9. May the woman in question 6 be delivered of an inviable child, supposing the child to be in articulo mortis?
10. May an ectopic fetus be killed by operation, electricity, or poison, to avert possible danger of death from the mother?
11. May a surgeon who has opened the abdomen for some condition not uterine incidentally remove a viable ectopic fetus?
12. With conditions like those in question 11, except that the fetus is not viable, may the surgeon remove the inviable ectopic fetus?
Three years later, August 19, 1889, the Holy Office answered these questions comprehensively: "In Catholic schools it may not be safely taught that craniotomy is licit, as was decided May 28, 1884, or any other surgical operation which directly kills the fetus or the pregnant mother." Safely taught here is a somewhat technical expression which has been interpreted by the Holy Office in another connection as meaning that the act is illicit morally.
The Holy Office, May 4, 1898, again decreed: "Necessitate cogente, licitam esse laparotomiam ad extrahendos e sinu matris ectopicos conceptus, dummodo et foetus et matris vitae, quantum fieri potest, serio et opportune provideatur."[104] This decision was not clearly understood, and on March 5, 1902, the same congregation reported the following question: "Is it ever licit to remove from the maternal pelvis an ectopic fetus which is still immature; that is, which has not yet completed the sixth month after conception?" The answer was, "No; according to the decree of May 4, 1898, which prescribes that the life of the fetus and the mother must as far as possible be carefully safeguarded. As to the time, according to the same decree, the questioner will remember that no premature delivery is permissible unless it is effected at such a time and by those methods which in ordinary circumstances safeguard the life of the mother and fetus."[105]
If the fetus is removed and so killed to avert a threatened danger to the maternal life, but not an actually operative destruction of her life, this removal or homicide is an evil means used to avert the danger. There is no question of a double effect, that is, of two effects, one good and the other evil, coming with equal directness from the cause, which is the removal or killing of the fetus; but of a good effect, the averting of the danger to the mother, issuing from an evil cause, the removal and death of the fetus. A good effect does not justify the use of evil means; it is not permitted morally directly to kill the fetus, as in this case, to save the mother from a threatened grave danger.
The case is not like that of the woman who has an operable cervical cancer while she is bearing an inviable fetus. If the cancerous uterus is not removed the woman will surely die; if it is removed she has a reasonable chance of cure; but if the inviable ectopic fetus is not removed it is by no means certain that the woman will die. In the cancer the uterus is directly removed, the fetus is indirectly killed; in the ectopic case the fetus is directly killed, and the danger to the woman's life is removed as a direct effect of the killing.
Again, the killing of the inviable ectopic fetus cannot be justified by maintaining that the fetus is an unjust aggressor against the life of the mother. An aggressor against life may be such formally or materially. A formally unjust aggressor consciously and voluntarily attacks the life of the victim unjustly. This perversion, or evil, in the aggressor's consciously actuated will sets his own right to life in juridic inferiority to that of the victim's right to life, and the victim may defend his own life, even unto the indirect death of the aggressor in necessity.
The materially unjust aggressor attacks the victim's life unjustly, but whether the aggressor is sane or insane, the attack is not voluntary. When an insane aggressor appears to use his will, such use lacks all moral quality because of the absence of intellect and reason; he wills improperly, as a brute is said to will. In either case, nevertheless, there is active aggression directed against the victim's life, which also sets the aggressor in juridic inferiority to the victim, and permits the victim to defend his own life to extremes. As great an authority as De Lugo holds that in such defence, whether the aggressor is formally or only materially such, the victim may directly kill, but direct killing is never necessary, as it is all a matter of intention.