ABORTO

ABORTION. -

1. MORAL THEOLOGY

It is the expulsion of the ovum, embryo, or immature fetus—that is, one not yet capable of extra-uterine life, whether naturally or artificially.

The term “ovum” is used to denote the product of conception from its beginning up to the completion of the second week; “embryo” is used for the period from the second to the fourth week; “fetus” for the months between the fourth week and normal delivery.

The act of abortion must be distinguished from: a) simple *acceleration of birth*. The fetus cannot live outside the maternal womb, generally, until after the completion of the seventh month of gestation; exceptionally, even after the sixth month, when the necessary means for the special care of the newborn are available, such as the artificial incubator. It must be noted, however, that in forming a judgment on the viability of the fetus separated from the mother, what counts is not so much the number of months, but its physical development and dispositions. The expulsion of the fetus between the seventh (or sixth) and ninth month of gestation is termed premature birth or acceleration of birth; b) *feticide* or *embryotomy* in its various forms (craniotomy, evisceration, passage of electric current) which kills the fetus in the maternal womb to make its extraction possible; c) contraceptive practices, which aim preventively to impede fertilization (v. BIRTH, CONTROL OF).

Abortion may occur spontaneously due to various morbid causes in the father or mother, e.g., syphilis (*involuntary or natural abortion*), or through human intervention (*voluntary or artificial abortion*). In the latter case, it is direct if the means employed are of their nature intended to procure it; indirect if neither the intention nor the act performed aims at this, but at another end, e.g., to cure a maternal illness; so that the abortion is merely a permitted consequence and not properly willed, even if foreseen.

Abortion may be desired and practiced for selfish, base, and perverse motives (*criminal abortion*), or for medical indications 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 for social indications*).

It is painfully well 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 recourse; to the point of being legalized in some States. This is chiefly due to growing irreligion and the materialistic conception of life, which drives one to seek pleasure at all costs, by any means, and to shirk any duty that proves burdensome.

PRINCIPLES. - a) It is gravely illicit to *directly kill* the ovum, embryo, or fetus in the maternal womb. This is in virtue of the natural law confirmed by the fifth divine commandment: “Thou shalt not kill.” The innocent creature that is opening to life has the right to live as any other human person. This killing remains gravely illicit even when it is intended only as a means to save the mother, because the end does not justify the means, nor is it ever lawful to do evil that good may come. Hence feticide or embryotomy in all its forms is forbidden. So the replies of the Holy Office of 28 May 1884, 19 Aug. 1889, 25 July 1895 (Denz.-U., nn. 1889, 1890, 1890a; cf. also the encyclical *Casti connubii* of Pius XI, 31 Dec. 1930; Denz.-U., nn. 2242, 2243).

b) It is gravely illicit to *procure direct abortion* of a living embryo or fetus (if the fetus were already dead, it is lawful to extract it). For this is equivalent to direct killing; a creature is expelled from the mother which, separated from her, cannot live. The illicit character remains even when abortion is procured as a means to save the honor of a young woman, or to avoid the infamy of the mother or the vengeance of the husband or the burden of offspring, or to safeguard the mother’s health; this always on the same ground that the end does not justify the means and one must not do evil to obtain a true or presumed good. Hence not only criminal abortion but every other direct abortion for therapeutic, social, or eugenic indications is condemned. So the Holy Office in its reply of 25 July 1895 (Denz.-U., n. 1890a; cf. also the very grave words, by some deemed an infallible definition, of the encyclical *Casti connubii*, Denz.-U., nn. 2242, 2243, 2244). All attempts at abortion, to which recourse is had by the most varied means and remedies, are also gravely illicit, at least on account of the bad intention, even if in fact they come to nothing.

