The Ethics of Medical Homicide and Mutilation

CHAPTER III. When Does Human Life Begin?

WHEN DOES HUMAN LIFE BEGIN?

Ancient and modern opinions. The fetus is animated at the moment of conception. The single cell as the primal life-organ. Cell growth and division. Germ cells. The development of the embryo. Fetal viability. Theories of development. The Aristotelian and Thomistic opinions. The formal principle. A soul exists. The primordial cell is a sufficient organ for the soul. Metabolism in the cell. Cell motion. Animal heat and energy. Life in separated tissues. The soul in monsters 33-82

CHAPTER IV. When Does Human Life End?

WHEN DOES HUMAN LIFE END?

The heart and life. Resuscitation after apparent death. The last sacraments in apparent death. Suspended animation. The living fetus in the womb of a dying or dead mother. Methods of resuscitation. Signs of death 83-91

CHAPTER V. Abortion

ABORTION

Abortion and miscarriage. Causes of abortion, fetal, maternal and paternal. Surgical operations and abortion. The debitum in pregnancy. Premature labor. Threatened, inevitable, and incomplete abortions. Treatment. The use of the tampon. Precautions against abortion. Therapeutic abortion. Methods of inducing abortion. Artificial abortion of an inviable fetus is never licit. Decrees of the church concerning abortion. The civil law on abortion 92-123

CHAPTER VI. Ectopic Gestation

ECTOPIC GESTATION

Ectopic gestation or extrauterine pregnancy. Anatomy of the uterus and its adnexa. Place of fecundation. The abnormal uterus. Tubal rupture and tubal abortion. Diagnosis. Decrees of the church on ectopic gestation. Removal of an inviable ectopic fetus except in present peril of life is illicit 124-132

CHAPTER VII. Cesarean Delivery

CESAREAN DELIVERY

Indications for cesarean delivery. Abnormal pelves. Symphyseotomy. Varieties of cesarean delivery. Morality. Amputation of the uterus after cesarean delivery. Precautionary sterilization of a cesarean case is illicit 133-142

CHAPTER VIII. Placenta Praevia and Abruptio Placentae

PLACENTA PRAEVIA AND ABRUPTIO PLACENTAE

Nature and effects of placenta praevia. Treatment. Morality and methods of treatment. Abruptio placentae. Morality of fetal removal 143-146

CHAPTER IX. Abdominal Tumors in Pregnancy

ABDOMINAL TUMORS IN PREGNANCY

Tumors blocking parturition. Fibroids or myomata. Ovarian tumors. Cancer. Effects and morality of operation 147-152

CHAPTER X. Appendicitis in Pregnancy

APPENDICITIS IN PREGNANCY

Occurrence. Time of operation. Diagnosis 153-154

CHAPTER XI

PUERPERAL INSANITY AND STERILIZATION

Causes. Varieties. Prognosis. Precautionary sterilization of puerperal psychopaths is illicit 155-157

CHAPTER XII

NEPHRITIS IN PREGNANCY

Frequency. Effects. Abortion as a treatment. Varieties of nephritis. Pyelitis. Catalepsy 158-161

CHAPTER XIII

ECLAMPSIA PARTURIENTIUM

Definition. Symptoms. Prognosis. Causes. Precautions against eclampsia. Forced delivery. The expectant treatment. Relative mortality and morality of the methods. Cesarean delivery as a treatment. The expectant treatment is apparently the best 162-169

CHAPTER XIV. Heart Diseases in Pregnancy

HEART DISEASES IN PREGNANCY

Factors in abnormal gestation. The use of pituitrin. Weak pains and the diseased heart. The diseased heart in actual parturition. Operative risk in cardiopaths. Heart block and mitral regurgitation in labor. Prognosis 170-176

CHAPTER XV. Hyperemesis Gravidarum

HYPEREMESIS GRAVIDARUM

Pernicious vomiting. Occurrence. Symptoms. Stages. Effects. Causes. Therapeutic abortion in pernicious vomiting. Treatment 177-181

CHAPTER XVI. Chorea Gravidarum and Hysteria

CHOREA GRAVIDARUM AND HYSTERIA

Varieties of chorea. Differentiation. Prognosis. Hysteria. Causes. Epidemics of hysteria. Symptoms. Prognosis 182-186

CHAPTER XVII. Acute Yellow Atrophy of the Liver in Pregnancy

ACUTE YELLOW ATROPHY OF THE LIVER IN PREGNANCY

Icterus gravis. Causes. Symptoms. Prognosis 187-188

CHAPTER XVIII

INFECTIOUS DISEASES IN PREGNANCY

Effects on mother and fetus. Abortions in infectious diseases. Placental permeability. Typhoid. Smallpox. Pneumonia. Influenza. Scarlatina. Measles. Cholera. Tuberculosis. Artificial abortion in tuberculosis 189-200

CHAPTER XIX. Syphilis in Pregnancy and Marriage

SYPHILIS IN PREGNANCY AND MARRIAGE

Prognosis. Abortion. Infection of mother and fetus. Colles' Law. Erroneous notions on the curability of syphilis. Once a syphilitic probably always a syphilitic. The professional secret in syphilis. Nature of secrets. The physician may warn an innocent person 201-211

CHAPTER XX. Gonorrhoea in Marriage

GONORRHOEA IN MARRIAGE

The cause of gonorrhoea. Tests of cure. Effects on a woman. Chronicity. Prevalence. Surgical treatment in women. Morality of the surgical treatment. Conservative surgery. Salpingotomy. Ovariotomy. Evil effects of ovariotomy. Internal secretion of the ovary. Results of various operations. Pregnancy after operation. Morality of infection. General effects of gonorrhoea. Ophthalmia neonatorum and gonorrhoea 212-229

