EMBRIOTOMY. — Fetal mutilation undertaken to complete a delivery obstructed by the disproportion between the diameters of the pelvis and those of the fetus, or by an abnormal presentation of the latter (shoulder presentation).
It consists in perforating the head or body of the fetus, still in the uterus, with special instruments, emptying it of its contents (evisceration), reducing its volume by crushing it with suitable forceps, and then extracting it, thus macerated, from the maternal birth canal. In this way, according to the circumstances, one proceeds to craniotomy, cephalotripsy, decapitation, basiotripsy and basiodasty (crushing of the base of the skull), rachitomy, and detroncation.
E. may be performed on a dead fetus or on a living fetus. The former, which raises no questions of moral liceity, has numerous legitimate indications, sparing the mother suffering and grave dangers at the sole sentimental cost of compromising the integrity of the dead fetus’s body. E. on a living fetus, by contrast, still represents a painful humiliation and a moral blemish upon obstetrics; it is therefore increasingly losing ground, defeated by the advances of obstetrical and surgical technique, which replace it with symphysiotomy, pubiotomy, and cesarean delivery; by a reasonably broader application of premature delivery, induced at a time when the fetus, although no longer in the abortive period, has not yet attained the diameters and volume of its full development; and by version procedures, intended to correct the presentation.
Even when recourse is had to these means, however, circumstances of time, place, and the course of labor may render the above-mentioned operations impossible, although they would be capable of saving both mother and fetus.
E. AND MORAL THEOLOGY. —
1. Historical notes
The ancients were not unaware of the direct killing of the fetus. That this was frequent in Rome is told us by Ovid (Amori, II, 14, 5-38) and Juvenal (Sutire, 6, 594-97), although their texts do not make clear how abortion (v.) and how far to e. or similar operations.Likewise in Catholic theology, from the ancient Fathers and apologists down to more recent times, the two questions of e. and direct abortion were the subject of a single treatment and, generally speaking, of a single condemnation (s. Zeno, Tractatus, I, 9: PL 11, 326-27; s. Augustine, De nuptis et conc., I, 17: CSEL, 42, 230).
The condemnation often excluded e., as well as abortion, of the lifeless fetus (c. 8, C. XXXI, q. 2). With regard, however, to the living fetus, the only dissenting voice in antiquity was perhaps that of Tertullian (De anima, 25: CSEL, 20, p. 343).
2. The illicitness of e
But the lively and closely contested debate on the liceity of e., when the mother’s life would otherwise be in danger, arose in the last century, when D’Annibale began to apply to these legitimate defense (v.), considering the human fetus that endangers the mother’s life as similar to a material aggressor, against whom it is lawful to defend oneself, even by killing.Appealing also to the principle of authority, D’Annibale further argued from the silence of the Holy See concerning the liceity or otherwise of such operations. Indeed, when consulted on the matter, the S. Penitentiary replied (28 Nov. 1872), referring the question to the teaching of ancient and recent authors. But D’Annibale’s thesis, founded on this silence, was soon undermined by another reply of the S. Office (28 May 1884), which declared that the liceity of craniotomy and similar operations could not be taught in Catholic schools (19 Aug. 1889). And since some, by subtle reasoning, interpreted the reply restrictively, as though it concerned only the certainty or otherwise of the doctrine and not the liceity of the operation in itself, the same Congregation, in a new reply (24 July 1895), specified the illicitness of resorting to e.
Besides, the argument of reason advanced by D’Annibale could not withstand closer criticism. The situation that arises in the womb of the pregnant mother is brought about only by a process voluntary at its beginning on the part of the mother and thereafter purely natural, due to malformations either pre-existing or subsequent in the mother and the unborn child; but the aggression, if it may be called such, would rather have to be attributed to the mother, at least insofar as concerns those voluntary acts that have brought about such a situation, and never to the unborn child, a wholly innocent creature. Nor can one speak of a conflict of rights and of priority, since all human beings have an equal right to life; nor of a “right arising from extreme necessity,” which can never be extended so far as to legitimize the sacrifice of an innocent person (cf. encik. Custi connubii, 31 Dec. 1930; AAS, 23 [1931], pp. 562-63). For these reasons, after a brief initial wavering of opinion, Catholic theology soon agreed on the illicitness of e., to which the prohibition of the divine commandment “Ne occides” had to be applied.
Nevertheless, it is lawful to resort to the surgical operation of e., and similar procedures, when the fetus is certainly dead. Some authors would extend this even to a case of doubt concerning the fetus’s viability, applying (though apparently inappropriately) the principle of double effect. In view, moreover, of the dramatic circumstances in which these problems are experienced in the conscience of the physician and the pregnant woman, it is advisable not to disturb their good faith if, without malice, they should consider recourse
(fol. Archives Phalagrophiques)
EMBRUN – Interior of the Cathedral (10th–13th century).
to an operation of e. or the like; but it is always beneficial to admonish them to provide in the best possible manner for safeguarding the life of the mother and the fetus. This is all the more so because civil legislation on the matter, partly contrary to Catholic morality, removes in such circumstances the responsibility of anyone who performs such operations, justifying them, as in Italian law, by the state of necessity (Penal Code, art. 54). But even in Italian law, the removal of responsibility does not go so far as to make the medical intervention a legal obligation or an official act (cf. V. PALMIRA, Medicina legale caustistica, Città di Castello-Bari 1946, pp. 307–309). In any event, the problem no longer appears to be of great relevance. As early as 1931, in the inaugural address to the XXX Italian Congress of Obstetrics and Gynecology, Prof. Pestalozzi stated that “owing to the progress of science, the indication for e. on the living fetus has disappeared.” The state of necessity would thus be eliminated at its root, and anyone who still wished to resort to certain operations could no longer justify his destructive intervention even before civil law.
3. E. and canonical censures. – Another problem was debated in the last century concerning e.: whether anyone who performed or permitted it incurred the censures imposed for abortion.
The question was first discussed in the treatises and commentaries that appeared after Pius IX’s Apostolic Constitution Apostolica Sedis (1869). Most authors excluded craniotomy and similar operations from the censure (Berardi, Hilarius a Sexton, Cornelisse, D’Annibale, etc.), and this remained the common opinion until the CIC. The principal reason is that here there is no question of expulsion, as in abortion, but of extraction, preceded by killing.
Even after the CIC, few authors asserted the contrary (Eichmann, Coronata, Wernz-Vidal, Stockams). For some, the offense assumes the character of homicide and is therefore subject to the irregularity mentioned in can. 985 no. 4, and is punishable by the penalties referred to in can. 2354. But perhaps the criterion to be followed in determining the point at which one is dealing with abortion or s., rather than being inferred from the method or technique employed in the operation, should be derived from whether or not the fetus is viable: abortion occurs, and therefore the corresponding penalties apply, if the expelled fetus is not viable; if it is viable, whatever technique is employed in killing it, e. has occurred, which may rightly be regarded as homicide, with all the moral and juridical consequences.
For operations on the ectopic fetus, V. ABORTO.