In my former lectures, gentlemen, I explained to you the principles
condemnatory of craniotomy and abortion, viewing these chiefly from the
standpoint of the ethical philosopher and the jurist. Not being a
physician myself, I think it proper, on matters of so much importance,
to quote here freely from a lecture delivered on this subject by a late
professional gynecologist, an old experienced practitioner, who was for
many years a professor of obstetrics in the St. Louis Medical College. I
quote him with the more pleasure because of my personal acquaintance
with him, and of the universal esteem for ability and integrity in which
he was held by the medical profession.
Dr. L. Charles Boislinière, to whom I refer, had by his scientific
acquirements and his successful practice, during forty years of his
life, become, to a great extent, identified with the progress of the
science of obstetrics in this country; and a few months before his late
demise, he had published a useful work on "Obstetric Accidents,
Emergencies, and Operations."
In 1892 he read, before the St. Louis Obstetrical and Gynecological
Society, a lecture on the moral aspects of craniotomy and abortion, of
which a considerable portion is very much to our present purpose. The
Doctor herein clearly demonstrates that, in this matter at least, Ethics
and Medical Science are to-day perfectly concordant. He says:
"The operation of craniotomy is a very old one. The ancients entertained
the belief that, in difficult labors, the unborn child was an unjust
aggressor against the mother, and must, therefore, be sacrificed to save
her life.
"Hippocrates, Celsus, Avicenna, and the Arabian School invented a number
of vulnerating instruments to enter and crush the child's cranium. With
the advance of the obstetric art, more conservative measures were
gradually adopted, such as the forceps, version, induction of premature
labor, and, finally, Cesarean section.
"Cesarean section is reported to have been performed by Nicola de Falcon
in the year 1491. Nufer, in 1500, and Rousset, in 1581, performed it a
great many times, always successfully; so that, Scipio Murunia affirms,
it was as common in France during that epoch as blood-letting was in
Italy, where at that time patients were bled for almost every disease.
However, a reaction soon followed, headed by Guillemau and Ambrose Pare,
who had failed in their attempts at Cesarean section. In our days a
marked change of opinion on this interesting and delicate question is
rapidly taking place.
"With these advances in view, the question now is:
"_Are we ever justified in killing an unborn child in order to save the
mother's life?_
"This is a burning question, and the sooner and more satisfactorily it
is settled, the greater will be the peace to the medical mind and
conscience.
"In answer to the question, I, at the outset, reply _No_, and claim
that, under no conditions or circumstances, is it ever allowable to
destroy the life of the child in order to increase the mother's chances
of living. And the day may arrive when, by the law of the land, the act
will be considered criminal and punished as such. In support of this
opinion, and to illustrate this position, allow me to take a purely
ethical and medico-legal view of the subject, and to relate to you a
parallel case, as also the decision arrived at by the Lord Chief Justice
of England, Judge Coleridge, than whom there is not a greater jurist
living.
"The case is that of the British yacht 'Mignonette.' On July 5, 1884,
the prisoners Dudley and Stevens, with one Brookes and the deceased, an
English boy between 17 and 18 years of age, part of the crew of the
'Mignonette,' were cast away in a storm at sea 1,600 miles from the Cape
of Good Hope, and were compelled to take to an open boat.
"They had no supply of water, no supply of food, and subsisted for
twenty days on two pounds of turnips and a small turtle they had caught.
They managed to collect a little rain-water in their oil-skin capes.
"On the eighteenth day, having been without food for seventeen days and
without water for five days, the prisoners suggested that some one
should be sacrificed to save the rest. Brookes dissented, and the boy,
to whom they referred, was not consulted. On that day Dudley and Stevens
spoke of their having families, and of their lives being more valuable
than that of the boy. The boy was lying in the bottom of the boat, quite
helpless, extremely weak and unable to make any resistance; nor did he
assent to be killed to save the others. Dudley, with the assent of
Stevens, went to the boy and, telling him that his time had come, put a
knife into his throat and killed him. They fed upon his flesh for four
days. On the fourth day the boat was picked up by a passing vessel, and
the sailors were rescued, still alive but in a state of extreme
prostration.