c) Acceleration of birth is not in itself illicit, provided there is a grave cause and it is performed in time and under conditions that assure the life of the fetus and the mother (Holy Office, 4–6 May 1898, 5 March 1902; Denz.-U., nn. 1890b–1890c). The grave cause may consist in saving the life of the mother or the fetus, when acceleration of birth is the only or the best remedy to attain the end. The cause must always be

proportionate to the danger (cf. L. A. Muñoyerro, p. 92 and the rich corresponding bibliography).

d) Indirect abortion is lawful when there is a grave cause. This is in virtue of the principle of double effect: it is lawful to perform a good or indifferent action from which there follows directly a twofold effect: one good, which is intended; the other bad, which is merely tolerated or permitted, provided there is a proportionately grave reason. It is therefore lawful to administer to a gravely ill mother a remedy, even if this should be prejudicial to the fetus, when these conditions are verified: the mother’s illness must be all the more grave in proportion to the greater danger of abortion; there must be no other harmless remedies; the remedy employed must directly benefit the mother, so that the eventual death of the fetus is not intended but merely foreseen as possible. Should abortion occur, the fetus 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 to the mother when the danger cannot be averted otherwise than by a surgical intervention. Thus: 1) when it is a case of a pregnant uterus affected by cancer or of a tumor that cannot be removed without at the same time removing the pregnant uterus, hysterotomy is licit, because the consequent death of the fetus is neither the end aimed at (finis operationis; the aim is to remove the uterus not insofar as it is pregnant, but insofar as it is infected), nor the object of the action (finis operis; the object here is simply 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 case of acute diarmonios or of a cancerous and retroflexed uterus that cannot otherwise be repositioned, it is not certain that piercing the membrane to allow the amniotic fluid to escape and thus facilitate the necessary maneuvers is illicit. Cf. *ibid.*, pp. 472–73; H. Davis, II, p. 189. 3) when it is a case of extrauterine pregnancy or of ectopic fetuses. Extrauterine pregnancy occurs when the fertilized ovum implants in the peritoneal cavity, on the ovary, or more frequently in the Fallopian tube. Such a pregnancy rarely reaches term, and in these cases surgical intervention is necessary; usually it is interrupted in the first months due to the onset of 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 of action should be taken? If the ectopic fetus is already viable, recourse may be had to the acceleration of birth (S. Office, 4–6 May 1898: Denz.-U., no. 1896 b). If the fetus is not viable and is presumed to be alive and there is no urgent danger of hemorrhage, one must wait and carefully monitor in order to intervene in time. When 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 act 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 the cited passages. Cf. also col. III, n. 4: *Indicazioni ostetriche*). Naturally, it is never licit to act directly upon the fetus and kill it, for in that case one would be committing direct homicide.

f) Other operations are licit when the fetus is viable, because they are not directly decisive for the fetus (Caesarean section, Porro’s operation, symphysiotomy, laparotomy, and the like); but the following conditions are required: that the death of the mother or the child cannot otherwise be averted; that there is a probable hope of saving the mother; and that provision is 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 mitigate in some way the gravity of the crime of abortion, recourse is had to many pretexts. Some of these appeal to the theory of birth control (for which V. NASCITE, CONTROLLO DELLE); others touch more closely upon our subject:

a) The embryo, and the fetus in its early stages, is not yet endowed with a rational soul; in this case, by procuring an abortion, one is not committing homicide. The reply is: Already the Holy Office (4 March 1679: Denz.-U., nos. 1184–85) has declared direct abortion illicit on the pretext that the fetus is inanimate. And rightly so; for the opinion widely held today is that the rational soul informs the ovum from the very first moment of fertilization. If the higher faculties are dormant, it is because the organism does not yet allow them to act, being not yet sufficiently developed. But the most modern histological studies on the phenomena occurring in the fertilized ovum reveal that there is present a vivifying principle that coordinates and directs everything. In all cases, one must reason thus: If the ovum or the embryo or the fetus is already endowed with a rational soul, there is direct homicide; all the more deplorable in that very often one deprives the incipient creature of eternal life; if perchance it is not yet animated, there is at least imperfect homicide, if one will, but still homicide, because one is truncating a vital process naturally ordained to issue in a human being. (Cf. R. Biot, pp. 121–23);

