If one of our congregants is diagnosed with an ectopic pregnancy, what guidance should be given to the couple by the church?
It’s especially difficult because it’s a matter of life and death for both mother and baby, and time is of the essence. Very easy to be caught flat-footed, unprepared. What preparation can be made, even? All the choices are bad. But…
This article, posted in an earlier thread, is the most helpful I’ve seen yet regarding ectopic pregnancy, and I commend it to any pastor or elder. Who knows when you may suddenly be called on to give counsel to someone in this situation?
I got two takeaways from this article:
Encourage the couple to ask their doctor whether there is any evidence the baby is alive.
Apparently in over 90% of ectopic pregnancies, by the time the ectopic pregnancy is diagnosed the baby has already died. Wouldn’t it be helpful for the couple to get what confirmation they can on that point and most of the time find that they are free to grieve the baby’s passing and take what measures are needed to help the mother without the added moral complexity of dealing with a baby’s life also.
If the baby is alive, I suspect that it may be important to recommend salpingostomy (surgically opening the fallopian tube to remove the baby) or salpingectomy (removal of the entire fallopian tube) rather than means (such as methotrexate) that directly kill the baby.
I know that, starkly stated, the default position is something approximating “We know that the baby will die anyway, so do whatever you need to to kill it, it doesn’t matter”; but this strikes me as a utilitarian argument that doesn’t take into account 2 Sam. 1:1-16.
I think there is a difference between taking an action that in the past has always resulted in death when that death isn’t our purpose, and killing with our own hands. More ethics work is needed here. Even at this point I think I would ask a couple to consider it.
The article also did some work I found very helpful in re-framing the question of double effect as a question of when and how to separate mother and baby rather than whether and how to remove a diseased organ. Every time I had read the Roman Catholic position where removing the whole fallopian tube was better morally than removing the baby from the fallopian tube I thought something didn’t follow.
I find the first point hard to believe. If the baby is dead, he is no longer growing. The course from there would be necrosis of the tissue, loss of hormones supporting the pregnancy, and the products of conception (baby/placenta/yolk sac) would pass with the next period, a miscarriage. So if rupture hasn’t happened yet, it’s unlikely to happen after the baby has died. I tracked down the article that I believe this figure was derived from, and it’s a retrospective study linking sonographic findings on trans-vaginal ultrasound to rupture of the Fallopian tubes. There was no intention in that study to determine if the babies were alive or dead. I think the author of the referenced article above took the findings that would be consistent with an unviable intrauterine pregnancy, and applied them to an ectopic pregnancy. This generalization is not exactly valid. These findings are only valid if the beta HCG levels in the mother’s blood are greater than 1500 mIU/mL, which is not specified in the study. Also it is much harder to visualize detailed anatomy of an ectopic pregnancy than an intrauterine pregnancy. More simply put, just because we can’t see the heart beat, doesn’t mean it’s not there. I don’t think your doctor can answer the question “is the baby alive?” with an acceptable level of accuracy to pacify the conscience.
On the second point, I for one have a tough time seeing the moral difference between killing the baby surgically or chemically. Unfortunately, he is about to hurt his mom and needs to be stopped. So far, there is not a reliable nonlethal solution to this problem, but I’m glad to see there are some who are working on it. In light of this, I would opt for methotrexate whenever possible since surgery of the Fallopian tubes will increase scarring and lead to greater risk for ectopic pregnancy in the future.
(For those who don’t know me; I was trained in medicine at Indiana University. I’ve had the benefit of Tim, Joseph, Daniel, and many others keeping watch over my soul as elders. I am currently about a year into residency in Louisiana.)
Thank you, Dan and Joe, for thinking this through. My pastoral counsel to a couple would be to save the mother’s life even at the expense of the baby’s life. And concerning whether that is the medical reality (or likely reality), I would do my best to assure the couple was getting their diagnosis and recommendations for therapy from a Christian physician, near or far, who is pro-life right down to his or her DNA.