"The prisoners were carried to the port of Falmouth and committed for
trial, the charge being murder. Their excuse was that, if they had not
killed the boy and fed upon his flesh, there being no sail in sight,
they would have died of starvation before being rescued. They said that
there was no chance of saving their lives, except by killing some one
for the others to eat. The prisoners were committed for murder and
sentenced to death, but appealed to the mercy of the court, pleading
ignorance. It was found by the verdict that the boy was incapable of
resistance, and authorities were then quoted to prove that, in order to
save your own life, you have the right to take the life of an unjust
aggressor in self-defence--a principle the truth of which is universally
admitted.
"But the evidence clearly showed that the defenceless boy was not an
unjust aggressor against their lives, and, consequently, their only plea
was that of expediency.
"In a chapter in which he deals with the exception created by necessity,
Lord Hale, quoted by Justice Coleridge, thus expresses himself:
"'If a man be desperately assaulted and in peril of death, and cannot
otherwise escape, except by killing an innocent person then present, the
act will not acquit him of the crime and punishment of murder; for he
ought rather to die himself than to kill an innocent.'
"In the case of two men on a plank at sea, which can only support one,
the right of one occupant to throw the other overboard to save his own
life, and in the instance of sailors, to save themselves, throwing
passengers in the sea, are equally condemned by Lord Coleridge as
unjustifiable homicide. So that under no circumstances is it allowable
to kill an innocent aggressor to save your own life. I say _innocent_
aggressor; but it is allowed, in self-defence, to kill, if necessary, an
_unjust_ aggressor against your life.
"This case is exactly analogous to that of the child lying helpless in
its mother's womb. She causes its death by her consent to the act of her
agent, the physician in attendance.
"Remark that Brookes, one of the sailors, dissented to the killing of
the sailor-boy. This may happen in consultation, when one of the
consultants does not admit the right to kill an unborn child. Please
also remember that the sailor-boy lay helpless at the bottom of the
boat when his assailants killed him to save their own lives.
"The child is not an unjust aggressor against the mother. It is placed
in the womb without its consent and is defenceless. It is the mother who
is, as it were, the aggressor from the obstacles caused by a deformed
pelvis, tumors, etc.; and she has not the right to ask or consent to the
killing of the child who does not attack her.
"Therefore, I repeat that the two cases are analogous; and if, as
remarked by Justice Coleridge, murder was committed in the first
instance, so is murder committed in the analogue. So, we see, the
principal points of the opinion enunciated by the learned judge, and the
principles therein laid down, can, with equal force, be applied to the
non-justification of craniotomy, by which the life of a defenceless
child is sacrificed to save the mother.
"Notice also that two of the perpetrators of the deed claimed that they
had families, and that their lives were more valuable than that of the
murdered boy. By craniotomists this reason or excuse is frequently given
with much sentimentality to justify the killing of the child. The child,
they say, has no social value, the mother is the idol of her husband,
the pride of the household, often an ornament to society, the mother of
living or possible children. Therefore, her life is more valuable than
that of the unborn child. But who is to be the judge of the value of
life? Were not Scipio Africanus, Manlius, was not Cæsar, from whom the
very name of the operation, delivered by section from their mother's
womb? The operation was familiarly known to Shakespeare, who tells us:
'Macduff was from his mother's womb untimely ripped.'
