious astronaut, so the unconscious astronaut flies out with the tank, and is killed by radiation. The tank never explodes, because the oxygen doesn't get depleted

Again, this seems a perfectly legitimate case of double effect reasoning.

What about the alternative of removing the child from the tube, which orthodox Catholic ethicists tend to reject (unless done in the hope reattaching in the correct place)? Well, the child is connected to the tube via a placenta. The placenta is to a large degree an organ of the child. As I understand it, removal of the child from the tube would require intentionally cutting the placenta, in a way that is fatal to the child. This directly fatal intervention seems akin to slicing the astronaut to remove them from the suit. This seems harder to justify.


entirelyuseless said...

These seem like really bad analogies. The explosive device is the dangerous thing which will be triggered by breathing. But it is the explosive device that is dangerous.

In the ectopic pregnancy, there is nothing wrong with the tube. It is NOT the dangerous thing. The dangerous thing is the child, who will rupture the tube. If something is analagous to the explosive device, it is the child.

I agree that that you need to use double effect reasoning to solve this situation, but the correct reasoning is that you can remove the child. Your purpose is to move it from a place where it endangers someone else, and your purpose is not to kill it.

Removing the tube on the grounds that the tube is dangerous is simply ridiculous. There is nothing wrong with the tube, and it is causing no danger.

Alexander R Pruss said...

There is nothing wrong with the tube, except the fact that it *will* rupture if a child grows there. And it is the rupturing that is the more direct cause of the danger than the child, just as the explosion is the more direct cause of the danger than the astronaut's breathing.

A Counter Rebel said...

There is nothing wrong with abortion. The few seconds of pain felt by the baby pales in comparison to the pain the baby would feel growing up in crappy circumstances plus the pain of the mother who isn't fit to be a mother yet (perhaps due to poverty or mental illness). So abortion benefits the baby and the mother. Back to the pain, it's highly likely the baby, if not aborted, would suffer more pain throughout its life (possibly getting tortured and raped in a dungeon, whilst God watches and does nothing) and through the dying period than from the abortion procedure.

Alexander R Pruss said...

The same argument would justify infanticide, and that's a reductio ad absurdum of the argument. In any case, the problem with murder isn't that death is painful. Murder is still wrong when painless.

Helen Watt said...

The problem with abortion is not simply that it targets an innocent life or at least, the body of an innocent human being. The more specific problem is that it deliberately ruptures a unique moral and biological bond between the woman and her child. Hence the sadness and guilt some women feel long afterwards until it's somehow resolved.

With morally completely unproblematic, emergency tube removals, the tube is already so damaged that even if the child were no longer there, the tube would still need to be removed.

If the tube is mostly fine, there still remains the issue, as Alex says, with the violent invasion of the fetal placenta, assuming the child is taken out of the tube. If the still-undamaged tube is removed (ie a tube which does not yet pose an emergency threat) then the question arises whether there's a problem with deliberate pre-viability removal in itself - given that the tube is here being used as a vehicle to remove the child.

I would say yes and call for expectant management in the pre-emergency situation, due to the enormous importance of a literally unconditional prenatal mother-child bond. That sounds stark, I know, but I'm not alone in arguing it (in my book on the ethics of pregnancy).

Scott said...

I think the fundamental question involved is this:

Is it morally licit to kill someone who is directly causing immanent danger to your life regardless of moral culpability? I feel like the principle of self-defense may apply here. However, I certainly am not an authority on the issue. An example I have thought of is this: Is it morally licit to shoot a five year old suicide bomber? Assuming the suicide bomber thinks that she is just playing and will get candy once she has done what her terrorist guardians tell her to do, she is clearly not morally culpable here. However, she is still a direct and immanent danger to herself and other people. The same could be said for an ax-wielding mentally ill person. I feel like an embryo may be like that. Morally innocent and not in control of his actions, but still directly (though unintentionally) causing harm to himself and another. I think I agree with entirelyuseless that in the analogy the baby would be the exploding tank. I think it is also important to define “directly” with precision in these situations. Is shooting someone “directly” killing them? You are pulling a trigger which releases a hammer which strikes a cap which applies pressure to primer which then ignited and the ignited primer then ignites the gun powder and the gas from the gun powder pushes the bullet through the barrel and the rifling in the barrel stabilizes the bullet and that finally hits the person you are trying to kill. Are we to say that that is direct but kicking someone off of a building is indirect killing (since it is the ground and not the kick that causes the death)?

I think this is definitely a moral issue that needs to be tackled with greater precision in the Catholic community. Of course, my ultimate hope and prayer is that medical technology advances so that this is an irrelevant moral conundrum.

James R said...

Anscombe has a good example related to this exact kind of case, I think, though she *might* deploy it towards opposite intuitions. Might try and find it.