Abortion, gentlemen, is the theme of my present lecture.
I. An important point to be determined is the precise time when the
human embryo is first animated by its own specific principle of life,
its human soul. It is interesting to read what various conjectures have
been ventured on this subject by the learned of former ages. They were
totally at sea. Though gifted with keen minds, they had not the proper
data to reason from. And yet some of those sages made very shrewd
guesses. For instance, as early as the fourth century of our era,
St. Gregory of Nyssa taught the true doctrine, which modern science has
now universally accepted. He taught that the rational soul is created by
Almighty God and infused into the embryo at the very moment of
conception. Still, as St. Gregory could not prove the certainty of his
doctrine, it was opposed by the majority of the learned.
The Schoolmen of the Middle Ages, while condemning abortion from the
time of conception, preferred the opinion of Aristotle, that the
rational soul is not infused till the fœtus is sufficiently developed to
receive it. The embryo lived first, they taught, with a vegetable life;
after a few days an animal soul replaced the vegetative principle; the
human soul was not infused into the tiny body till the fortieth day for
a male, and the eightieth day for a female child. All this sounds very
foolish now; and yet we should not sneer at their ignorance; had we
lived in their times, we could probably have done no better than they.
It was not till 1620 that Fienus, a physician of Louvain, in Belgium,
published the first book of modern times that came near the truth. He
maintained that the human soul was created and infused into the embryo
three days after conception. Nearly forty years later, in 1658, a
religious priest, called Florentinius, wrote a book in which he taught
that, for all we know, the soul may be intellectual or human from the
first moment of conception; and the Pope's physician Zachias soon after
maintained the thesis as a certainty that the human embryo has from the
very beginning a human soul.
Great writers applauded Fienus and his successors; universities favored
their views; the Benedictines, the Dominicans, and the Jesuits supported
them. Modern science claims to have proved beyond all doubt that the
same soul animates the man that animated the fœtus from the very moment
of conception. The "Medical Jurisprudence" of Wharton and Stillé quotes
Dr. Hodge of the Pennsylvania University as follows (p. 11): "In a most
mysterious manner brought into existence, how wonderful its formation!
Imperfect in the first instance, nay, even invisible to the naked eye,
the embryo is nevertheless endowed, at once, with the principles of
vitality; and although retained in the system of its mother, it has, in
a strict sense, an independent existence. It immediately manifests all
the phenomena of _organic_ life; it forms its own fluids and circulates
them; it is nourished and developed; and, very rapidly from being a
_rudis indigestaque moles_, apparently an inorganic drop of fluid, its
organs are generated and its form perfected. It daily gains strength and
grows; and, while still within the organ of its mother, manifests some
of the phenomena of animal life, especially as regards mobility. After
the fourth month its motions are perceptible to the mother, and in a
short period can be perceived by other individuals on close
investigation.
"The usual impression," the authors add, "and one which is probably
still maintained by the mass of the community, is that the embryo is
perfected at the period of quickening--say the one hundred and twelfth
or one hundred and twentieth day. When the mother first perceives
motion, is considered the period when the fœtus becomes animated--when
it receives its spiritual nature into union with its corporeal.
"These and similar suppositions are, as has been already shown, contrary
to all fact, and, if it were not for the high authorities--medical,
legal, and theological--in opposition, we might add, to common-sense."
At present, gentlemen, there seems to be no longer any authority to the
contrary. But many people, and some Doctors, seem to be several
generations behind the times; for they still act and reason as if in the
first weeks of pregnancy no immortal or human soul were in question.
Physicians worthy of their noble profession should strive to remove such
gross and mischievous ignorance. In many of the United States the law
casts its protection around an unborn infant from its first stage of
ascertainable existence; no matter whether "quickening" has taken place
or not, and consequently no matter what may be the stage of gestation,
an indictment lies for its wilful destruction (Wharton and Stillé,
p. 861). "Where there has been as yet no judicial settlement of the
immediate question, it may be reasonably contended that to make the
criminality of the offence depend upon the fact of quickening is as
repugnant to sound morals as it is to enlightened physiology" (ib.).