"There can never be a necessity for killing--except an unjust aggressor
and in self-defence--unless the killing can be justified by some
recognized excuse admitted by the law. In the case of the murdered
sailor-boy, there was not such an excuse, unless the killing was
justified by what has been called necessity. But, as stated above, there
never is an excuse for killing an innocent aggressor, and the temptation
to the act and its expediency is not what the law has ever called
necessity. Nor is this to be regretted; for if in this case the
temptation to murder and the expediency of the deed had been held by law
as absolute defence of the deed, there would have been no guilt in the
case. Happily this is not so. The plea of necessity once admitted might
be made the legal cloak for unbridled passions and atrocious crimes,
such as the producing of abortion, etc.
"As in the case of this young sailor, so in the killing of an unborn
child, no such excuse can be pleaded; the unborn child cannot be the
aggressor, no more so than the defenceless sailor-boy was.
"To preserve one's life is, generally speaking, a duty: but it may be
the plainest duty, the highest duty, to sacrifice one's life. War is
full of such instances in which it is not man's duty to live, but to
die. The Greek and Latin authors contain many examples in which the duty
of dying for others is laid down in most glowing and eloquent language.
"'_Dulce et decorum est pro patria mori_,' says Horace. Such was heathen
ethics, and it is enough in a Christian country to teach that there is
not always an absolute and unqualified necessity to preserve one's life.
"Thus, as a parallel case, is the situation of a woman in a difficult
labor, when her life and that of her unborn child are in extreme danger.
In this instance, it is the mother's duty to die rather than to consent
to the killing of her child.
"In a subject of such delicacy and importance I have avoided all
argument based upon the doctrines of any particular religion, and
considered the subject upon its purely ethical and scientific basis. I
am aware that I am taking a position quite at variance with that
occupied by many men influenced by former teachings and prejudices.
"I respect the honest convictions of those opposed to the opinions
presented in this paper. But it is hoped that thoughtful physicians will
soon reconsider their views and adopt a more just and humane method of
dealing with the rights of a living unborn child.
"As a hopeful sign, it is to be noticed that a gradual change is taking
place in the opinions of the profession as to the propriety of
performing craniotomy. Busey says: 'To state the issue plainly, the
averment must be made that no conscientious physician would deliberately
and wilfully kill a fœtus, if he believed that the act was a violation
of the commandment "Thou shalt not kill."' It has been well said by
Barnes, the ablest and most conservative defender of craniotomy, that
'it is not simply a question for medicine to decide. Religion and the
civil law claim a preponderating voice. In the whole range of the
practice of medicine, there arises no situation of equal solemnity.'
"Having thus far considered the subject from a purely ethical
standpoint, I shall now present its scientific and practical aspect.
"Parvin says that the improved Cesarean section has given in Germany
results so satisfactory that, possibly, the day is at hand when
craniotomy upon the living fœtus will be very rarely performed, if done
at all. Kinkead, a high English authority, states: 'To reduce the bulk
of the child, or to extract it afterward through a pelvis of two and
one-half or less conjugate diameter, is an operation of extreme
difficulty, lengthy, requiring a very great experience, as far as the
mother is concerned, requiring an amount of manual dexterity rarely to
be acquired outside of a large city. While, on the other hand, the
Cesarean section is an easy operation, capable of successful performance
by any surgeon of ordinary skill.'
"Tait remarks that he 'feels certain that the decision of the profession
will be, before long, to give up the performance of such operations as
are destructive to the child, in favor of an operation that saves it,
and subjects the mother to little more risk. The operation of Cesarean
section, or the Porro amputation of the pregnant womb, will
revolutionize the obstetric art, and in two years we shall hear no more
of craniotomy; for the improved method will save more lives, and is far
easier of performance. It is the easiest operation in abdominal surgery,
and every country practitioner ought to be able, and always prepared, to
do it.' So said Lawson Tait in 1888.
