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Chapter 8: Life, Health, and Bodily Inviolability

Question D: Is Abortion Always the Wrongful Killing of a Person?

Abortion sometimes is used to refer to any ending of a pregnancy, whether induced or a miscarriage, before the unborn can survive. But insofar as a miscarriage neither is nor presupposes any human act, it is a medical problem, posing no moral questions other than those relevant to any sort of fatal accident, for example, whether it was due to carelessness.

Considered as a human act, abortion is the deliberate ending of pregnancy before the unborn can survive, or, later, by a method chosen with the intention that the unborn not survive. It is not abortion to induce birth when the child is expected and intended to survive. (The morality of inducing birth should be judged in each case by the norms for accepting a risk to another’s life.)

In principle, the morality of killing the unborn is the same as that of killing people already born.48 Yet abortion presents two special difficulties. First, questions are raised about the status of the unborn: Are they really persons? When do people begin? Second, questions are raised about the application of relevant norms: In difficult cases, how can one act with proper regard for the lives of both the child and the mother? How does the distinction between intentional killing and accepting death as a side effect apply to acts that lead to the death of the unborn?49

1. It Is Reasonable to Hold that Human Persons Begin at Fertilization

Vatican II, pointing out that God has given human persons the responsibility of safeguarding life, draws the conclusion: “Therefore from the moment of its conception life must be guarded with the greatest care, while abortion and infanticide are unspeakable crimes” (GS 51). The Congregation for the Doctrine of the Faith points out that the Council’s teaching only summarizes and reaffirms unbroken Christian tradition: “The tradition of the Church has always held that human life must be protected and cherished from the beginning, just as at the various stages of its development.”50 So, John Paul II says nothing new in repeating over and over that human life is inviolable from the moment of conception.51

a) Personhood is not a status that other people confer. Persons exist only with other persons, and the social recognition of one’s personhood leads to social respect for one’s essential dignity and the fundamental rights flowing from it. Noting these facts, some draw the conclusion that personhood is a social status, rather like family membership or citizenship, which parents or society can confer or refuse to confer.52 However, the conclusion does not follow. While it is true that personhood does have important social implications, not everything social is subject to human determination, for human society itself presupposes persons and their essential attributes, including their equal personal dignity and fundamental rights. Moreover, the view that other people confer personhood conflicts with faith’s teaching that God creates all human persons in his own image and likeness, and destines each for a personal relationship with himself: “Before I formed you in the womb I knew you, and before you were born I consecrated you” (Jer 1.5; cf. Ps 139.13, Is 49.1, 2 Mc 7.20–23, Gal 1.15).

b) Personhood is not an attribute attained by development. Human individuals can claim and exercise their rights as persons only after becoming aware of their own interests. Some argue from this fact for a developmental view of personhood: that it begins only after birth, when a child becomes self-conscious, aware of his or her own future, and concerned about it. Until that happens, according to this view, unborn and even newborn babies are only potential persons.53 This argument also is fallacious. Human individuals can be persons with a right to life before they are aware of that right and able to claim it. So, unborn and newborn babies are not potential persons; they are actual persons, although they are only potentially self-conscious and concerned about their future as adults.

Both this notion of personhood and the previous one also miss what person usually means in ordinary language, where the word refers to newborn babies and the severely retarded as well as to normal, grown men and women.54 One can see why person is used as it is by considering how people think and talk about themselves. They regularly speak in ways that show they think of their personhood, not as an acquired trait, but as an aspect of what they are. When someone says “I was born at such and such a time and place,” the word I refers to the same being the speaker now is. This way of talking shows that the concept of person connotes an essential property, which implies that whatever has it necessarily has it and never exists without it. Hence, what people usually think of as an individual person simultaneously comes to be and becomes a person, and cannot cease to be a person without ceasing to be the individual he or she is.55 To use person in a different, special sense, and to say that unborn and newborn babies are only potential persons, as proponents of the developmental view do, is to manipulate language and discriminate against those who have not developed sufficiently to be aware of their right to life.56

c) Human persons are not realities other than their living bodies. Human persons can do things—think, make free choices, put things to use—which show that they are more than bodies. Moreover, not only Christians but most other people think a person’s soul (or spirit or ghost) somehow continues to exist after death. On the basis of such facts, some think human persons are spiritual realities essentially other than their living bodies, and they argue that, although abortion destroys a living human body, it does not destroy a person.57 This argument also is fallacious. Persons can be more than their bodies without being realities other than their bodies, since a whole can be more than one of its parts without being a reality other than that part.

Bodily life is an intrinsic good of persons (see above, A.2). Certainly, human persons are more than their bodies, and so persons cannot be identified exclusively with their bodies. Yet experience shows that one is not a reality other than one’s living body, since one is the subject of one’s bodily properties, processes, sensations, and feelings, just as truly as one is the subject of one’s intellectual knowledge, choices, and more-than-bodily use of things to achieve one’s purposes.58 Therefore, that persons transcend bodies does not provide any ground for supposing that in destroying a living human body abortion destroys something other than a person.

d) A personal soul should be considered present from conception. Relying on Aristotle’s biology, St. Thomas thought that an active power in the semen gradually forms a new living individual out of only potentially living matter (the menstrual blood) and that the developing body is not ready to be informed by a personal soul until at least forty days after conception.59 While Aristotle’s biology is universally rejected today, some nevertheless appeal to the theory of St. Thomas in support of the premise that, since the soul is the substantial form (that is, intrinsic, constitutive, determinative principle) of the living body and a substantial form can exist only in matter able to receive it, the personal soul can exist only in a highly organized body. They add a further premise, that specifically personal acts—thinking, making free choices—depend on sense organs and a brain. So, they conclude, an early embryo cannot be a human person, but is really only a prepersonal entity, which substantially changes into a person when the sense organs and brain begin to develop. (Against St. Thomas, they go on to assume that abortion of a prepersonal entity might be justified.)60

Even after being born, however, babies at first show no signs of being able to think and make free choices. The beginning of the brain’s development is not yet the bodily basis required for specifically personal acts but only its precursor. If this precursor satisfies the requirements of the theory of St. Thomas, there is no reason why precursors at earlier developmental stages should not also satisfy them. But modern biology makes it clear that each embryonic individual has from the outset its specific developmental tendency, which includes the epigenetic primordia (the sources for the development) of all its organs. Therefore, if the soul can exist only in a matter able to receive it, that fact does not mean that a human zygote cannot have a personal soul.61 It follows that the supposition that the human embryo is at first a prepersonal entity, which only later becomes a person, posits two entities where only one is necessary to account for the observed facts. But entities are not to be multiplied without necessity. Consequently, the view that the embryo becomes a person when the brain begins to develop should be rejected, and the personal soul should be considered to be present from conception.62

e) Absence of brain functioning is compatible with personhood. Some argue by analogy that, since brain death is sufficient to mark the death of the person, the onset of brain function is necessary to mark the person’s beginning.63 Some who propose this argument may think the irreversible loss of cerebral (higher brain) functions marks the person’s death, but that view is vulnerable to the same criticisms as the developmental view of the person’s beginning. However, only the irreversible loss of all brain functions is reasonably taken as marking the death of the person.64

