Double Effect Couldn't Help Savita

The story of a woman who died of sepsis as a result of her pregnancy is circulating today, and has sparked a new conversation about Catholic moral philosophy and double effect on my Facebook page.

In short, Savita Halappanavar sought treatment at a hospital in Ireland.  She was having a miscarriage and experiencing a lot of pain.  Savita requested an abortion to relieve the pain and complete the process which her body naturally began.  Her husband reported that:

This was refused, he says, because the foetal heartbeat was still present and they were told, “this is a Catholic country”.

She spent a further 2½ days “in agony” until the foetal heartbeat stopped.

....

The dead foetus was removed and Savita was taken to the high dependency unit and then the intensive care unit, where she died of septicaemia on the 28th.

The tragedy is that her death was completely preventable, had the doctors performed the abortion at Savita's request and administered strong doses of antibiotics.  Instead, they refused her request to directly terminate the pregnancy and apparently refused the antibiotics necessary to treat sepsis, assumedly because these strong antibiotics can be harmful in pregnancy.  

I posted this story on Facebook and a few Catholic friends responded to say that the doctors could have delivered the baby before treating Savita.  At 17 weeks the fetus would not be viable, but this would be an ethical way to handle her pregnancy under the Doctrine of Double Effect.

To review, the requirements of Double Effect are:

• the nature of the act is itself good, or at least morally neutral;
• the agent intends the good effect and not the bad either as a means to the good or as an end itself;
• the good effect outweighs the bad effect in circumstances sufficiently grave to justify causing the bad effect and the agent exercises due diligence to minimize the harm

In my opinion, Double Effect is bad moral philosophy, but in this scenario, there is simply no way to use Double Effect to escape the doctors' bad decision.

Under the first requirement, the act must be morally neutral.  However, as confirmed by Matt Yonke, who works for the Pro-Life Action League, delivering a baby at 17 weeks is essentially the same as abortion.  And as Catholic moral apologists like to say, "You can't do something evil in order to do good."

 Double Effect is often applied to ectopic pregnancy.   In this case, Catholic surgeons remove a woman's fallopian tube rather than opt for the less invasive option of drugs that would kill a fetus. Instead they opt for the more invasive procedure to remove the whole fallopian tube:

 [A] woman can have her whole tube removed (an unnecessary procedure that could reduce her future fertility), but she can not have the pregnancy plucked out (as is done with the standard therapy, a salpingostomy, where a small incision is made in the tube and the pregnancy removed) and she most certainly could not have the methotrexate [a cancer drug used to kill the rapidly dividing fetal cells].

This must be done to adhere to double-effect.

I think double-effect can't apply in Savita's case for the same reasons methotrexate cannot be used to treat ectopic pregnancy.  In order for it to apply one has to be accomplishing a side end, that coincidentally results in the loss of the fetus, but cannot treat the mother through a simple abortive procedure. The drugs required to naturally deliver the fetus at 17 weeks would essentially cause an abortion.  This is something the Catholic Church absolutely forbids. Of course, a c-section could be performed to deliver the baby, but since this carries an additional risk of infection, doing so would make it more difficult for the mother to recover from sepsis. Thus the outcome would more than likely be the same.

I think this shows why double-effect is moral rigamarole. In many cases, it simply can't be used, especially before the age of fetal viability. In other cases, the end result is the same for the fetus (dead), but the procedure used on the woman is more dangerous and invasive.

 Matt's response to this (Click to enlarge in a new window):

"[O]ne of the most unbelievably beautiful things a person can do is sacrifice their own life for the life of their child, or even for the knowledge that you didn't have your child killed."


I find this statement chilling when applied to this case.  No one should be legally obligated to sacrifice their life for anyone, including his or her child.  A person willingly making this sacrifice is a different matter, but it is still disturbing to venerate maternal death for a religious  or ideological reason.