Some women carry the child beyond term, with the effect that the baby is overgrown for normal delivery. The head is harder and more angular than it should be, the long bones stiffer and less pliable, the muscles tenser. All these changes make the delivery so difficult that the overgrown child may be fatally injured at birth. Physicians must be cautious in believing histories of enormous children at previous births at which they were not present. Mothers and nurses are likely to exaggerate the size of infants.
In cases where the children die at a particular time before term, premature labor should be induced to save the child, and when the child has been carried over term it may be necessary to induce labor. In the first condition labor is not to be induced a week earlier than is necessary. We talk so much of a seven months' child as viable that we forget that any child born before the thirtieth week of gestation has very small chance for survival. From 30 to 60 per cent. of all prematurely delivered infants die. The maternal passages do not dilate normally and the child is unformed; its bones fracture readily; it cannot sustain pressures and strains. All induced labors are dangerous to the mother by shock and possible infection, and only very grave necessity justifies any such procedure.
In inducing necessary premature labor the technical method may take on a moral quality. There are over a score of methods, and many of these, although used, are dangerous and should be obsolete. A very common method, begun in 1855, is to insert one or two elastic solid bougies into the uterus between the membranes and the uterine wall. This is a dangerous method and should be obsolete. Other dangerous and obsolete methods are the puncture of the membranes with a trocar high up in the uterus; intrauterine injections of hot or cold water, glycerine, milk, and other liquids; vaginal tamponade alone; irrigation of the vagina with carbon-dioxide water; a stream of hot water directed against the cervix, electricity, X-ray, dilatation of the vagina with a rubber bag, irritation of the nipples, the use of drugs like quinine, cimicifuga, ergot, or cantharides.
If haste is not necessary, packing the cervical canal and the lower uterine segment antiseptically with a strip of gauze three to five yards long and three inches wide and leaving it in for about twenty-four hours is one of the best methods. Where rapid delivery is required, cesarean section must be employed. In cases of somewhat less urgency the membranes are first punctured and balloon dilators are used. In any case puncture of the membranes is the most certain method to start labor, but it has many bad disadvantages. A dry labor in a primipara with an undilated cervix is a grave condition. If the fetal head is not engaged in the pelvis, puncture must not be attempted. When the head is not engaged in the pelvis like a ball-valve, the cord will prolapse, be pinched, and thus the blood supply will be cut off from the child and the loss will kill it. For the same reason, the waters must not be run off too quickly. Many operators insert a bag, dilate, and so start the labor, without puncturing the membranes, where there is no reason for haste.
Therapeutic abortion, as has been said, is never permissible, under any circumstances, if the child is not viable. In certain conditions, say, when a uterine tumor clearly threatens the life of the pregnant woman, or if in extrauterine gestation there is a rupture of the tube, an operation may be permissible, or even obligatory, which has for its direct end the removal of the tumor or the stopping of the hemorrhage. If such a removal or ligation, under these conditions, indirectly causes the abortion of the inviable fetus, or its death from a lack of blood, these indirect effects may be reluctantly permitted. They are cases of an equally immediate double effect, one good and one evil, where all the requirements are fulfilled. A direct abortion of an inviable fetus, however, is never licit even to save the mother's life, and in abortion the killing is direct because it is used as a means to an end. In a ruptured ectopic gestation the primary effect of the physical operation is to ligate the torn arteries to save the woman's life here and now; the secondary effect is the permitted death of the fetus from the shutting off of the blood supply. In the abortion of a premature fetus the primary effect of the operation is to separate the placenta from the uterus, to cut off the child's blood supply, and as a direct consequence of this act, which is essentially evil, the woman's life is saved. The original act in this abortion is evil, and evil may not be done even if good follows. Even in self-defence against an unjust aggressor one may not kill a man to save his own life—he tries to save his own life and reluctantly permits the death of the aggressor. In a killing in self-defence there are two distinct effects; in abortion there is only one effect, and the killing is a means to this one effect. That you may kill an irresponsible insane man who is attacking your life, or the life of one entrusted to your care, is no reason that you may attack a fetus in the womb. There is no parity. The insane man is a materially unjust aggressor; the fetus is not an aggressor at all. The mother placed it where it is; and if any one is an aggressor, she is. In the abortion you directly kill the fetus and indirectly save the woman's life, and this indirection uses the death of the fetus as a means to the end of saving the woman's life. In killing the insane aggressor you directly save the life of yourself or your ward, and reluctantly permit the death of the aggressor. The proofs of the essential immorality of direct homicide have already been established in the general chapter on Homicide.
