CONTENTS
| CHAPTER I | |
| GENERAL PRINCIPLES CONCERNING SUICIDE AND HOMICIDE | |
| PAGE | |
There is a Supreme Being who alone is master of life. The Natural Law. The nature and determinants of morality. Probabilism. Permissive suicide. Suicide is illicit. Conscience. Homicide, direct and indirect. Self-defence. Formal and material aggressors. Legalized homicide. Bibliography | [1]-22 |
| CHAPTER II | |
| GENERAL PRINCIPLES CONCERNING MUTILATION | |
Mutilation. Canonical irregularity. Self-mutilation. The double effect in morality. Direct and indirect mutilation. The State and mutilation. The dominion of the State | [23]-32 |
| CHAPTER III | |
| WHEN DOES HUMAN LIFE BEGIN? | |
Ancient and modern opinions. The fetus is animated at the moment of conception. The single cell as the primal life-organ. Cell growth and division. Germ cells. The development of the embryo. Fetal viability. Theories of development. The Aristotelian and Thomistic opinions. The formal principle. A soul exists. The primordial cell is a sufficient organ for the soul. Metabolism in the cell. Cell motion. Animal heat and energy. Life in separated tissues. The soul in monsters | [33]-82 |
| CHAPTER IV | |
| WHEN DOES HUMAN LIFE END? | |
The heart and life. Resuscitation after apparent death. The last sacraments in apparent death. Suspended animation. The living fetus in the womb of a dying or dead mother. Methods of resuscitation. Signs of death | [83]-91 |
| CHAPTER V | |
| ABORTION | |
Abortion and miscarriage. Causes of abortion, fetal, maternal and paternal. Surgical operations and abortion. The debitum in pregnancy. Premature labor. Threatened, inevitable, and incomplete abortions. Treatment. The use of the tampon. Precautions against abortion. Therapeutic abortion. Methods of inducing abortion. Artificial abortion of an inviable fetus is never licit. Decrees of the church concerning abortion. The civil law on abortion | [92]-123 |
| CHAPTER VI | |
| ECTOPIC GESTATION | |
Ectopic gestation or extrauterine pregnancy. Anatomy of the uterus and its adnexa. Place of fecundation. The abnormal uterus. Tubal rupture and tubal abortion. Diagnosis. Decrees of the church on ectopic gestation. Removal of an inviable ectopic fetus except in present peril of life is illicit | [124]-132 |
| CHAPTER VII | |
| CESAREAN DELIVERY | |
Indications for cesarean delivery. Abnormal pelves. Symphyseotomy. Varieties of cesarean delivery. Morality. Amputation of the uterus after cesarean delivery. Precautionary sterilization of a cesarean case is illicit | [133]-142 |
| CHAPTER VIII | |
| PLACENTA PRAEVIA AND ABRUPTIO PLACENTAE | |
Nature and effects of placenta praevia. Treatment. Morality and methods of treatment. Abruptio placentae. Morality of fetal removal | [143]-146 |
| CHAPTER IX | |
| ABDOMINAL TUMORS IN PREGNANCY | |
Tumors blocking parturition. Fibroids or myomata. Ovarian tumors. Cancer. Effects and morality of operation | [147]-152 |
| CHAPTER X | |
| APPENDICITIS IN PREGNANCY | |
Occurrence. Time of operation. Diagnosis | [153]-154 |
| CHAPTER XI | |
| PUERPERAL INSANITY AND STERILIZATION | |
Causes. Varieties. Prognosis. Precautionary sterilization of puerperal psychopaths is illicit | [155]-157 |
| CHAPTER XII | |
| NEPHRITIS IN PREGNANCY | |
Frequency. Effects. Abortion as a treatment. Varieties of nephritis. Pyelitis. Catalepsy | [158]-161 |
| CHAPTER XIII | |
| ECLAMPSIA PARTURIENTIUM | |
Definition. Symptoms. Prognosis. Causes. Precautions against eclampsia. Forced delivery. The expectant treatment. Relative mortality and morality of the methods. Cesarean delivery as a treatment. The expectant treatment is apparently the best | [162]-169 |
| CHAPTER XIV | |
| HEART DISEASES IN PREGNANCY | |
Factors in abnormal gestation. The use of pituitrin. Weak pains and the diseased heart. The diseased heart in actual parturition. Operative risk in cardiopaths. Heart block and mitral regurgitation in labor. Prognosis | [170]-176 |
| CHAPTER XV | |
| HYPEREMESIS GRAVIDARUM | |
Pernicious vomiting. Occurrence. Symptoms. Stages. Effects. Causes. Therapeutic abortion in pernicious vomiting. Treatment | [177]-181 |
| CHAPTER XVI | |
| CHOREA GRAVIDARUM AND HYSTERIA | |
Varieties of chorea. Differentiation. Prognosis. Hysteria. Causes. Epidemics of hysteria. Symptoms. Prognosis | [182]-186 |
| CHAPTER XVII | |
| ACUTE YELLOW ATROPHY OF THE LIVER IN PREGNANCY | |
Icterus gravis. Causes. Symptoms. Prognosis | [187]-188 |
| CHAPTER XVIII | |
| INFECTIOUS DISEASES IN PREGNANCY | |
Effects on mother and fetus. Abortions in infectious diseases. Placental permeability. Typhoid. Smallpox. Pneumonia. Influenza. Scarlatina. Measles. Cholera. Tuberculosis. Artificial abortion in tuberculosis | [189]-200 |
| CHAPTER XIX | |
| SYPHILIS IN PREGNANCY AND MARRIAGE | |
Prognosis. Abortion. Infection of mother and fetus. Colles' Law. Erroneous notions on the curability of syphilis. Once a syphilitic probably always a syphilitic. The professional secret in syphilis. Nature of secrets. The physician may warn an innocent person | [201]-211 |
| CHAPTER XX | |
| GONORRHOEA IN MARRIAGE | |
The cause of gonorrhoea. Tests of cure. Effects on a woman. Chronicity. Prevalence. Surgical treatment in women. Morality of the surgical treatment. Conservative surgery. Salpingotomy. Ovariotomy. Evil effects of ovariotomy. Internal secretion of the ovary. Results of various operations. Pregnancy after operation. Morality of infection. General effects of gonorrhoea. Ophthalmia neonatorum and gonorrhoea | [212]-229 |
