To the editor:
I would like to comment on Fr. Tad Pacholczyk’s article on ectopic pregnancy in the October 22, 2009, issue. As an RN I have over 18 years of experience in obstetrics and gynecology.
Ectopic pregnancy (pregnancy outside of the uterus) is the leading cause of maternal death in the first trimester. Sadly, this is a nonviable pregnancy and the embryo cannot be saved. At times the embryo will be spontaneously expelled and at other times medical intervention is required. The procedure depends on the clinical situation and location of the pregnancy. In early detection Methotrexate is the least invasive intervention.
The management of gynecological emergencies is directed at the preservation of life, health, sexual function, and the perpetuation of fertility. If we’re to respect life, it’s my opinion that we should respect all life and that includes that of the mother and her future children.
The recommendation of Father Pacholczyk’s article is to have a surgical procedure to remove the entire fallopian tube. As mentioned, this will result in permanent infertility on that particular side. However, what isn’t mentioned are the risks associated with an invasive surgical procedure, including, but not limited to: infection, hemorrhage, pain, blood clots, anesthesia reactions, hospitalization costs, and even death.
Patti Wetzel, RN, Watertown
Father Pacholczyk responds to letter
Father Pacholczyk replies:
Ms. Wetzel’s letter points out that if we are going to respect life, “we should respect all life and that includes that of the mother and her future children.” I am glad to see that Ms. Wetzel and I fully agree on that point.
The heart of the matter in the difficult case of ectopic pregnancy, however, is not only to respect the life of a mother and her “future” children, but also the life of the child she already has growing within her fallopian tube. In my column, I sought to address precisely this point.
Using a drug like methotrexate raises significant ethical concerns because there are, in fact, two patients involved in an ectopic pregnancy, and we must face the critical question of whether, by using this drug, we are not directly targeting one patient, the child, for the benefit of the other, the mother.
Both of them, not only the mother, are, properly speaking, subjects for appropriate medical care by the obstetrician/gynecologist, and each deserves medical attention that respects their dignity and humanity. In an abortion-centric culture like our own, this fact can be difficult to properly appreciate.
Ms. Wetzel seems to navigate around this central ethical consideration in her letter by drawing our attention towards a flawed criterion, namely, the “least invasive intervention” for the mother. Thus, she seems to imply that a non-surgical approach like methotrexate (aimed at preserving fertility in both fallopian tubes rather than just one) should be seen as acceptable, even if it might also be aimed at securing the death of the ectopic child.
In my article I note how avoiding a direct attack on the child by removing the affected tube offers a morally acceptable alternative, even though the mother will unfortunately suffer a partial loss of her fertility.
The article’s conclusion bears repetition: “Some say that cutting out a section of the tube with a baby inside is no different than using methotrexate because, in either case, the baby ends up dying. Yet the difference in how the baby dies is, in fact, critical. There is always a difference between killing someone directly and allowing someone to die of indirect causes. We may never directly take the life of an innocent human being, though we may sometimes tolerate the indirect and unintended loss of life that comes with trying to properly address a life-threatening medical situation.”
All of us, and particularly medical professionals, have an obligation to examine the influence on our own thinking by a culture which has devalued human life through its acceptance of abortion.
If we cloak our arguments in terms of “respecting life” but then go on to counsel the protecting of a mother’s fertility by a direct violation of the life of her own child, we further the nefarious agenda of those who claim that embryonic humans are less valuable than those of us who have had the privilege of birth.
Rev. Tadeusz Pacholczyk, Ph.D., Director of Education
The National Catholic Bioethics Center, Philadelphia, Pa.