By Lauretta Brown/National Catholic Register
Shortly after Roe v. Wade was overturned and pro-life states moved to ban abortion, a media narrative began to emerge that abortion bans would put women in danger, preventing them from lifesaving treatment in cases of ectopic pregnancy or miscarriage management.
Actress Halle Berry, for example, tweeted a graphic that read, “The treatment for an ectopic pregnancy is abortion. The treatment for a septic uterus is abortion. The treatment for a miscarriage that your body won’t release is abortion. If you can’t get these abortions, you die.”
But according to pro-life obstetrician-gynecologists, they have been able to provide lifesaving care in these situations without ever performing abortions, and they will continue to do so in the wake of Dobbs.
Dr. Christina Francis, a board member of the American Association of Pro-Life Obstetricians and Gynecologists (AAPLOG) and a practicing OB-GYN in Indiana, told the Register that “treating an ectopic pregnancy is not an abortion; it is a procedure to save a woman’s life.”
“It’s not even coded as an abortion in medical coding,” she pointed out.
Francis explained, “When we treat an ectopic pregnancy, our intent is to save the life of the mother, and that is absolutely needed. Our intent is not to end the life of that baby. Now, we do those procedures knowing that the unintended consequence is that that child is going to lose their life, but we have not intentionally done a direct action on that preborn child in order to end his or her life. These procedures in no way will be outlawed by any state that restricts abortion.”
Debunking Narratives
“Every state that I know of that has abortion restrictions that either automatically went into place when Roe was overturned or are debating potential abortion restrictions have life-of-the-mother exceptions, and many of the states actually have specific language in their laws that say an abortion is not referring to the treatment of an ectopic pregnancy,” she added.
Since Roe was overturned, abortion bans are currently in effect in seven states with more expected to go into effect in the coming weeks. The existing abortion bans in Alabama, Arkansas, Missouri, Oklahoma, South Dakota, Wisconsin and West Virginia all include exceptions for the life of the mother and some even include language stating that the removal of an ectopic pregnancy is not affected by the law.
In the case of a septic uterus, Francis said, “even if there’s still a heartbeat, our job as physicians is to intervene because that poses a threat to her life,” but “that can be done again in a way that doesn’t have direct action on that preborn baby, which many times can feel pain. We can induce her labor and allow her to deliver an intact child who she can hold and grieve.”
She said that in the case of a miscarriage, the “baby has already passed or its passing is inevitable, and in that situation then our duty is to the mother; and so that’s a situation that is not going to be impacted by the state laws.”
A recent Pew article said that “some clinics already are refusing to use mifepristone to help women pass an early miscarriage because the drug also can be used in medical abortions.”
Dr. Amy Domeyer-Klenske, an OB-GYN in Milwaukee who is vice chairwoman of the Wisconsin chapter of the American College of Obstetricians and Gynecologists, told Pew that without mifepristone, “doctors must either wait to see whether a patient passes the miscarriage on her own, or use less effective medications or perform a riskier surgical procedure.”
Francis countered this was an “illegitimate concern” because although there has been “a push recently, mostly by abortion proponents within the medical field, to use mifepristone in addition to misoprostol for miscarriage management,” doctors “have been using misoprostol alone to treat that condition, and, in fact, I use that in my practice.”
She referenced a 2018 study with 300 patients published in The New England Journal of Medicine that “claimed to show that if you add mifepristone to misoprostol for miscarriage management, it improves completion rates, meaning more women will successfully pass the baby and the placenta and any other pregnancy-related tissues.”
However, Francis said the study also found “that the women who received mifepristone in addition to misoprostol actually had a much higher hemorrhage rate than women who received misoprostol alone.” Consequently, “the vast majority of OB-GYNs are still using misoprostol” alone, Francis said.
She pointed out that the thousands of members of AAPLOG do not “perform abortions as part of our daily practice and medicine,” adding that “we have been providing excellent health care to our patients for decades.” She said she wanted “to calm the fears of so many out there that these laws that might restrict abortion are going to lead to women dying, when, in fact, we know that countries that have more restrictive abortion laws than the U.S. actually have better maternal mortality rates. So the data simply doesn’t bear out that restricting abortion is going to lead to the deaths of women.”
The Principle of Double Effect
Dr. Lester Ruppersberger, a retired OB-GYN in Pennsylvania and former president of the Catholic Medical Association, told the Register that there are difficult cases, such as giving a hysterectomy to a pregnant woman with uterine cancer, curing the woman but ending the life of the unborn baby. In that case, a physician can ethically perform the hysterectomy under the Principle of Double Effect, where “one particular action has two particular outcomes: One is good, and the other is evil. The good effect is the saving of the mother’s life; the bad effect is the death of the baby, but the death of the baby is not a desired consequence. It is a secondary outcome of the primary treatment of saving the mother’s life.”