When brain death is correctly understood, the argument by analogy fails, because it depends on the assumption that the absence of brain functioning has the same significance at life’s beginning as at its end. This is false, for when the whole brain is dead, there is no principle to integrate the functioning of the organism, and so the organism has ceased to be; therefore, the person is dead. By contrast, before the brain develops—even in the zygote (that is, the new, one-celled individual resulting from the fertilization of the ovum by a sperm)—something does integrate the whole embryo’s organic functioning, and so a unified human individual is developing. As the development of the whole goes on, so does the development of its integrating principle (whatever that is at various stages), until, finally, the mature brain integrates the mature individual’s functioning.

f) Absence of familiar personal qualities is compatible with personhood. Many arguments against the personhood of the unborn depend on common sense assumptions. For example, someone indicates some clear and striking difference between the early embryo and any experientially typical person, even a newborn: “The fertilized egg is much smaller than the period at the end of this sentence,” or “It has no eyes, no ears, no mouth, no brain, and, like a parasite, draws nourishment from the pregnant woman’s blood.” Pictures or drawings of very early embryos support such statements (just as pictures of twelve-week and older embryos support statements that they are persons), and this evidence is thought to show that the embryo becomes a person only after a period of development.

Such arguments are persuasive because they use imagery and directly affect feelings. Usually, in judging whether or not to apply a predicate to an experienced entity, one does not examine it to see whether it meets a set of intelligible criteria; instead, one judges by appearances, using as a guide past experience of individuals of that kind. Thus, people unfamiliar with snow and ice would find it strange that they are considered to be forms of water. The early embryo, usually never experienced, falls far outside the range of sensory standards for recognizing people; the test of appearances suggests that this strange entity is not a person. People react to images of early embryos as they might when seeing persons of a different race for the first time in their lives: those strangers surely are not people.

This argument can be answered only by dealing with its instances. In each case it is necessary to point out that, while the particular difference is striking because of the normal limits of human experience, entities that are different in that way certainly are living, human individuals.65 Then it can be pointed out that to deny that these individuals are persons simply on the basis of their small size or odd appearance would be discriminatory.

g) A person normally begins at conception. The preceding considerations show that human personhood cannot reasonably be denied of any living human individual; and the observed facts, as summarized by a biologist, show: “Fertilization in mammals normally represents the beginning of life for a new individual.”66 Therefore, conception, in the sense of fertilization—when the sperm and the ovum fuse—normally should be regarded as the beginning of a new person. But why normally and not always? Because the complications which sometimes arise require certain qualifications.67

Sometimes an early embryo divides and identical twins (or even more than two identical individuals) are formed. Moreover, abnormal fertilization can result in a hydatidiform mole: a growing mass of tissue, genetically distinct from the mother, but without the organization required to develop into a baby.68 While admitting that every living human individual is a person, some cite these and other facts in arguing that new human individuals do not begin at conception, when the sperm fertilizes the ovum. Instead, they say, conception results in a mass of separate and distinct cells from which a human individual arises only at the primitive-streak stage of development, when the embryo is implanted in the wall of the womb, and the new individual or individuals take definite shape with recognizable boundaries: a right side and a left side, a front and a back, a head end and a lower end. After that, the number of individuals will not change unless some die.69 Hence, they conclude, new human individuals, which are persons, begin two to three weeks after conception.

The first thing to notice is that the phenomena from which this argument begins are exceptions. Most unborn babies with their accessory tissues develop from a single zygote and are alone in developing from that zygote. So, in most cases individuality appears to begin at fertilization and to be continuous. Moreover, the facts do not support this theory’s assumption that fertilization and subsequent cell division keep giving rise to really distinct individuals until a small army of them form the true human individual.

When a new human divides into identical twins, one may speculate that perhaps the fertilized ovum contained primordia for two individuals from the outset. Even if not, however, such twins can be explained by saying that two generations have occurred rather than one, the first by the usual process of sexual reproduction, and the second by an unusual process of asexual reproduction: either the first individual reproduced by giving up part of itself, or the original individual ceased to be when it split, and two new individuals came to be. There is no logical or biological reason to reject this explanation.70

Some will object: But if this is so, when a couple have identical twins, they are really the grandparents of one or both of the babies, which is indeed odd. It is odd, but this oddity does not show that the explanation is faulty. Rather it shows that, while the facts provide some basis for saying that couples are “grandparents” of their identically twin offspring, there also are good reasons to follow ordinary usage and call them “parents.” But neither word’s meaning and connotations are entirely suited to the actual situation, which, being unusual, is bound to vex common sense.

A hydatidiform mole is a new organic individual, genetically both human and unique, but it is not a new human being. Why not? A sperm and an ovum are two distinct organisms, each an individual cell with its own membrane. A sperm loses its membrane when it enters the ovum; the ovum quickly reacts; the two cells fuse into one, and the process of development begins.71 The sperm and the ovum no longer exist as distinct entities; the activated ovum is a new, biologically human individual.72 If it has in itself the epigenetic primordia of a human body normal enough to be the organic basis of any intellectual act whatsoever, this new individual is a person. But the activated ovum lacks these primordia if it includes in itself anything predetermining it to develop into a hydatidiform mole.73

Nor does the fact that the embryo proper first becomes recognizable at the primitive-streak stage show that a substantial change brings the person into being only at this stage. For this line of argument is simply an appeal to common sense: everyone whom one knows has at least a recognizable, definitely shaped body; but prior to the primitive-streak stage, one cannot point out the embryo’s head end and lower end, its front and back, its right and left sides; so, prior to this stage there is no “real” human individual. Like all appeals to common sense, this argument is based on appearances. It does not show that a substantial change occurs at the primitive-streak stage, for it does not show that either a new individual or the epigenetic primordia of a developed human person are absent at fertilization.

h) Personhood is not disproved by a high mortality rate. Arguing that pregnancy losses before implantation are frequent, some theologians object to basing moral norms on the supposition that the new person begins at conception: “Will [today’s moral theologian] be able to admit that 50 percent of the ‘human beings’—real human beings with an ‘immortal’ soul and an eternal destiny—do not, from the very start, get beyond this first stage of a human existence?”74

The premise probably is false, since no one has shown that pregnancy losses are so high. However, even if the premise were true, the argument proves nothing. For many natural pregnancy losses are due to such severe chromosomal defects that the individual probably lacks the epigenetic primordia for a body normal enough to be the basis for any intellectual act (in which case, as explained above, these are not losses of human beings). Then too, for most of human history the infant mortality rate was very high. Are we to say that during that time infants were not persons? Theologically, moreover, the argument is presumptuous, since neither revelation nor reason shows that God cannot provide appropriately for those who never come to the use of reason.

