ABORTION. - 1. MORAL THEOLOGY. - It is the expulsion of the ovum or of the embryo or of the immature fetus, that is, not viable; in other words, not yet capable, naturally or artificially, of extrauterine life.
"Ovum" is the term used to indicate the product of conception from the beginning to the second full week; "embryo" is used for the period extending from the second week to the fourth; "fetus" for the months that elapse between the fourth week and normal delivery.
The act of abortion must be distinguished: a) from the simple acceleration of childbirth. The fetus cannot live outside the maternal womb except, generally, after the seventh full month of gestation; exceptionally also after the sixth, when the means for the special care necessary for the newborn are available, e.g. the artificial incubator. It must be noted, however, that in forming a judgment on the viability of the fetus separated from the mother, it is not so much the number of months that counts as its physical development and its dispositions. The expulsion of the fetus between the seventh (or sixth) and the ninth month of gestation is designated by the term premature birth or acceleration of childbirth; b) from feticide or embryotomy in its various forms (craniotomy, evisceration, passage of electric current) which kills the fetus in the maternal womb in order to make its extraction possible; c) from contraceptive practices, which aim preventively at preventing fertilization (v. NASCITE, CONTROLLO DELLE).
Abortion can occur spontaneously from various morbid causes of the father or of the mother, e.g. syphilis (involuntary or natural abortion) or through human intervention (voluntary or artificial abortion). In this case it is direct, if the means employed tends by its nature to procure it; indirect, if neither the intention nor the act performed aims at this, but at another purpose, e.g. treating an illness of the mother; so that the abortion is only a permitted and not properly willed consequence, even if foreseen.
Abortion can be willed and practiced for unworthy and perverse egoistic motives (criminal abortion) or for medical indication to save the mother (therapeutic abortion) or to prevent the birth of defective creatures (eugenic abortion) or to save honor or avoid economic harm (abortion on social indication).
It is painfully known how widespread the practice of abortion is in our times, to the point of becoming the most common solution to so many situations and the first to which recourse is had; to the point of being legalized in some States. This is due above all to growing irreligion and to the materialistic conception of life, which drives one to seek pleasure always, at any cost, by any means, and to shirk any duty that weighs upon one.
PRINCIPLES
a) It is gravely unlawful directly to kill the ovum or the embryo or the fetus in the mother's womb. This is so by force of the natural law confirmed by the 5th divine commandment: "Thou shalt not kill." The innocent creature that opens to life has the right to live like any other human person. This killing remains gravely unlawful even when it is intended only as a means of saving the mother, because the end does not justify the means, nor is it ever lawful to do evil that good may come of it. Therefore fetocide or embryotomy in all its forms remains forbidden. Thus the responses of the Holy Office of 28 May 1884, 19 Aug. 1889, 25 July 1895 (Denz.-U., nos. 1889, 1890, 1890 a. Cf. also the encyclical Casti connubii of Pius XI, 31 Dec. 1930: Denz.-U., nos. 2242, 2243).
b) It is gravely unlawful to procure the direct a[bortion] of the living embryo or fetus (if the fetus were already dead, it is of course lawful to extract it). For this is equivalent to a direct killing; indeed, a creature is expelled from the mother which, separated from the mother, cannot live. The unlawfulness remains even when the a[bortion] is procured as a means of saving the honor of the young woman, or of avoiding the infamy of the mother or the vengeance of the husband or the burden of offspring, or of securing the mother's own health; this always by force of the same reason, that the end does not justify the means and one must not do evil to obtain from it a real or supposed good. Therefore not only criminal a[bortion] is condemned, but every other direct a[bortion] for therapeutic, social or eugenic indication. Thus the Holy Office in its response of 25 July 1895 (Denz.-U., no. 1890 a. Cf. also the very weighty words, regarded by some as an infallible definition, of the encyclical Casti connubii, Denz.-U., nos. 2242, 2243, 2244). Also gravely unlawful, at least by reason of the bad intention, are all attempts at a[bortion], to which recourse is customarily had by the most varied means and remedies, even if in fact nothing is ultimately achieved.
c) The acceleration of birth is not unlawful in itself, provided there exists a grave cause and it is carried out at a time and under conditions that ensure the life of the fetus and of the mother (Holy Office, 4-6 May 1898, 5 March 1902: Denz.-U., no. 1890 b-1890 c). The grave cause may consist in saving the life of the mother or of the fetus, when the acceleration of birth is the only or the best remedy for attaining the end. The cause must always be proportionate to the danger (Cf. L. A. Muñoyerro, p. 92 and the rich bibliography corresponding thereto).
