Substantial medical evidence shows that about half of ovarian cancers originate in the fallopian tube. Some medical organizations and clinical articles have suggested opportunistic salpingectomy to reduce the risk of ovarian cancer in patients at average risk of developing it. This entails removing the fallopian tubes at the same time as another procedure that would occur anyway. The authors argue that the principles of totality and double effect can justify such salpingectomies, even though there is a low incidence of (...) ovarian cancer. Since screening tools for ovarian cancer are ineffective and treatment options are poor, the good effect of reducing the risk of death from this type of ovarian cancer can be proportionate to the bad effects of the minor increase in surgical risk over the other procedure, the unintended side effect of infertility, and the removal of normally functioning tissue. The authors conclude that it is within the purview of a patient and physician to determine whether the benefits are proportionate to the risks in a particular case. (shrink)

Medical literature on the protective effects of salpingectomy against ovarian cancer has challenged Catholic health care institutions to reexamine policies that prohibit tubal sterilization at the time of cesarean section. Salpingectomy performed for a woman whose fallopian tubes are known or suspected to have a serious and present pathology—risk-reducing salpingectomy—is morally justifiable as a therapeutic intervention. However, salpingectomy performed at the time of another medically indicated procedure, such as cesarean section, on an otherwise fertile woman whose (...) fallopian tubes are presumed to be healthy—opportunistic salpingectomy—constitutes direct sterilization and fails to meet the conditions of double effect. Moreover, until magisterial guidance clarifies the right application of Catholic teaching to the specific question of opportunistic salpingectomy, Catholic health care institutions should, out of prudential judgment and to avoid scandal, avoid establishing institution policies that permit the practice. (shrink)

Following new scientific evidence, removal of the fallopian tubes or the ovaries, or both, are options for reducing the risk of ovarian cancer. This paper examines the new scientific evidence on the origin of ovarian cancer and argues that the removal of fallopian tubes or ovaries in high-risk patients for the purpose of reducing risk of cancer is not intrinsically disordered. Although a present and serious pathology may not exist, this removal constitutes an indirect sterilization, because the immediate and primary (...) effect is the reduction in risk of a pathological condition. This effect occurs immediately, directly, and effectively, and sterilization is a secondary effect. The paper then reflects on the subsequent inadequacy of the language of “present and serious pathology” given the new evidence on ovarian cancer. National Catholic Bioethics Quarterly 14.1 : 67–79. (shrink)

This paper looks at the Catholic justification of medical interventions in ectopic pregnancies. The paper first shows that the way how Double Effect Reasoning is often applied to ectopic pregnancies is not consistent with the way Aquinas introduces this mode of reasoning. The paper then shows certain problems in common defences of the use of salpingectomies. The paper then re-evaluates the medical interventions used in the management of ectopic pregnancies, with both a focus on the aim of the treatment and (...) the timing of the treatment. (shrink)

If one accepts a version of absolutism that excludes the intentional killing of any innocent human person from conception to natural death, ectopic pregnancy poses vexing difficulties. Given that the embryonic life almost certainly will die anyway, how can one retain ones moral principle and yet adequately respond to a situation that gravely threatens the life of the mother and her future fertility? The four options of treatment most often discussed in the literature are non-intervention, salpingectomy (removal of tube (...) with embryo), salpingostomy (removal of embryo alone), and use of methotrexate (MXT). In this essay, I review these four options and introduce a fifth (the milking technique). In order to assess these options in terms of the absolutism mentioned, it will also be necessary to discuss various accounts of the intention/foresight distinction. I conclude that salpingectomy, salpingostomy, and the milking technique are compatible with absolutist presuppositions, but not the use of methotrexate. (shrink)

Completely updated and revised, the third edition of Catholic Health Care Ethics: A Manual for Practitioners sets the standard for Catholic bioethicists, physicians, nurses, and other health care workers. In thirty-nine chapters (many with subchapters), leading authors in their fields discuss a wide range of topics relevant to medicine and health care. The book has six parts covering foundational principles, health care ethics services, beginning-of-life issues, end-of-life issues, selected clinical issues, and institutional issues. Some highlights from the third edition include (...) new entries on the Ethical and Religious Directives for Catholic Health Care Services, certitude in moral decision-making, the principle of double effect, clinical ethics consultation, natural family planning, prenatal testing and diagnosis, care of fetal remains, challenges to neurological criteria, the use of ventilators, POLST, alkaline hydrolysis, opportunistic salpingectomy, so-called lethal prenatal diagnoses, transgenderism, and new age medicine. The volume continues to provide insightful information on the topics previously covered in the second edition, but with significant updates throughout. (shrink)