2. Every Human Should Be Considered a Person from Fertilization

Someone might object: Since there are so many complicated arguments on this matter, perhaps room remains for further questions about whether every human should be considered a person from fertilization. But this objection lacks force. There is no end to the raising of theoretical questions, but there are very strong factual and theoretical grounds for thinking that almost every human person once was a fertilized human ovum. The counterpositions are weak. There is no room for practical doubt.

To be willing to kill what for all one knows is a person is to be willing to kill a person. Hence, in making moral judgments people should consider the unborn persons from the beginning, their lives instances of innocent human life. As the magisterium teaches: “From a moral point of view this is certain: even if a doubt existed concerning whether the fruit of conception is already a human person, it is objectively a grave sin to dare to risk murder.”75

3. The Norms Protecting Others’ Lives Apply to the Unborn

Given the preceding answer to questions about the personhood of the unborn, only someone prepared to discriminate against them will deny that killing an unborn human individual is as bad as killing anyone else, and accepting or risking such an individual’s death is as serious as accepting or risking anyone else’s death. Thus, the magisterium often treats the killing of the unborn as an instance of the killing of the innocent (see the statement of Pius XII, quoted in B.3.b, above).

Moreover, John Paul II sometimes focuses on the peculiar malice of abortion and articulates the various aspects of its immorality:

God willed the loving union of husband and wife to be the source of new life. He wishes to share, as it were, his creative power with husbands and wives, endowing them with procreative power. God desires that this tremendous power to procreate a new human life should be willingly and lovingly accepted by the couple when they freely choose to marry. Parenthood has a dignity all of its own, guaranteed by God himself. On my part I owe it to my Apostolic Office to reaffirm as clearly and as strongly as possible what the Church of Christ teaches in this respect, and to reiterate vigorously her condemnation of artificial contraception and abortion.
 Yes, from the moment of conception and through all subsequent stages, all human life is sacred, for it is created in the image and likeness of God. Human life is precious because it is a gift of God, whose love knows no limit; and when God gives life, it is forever. Whoever attempts to destroy human life in the womb of the mother, not only violates the sacredness of a living, growing and developing human being, and thus opposes God, but also attacks society by undermining respect for all human life. I want to repeat here what I stated when visiting my homeland: “If a person’s right to life is violated at the moment in which he is first conceived in his mother’s womb, an indirect blow is struck also at the whole moral order, which serves to ensure the inviolable goods of man. Among those goods, life occupies the first place. The Church defends the right to life, not only in regard to the majesty of the Creator, who is the first Giver of this life, but also in respect of the essential good of the human person.”76
Both contraception and abortion are wrong, but abortion destroys the life of an actual person made in God’s image, attacks society by undermining respect for all human life, and strikes a blow at the whole moral order, which protects not only life but every other basic human good.

a) Abortion usually is intentional killing of the unborn. An abortionist intends to kill the unborn baby. Usually, he or she does not will the baby’s death for its own sake; the abortionist’s immediate end is to provide the service sought by those who wish to terminate pregnancies, and that generally is a means to the ulterior end of being paid. Of course, performing abortions sometimes is required as part of a medical-training program. But regardless of their exact ends, abortionists regularly use techniques chosen to ensure the baby’s destruction. Regarding a live birth as an unfortunate complication, they sometimes fulfill their undertaking by disposing of the tiny newborn in a way that will guarantee his or her prompt death.

Men who urge an abortion, arrange it, or pay for it usually intend the baby’s death. While some are concerned for the woman and are trying to help her obtain what she wants, many consider cheap and easy abortion a welcome alternative to self-sacrificing love. Many men involved in abortion are irresponsible husbands or lovers, who have negligently generated a child whom they do not wish to support and father; others are trying to cope with the consequences of some other man’s irresponsibility, while minimizing their own burden.

Women who seek an abortion also usually intend the baby’s death. Most do not will that death as an end, for they do not simply hate the new life growing within them. But they have reasons for wishing they were not pregnant, reasons which sometimes are in themselves sound: health concerns or the desire to avoid hardship for existing children in an impoverished family. Most often, the woman is not prepared to accept the responsibilities of motherhood or, if she already has children, does not wish to add to her responsibilities. Perhaps she wanted to have a baby but now knows or fears that the baby she bears is suffering from some serious disease or defect, and so wishes to terminate this pregnancy and try again. Perhaps she was taken advantage of or even raped, perhaps she was betrayed by an unfaithful lover, perhaps she used contraceptives unsuccessfully. Regardless of the circumstances which led to the pregnancy, however, completing it, giving birth, and then giving up the baby are repugnant to the woman. The alternative of quickly getting rid of the child seems preferable.

Thus, a woman contemplating abortion usually has an ulterior end, good or bad, for wishing to undo the pregnancy, make everything (insofar as possible) as it was, and go on with her life just as if another new life had never been growing within her. Willing that ulterior end, she considers the proposal of pregnancy termination and adopts it by a free choice, knowing what this proposal really involves.

Of course, a pregnant woman, particularly one of low intelligence or little sophistication, can be so misinformed or confused that she truly believes that new life does not begin at conception; she simply does not grasp that her pregnancy means a child is growing within her. Thinking perhaps that the abortion will only bring on a delayed menstrual period or get rid of some sort of prepersonal beginning of life, she truly misunderstands what she is doing and is not merely engaging in self-deception and rationalization. In choosing abortion, all such a woman really intends is the prevention of a new person’s coming to be: contraception. Also, women often choose abortion with great anguish and reluctance, under pressure from a social worker, a parent, a husband, a lover, an employer, a landlord, her own desperate need; reluctantly consenting to abortion, a woman may suffer it with great anguish as the only way to avoid what appears to be some disaster.

The point here is not to judge and condemn women undergoing abortion or others involved. It is simply that if they know the truth, that the abortion will destroy the life of a baby, those who choose abortion or formally cooperate in it usually intend the baby’s death.77 Almost always there are other ways to forestall or deal with the problems which lead to the choice of abortion, but they would require self-control and self-sacrifice, and it is easy to see these as greater evils than ending incipient life “when necessary.”

b) Sometimes intentional abortion does not involve intentional killing. As explained above (in B.1), according to the analysis of action used in this work, intentional killing as a means is choosing (adopting a proposal) to kill or to do something understood in such a way that its very meaning implies bringing about death. By contrast, many classical moralists thought that “direct” killing as a means is positing an action that straightaway brings about death. In their view, all “direct” abortion is “direct” killing of the innocent. But on the view taken in this work, someone might choose to abort without choosing to kill.