"I could quote many other authorities, showing the change that is taking
place in the profession upon this important question. It is established
by the consensus of professional opinion that craniotomy has been
frequently performed in cases where delivery could have been safely
accomplished by the forceps, turning, and even by the unaided power of
nature (Busey); and there is no case known to him where a woman, on whom
a section had been successfully performed, has refused to submit to its
repetition in subsequent pregnancies. In Belgium the Cesarean section
has been performed seven times on the same woman, and in Philadelphia
three times. Doctor Bretoneaux, of Tours, has performed it six times on
the same woman; and this woman his wife. 'The brutal epoch of craniotomy
has certainly passed. The legitimate aspiration and tendency of science
is to eliminate craniotomy on the living and viable child from obstetric
practice.'--Barnes' words as quoted by Busey. Tyler Smith is in perfect
accordance with Barnes. Barnes again writes: 'For the Cesarean section
two very powerful arguments may be advanced. First, that the child is
not sacrificed. Second, that the mother has a reasonable prospect of
being saved.'
"Late reports of the Dublin Rotunda Hospital show that, in 3,631 cases
of labor, craniotomy was performed only four times, and in three of
these, positive diagnosis of the child's death was ascertained before
the operation. In one of these cases the diagnosis was doubtful.
"More Madden, a celebrated obstetrician of forty years' experience,
never performed it once.
"'The brilliant achievements in abdominal surgery give assurance that
the Cesarean section is not only a legitimate operation, but one almost
free from danger; also, that the tragic scenes heretofore witnessed in
certain cases, in which the destruction of the child was resorted to,
may be relegated to history (A. P. Clarke).'"
Further on, Dr. Boislinière speaks more directly of abortion. He says:
"The principle once admitted that you are not justifiable in killing an
innocent aggressor except in self-defence, equally prohibits any
interference with early gestation.
"From the moment of conception the child is living. It grows, and what
grows has life. '_Homo est qui homo futurus_,' says an ancient and high
authority.
"Therefore, fœticide is not permissible at any stage of utero-gestation.
"The killing of the defenceless fœtus is sometimes done in cases of
uncontrollable vomiting of pregnancy, in cases of tubal or abdominal
gestation, and the killing of the fœtus is done by electricity,
injections of morphine in the amniotic sac, the puncturing of that sac,
etc.
"This practice is too lightly adopted by thoughtless or conscienceless
physicians. This practice is much on the increase. I once heard a known
obstetrician of the old school say: 'I would as lief kill, if necessary,
an unborn child as a rat.' So much for the estimate he put on the value
of human life! _O tempora! O mores!_
"Is it not time that this wanton 'massacre of the innocents' should
cease?
"Without wishing to load this paper with elaborate statistics, I shall
furnish the latest arrived at in the two operations of craniotomy and
Cesarean section.
"In the combined reports of the clinics of Berlin, Halle, and Dresden,
the maternal mortality in craniotomy was 5.8 per cent--of course, one
hundred per cent of the children lost.
"In Cesarean section the maternal mortality was eight or eleven
per cent; children's mortality, thirteen per cent.
"Caruso, the latest and most reliable statistician, not an optimist,
sums up the results from the different clinics, and comes to the
conclusion that craniotomy shows ninety-three and one one-hundredth
mothers recover, Cesarean section eighty-nine and four one-hundredths.
"Caruso, therefore, concludes that craniotomy on the living child is to
be superseded by Cesarean section. He says, therefore, that the mother
has three chances out of four, and her child nine out of ten, for life.
"Leopold, as stated above, shows a much better result, viz.: ninety-five
mothers saved out of one hundred by Cesarean section, a result equal
that obtained in craniotomy."
You notice, gentlemen, that the eminent physician whom I have been
quoting speaks with much indignation of the killing of the embryo, when
he calls it a "massacre of the innocents." By this odious term we
usually denote the massacre of the babes at Bethlehem, ordered by the
infamous Herod to defend himself against the future aggression, as he
imagined, of the new-born King of the Jews. A craniotomist would, no
doubt, feel insulted at being compared with Herod. And yet, if we
examine the matter closely, we shall find that the two massacres,
Herod's and the craniotomist's, could only be defended by the same plea,
that of necessity. "Necessity knows no law," writes Dr. Galloway, in his
defence of craniotomy, to which I referred in a former lecture. "The
same law," he writes in the "Medical Record" for July 27, 1895, "which
lies at the basis of Jurisprudence in this respect justifies the
sacrifice of the life of one person when actually necessary for the
preservation of the life of another, when the two are reduced to such
extremity that one or the other must die. This is the _necessitas non
habet legem_."
