St. Thomas and Critical Thinking Special Term 2023:
Final Course Requirement
Navarrete, Ivan S.
https://www.theguardian.com/commentisfree/2023/jul/10/
indiana-abortion-doctor-10-year-old-child-rape
I. Case
The case presented is Caitlin Bernard, a doctor from Indiana, who last 2022,
performed an abortion procedure on a 10-year-old rape victim who traveled from
Ohio, where abortion was illegal. The main issue is that abortion, which is a
deliberate action to terminate a pregnancy is basically wrong.
II. Case Analysis
1. If I were Caitlin, a physician, and a 10-year-old comes to us pregnant from
rape, what would I do?
2. If I were the guardian or simply someone who met and cares about the child
who feels violated and extremely traumatized and now carrying a result of
that violation at the expense of her health and physical wellness, what would
I do?
3. Is abortion really the answer?
4. Aren’t there any alternatives?
As a doctor who cares about the well-being of a pregnant, 10-year-old rape
victim, what is the best course of action/procedure?
Argument 1
With supportive/intensive care, let the pregnancy
run its course, whatever the result may be. The
deliberate removal of the fetus is abortion and is
wrong.
WHY?
Abortion, the intentional termination of pregnancy is wrong.
Therefore, letting the pregnancy progress, whether it ends in
the death of the young mother, or the fetus, or both, is the
right thing since neither life is deliberately ended. There have
been some cases where a child, one at even 5 years old,
successfully makes it to the end of pregnancy and delivers.
So that fact can give us an idea that it is possible. Two lives
may remain at the end.
WHY NOT?
However, according to UNICEF, maternal conditions are the second
leading cause of mortality in children ages 15-19 globally (Early
Childbearing and Teenage Pregnancy Rates by Country - UNICEF
DATA, 2023). What more for a 10-year-old? The simple knowledge
that a 10-year-old is not physically ready for a pregnancy should
already render letting the pregnancy run its course as harmful and
problematic. Refusing to terminate the pregnancy at any point even at
the expense of one’s life is wrong. This may lead to both lives lost.
Argument 2
Give supportive/ intensive care throughout
pregnancy but deliver/abort the child whenever
the 10-year-old mother’s life and health is
evaluated to be of great risk.
WHY?
We can give supportive care for the young mother and with the help of the
government, fund this care. It would be wrong to let them shoulder what
they did not voluntarily accept as a result of a traumatic experience. The
mother should have a pre-assessment through different tests then
meticulously monitored if allowed to carry on with the pregnancy then
when she comes to a point of high risk to her life and health, no matter
how soon this is, even at the pre-assessment phase, the pregnancy
should be terminated. Here, we give the pregnancy a chance, but we also
allow for its termination whenever necessary (therapeutic abortion), for the
sake of the mother.
WHY NOT?
The problem with this is the abortion part, which deliberately ends the life
of the fetus. Another is that medical conditions are individualized. The
moment there is a realization that the pregnancy cannot continue, the
young mother’s health may already have been greatly affected or entered
a point of no return. Yes, we intensively monitor the patient, but when a
doctor already has knowledge of the high tendencies of a specific
situation, he/she should then decide whether to start or not. Different
patients respond differently. Sudden changes may occur which can slip
past the monitoring. Afterall, no technology or human is perfect. This can
also ultimately lead to two lives lost.
Argument 3
Abort the unborn child immediately so the young
mother’s health and life won’t take the health
and life risks anymore.
WHY?
Knowledge is power. Knowing that physiologically, a 10-year-old’s body is
not ready for a pregnancy and can greatly threaten health and life itself,
should be an easy indicator to terminate the pregnancy immediately. In
the New York times, in line with this specific case of Dr. Bernard, doctors
claimed that a child’s pelvis is too small for childbirth and that pregnancy’s
toll on young bodies in general is very serious (Nolen, 2022). Therefore,
ending the pregnancy immediately will free the child of experiencing
further trauma and health risks, thus securing her life. She already
experienced sexual abuse. It is barbaric to let her go through more pain
and suffering which she doesn’t even fully comprehend at her age.