d) Indirect a[bortion] is lawful when there is a grave cause. This is by virtue of the principle of double causality: it is lawful to perform a good or indifferent action from which directly follow a double effect: the one good, which is aimed at; the other bad, which is only tolerated or permitted, provided however there be a proportionately grave motive. It is therefore lawful to administer to the gravely ill mother a remedy, even if this should be harmful to the fetus, when these conditions are met: the mother's illness must be the more grave the greater the danger of a[bortion]; other harmless remedies must be lacking; the remedy employed must serve directly for the benefit of the mother and therefore the eventual death of the fetus must not be intended, but avoided as far as possible. The fetus, should the a[bortion] occur, must be baptized (cf. L. A. Muñoyerro, p. 93).
e) The same principle can be applied in several other cases of grave danger of death for the mother, when the danger cannot be averted otherwise than by a surgical intervention. Thus: 1) when it is a matter of a cancerous gravid uterus or of a tumor, which cannot be removed without at the same time also removing the gravid uterus, hysterectomy is lawful, because the consequent death of the fetus is neither the purpose aimed at (finis operationis; the aim is to remove the uterus not as gravid, but as infected), nor the object of the action (finis operis; the object, here, is nothing but the organ to be removed). Cf. J. Aertnys and C. A. Damen, Theol. mor., I, 14th ed., Turin 1944, pp. 471-72. - 2) when it is a matter of acute hydramnios or of an incarcerated and retroflexed uterus, which cannot otherwise be repositioned, the puncture of the sac to let the amniotic fluid out and thus facilitate the necessary maneuvers is not established to be unlawful. Cf. ibid., pp. 472-73; H. Davis, II, p. 189. - 3) when it is a matter of extrauterine pregnancies or ectopic fetuses. There is an extrauterine pregnancy when the fertilized ovum has implanted in the peritoneal cavity, on the ovary or more frequently in the uterine tube. This pregnancy hardly ever reaches term and even in these cases surgical intervention is necessary; usually it is interrupted in the first months by the onset of a hemorrhage, or the rupture of the tube and the detachment of the placenta. All this causes the death of the fetus and constitutes a very grave danger for the mother. What course is to be followed? If the ectopic fetus is already viable, one may have recourse to the acceleration of birth (Holy Office, 4-6 May 1898: Denz.-U., no. 1890 b). If the fetus is not viable and is presumed alive and the danger of hemorrhage is not urgent, one must wait and watch attentively in order to be able to intervene in time. When the hemorrhage has occurred or is imminent, then one may intervene directly against the hemorrhage and remove the tumor, even if it is a fetal sac and the death of the fetus will follow. In this case the eventual a[bortion] is neither the finis operis nor the finis operantis (cf. H. Davis, II, pp. 171 ff.; L. A. Muñoyerro, p. 93 and appendix XVI, p. 191; J. Aertnys and C. A. Damen, op. cit. I, pp. 472-73, E. Bon, pp. 395 ff., and their excellent citations. See also col. 111, no. 4: Obstetric indications). Naturally it is never lawful to act directly on the fetus and kill it, because then there would be a direct homicide.
f) Other operations are lawful when it is a matter of a viable fetus, because they are not directly killing of the fetus (cesarean section, Porro operation, symphysiotomy, laparotomy and the like); but the following conditions are required: that the death of the mother or of the child cannot otherwise be averted; that there be probable hope of saving the mother and that provision be made for the spiritual and temporal welfare of the offspring (cf. L. A. Muñoyerro, p. 94, with the relevant citations).