Did not Herod look on the matter just in that light? Expecting Christ to
be, not a spiritual, but a temporal ruler, as the Jewish nation supposed
at the time, he looked upon it as a case of necessity to sacrifice the
lives of the innocents for his own preservation. "Necessity knows no
law" was his principle. True, many had to die on that occasion to save
one; but then he was a king. Anyhow, their death was necessary, and
_necessitas non habet legem_; that settles it: Herod must not be blamed,
on that principle. It is not even certain that, cruel as he was, he
would have confessed, with the modern obstetrician, "I would as lief, if
it were necessary, kill an unborn child as a rat."
Such sentiments, revolting as they are, and a disgrace to civilization,
are the natural outcome of rash speculations about the first principles
of morality.
The principle "_Necessitas non habet legem_" has indeed a true and
harmless meaning when properly understood; it means that no law is
violated when a man does what he is physically necessitated to do, and
that no law can compel him to do more than he can do. Thus a disabled
soldier cannot be compelled to march on with his regiment; necessity
compels him to remain behind. In this sense the principle quoted is a
truism; hence its universal acceptance. Applying the same principle in a
wider sense, moralists agree that human law-givers do not, and in
ordinary circumstances cannot, impose obligations the fulfilment of
which requires extraordinary virtue. Even God Himself does not usually
exact of men the performance of positive heroic acts. But no such plea
can be urged to justify acts which God forbids by the natural law.[1]
When necessity is used as a synonym for a "very strong reason," as it
is in the plea of the craniotomist, then it is utterly false that very
strong reasons for doing an act cannot be set aside by a divine law to
the contrary; what is wrong in itself can never become right, even
though the strongest arguments could be adduced in its favor. It would
be doing wrong that good may come of it, or making the end justify the
means. Such principles may be found in the code of tyrants and
criminals, but should not be looked for in the code of Medical
Jurisprudence.
[1] See this point more fully treated in the Author's "Moral
Philosophy," Book. I. c. ii., "The Morality of Human Acts."
There is but one plea left, I believe, on which, of late years, it is
sometimes attempted to justify the murder of little children. It is the
plea of some evolutionists who maintain that the infant has not yet a
true human soul. I should not deign to consider this theory if it were
not that I find it seriously treated by a contributor to the "Medical
Record," in an article which, on September 4, 1895, concluded a long
discussion on craniotomy published in that learned periodical.
The writer of this article asserts: "Procuring the death of the fœtus to
save the life of the mother is, I am sure, to be defended on ethical
grounds." And here is the way he attempts to defend it: "We may safely
assume," he argues, "that the theory of evolution is the best working
hypothesis in every branch of natural science. We are learning through
Herbert Spencer and all late writers on ethics and politics, that the
same principle will best explain the facts" (p. 395).
I do not deny that a certain school of scientists is trying to rewrite
all history and all Ethics and Jurisprudence. But the writer strangely
misstates the case when he says that "all great writers on ethics and
politics" agree with Mr. Spencer. Besides a multitude of others, Lord
Salisbury for one, has clearly shown of late that the school of agnostic
evolutionists is coming to grief; it has had its short day, and it is
now setting below the horizon of ignominy and subsequent oblivion. The
writer of the article in question does not attempt to prove the
evolution theory; therefore I need not stop to disprove it. But he makes
the following application of it to our subject--an application so
shocking to humanity and so revolting to common sense that, if it is
logical, it is by itself sufficient to refute the whole theory of
Mr. Spencer and his school.
