Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

(e) The same conditions could exist in the rupture of a pregnancy in a rudimentary uterine horn as in a rupture in tubal gestation.

What is the surgeon to do in a case like this? Fathers Holaind (Amer. Eccl. Rev., January, 1894, in a note on p. 39), Lehmkuhl and Sabetti say: do coeliotomy, ligate the mother's arteries, remove and baptise the foetus.

The analysis of the case is this: (i) The action is the stopping of a fatal hemorrhage in a woman, and possibly, though not certainly, an indirect incidental hastening of a foetus's inevitable death.

(2) The object of the action is the haemostasis, which is good, and the possible indirect hastening of the foetus's death, which is evil, but, as we shall see, excusable evil.

(3) The end of the action is to save the mother's life—a good end.

(4) The circumstances are: (a) that possibly, through mere luck, the woman's condition is not necessarily hopeless: a few women have escaped in this seemingly imminent peril—but that chance of escape is not soundly probable; the stronger probability by far is on the side of a fatal issue; therefore the chance for escape may be neglected, and the woman's case may be regarded as hopeless if operation is foregone.

(b) The quickest possible work on the surgeon's part is necessary, and there is no time or chance to examine the foetus's condition before tying the maternal arteries. Before he opens the mother's abdomen he can tell nothing whatever of the foetus's condition, but the probability is all in favour of the fact that the foetus is already dead or moribund.

(c) The means are coeliotomy, and the ligation of the [{25}] uterine and ovarian arteries to stop the mother's bleeding. This ligation, in the contingency that the foetus is still attached to the Fallopian tube, will also shut off the blood from the foetus, yet the uncertain shutting off of the foetal blood-supply is not intended by the surgeon as a means toward his end in any degree direct or indirect, but it is an evil circumstance associated with the action which may hasten the foetal death—even here the hastening is uncertain.

(5) The action has two effects,—one, the saving of the mother, is directly intended and evidently good; the other, the possible indirect hastening of the foetus's death, may or may not be evil. The moral centre of the whole case is this possible hastening of the foetus's death. If that possible hastening is licit the whole action is licit; if it is not permissible it will vitiate the entire action.

Suppose that there is no doubt that the ligation of the maternal arteries in this case really hastens the foetus's death some minutes: it would still be an indirect volition. Father Lehmkuhl also calls it indirect and licit. Father Sabetti denied that it is indirect, but he held that it is licit for another reason. Sabetti said (Aner. Eccl. Rev., August, 1894): "It is evidently false to say that a means which is directly adopted for obtaining an end is only indirectly contained in the intention of the agent who so adopts it." That is true, but the minor proposition in a syllogism drawn from that statement is to be emphatically denied. The cutting off of the foetal blood is a fact associated with the means, not a means direct or indirect toward the end, which is to save the mother—the means to save the mother is the stopping of her bleeding.