Are There Rare Cases
position statement of the
What about in cases of...
Rape and incest?
One can rarely engage in a discussion over abortion without one of the rare cases being brought up to justify abortion:
“What if the woman is raped?”
We would be remiss to deny the emotional sway of these rare scenarios that would pull at the heart-strings of any compassionate physician. We grieve with our patients who endure such tragedies in life, and want to provide the best healthcare possible to them. But do these dire circumstances justify an abortion?
It is easy to prove that these objections to the pro-life ethic are insincere. What if someone brought up these arguments to justify the killing of an infant: “The baby was conceived through rape” - “The infant is deformed and mentally handicapped” - “The mother’s health is suffering as a result of her baby.” Would anyone who endorses abortion in the womb openly justify the killing of an infant using these excuses? No, they would not. This proves that these objections are insincere and that the heart of the matter is whether the fetus is a living human. If it could be proven that the human fetus is just as alive and just as human as the infant, then these objections would not justify aborting a fetus any more than an infant. (For a thorough scientific argument proving that life begins at conception, please see the article on our website or the APP tract “When Does Human Life Begin?”)
We must respond to all tragic circumstances of pregnancy from the unshakeable foundation of two indisputable premises: human life begins at conception, and it is always wrong to intentionally kill an innocent human being. The unborn child’s right to life and liberty is given by his or her Creator, not by his or her parents or by the state. The right to life is inalienable: that is, not to be trespassed upon by another. In tragic circumstances such as rape or incest, we want to care for both the mother and her unborn baby. We want to relieve the suffering of the mother and her unborn baby. It is never right to intentionally kill an innocent person, even if it does relieve another’s emotional or physical suffering. It’s not up to a vote, and our obligation to submit unto divine judgments does not sway with our circumstances.
We should not kill an unborn baby to alleviate the suffering of the mother any more than we should kill her infant to alleviate her suffering. Neither should we commit an abortion of a malformed fetus in order to prevent his or her suffering later in life. Being handicapped is not a capital crime. The intentional destruction of health is not compassionate and it is not healthcare, it is assault. We must not be swayed from our pro-life ethic by emotional appeals that admittedly swell our eyes with tears. Truth and compassion prevent us from this fatal compromise.
We find it extremely unfortunate that many pro-lifers have regarded the health of the mother to be a consideration in whether or not she should have the right to terminate the life of her pre-born baby. Politicians who herald the title “pro-life” on the campaign trail frequently tout this health exception, as well as exceptions for rape and incest, as pragmatic compromises that will not offend political moderates and not alienate the pro-life community. We do not consider this compromise consistent with pro-life Hippocratic principles at all. To intentionally kill or condone the intentional killing of one innocent human being precludes one from being considered “pro-life” at all. A murderer of one person is not any less a murderer if he allows thousands to live, nor if he saves thousands from dying!
When the life of the mother is truly threatened by her pregnancy, if both lives cannot simultaneously be saved, then saving the mother’s life must be the primary aim. If through our careful treatment of the mother’s illness the pre-born patient inadvertently dies or is injured, this is tragic and, if unintentional, is not unethical and is consistent with the pro-life ethic. But the intentional killing of an unborn baby by abortion is never necessary.
Most of what passes as a therapeutic, or medically-necessary abortion, is not necessary at all to save the mother’s life. For example, if a mother has breast cancer and requires immediate chemotherapy to survive that can kill the baby, the physician will frequently recommend a therapeutic abortion. Another example: if a mother has life-threatening seizures that can only be controlled by medication that will kill or severely deform her unborn child, the physician will frequently prescribe a therapeutic abortion. In both of these cases, the abortion is not necessary to protect the mother’s health. The necessary medication may injure or kill the pre-born child, but this is no justification for intentionally killing the child. If the child is injured or dies from the medication prescribed to the mother to save her life, the injury was unintentional and, if truly medically necessary, not unethical.
Let us illustrate this principle further: if a rescuer is venturing into a burning vehicle to try to save its injured occupants, and is only able to save one of the two occupants, is it justifiable for him to then take out his gun and shoot the occupant he was unable to save? Of course not! Intentionally killing those you were not able to save is never justified in healthcare. We have the technology and expertise to provide quality healthcare to a pregnant woman without intentionally killing her unborn baby, regardless of the severity of her disease.