b) The child is a mere appendage of the mother; now it is licit to cut off one’s hand to save a life. No; the child from the beginning manifests an organism in formation, but autonomous, with its own circulation, its own blood, and its own pulsations; it draws from the mother, but elaborates for itself, by virtue of its own vital principle. It is therefore not an appendage, but a sui iuris individual;

c) The fetus is an unjust aggressor who attacks the life of the mother. The reply must be: No. In the same way, and with even greater reason, one would have to say that the mother who is not healthy, who has hepatic insufficiency or endocrine dysfunctions, such that the fetus cannot find in the maternal organism the conditions necessary for its development, is an aggressor; besides, the fetus is in no way to blame for having come into life. (Cf. enc. *Casti connubi*: Denz.-U., no. 2242; R. Biot, p. 123);

d) Must then two lives be lost? No, but both must be saved; the correct formula is not “either 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 dignity; one cannot kill one to save the other. One cannot in a shipwreck tear the life-preserver from one person to give it to another;

e) But is it not a horror to allow a mother to die and to deprive the family of its strongest support? The reply must be: All possible care, diligence, and assistance must be given to avert this painful danger; and if these are properly administered, generally both mother and child are saved. But in the deplorable case that no remedy exists, there is nothing left but to bow one’s head and lament human powerlessness. In a fire, in the sinking of a submarine, it is not always possible to save everyone; sometimes one is forced to contemplate the death of others without being able to intervene. To allow someone to die is not to kill; and one must allow death, but never bring it about. In no case. (Cf. R. Biot, pp. 124 ff.; G. Clément, 35 ff.);

f) In cases 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 and harmony, etc. Abortion, in these cases, would save everything. We must, however, observe that honor is saved by avoiding evil; not by doubling it;

g) “A woman has the right to abort just as she has the right to cut her hair and her nails, to grow fat or thin” (Madd. na 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 when considered as destined to be a child of God and to enjoy eternal happiness.

For the evaluation of objections deriving from medical indications, V. col. III, n. 4: *MEDICINA PASTORALE*.

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 a crime in itself. In ancient Greece, the prevailing laxity of morals not only tolerated but even encouraged abortion, as can be easily inferred from certain writings of Hippocrates and Aristotle. The Romans, convinced that the fetus was merely a part of the mother’s viscera, did not punish abortion as such (abstracting, that is, from any harm or injury caused to the mother) either during the Republic or in the early days of the Empire; it was only from the time of Septimius Severus onward that they assimilated it to *veneficium*, punishing it with fines, exile, forced labor, and even capital punishment if it caused the death of the pregnant woman.

From the earliest centuries, the Church regarded procured abortion as equivalent to murder (one need only recall: the Council of Elvira, c. 306, canon 63; the Council of Ancyra, c. 314, canon 21; the Quinisext Council, c. 692, canon 91; the Council of Worms, c. 869, canon 35), though distinguishing between the suppression of an animated fetus and that of an inanimate one (canon 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 in the constitution *Apostolicae Sedis* of 12 October 1869.

The current *Codex Iuris Canonici* (canon 2350, §1) includes procured abortion among crimes against life, thus resolving in the manner most consonant with tradition and Catholic doctrine the long-standing and still unresolved controversy over the juridical objectivity of this crime. For the canonist, the good protected by the penal norm is the life of the unborn, regardless of whether it is intrauterine life and whether the fetus can properly be called a subject of a right to life. Any faithful person, including the mother, can be held responsible for this crime, the material element of which consists in the violent interruption of pregnancy. The nature of the means used (internal or external, chemical, mechanical, or moral) is irrelevant.

The consummation of the crime coincides with the destruction of the product of conception, resulting from the abortive maneuvers; it is therefore a material crime, which admits of attempted commission in both the frustrated and inchoate forms. The psychological element consists in dolus, i.e., the consciousness and will on the part of the offender to bring about the abortion; hence, to constitute the crime, so-called indirect abortion is insufficient.

