Early Induction of Labor

1. Early Induction of Labor Jan C. Heller, Ph.D. Ethics and Theology Providence Health & Services

2. Presentation Objectives • Introduction: Key question… • When is induction not viewed morally as abortion? • We’ll move from easier to harder cases, and consider controversial issues along the way • Early induction… • After viability • Prior to viability • Discussion and Questions

3. Abortion • Human life should be respected from conception to death • Mothers and fetuses are of equal moral worth • Issues with early induction generally turns on the ERD definition of abortion, which puts a great deal of moral weight on viability • Direct abortion is always and everywhere wrong • Abortion defined as “the directly intended termination of pregnancy before viability or the directly intended destruction of a viable fetus” (ERD, 45).

4. Abortion • The “moral weight” of viability… • Viability is defined as that point when, if born, a fetus has a chance of surviving outside its mother’s uterus. • Given the availability of certain medical expertise and technologies, this point is currently about 23-24 weeks gestation. • But, is viability always relevant? Are some fetuses never viable?...We’ll come back to these questions below.

5. After Viability • “For a proportionate reason, labor may be induced after the fetus is viable” (ERD 49). • At issue here: What counts as a “proportionate” reason? • When the benefit of the induction for the mother, the fetus, or both is proportionate to the risk to either or both stemming from the induction

6. After Viability • People of good will will disagree, however • Some relatively clear examples… • Renal failure • Congestive heart failure • Hypertension • Some less clear examples… • Premature and irreversible rupture of membranes, before evidence of chorioamnionitis • Normal grief or emotional distress due to news about fetal condition, but not suicidal or clinically depressed

7. After Viability: Controversial Cases • Must the conditions of the principle of double effect be satisfied after viability? • Does a “proportionate reason” require double-effect? • People of good will will disagree • NCBC argues “yes.” • “The early induction of labor should be attempted only when there are no other feasible options available, that is, when the degree of the mother’s or the fetus’ pathology is serious or even life-threatening.” • Vs. permitting the mother and her physician to determine together what counts as a proportionate reason

8. Prior to Viability • “Operations, treatments, and medications that have as their direct purpose the cure of a proportionately serious pathological condition of the pregnant woman are permitted when they cannot be safely postponed until the unborn child is viable, even if they will result in the death of the child” (ERD, 47).

9. Prior to Viability • This directive is usually interpreted as meaning the induction must satisfy the four conditions of double effect • The act itself must be good or neutral, independent of its consequences • Agent intends only the good effect (and merely foresees the bad effect) • The bad effect must not be a means to the good effect • The good effect must (proportionately) outweigh the bad effect

10. Prior to Viability • In language from the Vatican… • Lives of both mother and child threatened by diagnosed pathological condition • No possibility of saving the child remains • Early induction is the only alternative to certain death of the mother and the child • But, does this language satisfy the conditions of double-effect? • Some examples… • Chorioamnionitis due to premature and irreversible rupture of membranes • Severe preeclampsia

11. Prior to Viability: Controversial Cases • Cases that are usually induced in secular settings but are usually prohibited in Catholic settings… • E.g., Fetuses with anencephaly or trisomy 13 or 18 • Prior to viability, these conditions should not lead to induction, unless other, relevant pathological conditions are also present • But, are there some conditions for which viability is not relevant? • Counter-claim: Innocent life should not be shortened without the presence of a pathology that threatens maternal health

12. Discussion and Questions