For example, suppose a woman suffering from kidney disease becomes pregnant and wants to avoid the health problems that will result from carrying the child; or a woman becomes pregnant as a result of rape and wants to be freed of her ongoing suffering. In either case, and perhaps in a few others, in seeking abortion the precise object of the pregnant woman’s choice might be, not the baby’s death, but the termination of pregnancy as the necessary means to the end in view: a benefit expected to flow from the baby’s removal rather than from the baby’s death or any consequence of it. On this assumption, the proposal adopted is, not to kill the unborn baby, but to have him or her removed from the womb, with death as a foreseen and accepted side effect. An abortion carrying out such a choice would not be an intentional killing.

Someone might object that this analysis opens the way for everyone involved in abortions, even abortionists, to say they do not intend the baby’s death, but only accept it as a side effect of terminating pregnancy. Many involved already claim abortion is only pregnancy termination and deny that they are killing babies; however, what matters is, not what anyone says, but what is really included in the proposal adopted when abortion is chosen as a means to some ulterior end. For reasons already sketched out, most people choosing abortion probably do regard killing the baby as necessary to their end; they consider the alternatives, find getting rid of the baby less repugnant than any other option, and rationalize choosing that option as a lesser evil. Furthermore, nonintentional killing is one thing, justifiable killing quite another.

c) Abortion, even if not intentional killing, usually is wrong. Even if the proposal adopted in choosing abortion does not include the baby’s death, that death almost always is unjustly accepted. People are generally prepared to sacrifice anything but their moral integrity to save their own lives or the life of someone they love, and they generally want others on whom they and their loved ones depend to pay a very high price rather than accept their death. So, it is unfair to accept any innocent person’s death, especially that of a dependent, in order to avoid lesser burdens, including those imposed by pregnancy and giving birth, short of a threat to the mother’s own life.78 Therefore, even if an abortion to bring the experience of rape to an end or to solve some health problem posing no immediate threat to the mother’s life does not carry out a choice to kill the unborn, it still involves wrongfully accepting the baby’s death.

Some deny this conclusion, especially with respect to cases of rape.79 Women who have been victims of this crime have suffered a very great wrong. However, if pregnancy results, the unborn baby is entirely innocent of any wrong. Terminating the pregnancy neither corrects nor limits the wrong done by the rapist, but only adds wrong to wrong. Justice forbids this, while mercy demands that the wrong already done be limited and overcome, so far as possible, with healing love. People plainly should extend this love to women who are victims of rape, and the latter should extend it to the new person, if one comes to be as a result of the crime.

Women who have been raped need to reaffirm their own worth rather than allowing what they have suffered to deprive them of their sense of self-worth and integrity. This requires correctly drawing the line between evil and good: the rapist’s act was evil, but the woman who is raped remains good, and the baby, though unwelcome, proceeds in part from her, is innocent, and so belongs on her side of the line. To reaffirm herself, she must accept the baby’s goodness, with the conviction that nothing that happened can make her and her baby bad.80 Nurturing the baby until its birth, she can then decide whether or not to continue to accept the responsibilities of motherhood.

d) Sometimes the baby’s death may be accepted to save the mother. Sometimes four conditions are simultaneously fulfilled: (i) some pathology threatens the lives of both a pregnant woman and her child, (ii) it is not safe to wait or waiting surely will result in the death of both, (iii) there is no way to save the child, and (iv) an operation that can save the mother’s life will result in the child’s death.

If the operation was one of those which the classical moralists considered not to be a “direct” abortion, they held that it could be performed. For example, in cases in which the baby could not be saved regardless of what was done (and perhaps in some others as well), they accepted the removal of a cancerous gravid uterus or of a fallopian tube containing an ectopic pregnancy.81 This moral norm plainly is sound, since the operation does not carry out a proposal to kill the child, serves a good purpose, and violates neither fairness nor mercy.82

At least in times past, however, and perhaps even today in places where modern medical equipment and skills are unavailable, certain life-saving operations meeting the four conditions would fall among procedures classified by the classical moralists as “direct” killing, since the procedures in question straightaway would lead to the baby’s death. This is the case, for example, if the four conditions are met during the delivery of a baby whose head is too large. Unless the physician does a craniotomy (an operation in which instruments are used to empty and crush the head of the child so that it can be removed from the birth canal), both mother and child eventually will die; but the operation can be performed and the mother saved. With respect to physical causality, craniotomy immediately destroys the baby, and only in this way saves the mother. Thus, not only classical moralists but the magisterium regarded it as “direct” killing: a bad means to a good end.83

However, assuming the four conditions are met, the baby’s death need not be included in the proposal adopted in choosing to do a craniotomy.84 The proposal can be simply to alter the child’s physical dimensions and remove him or her, because, as a physical object, this body cannot remain where it is without ending in both the baby’s and the mother’s deaths. To understand this proposal, it helps to notice that the baby’s death contributes nothing to the objective sought; indeed, the procedure is exactly the same if the baby has already died. In adopting this proposal, the baby’s death need only be accepted as a side effect. Therefore, according to the analysis of action employed in this book, even craniotomy (and, a fortiori, other operations meeting the four stated conditions) need not be direct killing, and so, provided the death of the baby is not intended (which is possible but unnecessary), any operation in a situation meeting the four conditions could be morally acceptable.85

e) Sometimes the baby’s life should be given priority. Sometimes three conditions are simultaneously fulfilled: (i) some pathology threatens the life (or at least seriously impairs the health) of a pregnant woman, (ii) an operation or treatment that is not intentional killing of the baby would benefit her, and (iii) the operation or treatment would lead to the baby’s death (or at least risk his or her life). When these three conditions are met, many people are quick to judge that the operation or treatment is morally acceptable; even classical moralists often will agree with them, provided “direct” abortion is not in question. However, justice or mercy can require that the pregnant woman and those caring for her give priority to her baby’s life.

As already explained (in c, above), if the mother’s life is not at stake, it is unfair to accept the baby’s death. So, if the pathology only impairs the mother’s health, an operation or treatment that surely will result in the baby’s death is not morally acceptable. For example, abortion to ameliorate a kidney disease posing no immediate threat to the mother’s life cannot be justified. Nor is the removal of the pregnant woman’s diseased uterus acceptable if it can safely be delayed or an alternative safely used with a prospect of the baby’s survival. Fairness even can exclude an operation or procedure involving only a risk to the baby’s life, if that risk is great and the prospective benefit to the mother is uncertain or if the risk to her involved in omitting the operation or procedure is not so great.

Again, in a situation in which the lives of both a pregnant woman and her child are at stake and both cannot be saved, if an operation can be performed with a prospect of saving one or the other, fairness can require the procedure more likely to save at least one. Proceeding in a way which surely will result in the baby’s death and offers only a limited chance of saving the mother may well be unfair discrimination, when the alternative would surely result in the mother’s death, with a better chance of saving the baby. (The point here is not to assert what fairness does require, but what it might require. An actual judgment must take into account not only the good of life, but other goods, including those instantiated in the mother’s relationships to that child, to other children, and so on.)