The penalties imposed by the *CIC* are as follows: “Those who procure abortion, the mother not excepted, incur, upon the effect following, a latae sententiae excommunication reserved to the Ordinary; and if they are clerics, they are to be deposed in addition” (canon 2350, §1). To incur excommunication, three conditions are required: a) that it be a true direct abortion (thus, acceleration of birth, embryotomy, and other illicit operations do not fall under the penalty). The distinction between an animated and an inanimate fetus is irrelevant; and the means employed are indifferent, provided they are the true cause of the abortion; b) that it be a procured abortion, i.e., deliberately willed and carried out; hence, under the term “procurantes,” all those must be understood without whom the abortion could not have been obtained, namely, the mother, the physician, the cooperating nurse, and the instigator (canons 2209, §1, 3; 2231); c) that the abortion has actually occurred.

Moreover, under the same conditions, guilty clerics become irregular (canon 985, n. 4) and are to be deposed (canon 2350, §1).

Regarding the factors that modify imputability, it must be noted that, since abortion is an intrinsically evil act, a state of necessity (of which a typical example is the case of a physician who believes he cannot save the life of the pregnant woman without procuring her abortion) does not eliminate the crime but constitutes a simple mitigating circumstance to be assessed case by case according to the circumstances (cf. canon 2205, §§2 and 3). When grave fear is involved, those guilty of direct abortion sin gravely, but, according to many theologians, they do not incur excommunication. For practical purposes, however, it must be borne in mind that, as with every other ecclesiastical crime, the principle laid down in canon 2218, §2 applies, whereby one is exempt from punishment if it is found that one is not gravely imputable.

The constitutive elements of the crime of procured abortion are found almost identically in most civil legislations, though its legal classification varies according to time and place. Some codes (such as the Tuscan Code of 1853 and the German Code) place it among crimes against life; others (e.g., the French Code) among crimes against the person; others still (such as the Sardinian Code of 1859 and the Belgian Code) among crimes against the order of the family; and others, finally (such as the Chilean Code) among crimes against public morals.

The current Italian Penal Code, innovating upon the abrogated one, places procured abortion in Title X, among “crimes against the integrity and health of the lineage.” It first distinguishes abortion of a non-consenting woman (art. 545) from abortion of a consenting woman (art. 546), providing in both cases a significant increase in penalty if the abortion results in the death of the pregnant woman or personal injury (art. 549); it punishes more mildly the woman who procures her own abortion (art. 547); it treats as a separate offense the act of one who incites a pregnant woman to abort by providing her with suitable means (art. 548); and it also assimilates, when punishable, to the crimes of personal injury and unintentional homicide the abortive practices performed on a woman erroneously believed to be pregnant, if they result in injury or death to the woman (art. 550). In any case, the offense is aggravated if the offender is a person exercising a health profession (art. 555); while the penalties, ranging from a minimum of six months to a maximum of fifteen years’ imprisonment, are reduced by half to two-thirds if the act was committed to save the honor of oneself or a close relative (art. 551).

4. PASTORAL MEDICINE

Two eminently physiological episodes in a woman’s life, pregnancy and childbirth, may in particular circumstances unfold in an abnormal manner, even becoming the cause of illness and even death. In such conditions, apart from the moral problem, medicine, concerned to save at least the mother’s life, resorts to 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 may vitiate their mechanisms, to what extent and with what harmful consequences for the mother and the foetus; what in such cases is the work of medicine, concerned only with saving the threatened life of the mother; to conduct a critical examination aimed at showing what is the real gravity of the danger run by the mother and the presumed medical necessity of provoking the abortion.

Abortion provoked for therapeutic (curative) ends, which is the concern of medicine, has the purpose of repairing the damage 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: gynaecological, obstetric, and medical.