Ruppersberger said that in treating ectopic pregnancy, the only ethically acceptable procedure is a partial salpingectomy, which is the removal of the portion of the fallopian tube where the baby is residing. “You’re removing a portion of damaged tissue, which is your primary surgical procedure and your primary intent. Within that damaged tissue there may be a living embryo, and your intent is not to kill the embryo directly, but the embryo will die if you remove the tissue because you’re cutting off its blood supply, but it is not your intent.”
He said another treatment, utilizing the anti-cancer drug methotrexate, directly targets the baby based on how it works, so it is not generally acceptable. But, he added, the use of methotrexate could be ethically acceptable in cases where “you don’t see a fetal heartbeat in the fallopian tube, and you make the determination that there is a fetal demise.” The third treatment option is a linear salpingectomy, which is a surgical procedure where you “make an incision in the fallopian tube and you go in and suck out or scrape out the baby and the placenta,” and it is not ethically acceptable because “you’re directly killing the baby.”
Father Tad Pacholczyk, director of education at the National Catholic Bioethics Center, told the Register that “The Ethical and Religious Directives for Catholic Health Care Services” from the U.S. Conference of Catholic Bishops address cases of ectopic pregnancy, stating “no intervention is morally licit which constitutes a direct abortion.” He said that “morally permissible approaches to resolving an ectopic pregnancy can never involve a direct attack on the embryonic human being, but may involve interventions, like a salpingectomy, that indirectly or secondarily result in a loss of the life of the young human.”
Pro-life legislation “should prohibit direct attacks on unborn human life, but should not preclude medical interventions that indirectly result in a loss of unborn life when the intention is to save the life of the mother and suitable alternatives are no longer available,” he said. “This is an example of the Principle of Double Effect, which is often misunderstood as permitting direct abortions in some cases.”
Father Pacholczyk again cited the USCCB’s “Ethical and Religious Directives,” which state, “Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of a pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the unborn child.”
Facing Ectopic Pregnancy
Mariah Buzza, a Catholic mom and the assistant director of health policy at the Catholic health-sharing ministry CMF Curo, told the Register about being in a position where she had to weigh treatment options for her ectopic pregnancy in March 2020.
At around six weeks of pregnancy, she received the diagnosis and described being apprehensive both because of the danger of the condition, but also knowing “certain treatments did not use abortifacients while others did.” She said after research she found that “a salpingectomy is considered morally safe because it doesn’t directly attack the life of the unborn child.”
“It’s really hard for me to see that the abortion advocates right now are identifying ectopic pregnancy loss as abortion because it’s not,” she said. “Our faith tells us an attack on human life is never right. Not all treatments for ectopic pregnancy do that, and many bioethicists recognize that within the Church.”
“When talking about ectopic pregnancies and medicine in general, the treatment we utilize must recognize the dignity and value of all human life,” she said. “I really believe my experience as a mother with an ectopic pregnancy taught me this.”
Abortionists’ Poor Standards of Care
Ruppersberger said he believes that bans on elective abortions will not “decrease the access to care because the clinics where abortions are done don’t provide those treatments. Planned Parenthood does not treat ectopic pregnancies; they do not provide care for miscarriages or missed abortions.”
Another pressing concern for women’s health for Ruppersberger is the Biden administration’s lifting of safety guidelines on the abortion medication mifepristone in December. He said the pill can now be prescribed “without the patient ever even seeing or talking to a doctor,” and “there will be no confirmatory ultrasounds, so ectopic pregnancies will be missed in those women who are actually taking the medical abortion pill, which are the majority of abortions now in the United States.”
Such a missed ectopic pregnancy could rupture, resulting in severe hemorrhaging and even death. He said abortion facilities, and not pro-life physicians’ offices, are the places where women may not receive essential care, including screenings and patient follow-up. He recalled treating patients who had attempted surgical abortions at Planned Parenthood, such as one woman who “did not have a complete termination of her pregnancy.” As a result, he had to operate to “empty the contents of what was started partially at an abortion clinic, only to find out a day or two later when I cultured her in the emergency room that she was also positive for chlamydia.” He then had to follow up with antibiotics “to treat her for a chlamydia infection, which she was never screened for when the original abortion provider was providing the abortion.”
In contrast, Father Pacholczyk said that respecting the dignity and value of all human life remains the focus of good health care, and Catholic hospitals are tasked with doing this in a preeminent way.
“It’s a great urban myth that banning elective abortions will decrease access to appropriate care for mothers,” he said.
“As a Catholic hospital treats and cares for both the mother and her unborn child, it remains committed never to crossing an important line: It may not directly take the life of an innocent human being as it cares for both patients. Catholic hospitals, nonetheless, are able to provide appropriate medical treatments that may result in the indirect loss of unborn life, tolerating that unintended loss when other alternatives are not available. Those admitted to Catholic health care institutions know one indisputable fact: They and their children will be treated using the highest standards of medical care, even as they remain safe from a direct assault upon either of their lives.”