WHY NOT?
The downside to this is that we are deliberately terminating the
pregnancy. We are ending the life of another.
Conclusion
Give supportive/ intensive care throughout
pregnancy but deliver/abort the child whenever
the 10-year-old mother’s life and health is
evaluated to be of great risk.
WHY?
Even with the knowledge of the mortality and risks that the
situation entails, this option gives, although very small, hope
and dignity for the fetus. It is the compromise between letting
the pregnancy progress to its fate, without intervention on the
fetus, and the direct and immediate termination of the
pregnancy.
But one can’t stress enough the level of meticulousness that the
monitoring or pre-assessment requires. No matter how soon, when there
is evidence of impending doom or risks for the young mother, may it be
from radiologic imaging, laboratory tests, etc., the fetus, unfortunately
must be aborted or delivered early (depends on the week of gestation).
This gives us somehow the idea that we gave every life a chance. It
defeats option 1 where we did give the two lives a chance in the
beginning but refuse to save one at the inevitable expense of the other. It
also gives the dignity that the unborn fetus deserves unlike in option 3,
where we immediately declare its case as hopeless.
III. Theories/Principles
A. Principle of Double effect
B. Beneficence and Nonmaleficence
C. Human Dignity
D. Autonomy
E. Correction Principle
F. Consequentialism
A. Principle of Double Effect
The principle of double effect is the most relatable to this case. The first condition of this principle
is that the act must be intrinsically good or indifferent. In this case, though it was not specified what
kind of abortion was done, it is intrinsically evil. Abortion can further be divided into direct and
indirect. Direct means attacking the fetus itself as in saline poisoning. Indirect abortion is a
procedure primarily towards another object other than the fetus, but with it the fetus inevitably dies.
An example is a hysterectomy (removal of the uterus) to prevent cancer spread. Direct abortion is
typically barbaric since almost all the procedures involve mutilating or physically destroying the
fetus. This is intrinsically evil. Indirect abortion on the other hand is more acceptable in terms of the
act itself. However, in this case it seems that the abortion is what we call “Therapeutic abortion”. It
is the intentional expulsion of the fetus to save the mother’s life. If the act itself was simply the
extraction of the fetus, it could be acceptable because in all the options, therapeutic abortion is
basically the only way, when worse comes to worst, that the young mother will be saved. If
this is not done, both lives will be lost.
The next condition of the principle is that the good effect instead of the bad
effect is the intention. It basically applies to all the options relating to the
abortive act. The abortion, if done, is intended to save the young mother’s life.
The third condition is that the good effect, the mother’s life saved, must not be
produced by the evil effect, the death, and expulsion of the fetus. It seems
that this is quite problematic. But again, when worse comes to worst, the least
we can do is save a life and that unfortunately means the demise of the fetus.
Unless of course, the young mother, when deemed at high risk is already on
a certain level of gestation wherein the fetus could be delivered early and live
from the support of medical equipment. But when impending doom of the
mother is established at about less than even 20 weeks of gestation, there is
a very small chance of fetal survival.
The fourth and last condition is that the evil effect must not outweigh
the good. In this case, it is a life for a life. They have equal weights.
Both lives are important, but unfortunately, one must fall for the other
to stand. It seems now that the case does not fit like a glove into
the principle of double effect. Some fingers fit perfectly, some stick
out. This is where we use our common sense and recognize the
need for exceptions. We do not want to commit the fallacy of
accident.
B. Beneficence and Nonmaleficence
Beneficence means we must prevent harm and do good.
Nonmaleficence is doing no harm or putting at risk of harm. When we let
the pregnancy progress without the therapeutic abortion as an
intervention when needed, we inflict more harm than when we expel the
fetus to save the mother. Therapeutic abortion in a sense, is what we did
good for the mother, and what prevented more harm from happening.
