One of my favorite Christian apologists, Greg Kokul, lays out a pretty succinct case for why abortion is legitimate during ectopic pregnancies. He essentially invokes the principle of "double effect." Double effect legitimizes some act which would otherwise be evil if the intent was equally weighty. Unintentionally killing an aggressor would be one example. If someone attacked you and you intended to shoot him to stop him (not pumping him full of bullets to kill him, but just trying to stop the threat), this would be double effect. Killing is bad, but your intentions were good and the killing was a result of stopping the threat. Stopping the threat was your goal and death of your assailant was a side effect. We don't usually call this murder, but self-defense.
Kokul argues that ectopic pregnancies are the same. There are two lives at stake here, and if allowed to progress, Kokul assumes that the mother will die. If the mother dies, the child also dies. Such an outcome produces two dead bodies. So when we abort a child in an ectopic pregnancy, our intent is not to kill the child, but rather to save the mother. The child's death is simply a result of what we're doing to save the mother's life. By performing an act which does evil, we actually end up saving one of the two lives, maximizing the good in the situation. How could one argue that allowing two deaths is better than saving one life?
The Philosophical Case Against Abortion in Ectopic Pregnancies:
I highly respect Greg Kokul, and I highly respect individuals I know who have chosen to have abortions of their ectopic pregnancies. In fact, I recognize that if we were faced with an ectopic pregnancy, it would be very difficult not to abort. I pray that God would give us the strength to make the right decision, but I just don't know. I empathize and mourn with those who have had to make a choice that we may never have to. However, I think it is important to be aware of what the choice for abortion actually entails in ectopic pregnancies.
The first thing I think Kokul gets wrong is the misuse of double effect. Kokul is assuming that the death of the child here is a byproduct or side effect, not the goal. While that is true in one sense (the mother wishes her child didn't have to be killed), the death of the child is actually the goal which is sought since it is the means for salvation. Let me provide you with two analogies and see which one you think is more representative of our ectopic situation.
Double Effect: While a woman is pregnant, she finds out she has cancer. She knows that if she takes chemotherapy, her child will almost certainly die. If she doesn't take chemotherapy, she will die, and so will her child. The mother chooses to take chemotherapy and prays that God would allow her baby to live. The mother's life is saved but the child dies as a result of the chemotherapy.
Double Effect: This short film provides us with a wonderful example of double effect. In the film, we see a father who is a drawbridge operator. He takes his son to work one day, and while his son is playing, he falls into a gap in the bridge. Unfortunately, at that exact moment, a train full of people is headed towards the open bridge. The father must decide whether to close the bridge or keep it open. When the father closes the bridge, he knows that the bridge will almost certainly kill his son, though the train full of people will be saved. The son's death is a side effect of using the bridge as a means to save lives. The son's life was not sought or necessary to save the train.
Not Double Effect: We see a terrible situation played out in 2 Kings 6:29. A city is besieged and its residents starving. Two neighbor women make a pact that today they will kill and eat a child from one family, and tomorrow they will kill and eat a child from the other family. If they don't kill and eat their children, everyone will die. If the adults die, then the children would die anyway. While Christians can be extremely sympathetic to this circumstance, and while we can recognize the great evil present in famine and war, almost no Christian would argue that murdering a child (or anyone else) to save one's life is morally legitimate. If such is the case with an infant or toddler, then why not with an embryo or fetus if we believe life begins at conception?
Not Double Effect: You are in need of a heart transplant quickly, but you are so far down on the list you know you will never last that long. While looking at the registry, you find another person who is in need of a liver, but who is also at the bottom of the list with no chance of survival. You think to yourself, "what's the point of us both dying?" You go to this man's house and shoot him in order to harvest an organ for yourself. You live (if you can find a shady doctor to do the transplant), while the other man dies. It's better that one live than neither. I would hope that all Christians are with me in agreeing that this would be evil. While death is not desirable, living at the expense of such a grievous evil is worse.
Not Double Effect: You are living under Nazi rule as they sweep through Europe. You are forced to go to a field where some of your Jewish neighbors are standing. The Nazis hand you a pistol and tell you to begin executing the Jews. If you don't, they will kill you. This is a scenario many pro-choice advocates saw in Ray Comfort's video, "180," and bemoaned the degredation of our society which pragmatically answered the question. "Well, if they're going to die anyway, and I'll die if I don't execute them, then I guess the best thing to do is kill the Jews." Most Christians recognize that this is a horribly immoral position to hold and is not a legitimate example of double effect.
I could provide you with a number of other examples of what I consider legitimate double effects and illegitimate double effects, but I think these are sufficiently helpful. And what is the difference between the legitimate and illegitimate? Notice that in the legitimate example of chemotherapy, the child's death is indeed a byproduct. The mother's cancer could be cured AND the child could live. The mother doesn't need the child to die or seek the child's death for her survival. In the other two examples, however, the death of another is a necessary part of the process and is sought out actively. It seems to me that ectopic abortions are much more like strangling a child to conserve oxygen or killing another adult for their organ. The only purpose of taking the abortive drug during a pregnancy is to kill the child. It is seeking out the death of another so one can survive. However, because a fetus is less visible, we treat the morality of this situation differently than we do when it comes to an adult or child outside of the womb.
The Medical Case Against Abortion in Ectopic Pregnancies:
I certainly need to do much more research on this, but I'll put a few sources and information for you to follow up. Please not that the philosophical/moral case above stands on its own. An action is not right or wrong based on how palatable it is to us. However, I do want to show how potentially misinformed we are about ectopic pregnancies and how our options may not be nearly as bad as we're told - death or abortion.
1. Many ectopic pregnancies terminate on their own, removing the need for one to take their child's life in their own hands.