"That it is inconsistent with the analogies of the law is shown by the
fact that an infant, born even at the extreme limit of gestation after
its father's death, is capable of taking by descent, and being appointed
executor" (ib.). Dr. Hodge adds this sensible remark: "It is _then_ only
[at conception] the father can in any way exert an influence over his
offspring; it is _then_ only the female germ is in direct union with the
mother--the connection afterwards is indirect and imperfect" (ib.). The
fact, therefore, is now scientifically established that the embryo from
the first moment of conception or fecundation is a human being, having a
human immortal soul.
II. Now we come to the direct study of abortion. Abortion, or
miscarriage, strictly means the expulsion of the fœtus before it is
viable, i.e., before it is sufficiently developed to continue its life
outside of the maternal womb. The period of arrival at viability is
usually after the twenty-eighth week of gestation. When birth occurs
later than that period, and yet before the full term of nine months, it
is called _premature birth_, which is altogether different from
abortion; for it may save the life of the child, which abortion always
destroys. "Premature labor is frequently induced in legitimate medical
practice, for the purpose of avoiding the risks which in some cases
attend parturition at term.... The average number of children saved by
this means is rather more than one-half of the cases operated upon," say
Wharton and Stillé ("Parturition," p. 96). But they caution the
physician against too ready recourse to this treatment; for, they add
very truly, "The sympathetic phenomena of pregnancy are often more
alarming in appearance than in reality, and will rarely justify any
interference with the natural progress of gestation. In all cases the
physician should consult with one or more of his colleagues before
inducing premature labor; in this manner his humane intentions will not
expose him, in case of failure, to reproach, suspicion, or prosecution."
The first time my attention was practically called to the case of a
child in danger of dying before the time of delivery occurred over
twenty years ago, when the mother of a highly respected family, then in
my spiritual charge, was wasting away with consumption during her state
of pregnancy. You know that we Catholics are very solicitous that
infants shall not die without Baptism, because we believe that heaven
is not promised to the unbaptized. I therefore directed the lady's
husband to consult their family physician on the prospects of the case,
and take timely precautions, so that, if death should come on the mother
before her delivery, the infant might be reached at once and be baptized
before it expired. The physician, a learned and conscientious
practitioner, answered that we should not be solicitous; for that Nature
had so provided that mothers in such cases rarely die before the child
is born. He was right. The child was born and baptized; the mother died
a few hours later; the little one lived several weeks before it went to
join the angels in heaven. I learned from that occurrence the lesson
which Wharton and Stillé inculcate that "the phenomena of pregnancy are
often far more alarming in appearance than in reality, and we are rarely
justified in interfering with the natural progress of gestation."
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.
2. If the medicine is not necessary to save the mother's life, though
very useful, for the sake of such an advantage, you cannot justly expose
the child's life to serious danger.
3. But if the danger it is exposed to is not serious but slight, and the
remedy, though not necessary, is expected to be very useful to the
mother, you may then administer the medicine; for a slight risk need not
prevent a prudent man from striving to obtain very good results.
4. But what if the drug is necessary to save the mother, and as
dangerous to the child as it is beneficial to her; can you then give the
medicine with the moral certainty that it will save her and kill her
child? When we know principles clearly we can apply them boldly. I
answer then with this important distinction: you can give such medicine
as will act on her system, her organs, in a manner to save her life, and
you may permit the sad effects which will indirectly affect the child;
but you cannot injure the child directly as a means to benefit her
indirectly; that would be using a bad means to obtain a good end.
Suppose, then, what is said to be a real case of occasional recurrence
in obstetrical practice, namely, that a pregnant mother is seized with
violent and unceasing attacks of vomiting, so that she must die if the
vomiting be not stopped; and you, as well as the consulting physician
called in, can discover no means of relieving the vomiting except by
procuring an abortion, by relieving the womb of its living burden.