C. Human Dignity
“The dignity of the human person lies in man’s capacity for union with
God, which, as St. Thomas teaches, is a union of love. It is this union that
fulfills the dignity of man, not the bestowal of rights or services that may
seem to cause pleasure or relief from pain. As St. Thomas repeatedly
affirms throughout his writings on man, “Naught can quiet man’s will, save
the universal good” (ST I-II, 2, 8) (OP & OP, 2020).
From this we know that every human person is of value regardless of
appearance, beliefs, differences, etc. God created man in His image. We
all have dignity and the right to life. No life is more important than another.
That is why we give equal regard to the fetus and the young mother. In
option 2, we give the fetus a chance but only to the point where it does not
endanger the mother, no matter how soon that might be.
D. Autonomy
The principle of autonomy follows human dignity. There should be an
acknowledgement of an individual’s beliefs, interests and values.
Therefore, the patient has the right to refuse treatment. Although in this
case, the patient is a minor. Autonomy will apply to the parent, immediate
relative or guardian. This is very important to remember as we do not
have the right to force people into doing something that isn’t acceptable
for them.
E. Correction Principle
The Thomistic institute formulated 7 principles , where faith and reason
work in harmony. One of those is the Correction principle which states
that the right faith can correct errors from reason. One might reason that
the life of the young mother is of higher regard than the fetus since the
former is already far more developed than a still unborn child. But the right
faith reminds us that God created all man in his image. This entails that
every living person, starting from the time of conception to death, is of
equal dignity.
F. Consequentialism
Consequentialism takes the effects/results of actions as the criteria of
judging whether those actions are right or wrong. This can be applied to all
the options. An argument might be as such, “Expulsion and the resulting
death of the fetus is unacceptable on all accounts”. At first glance, yes it
seems correct. But when two lives are at stake, and therapeutic abortion is
the only chance for the mother’s survival, it is acceptable. If this is not done,
both the life of the mother and fetus will be lost. Remember that the fetus
needs the mother alive and healthy for it to be as well. But if we expel the
fetus, we can save one life. This is the result that justifies the act of
therapeutic abortion.
IV. Reflection
*What this task has really taught me is that our ability to think is stronger
without the emotion. Not to say that emotions should be invalidated, but
they must be separate. I highly respect people who have resilient voices
of reason and morality. I wish to achieve the same.
V. References
Autonomy in Moral and Political Philosophy (Stanford Encyclopedia of Philosophy). (2020, June 29). https://plato.stanford.edu/entries/autonomy-moral/
Doctrine of Double Effect (Stanford Encyclopedia of Philosophy). (2018, December 24). https://plato.stanford.edu/entries/double-effect/#Bib
Donegan,
M.
(2023,
July
10).
She
performed
an
abortion
on
a
https://www.theguardian.com/commentisfree/2023/jul/10/indiana-abortion-doctor-10-year-old-child-rape
10-year-old
rape
victim.
Therightvilifiedher.
TheGuardian.
Early childbearing and teenage pregnancy rates by country - UNICEF DATA. (2023, March 24). UNICEF DATA. https://data.unicef.org/topic/child-health/adolescent-health/
Ethics Unwrapped. (2023, January 9). Consequentialism - Ethics Unwrapped. https://ethicsunwrapped.utexas.edu/glossary/consequentialism
Harmony of Faith and Reason: Seven Principles — Aquinas 101. (n.d.). Aquinas 101. https://aquinas101.thomisticinstitute.org/harmony-of-faith-and-reason-seven-principles
Knisley, K. (2020, February 28). How Early Can You Safely Give Birth? Healthline. https://www.healthline.com/health/pregnancy/how-many-weeks-is-it-safe-to-give-birth#earliestsafe-week
Nolen, S. (2022, July 19). What Pregnancy and Childbirth Do to the Bodies of Young Girls. The New York Times. https://www.nytimes.com/2022/07/18/health/young-girlspregnancy-childbirth.html
OP, B. a. B., & OP, B. a. B. (2020). The Honor of Seeking God: St. Thomas and Human Dignity | Dominicana. Dominicana. https://www.dominicanajournal.org/the-honor-ofseeking-god-st-thomas-and-human-dignity/
Varkey, B. (2020). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119