The assertion that an undeveloped fetus in the womb is not as valuable as the mother of a family is beside the question, and in certain vital distinctions it is untrue. Any human life, as such, whether in a fetus or an adult, is as valuable as another, inasmuch as no one but God has any authority to destroy it, except when it has lost its right to existence through culpable action. Secondly, the quality of motherhood is an accidental addition to a mother's life, not substantial as is the life itself. This quality of motherhood does not create any juridic imbalance of values which justifies the destruction of the rights inherent in the fetus. That the fetus may not be able to enjoy these rights if the mother dies is, again, an irrelevant consideration. There is no question of a comparison of values. A life is a life, whether in mother or fetus, and the destruction of an innocent life by any one except its creator, God, is essentially an evil thing, like blasphemy. An innocent fetus an hour old may not be directly killed to save the lives of all the mothers in the world. Insisting on such comparisons supposes ignorance and sentimental opposition to truth. It is a good deed to save a mother's life; but such saving by killing an innocent human being ceases to be good and becomes indescribably evil, an enormous subversion of the order of the natural law, as it is a usurpation of the dominion over life possessed by God alone. If I owe a man a vast sum of money and the payment of this debt will ruin me and my children, it would be a good thing for me and them to have this creditor put out of the way by death, but that fact is no justification whatever for me to kill the man. The fetus in the womb in a case where there is question of therapeutic abortion is like this creditor: it would be well for the mother to have this fetus out of the way, but that is no justification whatever for her to kill the fetus, or to let it be killed by a physician. The physician who kills such a fetus is exactly like a hired bravo who assassinates a troublesome creditor for a fee, except that the physician does the nasty job for less money.
To hasten even an inevitable death is homicide, and that quality of merely hastening adds nothing for extenuation: every murder is merely a hastening of inevitable death. To give a dying man a fatal dose of morphine "to put him out of misery" is as criminal a murder as to blow out his brains while he is walking the streets in health; to ease pain is not commensurate with the horrible deordination of taking a human life. This subversion of the moral law in the interest of mawkish sentimentality is one of the gravest evils of modern social ignorance. Physicians are constantly mistaking inclination, or the mental vagaries of the nurses who influenced their childhood, for rules of moral conduct. A physician is not a public executioner, nor a judge with the power of life and death: his business is solely to save human life, never to destroy it.
If there were anything in the objection that refusal to do abortion opposes the life of a useless fetus to that of a useful mother of a family, where would such false logic stop? If it held for the taking of life in an unpleasant condition, it would hold a fortiori in every other less unpleasant condition where a life would not be at stake. When a note that you had given falls due and it would bankrupt you to pay it, does this inconvenience let you out of the difficulty in honor, in the moral law, or in the civil law? It certainly does not; but it should if the doctrine of the sentimentalists on abortion were true. An eclamptic woman, or one with hyperemesis gravidarum, conceived the child, got into the difficulty, and she and her physician have no right to tear up the note they have given to the Creator, especially when such tearing implies murder. Suppose, again, a woman has done a deed for which she has in due process of just law been condemned to death; suppose, also, there is only one man available to put her to death, and if this man were killed she could escape. Would her physician be permitted to shoot that executioner to let her out of the difficulty? Certainly not. That, however, is just what the physician does who empties an eclamptic uterus of an unviable fetus. You may not do essential evil that anything under the sun, good, bad, or indifferent, may come of it.
If I may kill a so-called "useless fetus" to save a useful mother, do gross evil to effect great good, why should I stop there? Why, then, may I not rob a church to make my children rich, murder a useless miser to employ his money in founding orphanages, shoot any oppressor of the poor, kick out of doors my senile and bothersome father, reject all my most sacred promises whenever their observance makes me suffer? Where will the sentimental moralist draw the line? That the civil law permits therapeutic abortion is no excuse at all; it is merely a disgrace of the civil law. The American civil law permits many things that are contrary to morality and the law of God: it absolves bankrupts even if they afterward become solvent; it permits the marriage of divorced persons; it levies unjust school taxes; it gives unjust privileges; it squanders the money of the citizens; and so on.
If a woman marries in good faith a man she deemed a gentleman, but who turns out to be a syphilitic sot who disgraces her and makes her life a perpetual misery, immeasurably worse than the condition of any eclamptic woman, no greater blessing could come to her and her children than his death. Would she therefore be justified before any tribunal of God or man in murdering him to get rid of her trouble? No; she must bear with her evil for the sake of social order and of eternal right. So must the eclamptic woman.