Abortion is then the means used to stop the vomiting. Are you justified
in using that means? Abortion is the dislodging of the child from the
only place where it can live and where nature has placed it for that
purpose. Therefore abortion directly kills the child, as truly as
plunging a man under water kills the man. Can you thus kill the child to
save the mother? You _cannot_. Neither in this case nor in any other
case can you do evil that good may come of it.
You notice, gentlemen, that I lay great stress on, this principle that
_the end can never justify the means_. It is an evident principle, which
all civilized nations acknowledge. Its opposite, that the end justifies
the means, is so odious that the practice of it is a black stamp of
ignominy on any man or any set of men that would be guilty of it. The
Catholic Church has, all through her course of existence, taught the
maxim that the end cannot justify the means. She has impressed it on the
laws and hearts of all Christian peoples. She inculcates it in the
teachings of all her theologians and moral philosophers and in all her
channels of education. And since we Jesuits are among her leading
educators and writers, we have maintained that thesis in thousands of
printed volumes, as firmly as I am maintaining it before you to-day. No
Jesuit ever, nor any Catholic theologian or philosopher, has taught the
contrary. And yet even such pretentious works as the "Encyclopædia
Britannica" have carried all over the earth the slander that we teach
the opposite maxim, that the end does justify the means, and the odious
term _Jesuitry_ has been coined to embody that slander.
Is it not strange then, very strange, that they who thus falsely accuse
us are often the very men who will procure an abortion to save the
mother's life, who will do wrong that good may come of it? And you find
such men maintaining the lawfulness of abortion on the plea that the
operation, whether licit or not, is a necessary means to obtain a good
end.
IV. Gentlemen, if once you grant that grave reasons would justify
abortion, there is no telling where you will stop in your career of
crime. To-day, for instance, you are called to attend a mother, who, you
think, must die if you do not bring on a miscarriage. You are urged to
do it by herself and her husband, and perhaps by other physicians. There
are money considerations too, and the possible loss of practice. Will
you yield to the temptation? The next day you are visited by a most
respectable lady; but she has been unfaithful to her marriage vow. The
consequences of her fall are becoming evident. If her husband finds out
her condition, he may wreak a terrible vengeance. Her situation is
sadder than that of the sick mother of the preceding day. You can easily
remove the proof of her guilt, we will suppose, and spare a world of
woes. Will you withstand the temptation? The third day comes a young
lady, a daughter of an excellent family; bright prospects lie before
her; her parents' lives and happiness are wrapped up in that girl. But
in an evil hour she has been led astray. Now she is with child. She
begs, she implores you to save her from ruin, and her parents from
despair. If you do not help her, some other Doctor or a quack will do
it; but you could do it so much better. If you should have yielded on
the two former occasions, if you have already stained your heart with
innocent blood, will you now refuse? Where are you going to draw the
line?
The passions of men are insatiate, even in modern society; the more you
yield to them, the stronger grows their craving. Let me illustrate my
meaning by a fact that happened a few years ago in Russia. It is just to
our point. During a severe winter, a farmer, having his wife and
children with him on a wagon, was driving through a wild forest. All was
still as death except the howling of wolves in the distance. The howling
came nearer and nearer. After a while a pack of hungry wolves was seen
following in the track of the wagon. The farmer drove on faster, but
they gained on him. It was a desperate race to keep out of their reach.
At last they are just back of the wagon. What can be done? The next
moment the wolves may jump on the uncovered vehicle. The children,
horrified, crouch near their trembling mother. Suddenly the father,
driven to despair, seizes one of the little children and flings it among
the pack of wolves, hoping that by yielding them one he may save the
rest. The hungry beasts stop a few moments to fight over their prey. But
soon they are in hot pursuit again, fiercer because they have tasted
blood. A second child is thrown to them, and after a while a third and a
fourth.
Human society, gentlemen, in this matter of sacrificing fœtal life is as
insatiable as a pack of hungry wolves. Woe to any one of you if he
begins to yield to its cravings; there is no telling where he will stop.