Moreover, even if it otherwise is fair to accept or risk the unborn baby’s death as a side effect of some appropriate operation or treatment of a pregnant woman, she may be free to offer her own life or risk it to save her baby or prevent risking its life. If such self-sacrifice is not morally excluded—for example, by her other responsibilities—a Christian mother rightly does this work of mercy for her child.

f) Prenatal testing and counseling with a view to abortion are wrong. Medical diagnosis and treatment of the unborn are good, and may be obligatory, provided they are undertaken for the child’s benefit and meet the norms which govern therapeutic efforts in other cases: proper consent, the avoidance of unreasonable risks, and so on. Examinations and tests which do not benefit the child but are done merely to allay the parents’ anxiety or satisfy their curiosity can be justified only if they involve no significant risk to the child. However, prenatal testing “done with the thought of possibly inducing an abortion depending upon the results” is gravely wrong.86 The wrong involved is that of abortion itself, for abortion is conditionally intended by someone who chooses prenatal testing with a view to terminating the pregnancy if the test results are of a certain kind. The same wrong is done by those who formally cooperate, including advisers who suggest or condone abortion when counseling people about the results of prenatal tests.

g) Artificially produced embryos should be treated as persons. Sometimes human ova are fertilized in laboratories to produce human embryos, with a view to implanting them in women who want to have babies.87 Sometimes spare embryos or ones that are or may be abnormal are disposed of or used for experimentation. Because treating those admitted to be persons in this way plainly would be unjust, the sole ethical defense of such actions is that artificially produced human embryos are only “potential human beings.” However, since every human individual should be considered a person from fertilization, these actions really involve intentionally killing the innocent or unfairly accepting their deaths.

h) Many other risks to the unborn should not be accepted. The norms for accepting risks to others’ lives also hold for the unborn. No risk may be accepted in choosing to do something that would be wrong even apart from that risk. So, intemperate behavior is a more serious matter for a pregnant woman insofar as it involves a risk to her unborn child than for someone not pregnant. Also, one may not unfairly accept risks to others. So, a pregnant woman may not accept risks to her unborn child unless she has an adequate reason for doing so, and others (such as her husband) should cooperate with her in order to lessen the risks to the child.

4. To Use Certain Methods of “Contraception” Is to Procure Abortion

Since abortion is possible only after conception has occurred, it is essentially different from contraception. Although contraception also is morally wrong, it is not morally equivalent to abortion; abortion is far graver, because it is the destruction of an existing person, in violation of his or her right to life. Hence, it is important to recognize that certain choices to use so-called contraceptives really are choices to kill the unborn after fertilization.

a) Not all ways of preventing birth constitute contraception. People often use abortion as a backup after trying but failing to prevent conception. In such cases, it is clear that conception has occurred, and that the further intervention attacks the new life. But some people also resort to abortion when they omit contraception and fear pregnancy. The recourse to abortion can be very early, even before evidence of conception is available, and can involve scraping the lining of the uterus with an instrument (dilatation and curettage), evacuating the uterus (so-called menstrual extraction), or abortifacient drugs (the “morning-after pill”).

At least sometimes, too, some so-called contraceptive techniques, though used before intercourse, prevent birth by interfering with the reproductive process after fertilization. This is how intrauterine devices work, not always but certainly often, and the same is true, though probably less often, of the various oral contraceptives (forms of the birth control pill).88 All such methods are partly abortifacient, not merely contraceptive.

b) It is unjust to use possibly abortifacient “contraceptives.” If, knowing the facts, someone chooses to prescribe, use, or encourage the use of such a method, the intention can be simply to prevent birth, whether the objective is accomplished by preventing conception or by killing the conceptus. But since the conceptus should be considered a person, that is a conditional intention to kill an innocent person.

Someone might argue that, if a method of birth prevention sometimes prevents conception and sometimes prevents implantation, the intention in choosing it could be to prevent conception, and its possible interference with the reproductive process after conception could be accepted as a side effect. Even if such a method can be chosen in this way, however, it is not possible justly to accept as a side effect the death of an individual whose conception is not prevented. For contraception itself always is wrong, and so one cannot justly choose to use it while accepting the possibility of killing someone as a side effect.89

48. A treatment of various aspects of abortion: Germain Grisez, Abortion: The Myths, the Realities, and the Arguments (New York: Corpus Books, 1970); note, however, that this work not only is outdated in some respects by subsequent developments but superseded both by the line of argument offered here for the personhood of the unborn and by more adequate research in some areas by others; for example, see Connery, Abortion, for the history of Catholic teaching on abortion.

49. Many documents of the magisterium deal with abortion; see, for example: Congregation for the Doctrine of the Faith, Declaration on Procured Abortion, AAS 66 (1974) 730–47, Flannery, 2:441–53; Ad Hoc Committee on Pro-Life Activities, National Conference of Catholic Bishops, “Pastoral Guidelines for the Catholic Hospital and Catholic Health Care Personnel” (11 Apr. 1973), in Pastoral Letters, ed. Nolan, 3:370–74.

50. Congregation for the Doctrine of the Faith, Declaration on Procured Abortion, 6, AAS 66 (1974) 733, Flannery, 2:443. Canon law emphasizes abortion’s seriousness by treating it as a special crime: CIC, c. 1398: “A person who procures a completed abortion incurs an automatic excommunication.” Accomplices incur the penalty if the abortion would not have been done without their cooperation: c. 1329, §2. Although the Church always has held that it is grave matter to destroy unborn life at any stage of development, canon law has not always treated abortion at the early stages as a crime: see Roger John Huser, O.F.M., The Crime of Abortion in Canon Law: An Historical Synopsis and Commentary (Washington, D.C.: The Catholic University of America Press, 1942), 30–78.

51. For examples of such statements, see A.2.a, A.2.d, above. Besides the works cited in subsequent notes, for arguments to support the view that the person begins at conception, see Francis C. Wade, S.J., “Potentiality in the Abortion Discussion,” Review of Metaphysics 29 (1975): 239–55; John Gallagher, C.S.B., Is the Human Embryo a Person? A Philosophical Investigation (Toronto: Human Life Research Institute, 1985); Germain Grisez, “When Do People Begin?” Proceedings of the American Catholic Philosophical Association 63 (1989): 27–47.

52. See, for example, Pierre de Locht, “Discussion,” in L’Avortement: Actes du Xème colloque international de sexologie (Louvain: Centre International Cardinal Suenens, 1968), 2:155; Louis Beirnaert, S.J., “L’avortement: est-il un infanticide?” Études 333 (1970): 520–23; Mary Warnock, “Do Human Cells Have Rights?” Bioethics 1 (1987): 2.