Gynaecological indications arise 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 (tumours) of the uterus and its appendages (ovaries and Fallopian tubes). Pelvic deformities, by altering the shape and dimensions of the bony passage through which childbirth must pass, if of a high degree, may represent a serious impediment to the expulsion of a full-term foetus, with consequences that may even be fatal for it and for the mother. Abortion, provoked in the past at an early stage of foetal development so that its smaller size would allow extraction through the natural passages, is now replaced—given suitable environmental conditions and the doctor’s technical skill—by operations aimed at increasing the diameters of the passages that the foetus must traverse (symphysiotomy, pubiotomy, pelvic resections) or intended to extract it directly from the uterus without passing through the aforementioned passages (obstetric laparotomy or Caesarean section); in this way, harm to both mother and child may be avoided.

Malignant neoplasms (cancers) that develop in one of the organs constituting the female reproductive apparatus, particularly cancer of the uterine cervix, require extensive surgical demolition of such parts, which, in the event of a concomitant pregnancy that has not yet reached at least the 180th day of gestation, involves the sacrifice of foetal life (indirect abortion).

Obstetric indications for abortion arise from the abnormal unfolding of pregnancy: repeated haemorrhages due to partial placental detachments, whether spontaneous or following attempts at criminal abortion; ectopic implantation of the ovum with the development of extra-uterine pregnancies (particularly tubal pregnancy). In this eventuality, the mother is exposed, as pregnancy progresses—usually in the second or third month—to the rupture of the organ housing the ovular implantation, which is incapable of accommodating its development as the uterus would; this gives rise to severe internal haemorrhages, more or less sudden, such as to interrupt the pregnancy and place the mother, from one moment to the next, in serious danger of death. Only the most prompt laparotomic intervention, aimed at removing the ruptured appendage (ovary and Fallopian tube) together with its foetal contents (which is equivalent to determining an abortion if the foetus was still alive), can save the mother from death by acute anaemia.

As regards the fate of the foetus in the various eventualities of ectopic pregnancy, what has already been noted in n. 1 must be repeated, namely that in exceptional cases it may reach the end of its development; expulsion through the natural passages is, however, impossible, so that if it is not extracted by laparotomy it is condemned to die at the site of its implantation. On the contrary, the ordinary outcome of an extra-uterine pregnancy is the death of the foetus (internal abortion) in the first months of pregnancy (2nd–3rd).

To avoid the grave risk, once the diagnosis is confirmed, if the woman cannot be kept under continuous observation for the eventuality of a timely and rapid intervention in the case of sudden rupture of the tube and internal haemorrhage, preventive removal of the gestational sac is permitted, hence the abortive interruption of the pregnancy.

Medical indications for abortion are linked either to diseases from which the woman already suffered and which worsen with the onset of pregnancy, or to disorders of a medical nature, sometimes even very serious, which are caused by an intoxication related to the gravidic state. In such a case, the mother appeared healthy before the pregnancy, which proves to be the direct causal factor of the subsequent illnesses.

The first group includes some severe nervous and mental illnesses, pulmonary and laryngeal tuberculosis, and heart diseases; the second group includes hyperemesis or intractable vomiting of pregnancy (v. GRAVIDIC INTOXICATIONS). Unlike what was said in the past, it is now admitted that in cases of the first group statistics show that “on the whole a greater number of human lives are saved by never interrupting pregnancy than by interrupting it” (Scremin, op. cit., p. 34), thus safeguarding both the interests of the foetus and those of the mother; and it may be maintained that “the application of the ethical norm saves more human lives than are actually saved or spared by therapeutic abortion,” although it cannot be “denied that the application of that norm in some particular cases also requires the sacrifice of life and that the refusal of therapeutic abortion by the pregnant woman is in certain cases a heroic act” (Scremin, op. cit., pp. 35–36). As regards gravidic intoxications, it may be said that in almost all cases they can be overcome by medicinal and psychotherapeutic treatments.

Giuseppe de Ninnò