In proof of my statement, let me read to you an extract from a lecture
on Obstetrics, delivered by Doctor Hodge, of Philadelphia, to the
medical students of the University of Pennsylvania: "We blush while we
record the fact, that, in this country, in our cities and towns, in this
city where literature, science, morality, and Christianity are supposed
to have so much influence; where all the domestic and social virtues are
reported as being in full and delightful exercise; even here
individuals, male and female, exist who are continually imbruing their
hands and consciences in the blood of unborn infants; yea, even medical
men are to be found who, for some trifling pecuniary recompense, will
poison the fountains of life, or forcibly induce labor, to the certain
destruction of the fœtus and not infrequently of the parent.
"So low, gentlemen, is the moral sense of the community on this subject,
so ignorant are the greater number of individuals, that even mothers, in
many instances, shrink not from the commission of this crime, but will
voluntarily destroy their own progeny, in violation of every natural
sentiment and in opposition to the laws of God and man. Perhaps there
are few individuals in extensive practice who have not had frequent
applications made to them by the fathers and mothers of unborn infants
(respectable and polite in their general appearance and manners) to
destroy the fruit of illicit pleasure, under the vain hope of preserving
their reputation by this unnatural and guilty sacrifice.
"Married women, also, from the fear of labor, from indisposition to have
the care, the expense, or the trouble of children, or some other motive
equally trifling and degrading, have solicited that the embryo should be
destroyed by their medical attendant. And when such individuals are
informed of the nature of the transaction, there is an expression of
real or pretended surprise that any one should deem that act improper,
much more guilty; nay, in spite even of the solemn warnings of the
physician, they will resort to the debased and murderous charlatan, who,
for a piece of silver, will annihilate the life of the fœtus, and
endanger even that of its ignorant or guilty mother.
"This low estimate of the importance of fœtal life is by no means
restricted to the ignorant or to the lower classes of society. Educated,
refined, and fashionable women, yea, in many instances, women whose
lives are in other respects without reproach--mothers who are devoted
with an ardent and self-denying affection to the children who already
constitute the family--are perfectly indifferent concerning the fœtus
_in utero_. They seem not to realize that the being within them is
indeed _animate_, that it is in verity a _human_ being, body and spirit;
that it is of importance; that its value is inestimable, having
reference to this world and the next. Hence they in every way neglect
its interests. They eat and drink, they walk and ride; they will
practise no self-restraint, but will indulge every caprice, every
passion, utterly regardless of the unseen, unloved embryo....
"These facts are horrible, but they are too frequent and too true;
often, very often, must all the eloquence and all the authority of the
practitioner be employed; often he must as it were grasp the conscience
of his weak and erring patient, and let her know, in language not to be
misunderstood, that she is responsible to her Creator for the life of
the being within her." (Wharton and Stillé's Med. Jur., Parturition,
p. 92.)
Dr. Walter Channing, of Massachusetts, refers to the difficulty of
obtaining a conviction for abortion, and adds: "I believe there has
never been one in this State, this moral State by eminence, and perhaps
in none is this crime more rife." ("Boston Med. and Surg. Journal,"
April, 1859, p. 135).
V. We have, then, proved, gentlemen, two important and pregnant
principles: 1. That we can never directly procure abortion, and 2, that
we can procure it indirectly in extreme cases; or rather that we can
take such extreme measures in pressing danger as may likely result in
abortion against our will.
While these principles are clear and undoubted, there are cases in which
the right application of them is beset with great difficulties. These
often occur in connection with what is called _ectopic_ or
_extra-uterine gestation_, namely, when the nascent human form lodges in
some recess not intended by nature for its abode. Of late years,
Dr. Velpeau, of Paris; Dr. Tait, of Birmingham, and many other eminent
physicians have shown that cases of ectopic gestation are more numerous
than had been supposed; one practitioner reports that he had attended
fifty cases, another eighty-five.
1. We will first suppose the case of an interior growth occurring, the
nature of which cannot be determined. It may be only a tumor, yet it may
be the growth of a living fœtus. If no immediate crisis is feared, you
will wait, of course, for further developments. If it proves to be a
child, you will attempt no operation till it becomes viable at least.