53. A leading proponent of this view: Michael Tooley, Abortion and Infanticide (Oxford: Oxford University Press, 1983). Throughout his book, Tooley also proceeds on an implicit presupposition that the developmental view is to be preferred because it leads to what he thinks his readers will consider to be more satisfactory results than any alternative view. For an explicit argument along the same lines, see Daniel Callahan, Abortion: Law, Choice and Morality (New York: Macmillan, 1970), who embraces the developmental view (although he does not face its implications for infanticide): “Abortion is an act of killing, the violent, direct destruction of potential human life, already in the process of development. That fact should not be disguised, or glossed over by euphemism and circumlocution. It is not the destruction of a human person—for at no stage of its development does the conceptus fulfill the definition of a person, which implies a developed capacity for reasoning, willing, desiring and relating to others—but it is the destruction of an important and valuable form of human life” (497–98; cf. 384–89, where he first adopts the developmental notion of personhood). Callahan likes this view partly for the precise reason that it “provides a way of weighing the comparative value of the lives at stake” (396). This argument is an instance of consequentialism (criticized in CMP, 6). As usual, the consequentialist who provides the scales determines the outcome of the weighing: for Callahan, the “body-life” of the potential person is easily outweighed by the “person-life” of the pregnant woman in “a huge number of situations” (496; cf. 398, 498).

54. Both Webster’s Third New International Dictionary and the Oxford English Dictionary say that a standard use of person is to refer to a living, human individual. Criticizing Grisez, Abortion: The Myths, the Realities, and the Arguments, for holding that a person is “nothing more than a living human individual,” Michael J. Coughlan, The Vatican, the Law and the Human Embryo (Iowa City, Iowa: University of Iowa Press, 1990), 61, says: “In fact Grisez seems to think that where we draw the line between persons and non-persons is almost arbitrary: ‘Anyone with sufficient ingenuity in metaphysical argument should be able to construct some sort of plausible theory of personality according to which any one of us will turn out to be a non-person’ [reference to p. 306].’ Why, then, does Grisez think that his definition should be given preference? Because, he suggests, it is given in Webster’s Dictionary as the oldest meaning of the word, and because it is a more comprehensive definition than later alternatives, such as ‘a being characterised by conscious apprehension, rationality and a moral sense’. Public policy for a pluralistic society ought to accept the more comprehensive view, he argues [reference to pp. 418f.].” However, as here, the reference to the dictionary definition of person in Abortion is part of a more extensive argument, and both that reference and the consideration about comprehensiveness occur in a jurisprudential argument (418–19), more than one hundred pages after the conclusion of the argument for the personhood of the unborn (306), from which Coughlan’s quotation is drawn. He simply ignores the argument itself, which begins (273) with the heading: “Is the Aborted Embryo or Fetus a Human Being?” Moreover, the sentence before the one Couglan quotes (from 306) is: “If a utilitarian theory is accepted, not only the personhood of the unborn, but the personhood of all of us is put in jeopardy”; thus, instead of saying “Grisez seems to think that where we draw the line between persons and non-persons is almost arbitrary” Couglan should have said: “Grisez argues that once utilitarianism is accepted, the drawing of the line between persons and non-persons becomes arbitrary.”

55. To develop this argument, see David Wiggins, “Locke, Butler and the Stream of Consciousness: and Men as a Natural Kind,” Philosophy 51 (1976): 131–58, and the works Wiggins cites in his n. 33; James W. Anderson, “Three Abortion Theorists: A Critical Appraisal” (Ph.D. diss., Georgetown University, 1985), 176–201; Michael Lockwood, “Warnock versus Powell (and Harradine): When Does Potentiality Count?” Bioethics 2 (1988): 187–213; idem, “Hare on Potentiality: A Rejoinder,” Bioethics 2 (1988): 343–52.

56. Stephen D. Schwarz, The Moral Question of Abortion (Chicago: Loyola University Press, 1990), 86–112, develops some other lines of argument against the developmental view, and points out some implications of using for personhood criteria that are subject to degree. On this, also see Grisez and Boyle, Life and Death with Liberty and Justice, 229–36. Two criticisms of the earlier version of Tooley’s argument will repay study: James G. Hanink, “Persons, Rights, and the Problem of Abortion” (Ph.D. diss., Michigan State University, 1975), 42–172; Gary M. Atkinson, “Persons in the Whole Sense,” American Journal of Jurisprudence 22 (1977): 86–117.

57. See Joseph Fletcher, Morals and Medicine (Boston: Beacon, 1954), 152, 211–13; Tooley, Abortion and Infanticide, 64, 103, 130, 154–55, 163–64, 175–76.

58. Some philosophical arguments against dualism (the view that human bodies are not persons): B. A. O. Williams, “Are Persons Bodies?” in The Philosophy of the Body: Rejections of Cartesian Dualism, ed. Stuart F. Spicker (New York: Quadrangle/New York Times Books, 1970), 137–56; Gabriel Marcel, The Mystery of Being, vol. 1, Reflection and Mystery (Chicago: Henry Regnery, 1960), 127–53; Grisez and Boyle, Life and Death with Liberty and Justice, 70–71, 375–79, 402; J. M. Cameron, “Bodily Existence,” Proceedings of the American Catholic Philosophical Association 53 (1979): 59–70. On Kant’s form of dualism and some related theories: Joseph M. Boyle, Jr., Germain Grisez, and Olaf Tollefsen, Free Choice: A Self-Referential Argument (Notre Dame, Ind.: University of Notre Dame Press, 1976), 110–21.

59. Congregation for the Doctrine of the Faith, Declaration on Procured Abortion, 7, AAS 66 (1974) 734, Flannery, 2:443, points out that “the various opinions on the infusion of the spiritual soul did not cast doubt on the illicitness of abortion. It is true that in the Middle Ages, when the opinion was generally held that the spiritual soul was not present until after the first few weeks, a distinction was made in the evaluation of the sin and the gravity of penal sanctions. In resolving cases, approved authors were more lenient with regard to that early stage than with regard to later stages. But it was never denied at that time that procured abortion, even during the first days, was objectively a grave sin.” A reading of Connery’s detailed history, previously cited, substantiates this assertion. And it stands to reason that through the centuries in which all Christians considered both contraception and abortion grave sins, theoretical doubts about the personhood of the early conceptus made little practical difference to judgments about the immorality of attempts to terminate pregnancy at that stage.

60. Joseph F. Donceel, S.J., “Immediate Animation and Delayed Hominization,” Theological Studies 31 (1970): 76–105, argues for this view. Also see Thomas A. Shannon and Allan B. Wolter, O.F.M., “Reflections on the Moral Status of the Pre-Embryo,” Theological Studies 51 (1990): 603–26, who attempt to support the theory by appealing to additional supposed facts, some drawn from the work of Norman M. Ford, S.D.B., which will be criticized below, and others from sources such as Carlos A. Bedate and Robert C. Cefalo, “The Zygote: To Be or Not To Be a Person,” Journal of Medicine and Philosophy 14 (1989): 641–45, whom Shannon and Wolter use to support their view that the zygote does not contain sufficient genetic information to “develop into an embryo that will be the precursor of an individual member of the human species” (608). However, Antoine Suarez, “Hydatidiform Moles and Teratomas Confirm the Human Identity of the Preimplantation Embryo,” Journal of Medicine and Philosophy 15 (1990): 627–35, argues cogently that recent research contradicts the Bedate-Cefalo thesis.