2. APOLOGETICS
In order to contest in some way the grave crime of abortion, recourse is had to many pretexts. Some of them appeal to the theory of birth control (for which v. NASCITE, CONTROLLO DELLE); others touch more closely on our subject: a) The embryo, and the fetus in its early stages, is not yet animated by the rational soul; in this case, by procuring abortion, one does not commit homicide. Answer: The Holy Office already (4 March 1679: Denz.-U., nn. 1184-85) declared direct abortion unlawful on the pretext that the fetus is inanimate. And rightly so; for the opinion that the rational soul informs the ovum from the very first moment of fertilization is today widely shared. If the higher faculties sleep, it is because the organism does not yet permit them to act, since it is not yet sufficiently developed. But the most modern histological studies of the phenomena that occur in the fertilized ovum reveal that a vivifying principle is present which coordinates and orients everything. In all cases one must reason thus: If the ovum or the embryo or the fetus is already animated by the rational soul, there is direct homicide; all the more deplorable in that very often the incipient creature is deprived of eternal life; if perchance it were not yet animated, there is an imperfect homicide, if you will, but still homicide, because a vital process naturally preordained to culminate in a human being is cut short. (Cf. R. Biot, pp. 121-23); b) The child is a mere appendage of the mother; now it is lawful to cut off one's hand to save a life. No; the child demonstrates from the very beginning an organism in formation, but autonomous, with its own circulation, with its own blood, and its own pulsations; it draws from the mother, but elaborates by itself, by force of a vital principle of its own. It is therefore not an appendage, but an individual sui iuris; c) The fetus is an unjust aggressor that threatens the life of the mother. One must answer: No. In the same way and with greater reason one would have to call the mother an aggressor who is not healthy, has insufficient hepatic function, endocrine dysfunctions, so that the fetus does not find in the maternal organism the conditions necessary for its development; besides, the fetus has no fault if it has come to life. (Cf. enc. Casti connubii: Denz.-U., n. 2242; R. Biot, p. 123); d) Must two lives then be lost? No, but both must be saved; the exact formula is not "the mother or the child," but "both the mother and the child." The rights of the mother and of the child are the rights of two human persons of equal rank; one cannot be killed to save the other. In a shipwreck one cannot snatch the lifebuoy from one to give it to another; e) But it is a horror to let a mother die and deprive the family of its strongest support. One must answer: All possible care and solicitude and assistance are needed to avert this painful danger; and if these are well conducted, generally both the mother and the child are saved. But in the deplorable case that no remedy exists, there is nothing to do but bow one's head and lament human impotence. In a fire, in the sinking of a submarine, it is not always possible to save everyone; one is sometimes forced to contemplate the death of others without being able to intervene. To let die is not to kill; and one must let die, but never kill. In no case. (Cf. R. Biot, p. 124 ff.; G. Clément, 35 ff.); f) In the case of extramarital pregnancies, the honor of a girl or of a married woman and of their families is at stake. And not only honor, but peace, harmony, etc. Abortion, in these cases, would save everything. We must observe, however, that honor is saved by avoiding evil; and not by doubling it; g) "Woman has the right to abort as she has the right to cut her hair and nails, to gain or lose weight" (Madéna Pelletier, in L'émancipation sexuelle de la femme, cited by R. Biot, p. 118). The objection is too vulgar and unworthy; no comparison is possible between hair, nails, etc. and a human creature, especially considered as destined to be a daughter of God and to enjoy eternal happiness.
For the evaluation of objections deriving from medical indications, v. col. 111, n. 4: MEDECINA PASTORALE.
Bibliography18 works
Celestino Testore
3. LAW
The first mention of abortion as a crime is found in a passage of the Bible (Ex. 21, 22), where, however, it is considered more as a consequence of personal injury than as an offense in its own right. In ancient Greece, the prevailing laxity of morals not only tolerated but even favored abortion, as is easy to gather from certain writings of Hippocrates and Aristotle. The Romans, convinced that the fetus represented simply a portion of the maternal viscera, did not punish abortion procured as such (abstracting, that is, from the damage and injury eventually caused to the mother) either during the republic or in the early times of the empire; and only from the age of Septimius Severus onward did they assimilate it to veneficium, repressing it with a fine, with exile, with forced labor and even with capital punishment if it had caused the death of the pregnant woman.
The Church from the earliest centuries considered procured abortion in the same category as homicide (recall: the Council of Elvira, a. 306, can. 63; the Council of Ancyra, a. 314, can. 21; the Council in Trullo, a. 692, can. 91; the Council of Worms, a. 869, can. 35), distinguishing however between the suppression of the animated fetus and that of the inanimate fetus (can. 8, C. XXXII, q. 2). This distinction was reaffirmed by Gregory XIV in the constitution Sedes Apostolica of 31 May 1591, but was later abandoned by Pius IX with the constitution Apostolicae Sedis of 12 Oct. 1869.
The current CIC (can. 2350, § 1) treats procured abortion among the crimes against life, thus resolving in the manner most consonant with tradition and Catholic doctrine the controversy long agitated, and not yet settled, concerning the juridical object of the offense in question. The good protected by the penal norm is, therefore, for the canonist, the life of the unborn child, it being of no relevance that it is intrauterine life and that the fetus cannot properly be called the subject of a right to life. Any member of the faithful, not excluding the mother, can make himself responsible for this crime, whose material element consists in the violent interruption of pregnancy. The nature of the means (internal or external, chemical, mechanical, moral) used to commit it is indifferent.
