Double Effect

I had to help take a life recently while on call.

A woman came into the emergency department with abdominal pain. An ultrasound revealed a tiny beating heart in her pelvis - in a fallopian tube, not in the uterus. An ectopic pregnancy.

These can be lethal.

Among three possible treatments for ectopic pregnancies - methotrexate (a drug to promote reabsorption of the fetus), salpingostomy (opening the fallopian tube to remove the "products of conception"), and salpingectomy (surgical excision of the affected fallopian tube) - only salpingectomy is considered morally licit by the Catholic Church, because the death of the fetus can be considered an unwanted but, unfortunately, inevitable by-product of a procedure done specifically to save the mother's life (rather than a direct consequence of the treatments, as it would be in the use of methotrexate or salpingostomy). Some might argue that this kind of hair-splitting is silly when the end result is the same, but I think the idea, for members of the Catholic community, is that intention really matters.

Aquinas first articulated this principle of "double effect" in his writings about self-defense: "Nothing hinders one act from having two effects, only one of which is intended, while the other is beside intention...Accordingly, the act of self-defense may have two effects: one, the saving of one's life; the other, the slaying of the aggressor...And yet, though proceeding from a good intention, an act may be rendered unlawful if it be out of proportion to the end. "

I am no theologian. I try to act according to my conscience and to be mindful of my choices. I wasn't thinking about Aquinas, or double effect, or any fancy ethical theories the night I gave this woman anesthesia for a salpingectomy. All I could think, as I held her hand and reassured her that she wouldn't be alone, as I watched her smile bravely but with small tears trickling into the corners of her eyes, was that I needed to execute an anesthetic that would maximize her safety and minimize her pain. The anesthetic itself went smoothly, no problems. But all through the case I kept thinking about those tiny tears trying not to spill down her cheeks, and I knew there was so very little that I could really do for her.

Just hours before, I had placed an epidural for a woman expecting her first child to enter the world that day. As the surgeon removed the small, dark-purple sac from our current patient's body, I winced thinking of the little life that was getting snuffed out. I felt sad, especially because I knew the mother was sad about it. Then I turned back to the mother and prepared her for her awakening.