2. A not so small number of ectopic pregnancies are healthy pregnancies which have been misdiagnosed.
3. A transplant of a fetus to the uterus was recorded as early as 1915, and has been repeated. While this has only been shown to be possible in a very young fetus (under 40 days, I believe), technological advancement may make success more likely today.
4. Sometimes in a tubal pregnancy, after a rupture, the fetus dislodges and relocates to a more habitable part of the woman's body. There are many cases (well, a lot more than 0, at least) of ectopic pregnancies leading to healthy delivery
5. Not all ectopic pregnancies are the same. Ectopic pregnancies can mean a fetus is housed in the ovary, fallopian tube (tubal pregnancy), or abdomen. The abdomen in particular provides a much better chance at a child growing to maturity. Not all ectopic pregnancies are the same, though doctors often imply the same result across the board.
6. Ectopic pregnancies rarely lead to the death of a mother if monitored correctly. They may produce pain and require extended hospitalization, but very reliable methods are known which can allow the mother to survive without having to abort.
For a lengthy list of resources discussing all of the above, you can follow this link. Please note that I am just beginning my research. I can't fully vouch for this site, and it certainly has a clear view (and potential bias), but it does a good job listing sources which you can follow and verify for yourself. This is another good resource you can follow to get a glimpse at our current medical diagnosis.
What Are Legitimate Moral Options for Ectopic Pregnancies?
It's clear that I think the morally appropriate answer to ectopic pregnancies is not to abort. Again, that is a hard answer to accept. How could we just allow someone to die when we could knowingly prevent it? Well, we do it all the time. We resign ourselves to death when we're hopelessly at the bottom of the organ donor list. Many of us Christians resign ourselves to suffering and death rather than support embryonic stem cell research which might cure our ailment. There are all sorts of scenarios - medical and otherwise - where we refuse to do evil to accomplish the good of saving a life. Why not do the same here if we need to? It strikes me as odd that most pro-lifers I know would ask a Christian mother in a developing country not to abort, even if she knew she couldn't provide enough food for both her and her child. We would ask her to trust God and be obedient, even if that obedience required death. For we believe that the marring of the soul is worse than the death of the body. Yet in our advanced nations, we are unwilling to face difficult situations and excuse our actions as necessary or a moral lesser of two evils.
But the outlook is much better than this. The medical information seems to indicate that mothers (at least in places with decent medical care) don't have to resign themselves to death even if they go through with their ectopic pregnancy. There are all sorts of options available to monitor and assist the mother. If we do want to go with a more invasive option, especially if we're talking about a riskier tubal pregnancy, then let's advocate for a legitimate double effect scenario. Slice the tube and attempt to transplant the embryo to the uterus. Now, unless we're talking about a very young embryo, this has an almost zero percent chance of working with our current medical procedures. But notice that this action is much more akin to a mother taking chemotherapy than it is to the other scenarios where we illegitimately take life. Yes, it's more invasive than just taking a drug to abort. Yes, it may permanently impede the mother's fertility. Yes, it may not have much chance - if any - of working to save the child's life. But if we're not killing the child and we're hoping to save it, and if this is the best we can do - to seek to save the mother's life without using death as a means - then this is a legitimate, moral option.
This is a difficult issue that I know touches many lives. However, I don't think it's fair to take the easy way out as Christians and ignore this information. If we truly value life and if we truly value consistent morality, then we need to demonstrate such a morality to the world. Most Christians haven't thought through this issue, and I completely understand that. But after being informed, you have a significant responsibility to model consistency to a world who can always smell the hypocrisy on Christians.
The one positive aspect of Christian inconsistency here is that it reflects something we Christians are often lacking - empathy. We aren't inconsistent with ectopic pregnancies because we are "baby killers," but because we recognize that the world is filled with difficult choices, natural evils, pain, and death. We Christians all too often forget this when we are pointing fingers at other mothers who face hard decisions simply because they're situation doesn't resonate with us. We tell mothers who have had sex outside of marriage that they must deal with the consequences of their sin. We middle and upper-class Christians tell the impoverished mothers that circumstances don't excuse abortion because we ourselves can't empathize with their difficult situation or plight. Yet when something like an ectopic pregnancy encroaches on us, we throw up our arms and recognize our own situation as difficult and call the decision to abort a "moral conundrum," "morally ambiguous," or a "lesser of two evils" problem. Dealing with the issue of ectopic pregnancies not only gives Christians an opportunity to be a morally consistent example to the world, but it provides us with a situation that can help us to empathize with the majority of moms who aren't "baby killers" just looking to destroy their offspring, but real people who are struggling through the difficulties life brings.
I hope that I don't say any of this with an air of superiority. I empathize with those who have had ectopic pregnancies, and I empathize with many who have had abortions in out of what they felt were necessities or the lesser of two evils. In fact, while I believe that the moral answer to abortion - the purposed killing of a fetus - is clear, I have to admit that there are circumstances (like an ectopic pregnancy) where I couldn't guarantee that our family would choose what I believe to be morally right. I hope we would, and thinking about such things now certainly helps to prepare us. But I in no way am saying that I or my family or those who never have abortions are morally superior. By God's help - and only with God's help - we can do what is right.
1. The Foundational Question: What is killed in abortion?
2. How to Determine Value and Rights: What quality and types of qualities confer rights and value to an individual?
3. Justified Reasons for Taking Human Life: What justifies the taking of human life?
4. Unjustified Reasons for Taking Life: What reasons fail to justify the taking of human life?
5. Bad Christian Arguments and Witness: Common pro-life/Christian arguments and actions which can undermine the pro-life position.
6. Counterrebuttals: A response to significant objections to the pro-life arguments.