The consummating moment coincides with the destruction of the product of conception, occurring as a consequence of the abortive maneuvers; it is therefore a material crime, which admits of attempt under the twofold aspect of the frustrated attempt and the mere attempt. The psychological element consists in intent (dolus), that is, in the consciousness and will on the part of the offender to provoke the abortion; hence, to constitute the crime, so-called indirect abortion is not sufficient.
The penalties inflicted by the CIC [Code of Canon Law] are the following: « Procurantes abortum, matre non excepta, incurrunt, effectu secuto, in excommunicationem latae sententiae, Ordinario reservatam; et si sint clerici, praeterea deponantur » (can. 2350, § 1). To incur the excommunication, therefore, three conditions are required: a) that it be a question of true direct abortion (thus the acceleration of labor, embryotomy and other illicit operations do not fall under the penalty). The distinction between an animated and a non-animated fetus counts for nothing; and the means employed is indifferent, provided it be the true cause of the abortion; b) that it be a question of a procured abortion, that is, willed and carried out deliberately: therefore under the term « procurantes » must be understood all those without whom the abortion could not have been obtained, that is, the mother, the physician, the nurse who cooperates, the one who commissions it (can. 2209 § 1, 3; 2231); c) that the abortion actually took place.
Furthermore, under the same conditions, guilty clerics become irregular (can. 985, n. 4) and must be deposed (can. 2350, § 1).
As regards the causes modifying imputability, it must be noted that, since it is a question of an actus intrinsece malus, the state of necessity (of which a typical example is the case of the physician who believes he cannot save the life of the pregnant woman except by procuring an abortion for her) does not remove the crime, but constitutes a simple attenuating circumstance to be evaluated case by case according to the circumstances (v. can. 2205, §§ 2 and 3). When it is a question of grave fear, those guilty of direct abortion sin gravely, but, according to many theologians, they do not incur the excommunication. It must nevertheless be borne in mind, for practical purposes, that for this too, as for every other ecclesiastical crime, the principle laid down by can. 2218, § 2, holds, by virtue of which he is exempt from penalty who is shown not to be gravely imputable.
The constitutive elements of the crime of procured abortion are found almost identical in most civil legislations, although its juridical classification appears different, varying with times and places. Some codes (such as the Tuscan code of 1853 and the Germanic one) place it among crimes against life; others (e.g. the French Code) among crimes against the person; others again (Sardinian Code of 1859 and Belgian Code) among crimes against the order of families; others, finally (such as the Chilean Code) among crimes against good morals.
The Penal Code in force in Italy, innovating with respect to the abrogated one, places procured abortion in Title X, among the « crimes against the integrity and health of the race ». It distinguishes, first of all, abortion of a non-consenting woman (art. 545) from abortion of a consenting woman (art. 546), providing in both hypotheses a notable aggravation of penalty for the case in which the death of the pregnant woman or a personal injury has resulted from the abortion (art. 549); more mildly it punishes the woman who procures the abortion herself (art. 547); it considers as a separate offense the act of one who instigates a pregnant woman to abort, supplying her with suitable means (art. 548); and it further assimilates, quoad poenam, to the crimes of personal injury and of preterintentional homicide the abortive practices committed on a woman erroneously believed to be pregnant, whenever a lesion or the death of the woman results from them (art. 550). In every case the circumstance that the guilty party is a person practicing a health profession aggravates the offense (art. 555); while the penalties, varying from a minimum of six months to a maximum of fifteen years of imprisonment, are reduced by one half to two thirds if the act was committed to save one's own honor or that of a close relative (art. 551).
Bibliography7 works
4. PASTORAL MEDICINE
Two eminently physiological episodes in the life of a woman, pregnancy and childbirth, can under particular conditions unfold in an anomalous manner, to the point of becoming a cause of illness and even of death. In such conditions, setting aside the moral problem, medicine, concerned with saving at least the life of the mother, arrives at therapeutic abortion.
For a correct understanding of the problem from the medico-legal and moral point of view, it is necessary: to know the physiological conditions through which pregnancy and childbirth unfold (v. the corresponding entries); the circumstances that can impair their mechanisms, to what extent and with what harmful consequences for the mother and for the fetus; what in such cases is the work of medicine, concerned only with saving the threatened life of the mother; to conduct a critical examination directed at showing what is the real gravity of the danger run by the mother and the presumed medical necessity of provoking the abortion.