61. Against Donceel’s theory, Benedict Ashley, O.P., offers cogent criticism: “A Critique of the Theory of Delayed Hominization,” in An Ethical Evaluation of Fetal Experimentation: An Interdisciplinary Study, ed. Donald G. McCarthy and Albert S. Moraczewski, O.P. (St. Louis: The Pope John Center, 1976), 113–33. Ashley points out that Donceel drastically understates the case when he says that St. Thomas knew well that the early embryo was not yet a fully organized body. In fact, following Aristotle, Thomas thought that life originates from the semen and the menstrual blood, that neither is alive, and that the very limited, active instrumental power in the semen only gradually organizes the blood into a body that can begin to grow and nourish itself. But Thomas also held that God’s infinite power accomplished instantaneously in the conception of Jesus what the semen’s power normally takes forty or eighty days to do. Thus, it seems that Thomas accepted Aristotle’s theory of the person’s becoming, not because he thought that matter cannot receive a personal soul until it has the organs required for the sensory basis of spiritual activities, but only because he thought that the semen’s power is so limited that it cannot bring about the epigenetic primordium of the personal body until forty or eighty days. Against some more recent arguments for delayed animation, see Augustine Regan, C.Ss.R., “The Human Conceptus and Personhood,” Studia Moralia 30 (1992): 97–127; Stephen J. Heaney, “Aquinas and the Presence of the Human Rational Soul in the Early Embryo,” Thomist 56 (1992): 19–48.

62. Moreover, to maintain his hypothesis, Donceel is forced to add another. He stresses (“Immediate Animation,” 85) that the soul, as form, cannot be the efficient cause of the embryo’s development, rather, the soul is the term of the generative process. St. Thomas thought that the father imparted instrumental efficacy to the semen, and that the semen remained present as the active principle of development. Since that hypothesis plainly is mistaken, Donceel offers another: somewhat as in evolutionary development of humans from lower forms of life, God is the proper efficient cause of embryonic development, creatively transforming the parents’ contributions until the material is ready to receive a personal soul, which he then also creates. Donceel also claims (92–96) that historical evidence shows that delayed hominization was given up under the influence both of the erroneous biological theory of preformation and of Cartesian dualism. This is not so: Grisez, Abortion, 171–72.

63. A clear statement of this argument: Robert M. Veatch, “Definitions of Life and Death: Should There Be Consistency?” in Defining Human Life: Medical, Legal, and Ethical Implications, ed. Margery W. Shaw and A. Edward Doudera (Ann Arbor, Mich.: AUPHA Press, 1983), 99–113.

64. See Grisez and Boyle, Life and Death with Liberty and Justice, 59–78; Benedict M. Ashley, O.P., and Kevin D. O’Rourke, O.P., Healthcare Ethics: A Theological Analysis, 3rd ed. (St. Louis: Catholic Health Association of the United States, 1989), 366–68.

65. Schwarz, The Moral Question of Abortion, 70–85, skillfully treats several versions of the common sense argument, and in doing so provides a model for treating others.

66. This statement appears at the beginning of a recent, masterful, fifty-page summary of what is currently known about mammalian fertilization: R. Yanagimachi, “Mammalian Fertilization,” in The Physiology of Reproduction, ed. E. Knobil et al. (New York: Raven, 1988), 135.

67. For a good, slightly fuller statement of these arguments and replies to them, using somewhat different materials than those used here, see Albert S. Moraczewski, O.P., “Personhood: Entry and Exit,” in The Twenty-fifth Anniversary of Vatican II: A Look Back and a Look Ahead, ed. Russell E. Smith (Braintree, Mass.: The Pope John Center, 1990), 87–96.

68. Suarez, “Hydatidiform Moles and Teratomas,” 629, describes the origin of such moles: “Hydatidiform moles of the complete type (CHM) arise from androgenetic eggs (i.e., from eggs with two paternal nuclei). Most CHM arise from fusion of an egg and sperm followed by duplication of the sperm genome and loss of the female nucleus. A smaller number of CHM arise by dispermy (two sperms enter into the egg) and loss of the female nucleus [citations of supporting scientific articles omitted].”

69. The fullest articulation of this line of argument: Norman M. Ford, S.D.B., When Did I Begin? Conception of the Human Individual in History, Philosophy and Science (Cambridge: Cambridge University Press, 1988). An excellent critique of Ford’s book: Anthony Fisher, O.P., “Individuogenesis and a Recent Book by Fr. Norman Ford,” Anthropotes 7 (1991): 199–244. Also see Nicholas Tonti-Filippini, “A Critical Note,” Linacre Quarterly 56 (Aug. 1989): 36–50.

70. The fact that individual plants remain individuals although they could be divided and grafted shows that there is nothing logically or biologically absurd in an organism remaining substantially the same although it could have been divided into two or more individuals of the same kind or combined with another or others. On this and other facts used by Ford and others to argue against the individual’s beginning at fertilization, see Thomas V. Daly, S.J., “The Status of Embryonic Human Life: A Crucial Issue in Genetic Counselling,” in Health Care Priorities in Australia: 1985 Conference Proceedings, ed. Nicholas Tonti-Filippini (Melbourne, Australia: St. Vincent’s Bioethics Centre, 1985), 45–57.

71. See Ford, When Did I Begin? 102–8. If two or more sperm enter before the ovum reacts, the resultant individual, which may be a hydatidiform mole, cannot develop normally. A factual description of the fusion of sperm and ovum and the initial development of the new individual: R. G. Edwards, Conception in the Human Female (London: Academic Press, 1980), 593–605.

72. For a detailed defense of the position that the new individual begins at this point, not at syngamy, see: St. Vincent’s Bioethics Centre Working Party, “Identifying the Origin of a Human Life: The Search for a Marker Event for the Origin of a Human Life,” St. Vincent’s Bioethics Centre Newsletter 5.1 (Mar. 1987): 4–6; T. V. Daly, S.J., “Individuals, Syngamy and the Origin of Human Life: A Reply to Buckle and Dawson,” St. Vincent’s Bioethics Centre Newsletter 6.4 (Dec. 1988): 1–7.

73. An analogous account, presumably, can be given of any embryo having so abnormal a genetic structure or organization that it is intrinsically predetermined never to develop a brain. This seems true, too, of an ovum developing parthenogenetically; however, if some parthenogenetically developing human ovum had in itself the necessary epigenetic primordia, it too would be a person. What about an anencephalic baby? In most cases the cause of anencephaly is unknown, and cases vary greatly: D. Alan Shewmon, “Anencephaly: Selected Medical Aspects,” Hastings Center Report 18.5 (Oct.–Nov. 1988): 11–19. Even if such a baby now lacks (but previously had the primordium of) the bodily basis of some intellectual act, he or she is a brain-damaged person, just as is the adult whose higher brain functions are irreparably lost. The facts appear to show that the anencephalic baby is a brain-damaged person, and so in practice such babies should be regarded as persons with a right to life.

