Moral Principles and Medical Practice: The Basis of Medical Jurisprudence

by Charles Coppens

To return to our subject. Abortion, or miscarriage, is often, as you know, gentlemen, the result of natural causes beyond human control; at other times it is brought on by unintentional imprudence on the part of the mother or her attendants. It is the duty of the family physician, when occasions offer, to instruct his pregnant patients and other persons concerned on the dangers to be avoided. A good Doctor should be to his patients what a father is to his children; very important matters are confided to him, and therefore grave responsibilities rest on his conscience.

III. We are now ready to consider the chief question of this lecture, namely, whether there can be any cases in which a physician is justified in bringing about an abortion, or in prescribing a treatment from which he knows an abortion is likely to result.

1. It is evident that, if he acts with due prudence, and yet, from some cause which he did not foresee and could not have been foreseen, his treatment brings about a miscarriage, he cannot justly be held accountable for what he could not help.

2. But what if he foresees that a drug or treatment, which, he thinks, is needed for the mother’s health, may perhaps bring on a miscarriage? Can he still administer that drug or prescribe that treatment? Notice the question carefully. It is not supposed that he wants to bring on the miscarriage. He does not; he will do all he can to prevent it. Nor will his treatment or drug directly destroy the life or the organism of the embryo; but it is intended to affect favorably the system of the mother, and it is applied to her own organism. Still the Doctor knows that the prescription may indirectly bring about abortion. Can he prescribe the drug or treatment from which he knows the death of the fœtus may indirectly result, the direct purpose being to remove an ailment of the mother’s?

There is a sound moral principle bearing on such cases; it is universally admitted in Ethics and Jurisprudence, and its application is so extensive that it well deserves careful study. It is this: “He who wilfully puts a cause is answerable for the effect of that cause,” causa causæ est causa causati. Therefore, if the effect is evil, he is answerable for that evil. This, however, supposes that he could foresee the danger of such evil effect.

That evil effect is said to be indirectly willed; for it follows from a cause which is directly willed. If, then, you should give a dose to a pregnant mother which is intended to stop her fever or other ailment, but may also bring on abortion, the stopping of her fever is directly intended, and the abortion is said to be indirectly intended or willed. Those are the received terms in moral science. It were more correct to say that the abortion in this case is an effect not intended at all, but only permitted. That, then, which is permitted to result from our acts is said to be indirectly willed.

Are we then always responsible for evil effects permitted or indirectly willed? The principle laid down seems to say so. But then that principle admits of important exceptions. If we could never do an act from which we know evil consequences may follow, then we could scarcely do anything of importance; a young man could certainly not become a physician at all, for he is almost certain to injure some of his patients in the course of his professional life. But if we had no Doctors, such a loss would be a much greater evil to mankind than their occasional mistakes. Here then we seem to be in a dilemma, with evil on both sides of us. And then we are reminded of that other principle of which we spoke before, that we may never do evil at all that good may come of it. What shall we do? The solution is this: we should never do evil, but we are often justified in permitting evil to happen; in other words, we can never will evil directly, but we can often will it indirectly: we can do what is right in itself, even though we know or fear that evil will also result from our good act.

This conduct requires four conditions: 1. That we do not wish the evil itself, but make all reasonable effort to avoid it. 2. That the immediate effect we wish to produce is good in itself. 3. That the good effect intended is at least as important as the evil effect permitted. 4. That the evil is not made a means used to obtain the good effect.

Now let us apply these principles to the case in hand.

1. If the medicine is necessary to save the mother’s life, and it is not certain to bring on abortion, though it is likely to do so, then the good effect is greater and more immediate or direct than the bad effect; then give the medicine to save the mother, and permit the probable death of the child.