Before presenting the cases of ectopic gestation that occur in medical practice, the fundamental ethical principles that are to be applied in judging the morality of the surgeon's interference should be given.
The morality of any action is determined, (1) by the object of the action; (2) by the circumstances that accompany the action; (3) by the end the agent had in view.
1. The term object has various meanings, but here it means the deed performed in the action, the thing which the will chooses. That deed by its very nature may be good, or it may be bad, or it may be indifferent morally. In themselves to help the afflicted is a good action, to blaspheme is a bad action, to walk is an indifferent action. Some bad actions are absolutely bad, they never can become good or indifferent (blasphemy or adultery, for example); others, as stealing, are evil because of a lack of right in the agent: these may become good by acquiring the missing right. Others are evil because of the danger necessarily connected with their performance,—the danger of sin connected with them, or the unnecessary peril to life. An action to have the moral quality must be voluntary, deliberate; and mere repugnance in doing an act does not in itself make the act involuntary.
2. Circumstances sometimes, though not always, can add a [{13}] new element of good or evil to an action. The circumstances of an action are the agent, the object, the place in which the action is done, the means used, the end in view, the method observed in using the means, the time in which the deed is done. If a judge in his official position tells a sheriff to hang a criminal, and a private citizen gives the same command, the actions are very different morally because of the circumstances of the agent giving the command. The object—it changes the morality of the deed if a man steals a cent or a thousand dollars. The place—what might be merely a filthy action in a house might be a sacrilege in a church. The means—to support a family by labour or by thievery. The end in view—to give alms in obedience to divine command or to give them to buy votes. The method observed in using means—kindly, say, or cruelly. The time—to do manual labour on Sunday or on Monday. Some circumstances aggravate the evil in a deed, some extenuate it. Others may so colour a deed that they specify the deed, make the action some special virtue or vice. The circumstance that a murderer is the son of the man he kills specifies the deed as parricide.
The end also determines the morality of an action (see St Thomas, Sum. Theol. I. 2., q. xviii., a. 4 and 7). Since the end is the first thing in the intention of the agent, he passes from the object wished for in the end to choosing the means for obtaining it. Without the end the means can not exist as such. There are occasions when an end is only a circumstance: for example, if it is a concomitant end. When an end is a, finis extrinsecus operantis, when it is in keeping with right reason or discordant thereto, it may become a determinant of morality.
In every voluntary, or human, act there is an interior and an exterior act of the will, and each of these acts has its own object. The end is the proper object of the interior act of the will; the exterior object acted upon is the object of the exterior act of the will; and as this exterior act specifies the morality, so does the interior object—which is the end—specify it, and even more importantly than the exterior object does.
The will uses the body as an instrument on the external [{14}] object, and the action of the body is connected with morality only through the will. We judge the morality of a blow, not by the physical stroke, but from the intention of the striker. The exterior object of the will is, in a way, the matter of the morality, and the interior object of the will, or the end, is the form. Aristotle (Ethics, lib. v., cap. 2) says: "He that steals that he may commit adultery, is, absolutely speaking, more an adulterer than a thief." The thievery is a means to the principal end, and it is this principal end that chiefly specifies or informs the action.
The means used to obtain an end are very important in a consideration of the morality of an act. There are four classes of means,—the good, the bad, the indifferent, and the excusable.
Good means may be absolutely good, but commonly they are liable to become vitiated by circumstances,—almsgiving is an example. Some means are bad always and inexcusable,—lying, for example. The excusable means are those which are bad, but justifiable through circumstances. To save a man's life by cutting off his leg is an excusable means.
The existence of excusable means whereby some good actions are effected does not establish the assertion that the end justifies the means. The end sometimes may incriminate or sanctify indifferent means, but it does not in itself justify all means. The means, like other circumstances, are accidents of an action, but they are in an action just as much as colour is in a man. Colour is not of a man's essence, but you can not have a man without colour.
The effect of an action, the result or product of an effective cause or agency, may in itself be an end or an object or a circumstance, and it has influence in the determination of morality. Sometimes an act has two effects, one good and the other bad; and that such an action be lawful it is necessary (1) that the action itself be good or indifferent; (2) that the good effect be intended and the evil effect be not intended (chosen) but only reluctantly permitted; (3) that the evil effect be not a means to secure the good effect; (4) that there be present a motive sufficiently grave to excuse or counterbalance the bad effect. [{15}] St. Thomas (Sum. Theol. 2. 2. q. 64, a. 7) Speaking of killing a man in self-defence, says: "Nihil prohibet unius actus esse duos effectus, quorum alter solum sit in intentione, alius vero sit praeter intentionem. Morales autem actus recipiunt speciem secundum id quod intenditur, non autem ab eo quod est praeter intentionem, cum sit per accidens."