But suppose that fatal consequences are apprehended before the presence
of a human being can be ascertained by the beating of the heart; suppose
that delay would endanger the mother's life; and yet if you undertake to
cut out the tumor, you may find it to contain fœtal life. In such urgent
danger, can you lawfully perform the operation? Let us apply our
principles. You mean to operate on a tumor affecting one of the mother's
organs. The consequences this may have for the child are not directly
willed, but permitted. The four conditions mentioned before are hereby
verified, under which the evil result, the death of the possible fœtus,
may be lawfully permitted; namely: (_a_) You do not wish its death;
(_b_) What you intend directly, the operation on the mother's organism,
is good in itself; (_c_) The good effect intended, her safety, to which
she has an undoubted right, overbalances the evil effect, the possible
death of the child, whose right to life is doubtful, since its very
existence is doubtful; now, a certain right must take precedence of a
doubtful right of the same species; (_d_) The evil is not made the means
to obtain the good effect (see "Am. Eccl. Rev.," Nov., 1893, p. 353).
This last condition would not be verified if it were proposed, not to
cut out the cyst, but to destroy its contents by an electric current.
Then, it would seem, the fœtus itself, if there be one, would be
directly attacked.
2. The case would present greater difficulties if the growth in question
were _known_ to contain a living fœtus. Such a case is discussed in all
its details, with remarkable philosophical acumen, and in the light of
copious information furnished by prominent members of the medical
profession, in the pages of the "American Ecclesiastical Review" for
November, 1893, pages 331-360. The participants in this interesting
discussion are writers who enjoy a world-wide reputation for keenness of
intellect and soundness of doctrine in philosophical and theological
learning. They are not at all agreed as to the practical conclusion
arrived at, and even those who agree to the same conclusion do so for
different reasons. Three of them agree that in the case of a cyst known
to contain a living embryo, when a rupture most probably fatal to mother
and child is imminent, the abdominal section might be performed
lawfully, the cyst opened and the child baptized before its certain
death. Two of these justify this conclusion on the principle that the
death of the child is then permitted only or indirectly intended; one
maintains that the killing of the embryo is then directly procured, but
he considers that an embryo in a place not intended for it by nature is
where it has no right to be, and therefore may be treated as an unjust
aggressor upon the mother's life. At least one of the disputants
condemns the operation as absolutely unlawful.
Gentlemen, when such authorities disagree, I would not presume to
attempt a theoretic decision. But then we have this other principle
practically to guide us, that in matters so very doubtful we need not
condemn those who differ from our view, as long as they feel convinced
that they are acting wisely and prudently. In Jurisprudence, reason must
be our guide when it affords us evidence of the truth. But when our
reason offers arguments on both sides of the question, so that we can
arrive at no certain conclusion, then we act prudently by invoking the
authority of wiser minds who make moral questions a speciality, and we
are perfectly safe if we follow the best authority obtainable.
A Catholic physician has here a special advantage: for he has in cases
of great difficulty the decisions of Roman tribunals, composed of most
learned men, and renowned for the thoroughness of their investigations
and the prudence of their verdicts, to serve him as guides and vouchers
for his conduct. Although these tribunals claim no infallibility, yet
they offer all the advantages that we look for, with regard to civil
matters, in the decisions of our Supreme Court. These Roman courts have
uniformly decided against any operation tending directly to the death of
an innocent child ("Am. Eccl. Rev.," Nov., 1893, pp. 352, 353; Feb.,
1895, p. 171).
Non-Catholics are, of course, not obliged to obey such pronouncements;
yet, even for them, it cannot be injurious, but rather very useful, to
know the views of so competent a court on matters of the most vital
interest in their learned profession. This is the reason why the
"Medical Record" has published of late so many articles on the teachings
of Catholic authorities with regard to craniotomy and abortion (see vol.
xlvii. nos. 5, 9, 25; vol. xlviii. nos. 1, 2, 3, 4).