The abortion provoked for therapeutic (curative) purposes, with which medicine is concerned, has the aim of remedying the damages and dangers to which the mother may be exposed in relation to a pregnancy that does not unfold in a physiological manner.
A threefold order of indications for therapeutic abortion is distinguished: gynecological, obstetric, medical.
Gynecological indications when the obstacle to the normal unfolding and completion of childbirth is constituted by congenital anomalies or acquired diseases of the mother's reproductive apparatus, particularly pelvic deformities and neoplasms (tumors) of the uterus and of the adnexa (ovaries and tubes). Pelvic deformities, by altering the shape and dimensions of the bony stricture through which childbirth must be accomplished, if of a high degree, can represent a grave impediment to the expulsion of a fetus developed to term, whence consequences even fatal for it and for the mother. The abortion provoked in the past at an early period of fetal development, so that the smaller size might permit its extraction through the natural passages, is at present replaced, since the conditions of environment and the physician's technical skill permit it, by operations directed at increasing the diameters of the passages that must be traversed by the fetus (symphysiotomy, pubiotomy, pelvic resections) or aimed at extracting it directly from the uterus without making it pass through the aforesaid passages (obstetric laparotomy or cesarean section); thus the harm of the mother and of the child can be avoided together.
Malignant neoplasms (cancers) that develop in one of the organs constituting the woman's reproductive apparatus, particularly cancer of the cervix, require a vast surgical demolition of such parts which, in the event of a concomitant pregnancy that has not yet reached at least the one hundred eightieth day of gestation, involves the sacrifice of the fetal life (indirect abortion).
The obstetric indications for abortion arise from the abnormal course of pregnancy: repeated hemorrhages due to partial detachments of the placenta, whether spontaneous or following attempts at criminal abortion; ectopic insertions of the ovum with the development of extrauterine pregnancies (particularly tubal pregnancy). In this eventuality, the mother is exposed, as the pregnancy progresses, usually in the second or third month, to the rupture of the organ that is the site of the ovular implantation, which is incapable of following its development as the uterus would; hence severe internal hemorrhages, more or less sudden, such as to interrupt the pregnancy and place the mother, at any moment, in serious danger of death. Only a very prompt laparotomic intervention aimed at removing as a whole the lacerated adnexum (ovary and tube) together with its fetal content (which amounts to bringing about the abortion if the fetus was still alive) can save the mother from death by acute anemia.
As regards the fate of the fetus in the various eventualities of ectopic pregnancy, what has already been mentioned in no. 1 must be repeated, namely that in exceptional cases it can reach the end of its development; the possibility of its expulsion through the natural passages is however excluded, so that if it is not extracted by the laparotomic route it is condemned to die in the site of its implantation. On the contrary, the ordinary outcome of an extrauterine pregnancy is the death of the fetus (internal abortion) in the early months of pregnancy (2nd-3rd).
To avoid the serious risk, once the diagnosis has been established, if the woman cannot be kept under continuous supervision for the eventuality of a timely and rapid intervention in the case of sudden rupture of the tube and internal hemorrhage, the preventive removal of the gestational sac is permitted, whence the abortive interruption of the pregnancy.
The medical indications for abortion are linked either to illnesses from which the woman was already suffering and which worsen with the onset of pregnancy, or to disorders of a medical nature, at times even quite serious, which recognize as their cause an intoxication linked to the pregnant state. In such a case, the mother was or appeared healthy before the pregnancy, which proves to be the direct causal factor of the ailments that supervened.
The first group includes certain serious nervous and mental illnesses, pulmonary and laryngeal tuberculosis, and heart diseases; the second group includes hyperemesis or incoercible vomiting of pregnant women (v. INTOSSICAZIONI GRAVIDICHE). Unlike what was said in the past, it is currently admitted that in cases of the first group statistics demonstrate that "on the whole a greater number of human lives is saved by never interrupting the pregnancy than by interrupting it" (Scremin, op. cit., p. 34), thus saving together the interest of the fetus and that of the mother, and it may be maintained that "the application of the ethical norm saves more human lives than are really saved or spared by therapeutic abortion," although it cannot be "denied that the application of that norm in certain particular cases also requires the sacrifice of life and that the refusal of therapeutic abortion on the part of the pregnant woman is in given cases a heroic act" (Scremin, op. cit., pp. 35-36). As regards the toxemias of pregnancy, it may be said that in almost all cases these can be overcome by medicinal and psychotherapeutic treatments.
Bibliography3 works
Giuseppe de Ninnio