CHAPTER XXI. Diabetes in Pregnancy

DIABETES IN PREGNANCY

Fatality of diabetes in pregnancy. Diagnosis. Sterility of diabetics. Prognosis. Heredity in diabetes. Therapeutic abortion in diabetes 230-231

CHAPTER XXII. Childbirth in Twilight Sleep

CHILDBIRTH IN TWILIGHT SLEEP

Twilight sleep to avert pain in parturition. Stages of labor. Drugs used. Scopolamine and morphine. Danger in the use of these drugs in labor. Contradictory report of physicians on twilight sleep. Eminent authorities opposed to the methods. Baer's report on the evil effects. The methods are morally illicit and useless 232-244

CHAPTER XXIII. Vasectomy, or Sterilization, by State Law

VASECTOMY, OR STERILIZATION, BY STATE LAW

The States that have this law. Reasons for the law. Hereditary transmission of certain diseases. The operation. Its effects. Restoration of the function of the interrupted vas deferens. Vasectomy and impotence. Onanism. Vasectomy effects impotence from the moral point of view. Other conditions in the male that effect moral impotence. Immorality of artificial impregnation. Vasectomy a grave mutilation. Vasectomy as ordinarily practised is illicit. The State and vasectomy. The limitations of the State's dominion. The State surgeon and vasectomy. Bibliography 245-268

CHAPTER XXIV

THE ETHICS OF BIRTH CONTROL 269

Index 281

PREFACE

In this book is discussed the morality involved in the ordinary cases of medical homicide and mutilation. Craniotomy has been omitted because this operation on the living child is never morally licit, and when done on the dead fetus it has no moral quality that requires explanation.

The articles may seem to be intended for Catholic physicians and spiritual directors alone, but the desire in writing them was to reach all practitioners, to the end that the Natural Law which binds every man may be observed. Morality is not made such in its fundamental principles by any religious creed, but by the requirements of Divine Order, which finally prevails no matter what the opposition. Killing and maiming without sufficient extenuation did not become unlawful solely by the establishment of Christianity. Practically, however, physicians who have no religion, or a religion which is so illogical as to pay no attention to dogma, or even to rail at it as obtrusive, necessarily gravitates to the emotional in morality, and the principles of this book will not even interest them. Dogmas are abstract propositions, and all human society rests on abstract propositions. The most vital facts in morality, the basic distinction between crime and all that is virtuous or indifferent morally, is in abstract principle alone, but physicians and pastors who are not trained in philosophy and rational religion cannot appreciate an abstract principle--they are influenced only by the concrete.

Obstetrical text-books, unfortunately, are written by such emotional men; by men who lack all training in ethics other than that inculcated in childhood out of the mental vagaries of the women in the household; and these authors prescribe therapeutic homicide as if it were a drug in the American Pharmacopœia. The reader is told that if the patient is a Catholic he is to respect her religious "prejudices"; if she is not a Catholic one need not bother about moral scruples when it is necessary to take a life to stop fits. Since the civil law does not prosecute a physician for therapeutic abortion on an inviable child, most physicians deem such an act not only permissible but scientific, and they hold that if a man's conscience will not let him kill a fetus to alleviate maternal distress he is guilty of malpractice.

Decrees of the Catholic Church are cited in these pages, not because morality is an asset of the Catholic Church alone, but because it alone pronounces officially on these medical subjects after careful consideration by competent specialists. This Church has made decisions in comparatively few medico-moral cases, and the questions still undecided authoritatively are very numerous. They are quite difficult, too, because judgment supposes a knowledge of both medicine and ethics, a combination seldom found in one person. As physicians do not know ethics, and moralists do not know medicine, there is often trouble in getting at even a statement of the questions at issue between them. In the preface to Essays in Pastoral Medicine, in 1906, I mentioned a noted case of this kind, and in 1911 a similar incident occurred in a discussion of the morality involved in the sterilization of criminals and the defective by the state. This dispute was taken up by the leading canonists and moral theologians in the United States, Belgium, Holland, Austria, Spain, Italy and France, and for nearly two years these men wrote article after article based upon utterly erroneous physical data.

The books we have on medico-moral subjects are either obsolete at present, or insufficient; or, more commonly, they are the work of amateurs in medicine. These last are worthless when they are not harmful. If, however, I may judge from the questions sent to me for answer by clergymen and physicians from all parts of the country, our theological seminaries and medical schools are in grave need of courses on the morality of medical practice. In this book, to the preparation of which I have given years of anxious thought because of the extreme responsibility involved in its decisions, the data for the most important parts of such courses are presented.

AUSTIN O'MALLEY.

THE ETHICS OF

MEDICAL HOMICIDE AND MUTILATION

THE ETHICS OF MEDICAL HOMICIDE AND MUTILATION

CHAPTER I. General Principles Concerning Suicide and Homicide

GENERAL PRINCIPLES CONCERNING SUICIDE AND HOMICIDE

A Discussion of euthanasia through the use of narcotics in cases of incurable diseases periodically recurs, and the opinions of those in favor of putting the patient out of his misery are expressions of mere sentimentality, as in Maeterlinck's essay, Our Eternity. They think either that the passing of a law by a legislature removes all moral difficulty, or that morality is a trifle which should never stand in the way of expediency. Those who oppose this method of euthanasia base their argument, first, on the fact that many patients supposed by even clever diagnosticians to be incurable recover health; and, secondly, on the fact that the giving power of life and death to physicians is liable to grave abuse. This side misses the central truth and argues from accidental and secondary premises. Whether it is expedient, humane, or impolitic to kill incurable patients are almost irrelevant considerations: the fundamental question to be answered here is, Is there a Supreme Being who alone is master of life, to give it or to take it?

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