We are convinced that much of the pressure physicians place upon ailing women to get a therapeutic abortion is due to fear of malpractice suits. Two female patients have reported to me that physicians unduly pressured them into getting an abortion because their contraception failed and they conceived at the same time that they were taking a medication that could be very injurious to an unborn child. The motive for prescribing an abortion in such cases is not compassion, but completely selfish. The potential of a malformed or mentally retarded child does not ever justify killing the child, malpractice threats notwithstanding. It is always wrong to intentionally kill an innocent human being, even if you are going to get sued if you let them live.
As we now carefully consider a scenario when the mother’s life would be truly threatened by her pregnancy, let us remind ourselves of our two basic premises: human life begins at fertilization, and it is absolutely wrong to intentionally kill innocent human beings. We must stand true to these foundational principles through every emotional appeal and in every tragic scenario if we are to have any principles at all for which to stand.
“What About an Ectopic Pregnancy?”
The abortion exception for the life of the mother is the exception that most commonly seduces the sincere pro-lifer. The scenario in which this exception is most frequently packaged is an ectopic pregnancy, which is when the embryo attaches somewhere inside the mother’s body in a place other than the inner lining of the uterus. It is argued that in an ectopic pregnancy, an abortion must be performed in order to save the mother’s life.
What is rarely realized is that there are several cases in the medical literature where abdominal ectopic pregnancies have survived! There are no cases of ectopic pregnancies in a fallopian tube surviving, but several large studies have confirmed that time and patience will allow for spontaneous regression of the tubal ectopic pregnancy the vast majority of the time. So chemical or surgical removal of an ectopic pregnancy is not always necessary to save the mother’s life after all.
However, if through careful follow-up it is determined that the ectopic pregnancy does not spontaneously resolve and the mother’s symptoms worsen, surgery may become necessary to save the mother’s life. The procedure to remove the ectopic pregnancy may not kill the unborn child at all, because the unborn child has likely already deceased by the time surgery becomes necessary. But even if not, the procedure is necessary to save the mother’s life, and the death of the unborn baby is unavoidable and unintentional.
A chemical abortion with a medicine called methotrexate is often recommended by physicians to patients with early tubal ectopic pregnancies, when the baby may still be alive, to decrease the chances of a surgical alternative being necessary later, but we have found this to be an unnecessary risk to human life. We offer the following true case to demonstrate this point.
One patient was diagnosed with a tubal ectopic pregnancy by her obstetrician, and he informed her that they were fortunate to have made the diagnosis early and that she should have a methotrexate abortion. The patient was pro-life, and did not want to take the medicine, but the physician insisted. The baby was not going to survive, he argued, and a chemical abortion now could prevent the need for a surgical procedure later. The chemical abortion would lessen her chances of a rupture of her fallopian tube and subsequent life-threatening hemorrhage. The chemical abortion was also better at preserving future fertility than surgical removal of the ectopic pregnancy later. Feeling like she had no other reasonable alternative, she took the methotrexate.
However, there was a complication. Two weeks later, she still had vaginal bleeding and pelvic discomfort. A repeat ultrasound confirmed the physician’s worst fears: his patient was pregnant with twins – one in the fallopian tube, and one in the uterus! He missed the uterine pregnancy in his ultrasound examination, and that baby was dying from his prescription.
Holding off surgery and watchful waiting in this case might have resulted in spontaneous resolution of the tubal pregnancy or would have required surgical removal of the tubal pregnancy when the embryo was likely to be dead, but in both cases the uterine pregnancy would probably have survived. Unfortunately, the chemical abortion killed both babies, much to the dismay of this young pro-life woman.
It is only ethical to remove the tubal pregnancy if spontaneous resolution does not occur after watchful waiting and if the physician is 100% certain that there are no twins. At this point, the embryo in the fallopian tube is likely to be dead and, even if not, the death is unavoidable and unintentional, and the procedure is necessary to save the life of the mother.
In conclusion, there are no occasions in which the intentional killing of the pre-born child is justified. Scientific fact and divine law are clear: life begins at conception, and there are no exceptions to the prohibition of intentionally killing an innocent human being. We must stand true to these foundational principles through every emotional appeal and in every tragic scenario if we are to have any principles at all for which to stand.
Saving lives t Saving medicine
Association of Pro-Life Physicians