74. Donceel, “Immediate Animation,” 100, quotes this from Karl Rahner, Schriften zur Theologie, 8 (Einsiedeln: 1967), 287 (Theological Investigations, vol. 9, Writings of 1965–67: I, trans. Graham Harrison [New York: Herder and Herder, 1972], 226).

75. Congregation for the Doctrine of the Faith, Declaration on Procured Abortion, 13, AAS 66 (1974) 739, Flannery, 2:446. The point is further explained (in n. 19, AAS 738, Flannery, 452): the question of the moment when the spiritual soul is infused “is a philosophical problem from which our moral affirmation remains independent for two reasons: (1) supposing a later animation, there is still nothing less than a human life, preparing for and calling for a soul in which the nature received from parents is completed; (2) on the other hand it suffices that this presence of the soul be probable (and one can never prove the contrary) in order that the taking of life involve accepting the risk of killing a man, not only waiting for, but already in possession of his soul.”

76. John Paul II, Homily at Mass for Families (Cebu City, Philippines), 5–6, AAS 73 (1981) 365–66, OR, 2 Mar. 1981, 5, emphasis in AAS.

77. Through 1963, the Planned Parenthood Federation of America published a pamphlet, Plan Your Children for Health and Happiness, which contained the truthful statement: “An abortion requires an operation. It kills the life of a baby after it has begun.” The 1964 revision omitted this statement, and Planned Parenthood subsequently became a leading proponent and supplier of abortion.

78. Judith Jarvis Thomson, “A Defense of Abortion,” Philosophy and Public Affairs 1 (1971): 47–66, tries to challenge this conclusion; for critiques of her work, see Grisez and Boyle, Life and Death with Liberty and Justice, 205–7; Michael Davis, “Foetuses, Famous Violinists, and the Right to Continued Aid,” Philosophical Quarterly 33 (1983): 259–78; Francis J. Beckwith, “Personal Bodily Rights, Abortion, and Unplugging the Violinist,” International Philosophical Quarterly 32 (1992): 105–18.

79. Because of the inadequacy of consent due to immaturity or other causes, any true victim of incest is a victim of rape. Those who consent to incest with full voluntariness are not victims but initiators of it or conspirators in it.

80. For some psychological evidence that abortion is not beneficial to victims of rape and incest: Sandra Kathleen Mahkorn, “Pregnancy and Sexual Assault,” and George E. Maloof, “The Consequences of Incest: Giving and Taking Life,” in The Psychological Aspects of Abortion, ed. David Mall and Walter F. Watts (Washington, D.C.: University Publications of America, 1979), 53–110. For some first-person accounts by victims of rape or incest who underwent abortion: David C. Reardon, Aborted Women: Silent No More (Chicago: Loyola University Press, 1987), 206–18.

81. See United States Catholic Conference, Ethical and Religious Directives for Catholic Health Facilities (Washington, D.C.: United States Catholic Conference, 1977), directives 13, 16, and 17. On ectopic pregnancies, also see T. Lincoln Bouscaren, S.J., Ethics of Ectopic Operations, 2nd ed. rev. (Milwaukee: Bruce, 1944).

82. Obviously, if the embryo could be transplanted from the tube to the uterus and both persons saved, it hardly would be fair to allow the baby to die: Thomas J. O’Donnell, S.J., Medicine and Christian Morality, 2nd ed. rev. (New York: Alba House, 1991), 166–67.

83. The magisterial teaching is in nineteenth-century decrees of the Holy Office, regulating what can be taught safely in Catholic schools; see DS 3258/— (the 1889 decree), which refers to a prior, similar decree, confirmed by the pope (ASS 17 [1884] 556); DS 3298/1890a (confirmed by the pope, 25 July 1895).

84. See Joseph M. Boyle, Jr., “Double-effect and a Certain Type of Embryotomy,” Irish Theological Quarterly 44 (1977): 303–18.

85. If the analysis proposed here should lead in practice to a judgment in conflict with the Church’s teaching, I would follow and urge others to follow the Church’s teaching. If the teaching is open to refinements in respect to its application, these must be completed by the magisterium.

86. See Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day, 1.2, AAS 80 (1988) 79–80, OR, 16 Mar. 1987, 3.

87. In itself, this procedure is morally wrong: see Congregation for the Doctrine of the Faith, Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day, 2.B.4–5, AAS 80 (1988) 90–94, OR, 16 Mar. 1987, 5–6; In Vitro Fertilisation and Public Policy, Evidence Submitted to the Government Committee of Inquiry into Human Fertilisation and Embryology by the Catholic Bishops’ Joint Committee on Bio-Ethical Issues, on Behalf of the Catholic Bishops of Great Britain (London: Catholic Information Services, May 1983); William E. May, “Catholic Teaching on the Laboratory Generation of Human Life,” in The Gift of Life: The Proceedings of a National Conference on the Vatican Instruction on Reproductive Ethics and Technology, ed. Marilyn Wallace, R.S.M., and Thomas W. Hilgers (Omaha, Neb.: Pope Paul VI Institute Press, 1990), 77–85.

88. Susan Harlap, Kathryn Kost, and Jacqueline Darroch Forrest, Preventing Pregnancy, Protecting Health: A New Look at Birth Control Choices in the United States (New York: The Alan Guttmacher Institute, 1991), state that when not effective in some other way, intrauterine devices work “by initiating a local inflammatory response to a foreign body, which inhibits implantation should fertilization occur” (27), combined oral contraceptives “change the uterine lining to inhibit implantation should fertilization occur” (27), the progestin-only pill works by “inhibiting implantation” (28), contraceptive implants work by “inhibiting implantation of a fertilized ovum” (28), and progestin-only injectables work in ways “similar to those of the minipill and implants” (29). See Ashley and O’Rourke, Healthcare Ethics, 3rd ed., 278–79; Kristine M. Severyn, “Abortifacient Drugs and Devices: Medical and Moral Dilemmas,” Linacre Quarterly 57 (Aug. 1990): 50–67; Rudolf Ehmann, “Problems in Family Planning,” Anthropotes 7 (1991): 100–101.

89. Suppose the same pill were used, not as a contraceptive, but in a way morally acceptable in itself, for example, to treat a disease of the uterus of a married woman. Would its possible abortifacient action be acceptable as a side effect? O’Donnell, Medicine and Christian Morality, 2nd ed. rev., 229, thinks so. However, it seems more reasonable to say that the seriousness of the disease, the greatness of the risk, treatment options, and possible abstinence from marital intercourse should be considered, and a judgment made on the same basis as in other cases involving risks to life.