| CHAPTER XXI | |
| DIABETES IN PREGNANCY | |
Fatality of diabetes in pregnancy. Diagnosis. Sterility of diabetics. Prognosis. Heredity in diabetes. Therapeutic abortion in diabetes | [230]-231 |
| CHAPTER XXII | |
| CHILDBIRTH IN TWILIGHT SLEEP | |
Twilight sleep to avert pain in parturition. Stages of labor. Drugs used. Scopolamine and morphine. Danger in the use of these drugs in labor. Contradictory report of physicians on twilight sleep. Eminent authorities opposed to the methods. Baer's report on the evil effects. The methods are morally illicit and useless | [232]-244 |
| CHAPTER XXIII | |
| VASECTOMY, OR STERILIZATION, BY STATE LAW | |
The States that have this law. Reasons for the law. Hereditary transmission of certain diseases. The operation. Its effects. Restoration of the function of the interrupted vas deferens. Vasectomy and impotence. Onanism. Vasectomy effects impotence from the moral point of view. Other conditions in the male that effect moral impotence. Immorality of artificial impregnation. Vasectomy a grave mutilation. Vasectomy as ordinarily practised is illicit. The State and vasectomy. The limitations of the State's dominion. The State surgeon and vasectomy. Bibliography | [245]-268 |
| CHAPTER XXIV | |
| THE ETHICS OF BIRTH CONTROL | [269] |
| Index | [281] |
PREFACE
In this book is discussed the morality involved in the ordinary cases of medical homicide and mutilation. Craniotomy has been omitted because this operation on the living child is never morally licit, and when done on the dead fetus it has no moral quality that requires explanation.
The articles may seem to be intended for Catholic physicians and spiritual directors alone, but the desire in writing them was to reach all practitioners, to the end that the Natural Law which binds every man may be observed. Morality is not made such in its fundamental principles by any religious creed, but by the requirements of Divine Order, which finally prevails no matter what the opposition. Killing and maiming without sufficient extenuation did not become unlawful solely by the establishment of Christianity. Practically, however, physicians who have no religion, or a religion which is so illogical as to pay no attention to dogma, or even to rail at it as obtrusive, necessarily gravitates to the emotional in morality, and the principles of this book will not even interest them. Dogmas are abstract propositions, and all human society rests on abstract propositions. The most vital facts in morality, the basic distinction between crime and all that is virtuous or indifferent morally, is in abstract principle alone, but physicians and pastors who are not trained in philosophy and rational religion cannot appreciate an abstract principle—they are influenced only by the concrete.
Obstetrical text-books, unfortunately, are written by such emotional men; by men who lack all training in ethics other than that inculcated in childhood out of the mental vagaries of the women in the household; and these authors prescribe therapeutic homicide as if it were a drug in the American Pharmacopœia. The reader is told that if the patient is a Catholic he is to respect her religious "prejudices"; if she is not a Catholic one need not bother about moral scruples when it is necessary to take a life to stop fits. Since the civil law does not prosecute a physician for therapeutic abortion on an inviable child, most physicians deem such an act not only permissible but scientific, and they hold that if a man's conscience will not let him kill a fetus to alleviate maternal distress he is guilty of malpractice.
Decrees of the Catholic Church are cited in these pages, not because morality is an asset of the Catholic Church alone, but because it alone pronounces officially on these medical subjects after careful consideration by competent specialists. This Church has made decisions in comparatively few medico-moral cases, and the questions still undecided authoritatively are very numerous. They are quite difficult, too, because judgment supposes a knowledge of both medicine and ethics, a combination seldom found in one person. As physicians do not know ethics, and moralists do not know medicine, there is often trouble in getting at even a statement of the questions at issue between them. In the preface to Essays in Pastoral Medicine, in 1906, I mentioned a noted case of this kind, and in 1911 a similar incident occurred in a discussion of the morality involved in the sterilization of criminals and the defective by the state. This dispute was taken up by the leading canonists and moral theologians in the United States, Belgium, Holland, Austria, Spain, Italy and France, and for nearly two years these men wrote article after article based upon utterly erroneous physical data.
The books we have on medico-moral subjects are either obsolete at present, or insufficient; or, more commonly, they are the work of amateurs in medicine. These last are worthless when they are not harmful. If, however, I may judge from the questions sent to me for answer by clergymen and physicians from all parts of the country, our theological seminaries and medical schools are in grave need of courses on the morality of medical practice. In this book, to the preparation of which I have given years of anxious thought because of the extreme responsibility involved in its decisions, the data for the most important parts of such courses are presented.
Austin O'Malley.