He argues that, if that theory be admitted, it must necessarily follow
that, while the human embryo is from the first alive, it is not a human
being until it has developed and differentiated to such a point as
corresponds to that point at the birth of the race where the animal
becomes a man. "I am sure," he adds, "I do not know when that occurred
in the past, and I do not know at what point it occurs in the
individual.... In inquiring for that distinct feature which
distinguishes the man from the animal, I find none but mentality. If we
wait for distinct mentality to appear in the development of the
individual, it would be some time after birth."
According to this reasoning a child is not known to be a human being
till some time after its birth. And this is not uttered by some
speculative philosopher in his closet, but by a medical practitioner on
his daily rounds, tools in hand, as it were, to carry out his theory and
break the skulls of any and all luckless babes that may come in his way
in the exercise of what he calls his legitimate practice. How long after
birth the child remains without becoming a human being, he does not
pretend to know; they remain non-human till they manifest mental action.
Till then, not being human, he assigns them no human rights--no rights
at all which we are conscientiously obliged to respect. Herod may have
been right after all when he appointed the term of two years old and
under as the limit of the butchery at Bethlehem. The writer pretends to
lessen the horror inspired by his theory by referring to some
restrictions of canon law. But what do he and his like care about canon
law? He would be the first to scout the idea of letting canon law limit
his freedom of action and speculation.
What would be the real results in practical life if we were to accept as
rules of conduct these rash theories of agnostic philosophers and
infidel scientists? Justly does the writer proceed to say: "I am well
aware that the idea arouses antagonism and inflammatory denunciation in
some minds." Certainly it does. He adds: "That it [the idea] will prove
to be the true one, however, depends only on the truth of the general
theory of development." If this be the logical consequence of evolution,
or Darwinism, as he calls it, then all the worse for Darwinism. Society
cannot get along on a theory that begets such principles of action; the
more so since, in Spencer's and in Darwin's system, the human soul, even
in grown persons, is only a material modification of the body and
perishes with it in death. Hence there would be no responsibility after
death. On this theory the physician is only a lump of very curiously
evolved matter; he, too, like the embryo, is without an immortal soul,
is not a free being, and therefore is incapable of having rights or
duties.
Before we remodel our codes of Ethics and Jurisprudence by the admission
into them of such destructive and revolutionary principles, we shall at
least be allowed to challenge these aggressors and ask solid proof of
their rash innovations. We may address to them the wise words uttered
against similar speculators by one of the most logical of modern
reasoners, the illustrious Cardinal Newman. "Why may not my first
principles contest the prize with yours? they have been longer in the
world, they have lasted longer, they have done harder work, they have
seen rougher service. You sit in your easy-chairs, you dogmatize in your
lecture-rooms, you wield your pens: it all looks well on paper; you
write exceedingly well; there never was an age in which there was better
writing, logical, nervous, eloquent, and pure,--go and carry it out in
the world. Take your first principles, of which you are so proud, into
the crowded streets of our cities, into the formidable classes which
make up the bulk of our population: try to work society by them. You
think you can; I say you cannot; at least you have not as yet, it is to
be seen if you can.... My principles, which I believe to be eternal,
have at least lasted eighteen hundred years; let yours last as many
months.... These principles have been the life of nations; they have
shown they could be carried out; let any single nation carry out yours"
("Present Position of Catholics in England." p. 293).
Gentlemen, let no one trifle with the principles of Ethics and
Jurisprudence; human society cannot get along without them. Morality is
the heart of civilization: its principles are the life-blood, which it
sends forth to feed and warm and strengthen and beautify all the organs
of its earthly frame. A flesh-wound may be healed, a bone may be set, it
may knit and grow vigorous again; but you must not puncture the heart,
nor attempt to change the natural channels of the circulating blood,
under the penalty of having a corpse on your hands. So you must respect
the eternal laws that direct the current of man's moral actions, the
principles of Ethics and Jurisprudence.